Vandœuvre-lès-Nancy, France
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Gai L.,China Institute of Technology | Zhang J.,Shandong University | Zhang H.,China Institute of Technology | Gai P.,Shandong Provincial Hospital | And 2 more authors.
Contraception | Year: 2011

Background: Depot medroxyprogesterone acetate (DMPA) as a hormonal contraceptive is highly effective and widely used, but it may reduce bone mineral density (BMD) and increase the risk of osteoporosis. We compared BMD between users of intramuscular DMPA and nonhormonal subjects and evaluated the changes in BMD after discontinuation of DMPA. Study Design: The study included 68 women aged between 25 and 40 years using DMPA for 24 months and 59 women aged between 25 and 40 years using nonhormonal contraception as nonusers of hormonal contraception. Sixty-one women in the DMPA group and 52 women in the nonusers of hormonal contraception group completed the 2-year post-treatment periods. BMD of the lumbar spine and femoral neck was measured every 12 months for 48 months using dual-energy X-ray absorptiometry, comparing mean BMD changes in DMPA users and discontinuers with nonusers. Results: At 24 months of treatment, as compared to baseline, the mean BMD of DMPA users in lumbar spine and femoral neck decreased by 5.52% and 6.35%, respectively. Lumbar spine and femoral neck BMD in women who used DMPA significantly decreased compared to the nonusers (p<.001). At 24 months after DMPA discontinuation, the mean BMD values in DMPA users increased significantly. Although the values of the lumbar spine and femoral neck BMD in DMPA users were still 1.08% and 2.30%, respectively, below their baseline values, there were no significant difference when compared to nonusers (p>.05). Conclusion: These results show that BMD declined during use of DMPA in women aged 25 to 40 years. Bone loss occurring with DMPA use is reversible after DMPA discontinuation. © 2011 Elsevier Inc. All rights reserved.


Al-Mulla F.,Kuwait University | Marafie M.,Maternity Hospital | Tan T.Z.,National University of Singapore | Thiery J.P.,National University of Singapore | Thiery J.P.,Institute of Molecular and Cell Biology
Journal of Cellular Biochemistry | Year: 2014

In this study, we examined the association between the RKIP expression and the molecular subtypes of breast cancer. Microarray gene expression data of 2,333 human breast cancer from 26 different cohorts performed on Affymetrix U133A or U133Plus2 platforms were downloaded from Array Express and Gene Expression Omnibus and the molecular subtype of breast cancer for the samples was determined by single sample Gene Set Enrichment Analysis. Differences in recurrence-free survival (RFS) were tested using the Log-rank test in univariate analysis and displayed using Kaplan-Meier curves. Cox proportional-hazards model was used to calculate the hazard ratio using univariate and multivariate analysis. Loss or reduced RKIP expression was associated with reduced RFS in breast cancer using univariate and multivariate analyses, which was independent of lymph node (LN) metastasis status. Basal-like, Claudin-low, and Her-2-enriched tumors had significantly lower RKIP levels compared to other subclasses (P < 0.0001). Conversely, the Luminal subclass exhibited the highest expression levels of RKIP (P < 0.0001 for Luminal A and P = 0.0005 for Luminal B subtype), while in normal-like breast cancer subtype, RKIP expression was not informative. RKIP expression was prognostic in ER+ and ER- subgroups. RKIP expression had no significant prognostic power within Basal-like, Claudine-low, Luminal B, or Her-2-enriched breast cancer subtypes. However, its expression pinpointed excellent from intermediate-poor Luminal A survivors, in both ER+ (P = 0.035) and ER- (P = 0.012) subgroups, especially in LN negative breast cancers. In conclusion, RKIP expression adds significant value to the molecular subclassification of breast cancer especially for the Luminal A subtype. J. Cell. Biochem. 115: 488-497, 2014. © 2013 Wiley Periodicals, Inc.


Iffy L.,UMDNJ | Varadi V.,Maternity Hospital | Papp Z.,Maternity Hospital
Archives of Gynecology and Obstetrics | Year: 2015

Purpose: The first part of the study involved data collection for the detection of geographic variations and chronologic fluctuations in the rates of shoulder dystocia. The second part of the research evaluated head-to-body delivery times in cases of arrest of the shoulders at birth that had resulted in fetal damage during the last four decades in the USA. Methods: The study of geographic and chronologic changes in the rates of shoulder dystocia rested on reported statistics coming from the USA and 11 other countries. These data were obtained by computer search. Evaluation of head-to-body delivery times rested on 104 well-documented cases that resulted in permanent neonatal damage. Results: Literary reports of shoulder dystocia indicate that the incidence of shoulder dystocia has increased in the USA about fourfold since the middle of the twentieth century. No comparable trend has been reported from most other countries. Study of head-to-body delivery times revealed that more than two-thirds of all injured fetuses had been extracted from the birth canal within 2 minutes. Conclusions: Incidents of shoulder dystocia began to escalate in the USA during the 1980s, shortly after the introduction of “active management” of the birthing process. This new technique replaced a conservative philosophy which had recommended abstinence from intervention on the part of the accoucheur. The authors consider the interventionist approach largely responsible for the exponential increase in the rates of shoulder dystocia in the USA. They recommend adherence to the traditional method of delivery on the part of obstetricians in Europe and elsewhere. © 2014, Springer-Verlag Berlin Heidelberg.


Korkmazer E.,Giresun University | Solak N.,Maternity Hospital
Journal of Obstetrics and Gynaecology | Year: 2015

Gestational diabetes mellitus (GDM) is associated with an increased risk of postpartum type 2 diabetes mellitus and cardiovascular risk factors, such as obesity, hypertension, dyslipidaemia and systemic inflammation. We aimed to evaluate further lipid profile and inflammatory status assessed by high sensitive C-reactive protein (hsCRP) and TNF-α in GDM. Based on oral glucose tolerance testing, participants were stratifi ed into three groups: normal 50 g glucose challenge test (GCT), normal 100 g glucose tolerance test (NOGTT) (control group) (n = 40); abnormal GCT NOGTT (glucose intolerance) (n = 37); and GDM (n = 39), defined by Carpenter and Coustan. The three groups did not demonstrate significantly different hsCRP levels (p = 0.4180) and lipid profile parameters, such as total cholesterol (p = 0.4210) and LDL-cholesterol (p = 0.4440) levels. Triglycerides (p = 0.0150) and atherogenic index of the plasma levels (p = 0.0280) were slightly higher in the GDM group. But, TNF-α levels increased significantly in the GDM (p < 0 .0001) and in glucose intolerance (p = 0.0062) groups as compared with the control group. Among the metabolic syndrome components, insulin resistance was apparently associated with TNF-α, whereas dyslipidaemia was slightly associated with hsCRP because of the effects of maternal age on lipid markers. These findings suggest that TNF-α has a stronger correlation with pregnancy-associated insulin resistance than hsCRP at 24 to 28 weeks' gestation. © 2014 Informa UK, Ltd.


Poets C.F.,University of Tübingen | Wallwiener D.,University of Tübingen | Vetter K.,Maternity Hospital
Deutsches Arzteblatt International | Year: 2012

Background: There is an increasing trend towards delivery before 39 weeks of gestational age. The short- and longterm effects of early delivery on the infant have only recently received scientific attention. Methods: Selective review of the literature Results: Delivery at any time before 39 weeks is associated with significantly higher infant mortality and with an increase of the risk of impairments after birth from 8% to 11%. The increase in risks of various kinds is disproportionately more pronounced the earlier the child is delivered. For example, the risk of needing respiratory support or artificial ventilation after birth increases from 0.3% with delivery at 39-41 weeks of gestational age to 1.4% at 37 weeks and 10% at 35 weeks, while the risk of death or neurological complications increases from 0.15% at 39-41 weeks of gestation to 0.66% at 35 weeks. Delivery at 34.0 to 36.6 weeks of gestation also has long-term effects. Compared to delivery at term, the frequency of cerebral palsy rises threefold, from 0.14% to 0.43%; the risk of death in early adulthood rises by about half, from 0.046 to 0.065%; and the risk of dependence on government benefits in early adulthood also rises by about half, from 1.7% to 2.5%. Conclusion: Studies from the USA have shown that the number of medically indicated deliveries before 39 weeks can be lowered by 70% to 80% through consistently applied measures for quality improvement. If similar results could be achieved in Germany, the iatrogenic complications of delivery would become less common in this country as well.


Abdulsid A.,University of Glasgow | Hanretty K.,Maternity Hospital | Lyall F.,University of Glasgow
PLoS ONE | Year: 2013

Placental oxidative stress is a feature of both human labor and the pregnancy syndrome preeclampsia. Heat shock proteins (HSPs) can be induced in cells as a protective mechanism to cope with cellular stress. We hypothesized that HSP 70 would increase during labor and preeclampsia and that expression would vary in different placental zones. Samples were obtained from 12 sites within each placenta: 4 equally spaced apart pieces were sampled from the inner, middle and outer placental regions. Non-labor, labor and preeclampsia were studied. HSP 70 expression was investigated by Western blot analysis. HSP 70 protein expression was increased in the middle compared with the outer area (p = 0.03) in non-labor and in both the inner and middle areas compared with the outer area (p = 0.01 and p = 0.02 respectively) in labor. HSP 70 was increased in the preeclampsia non-labor group compared to the control non-labor group in the inner region (p = 0.003) and in the control labor group compared with the preeclampsia labor group at the middle area (p = 0.001). In conclusion HSP 70 is expressed in a spatial manner in the placenta. Changes in HSP 70 expression occur during labor and preeclampsia but at different zones within the placenta. The physiological and pathological significance of these remains to be elucidated but the results have important implications for how data obtained from studies in placental disease (and other organs) can be influenced by sampling methods. © 2013 Abdulsid et al.


Mogra R.,University of Sydney | Alabbad N.,Maternity Hospital | Hyett J.,University of Sydney
Early Human Development | Year: 2012

Sonographic assessment of fetal nuchal translucency (NT) thickness is the cornerstone of screening for chromosomal abnormality at 11-13+6weeks gestation. This marker was first recognized in pregnancies being karyotyped for advanced maternal age, but its underlying pathophysiology remains to be fully determined. Although increased NT is clearly associated with changes in both lymphatic and cardiac development, neither is an obvious causative agent. The association with cardiac defects has now being subjected to a significant amount of research, with a large body of evidence showing that this marker is also a screening tool for major cardiac defects - although it performs more modestly than for chromosomal abnormality. The field continues to change rapidly. Recent evidence that uses a combination of increased NT, tricuspid regurgitation and abnormal flow in the 'a' wave of the ductus venosus can provide an effective screening strategy to predict many major cardiac defects at this early stage of pregnancy. © 2012.


Pashaj S.,Maternity Hospital | Pashaj S.,Center for Prenatal Diagnosis and Therapy | Merz E.,Center for Prenatal Diagnosis and Therapy | Wellek S.,University of Mainz
Ultrasound in Obstetrics and Gynecology | Year: 2013

Objectives To construct reference ranges of quantitative characteristics of the fetal corpus callosum. Methods Women referred to a tertiary center for sonographic examination were recruited to undergo a detailed fetal scan from 17 to 41 weeks of gestation. Three-dimensional (3D) sonographic volumes of normal fetal brains were acquired and analyzed offline. We obtained three different measurements of the corpus callosal length, as well as the height (/thickness) of its segments, namely the rostrum, genu, body and splenium. Results Initially we recruited 604 pregnant women, of whom 138 were excluded because of various disorders/abnormalities, multiple pregnancy or gestational age < 18 weeks. Thus, included in the analysis were 466 sonographic volumes of normal fetal brains from singleton pregnancies, acquired by transabdominal (n = 170) or transvaginal (n = 296) ultrasound. The corpus callosum was visualized as a hypoechoic structure. Reference ranges were established for the following parameters: curved corpus callosal length, inner-inner corpus callosal length, outer-outer corpus callosal length, rostrum height, genu height, body height and splenium height. We observed non-linear growth and an approximately four-fold increase in all corpus callosal lengths, a three-fold increase in rostrum height, a four-fold increase in genu height, a two-fold increase in body height and a three-fold increase in splenium height between 18 and 41 weeks. The growth patterns of rostrum and body height appeared to be similar: there was rapid development until 24 and 22 weeks of gestation, respectively, and growth slowed beyond this period. The growth patterns of genu and splenium were also similar, being characterized by progressive growth throughout gestation. Conclusions Using 3D ultrasound, we have constructed reference charts for measurements of the corpus callosum. Knowledge of the normal growth pattern may be useful for evaluation of abnormal development of the corpus callosum, and so help in the accurate diagnosis of pathologies such as hypogenesis and dysgenesis. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.


Safar F.H.,Kuwait University | Mojiminiyi O.A.,Kuwait University | Al-Rumaih H.M.,Maternity Hospital | Diejomaoh M.F.,Kuwait University
Clinical Chemistry | Year: 2011

BACKGROUND: Insulin resistance (IR) plays an important role in the pathogenesis of polycystic ovary syndrome (PCOS), but identification of insulin-resistant individuals is difficult. The homeostasis model assessment (HOMA), a surrogate marker of IR, is available in 2 computational models: HOMA1-IR (formula) and HOMA2-IR (computer program), which differ in incorporated physiological assumptions. This study evaluates the associations of the 2 models as markers of IR, the metabolic syndrome (MS), and PCOS. METHODS: Anthropometric, hormonal, and biochemical parameters were measured in 92 PCOS women and 110 controls. HOMA1 and HOMA2 were used to assess IR. Regression analyses were used to find the associations of the 2 models with different variables, MS, and PCOS. RESULTS: The cutoff levels for definition of IR were HOMA1-IR ≥2.9 and HOMA2-IR ≥1.7. Mean HOMA1-IR (2.79) and HOMA2-IR (1.42) differed substantially. The difference (HOMA1-IR - HOMA2-IR) was significantly correlated with insulin, fasting plasma glucose, triglycerides, HDL cholesterol, waist circumference, leptin, and adiponectin (all P < 0.05). HOMA1-IR and HOMA2-IR were significantly associated with MS (odds ratio 5.7 and 4.2, respectively) and PCOS (odds ratio 3.7 and 3.5, respectively). CONCLUSIONS: HOMA computational methods significantly affect the associations and cutoff values used for definition of IR. The correlations of the difference in the computational methods corroborate differences in captured physiological mechanisms. As precise identification of IR in PCOS patients is of practical importance, practitioners and researchers should be aware of these differences in the HOMA computational methods. © 2010 American Association for Clinical Chemistry.


Volmanen P.,Savonlinna Central Hospital | Palomaki O.,University of Tampere | Ahonen J.,Maternity Hospital
Current Opinion in Anaesthesiology | Year: 2011

Paracervical block with modern technique is a viable option for selected cases. It is rapid and does not affect the course of labor, but its efficacy is only modest. Pudendal block can be used in the second stage of labor or for episiotomy tear repair and pain. Intravenous remifentanil is currently becoming an established method, although its safety is still an issue. Nitrous oxide is a useful method to be used alone or together with the other methods. © 2011 Wolters Kluwer Health.

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