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Luke B.,Gynecology | Brown M.B.,University of Michigan | Grainger D.A.,University of Kansas | Cedars M.,University of California at San Francisco | And 3 more authors.
Fertility and Sterility | Year: 2010

Objective: To evaluate factors associated with the use of elective single embryo transfer (eSET) and its effect on assisted reproductive technology (ART) outcome. Design: Historical cohort. Setting: Clinic-based data. Patient(s): A total of 69,028 ART cycles of autologous fresh embryo transfers with additional embryos cryopreserved during the same cycle performed during 2004-06 and reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database. Intervention(s): None. Main Outcome Measure(s): Factors associated with the number of embryos transferred, and the odds of pregnancy, live birth, and multiple-infant live birth by number of embryos transferred as adjusted odds ratios (AORs). Result(s): Single embryo transfer was used more with uterine factor (AOR 1.76) and less with male factor, endometriosis, or tubal factor (AOR 0.81, 0.72, 0.83, respectively). Compared with women aged <30 years, eSET was used less among women aged 35-39 years and ≥40 years (AOR 0.74 and 0.39, respectively). Compared with White women, eSET was used more with Asian (AOR 1.52) and less with Black or Hispanic women (AOR 0.73 and 0.67, respectively). Compared with eSET, the likelihood of pregnancy, live birth, or multiple-infant live birth was more likely with two embryos (AOR 1.33, 1.34, and 27.4, respectively). Conclusion(s): Elective SET, used more for younger women with specific diagnoses, is associated with slightly reduced likelihood of a live birth but much reduced likelihood of multiples. © 2010 American Society for Reproductive Medicine.


Fujimoto V.Y.,University of California at San Francisco | Luke B.,Gynecology | Brown M.B.,University of Michigan | Jain T.,University of Illinois at Chicago | And 3 more authors.
Fertility and Sterility | Year: 2010

Objective: To evaluate ethnic differences in assisted reproductive technology (ART) outcomes in the United States. Design: Historical cohort study. Setting: Clinic-based data. Patient(s): A total of 139,027 ART cycles from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System online database for 2004-2006, limited to white, Asian, black, and Hispanic women. Intervention(s): None. Main Outcome Measure(s): Logistic regression was used to model the odds of pregnancy and live birth; among singletons and twins, the odds of preterm birth and fetal growth restriction. Results are presented as adjusted odds ratios, with white women as the reference group. Result(s): The odds of pregnancy were reduced for Asians (0.86), and the odds of live birth were reduced for all groups: Asian (0.90), black (0.62), and Hispanic (0.87) women. Among singletons, moderate and severe growth restriction were increased for all infants in all three minority groups (Asians [1.78, 2.05]; blacks [1.81, 2.17]; Hispanics [1.36, 1.64]), and preterm birth was increased among black (1.79) and Hispanic women (1.22). Among twins, the odds for moderate growth restriction were increased for infants of Asian (1.30) and black women (1.97), and severe growth restriction was increased among black women (3.21). The odds of preterm birth were increased for blacks (1.64) and decreased for Asians (0.70). Conclusion(s): There are significant disparities in ART outcomes according to ethnicity. © 2010 American Society for Reproductive Medicine.


PubMed | Marienhospital, University of Tübingen, Diagnostic Breast Center Turmcarree, Radiology and 4 more.
Type: Journal Article | Journal: Ultraschall in der Medizin (Stuttgart, Germany : 1980) | Year: 2016

Mammographic breast density correlates with breast cancer risk and also with the number of false-negative calls. In the USA these facts lead to the Breast Density and Mammography Reporting Act of 2011. In the case of mammographically dense breasts, the Working Group on Breast Ultrasound in Germany recommends explaining the advantages of adjunct imaging to women, depending on the individual breast cancer risk. Due to the particular structure of German healthcare, quality-assured breast ultrasound would be the first choice. Possible overdiagnosis, costs, potentially increased emotional stress should be addressed. In high familial breast cancer risk, genetic counselling and an intensified early detection program should be performed.


Diamond M.P.,Wayne Sate University | Mitwally M.,Canadian American Reproductive Medicine | Casper R.,Samuel Lunenfeld Research Institute | Ager J.,Wayne State University | And 5 more authors.
Contemporary Clinical Trials | Year: 2011

Infertility afflicts 15% of couples who wish to conceive. Despite intensive evaluation of both male and female partners, the etiology may remain unknown leading to a diagnosis of unexplained infertility. For such couples, treatment often entails ovulation induction (OI) with fertility medications coupled with intrauterine insemination. Complications of this therapy include ovarian hyperstimulation syndrome and creation of multiple gestation pregnancies, which can be complicated by preterm labor and delivery, and the associated neonatal morbidity and expense of care for preterm infants. The Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) study is designed to assess whether OI in couples with unexplained infertility with an aromatase inhibitor produces mono-follicular development in most cycles, thereby reducing multiple gestations while maintaining a comparable pregnancy success rate to that achieved by OI with either gonadotropins or clomiphene citrate. These results will provide future guidance of therapy for couples with unexplained infertility, and if comparable pregnancy rates are achieved with a substantial reduction in multiple gestations, the public health benefit will be considerable. © 2011 Elsevier Inc.


Vlahovic-Stipac A.,Clinical Hospital Center Zemun | Stankic V.,Gynecology | Popovic Z.B.,Vascular Imaging | Putnikovic B.,Clinical Hospital Center Zemun | Neskovic A.N.,Clinical Hospital Center Zemun
American Journal of Hypertension | Year: 2010

Background Gestational hypertension (GH) is associated with hemodynamic changes, and alterations of systolic and diastolic left ventricular (LV) function. However, the magnitude and pattern of changes of different parameters of LV function and contractility in this patient population have not been fully clarified. Methods Thirty-five pregnant women with GH underwent three echocardiographic examinations, in second and third trimester of pregnancy, and 1 month after delivery. Twelve normotensive pregnant women served as gestational age-matched controls. Hemodynamic parameters and standard indexes of LV systolic and diastolic function were analyzed. Additionally, we have measured peak systolic velocity of mitral annulus (S′), end-systolic elastance (Ees), and early transmitral to early lengthening velocity of mitral annulus ratio (E/E′) as parameters of longitudinal function, contractility, and filling, respectively. Results Women with GH had initially higher body weight, blood pressure, and heart rate (P 0.005, P 0.0001, and P = 0.011, respectively). Temporal analysis of different echocardiographic parameters revealed increase in wall thickness from baseline to second measurement, with consequential increase in LV mass in women with GH (P = 0.014 for septum, P = 0.010 for posterior wall, and P = 0.09 for LV mass). No significant changes of LV volumes, ejection fraction (EF), transmitral flow parameters, S′, Ees, and E/E′ were observed throughout the follow-up in both groups (P = nonsignificant for all). Importantly, pattern of changes was similar in both groups for all examined parameters (P = nonsignificant between groups, for all). Conclusions It appears that changes of LV longitudinal function, filling, and contractility during pregnancy are not significant and not influenced by GH. © 2010 American Journal of Hypertension, Ltd.


Papanna R.,Gynecology | Fletcher S.,Gynecology | Moise K.J.,Jr. | Mann L.K.,Gynecology | Tseng S.C.G.,Gynecology
Obstetrics and Gynecology | Year: 2016

BACKGROUND: There is an urgent need is for a regenerative patch for in utero repair of spina bifida in situations in which primary closure is difficult. CASES: We present two cases of large myeloschisis defects that underwent in utero spina bifida repair at midgestation with closure of the skin defect by using a cryopreserved human umbilical cord patch. The pregnancies were uncomplicated, and the births occurred at 37 weeks by planned cesarean delivery. The repair sites were intact with no evidence of cerebrospinal fluid leakage, with skin regenerated after delivery over a period of 3-4 weeks. The short-term outcomes after delivery showed reversal of hindbrain herniation, minimal spinal cord tethering, and normal function of the lower extremities. CONCLUSION: Cryopreserved human umbilical cord may be a suitable patch system for the spina bifida closure. © 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.


Simon J.,George Washington University | Portman D.,Columbus Center for Womens Health Research | Mabey R.G.,Gynecology
Maturitas | Year: 2014

Objective To examine the long-term safety of oral ospemifene, a non-estrogen tissue-selective estrogen agonist/antagonist, for the treatment of moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy (VVA) due to menopause. Study design This multicenter, long-term, open-label, safety extension study was conducted in women without a uterus aged 40-80 years (N = 301) who received oral ospemifene 60 mg/day for 52 weeks. Participants either continued their 60-mg/day ospemifene dose from the initial 12-week pivotal efficacy study or switched from blinded placebo or ospemifene 30 mg/day to open-label ospemifene 60 mg/day. The 52-week open-label extension period plus initial 12-week treatment period totaled up to 64 weeks of ospemifene exposure. A 4-week posttreatment follow-up ensued (68 weeks total). Main outcome measures Safety assessments included adverse events, laboratory studies, physical and gynecologic examination, vital signs, breast palpation, and mammography. Results Most treatment-emergent adverse events (TEAEs) during the extension study were mild or moderate in severity. The most common TEAE related to study drug was hot flushes (10%; leading to discontinuation for 2% of patients). One serious TEAE, a non-ST-elevation myocardial infarction in a patient with pre-existing cardiac disease, was considered possibly related to study medication. One mild breast-related TEAE, considered unrelated to study drug, was ongoing at study completion. There were no instances of pelvic organ prolapse, incontinence, venous thromboembolism, fractures, breast cancers or death. No clinically significant adverse changes were observed in other safety parameters. Conclusions Ospemifene is clinically safe and generally well tolerated in postmenopausal patients with dyspareunia, a symptom of VVA. © 2013 Elsevier Ireland Ltd. All rights reserved.


Madjar H.,Gynecology | Sauerbrei W.,University Hospital Freiburg | Hansen L.,Gynecology
Ultraschall in der Medizin | Year: 2011

Purpose: To improve differentiation between benign and malignant breast lesions by Doppler measurements and to validate results in a normal clinical setting in comparison to study conditions. Materials and Methods: Doppler measurements of 458 patients were compared in benign and malignant tumors in a prospective study. In a multivariate analysis a diagnostic score was developed using a logistic regression model and stepwise selection. These results were compared with 272 patients who were examined under routine clinical conditions. Results: Most measurements showed highly significant (p<0.001) differences between benign and malignant tumors. For each measurement we considered two cut-points to define a diagnostic rule. Despite significant differences, none of the corresponding classification rules exceeded 90% sensitivity and specificity. Multivariate analysis selected a model including age and the number of arteries and contralateral arteries. Although significant, the last factor barely improved diagnostic accuracy. Therefore, we deleted it from the multivariate model. Based on a simple model including age and the number of tumor arteries, we defined classification rules with high sensitivity and specificity. The RI measurement did not improve the discriminatory power of our score. In the validation study the sensitivity decreased from 89-98% to 58-78% with a specificity of 82-92% vs. 83-86%. Conclusion: Color Doppler can be used for breast cancer differentiation. However, in the clinical routine the sensitivity decreases considerably compared with optimized study conditions. © 2011 Georg Thieme Verlag KG Stuttgart. New York.


PubMed | Dermatology, Gynecology and Dermatopathology
Type: Journal Article | Journal: Dermatology practical & conceptual | Year: 2016

Hypomelanotic or amelanotic melanomas are challenging to identify, especially at mucosal sites. The dermoscopic clues to the diagnosis of mucosal melanomas have been reported to be structureless zones with the presence of blue, gray, or white colors.A female in her seventies noted a new lesion on the inside of her right labia that first appeared two months prior. Her past medical history was significant for rheumatoid arthritis requiring ongoing treatment with methotrexate for 20 years and adalimumab for 10 years. After no response to two weeks of local treatment for suspected herpes simplex infection, her gynecologist performed a skin biopsy. Based on the histopathological diagnosis of an amelanotic melanoma (Breslow thickness of 1.3 mm) the patient was referred to dermatology for further assessment. Polarized dermoscopy revealed a distinct asymmetric, sharply demarcated homogenous white papule (4 5 mm) as well as polymorphous vessels.Dermoscopy may aid in the diagnosis of amelanotic mucosal melanomas. Our case revealed a structureless white area and polymorphous vessels. Additional clues to the diagnosis were the advanced age of the patient and the clinical presentation of a new lesion.


PubMed | Gynecology and Radiology
Type: Case Reports | Journal: The journal of obstetrics and gynaecology research | Year: 2016

A 27-year-old woman underwent a first vaginal delivery at our institution. She returned four days after delivery, presenting with abdominal pain and an unexplained drop in her hemoglobin value, without external bleeding. The initial computed tomography abdominal scan revealed an isolated diffuse hemoperitoneum. A laparoscopy did not find the cause of bleeding. A second computed tomography scan, performed 15 days later, revealed hemoperitoneum associated with a false aneurysm of the right uterine artery. Treatment consisted of embolization of the uterine arteries, with clinical success. False aneurysms are a rare cause of intra-abdominal non-exteriorized bleeding in late post-partum hemorrhage.

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