Frequent causes of premature ductal closure include spontaneous idiopathic closure in utero and maternal use of nonsteroidal anti-inflammatory drugs late in pregnancy.We describe a case of a preterm infant born to a mother treated with lithium throughout pregnancy who presented with right-sided cardiac enlargement at 18 weeks' gestation. Immediately following delivery, echocardiography demonstrated a small closing patent arterial duct.We recommend that serial fetal echocardiography with emphasis on Doppler interrogation of the patent arterial duct be performed whenever a pregnant woman is taking lithium. The interrogation of the patent arterial duct is particularly important if right-sided chamber enlargement is noted at fetal sonography as this finding can be an early manifestation of premature ductal constriction.

Granular cell tumor (GCT) is a relatively rare and nearly always benign neoplasm that has been described in many sites and organs including the tongue, skin, subcutaneous tissue, breast, and vulva. However, it is rarely seen in the uterine cervix.We report a case of granular cell tumor of the cervix in a 38-year-old woman. Upon microscopic examination the tumor was found to comprise large polygonal cells with an abundant eosinophilic granular cytoplasm and round to oval nuclei. Upon immunohistochemical staining the large cells showed S-100, neuron specific enolase, and CD68 positive in the cytoplasm. Clinical presentation of the patient, histopathological features of the lesion, and treatment approach are discussed.GCTs of the cervix are extremely rare. To the best of our knowledge this report is the first Chinese case of cervical GCT in the English-language literature. GCTs should always be considered during the diagnosis process with large cell lesions of the cervix. Extensive surgical resection appears to be adequate for most GCTs. Because of the unpredictable clinical outcome of this tumor, strict and long-term follow-up are recommended.

Pregnancies after endometrial ablation (EA) are rare and are associated with high morbidity, especially in the second and third trimesters.We report 3 cases of pregnancy after EA in which severe complications occurred during the first trimester. The first case concerns an unexpected pregnancy after EA in a 50-year-old woman. Hysterectomy via laparotomy was needed because of heavy bleeding and severe anemia. Pathology showed a complete hydatidiform mole without invasion. Ultrasound-guided in situ methotrexate injection could be a nonsurgical alternative to terminate an intrauterine pregnancy after EA when the pregnancy is located within uterine synechiae, as shown by the second case. The third case presented as an accreta placentation mimicking hyperplastic myometrial invasion in a 46-year-old patient.Because of the high morbidity of these pregnancies that could still occur after EA, patients need contraception after EA, and concomitant hysteroscopic sterilization should be proposed at the same time.

To review the impact of the changes that have occurred in the standard of care in obstetrics and in the trend of cesarean delivery rates in recent times and factors associated with peripartum hysterectomy procedure.A retrospective analysis of all cases of peripartum hysterectomies among inpatient hospitalizations at 4 major hospitals in the Washington metropolitan areas of the District of Columbia from January 1, 2000, through December 31, 2009, was conducted.The total number of deliveries and postpartum hysterectomies that occurred at all 4 locations was 150,847 and 128, respectively. The rate of peripartum hysterectomies per 1,000 deliveries was 0.85. Primary and repeat cesarean deliveries, advanced maternal age, obesity, and grand multiparity have direct association with peripartum hysterectomy. Up to 80% of all cases of peripartum hysterectomy are accounted for by class III and IV hemorrhage. Peripartum hysterectomy is associated with increased prevalence of uterine atony, placenta previa, and placenta accreta.Our results suggest that primary and repeat cesarean deliveries, advanced maternal age, obesity, and grand multiparity, uterine atony, placenta previa, and placental accreta, and class III and IV hemorrhage are independently associated with an increased risk for peripartum hysterectomy. These findings may be of concern given the increasing rate of cesarean deliveries in the District.

To determine the role of human amniotic fluid (HAF) in preventing or reducing postoperative adhesions.Uterine horn adhesion model was carried out in 24 female Wistar rats. The animals were randomized into 4 groups: (1) control, (2) Ringer's lactate, (3) whole HAF, and (4) HAF depleted from cells and proteins. Adhesion grade and histologic findings of adhesion-carrying tissues were evaluated and groups were compared according to these parameters.Rats treated with whole HAF had less adhesion grade when compared to the control group, but the difference was not statistically significant. On the other hand, centrifuged amniotic fluid treatment significantly reduced peritoneal adhesion grade, fibrosis and inflammation (p < 0.05).Whole HAF seems to have no beneficial effect on peritoneal adhesion formation, but HAF depleted of protein and cells does have a positive effect on reducing adhesion formation.

To explore the comparative efficacy, safety, and tolerability of agents used for ovarian stimulation and luteal support when applied in a population of women undergoing in vitro fertilization (IVF) using a gonadotropin-releasing hormone (GnRH) antagonist protocol.A phase 4, multicenter, randomized, open-label, exploratory clinical trial was performed at 7 assisted reproductive technology centers in the United States. Subjects included 173 women aged 18-42 years with a documented history of infertility who were undergoing IVF. Subjects were randomized to treatment with highly purified human menopausal gonadotropin (HP-hMG) or recombinant human follicle-stimulating hormone (rhFSH) for ovarian stimulation and progesterone vaginal inserts (PVIs) or intramuscular injection of progesterone in oil (PIO) for luteal support. Protocols for IVF followed the standard practices of participating centers within the parameters of the study.Biochemical, clinical, and ongoing pregnancy rates were the main outcome measures. Ongoing pregnancy rates for individual treatment groups ranged from 44.0-46.9%. No statistically significant differences were observed in pregnancy outcomes for the comparisons of HP-hMG vs. rhFSH or PVI vs. PIO. All study medications were generally safe and well tolerated.In this study HP-hMG and rhFSH were equally effective for ovarian stimulation during GnRH antagonist IVF cycles. Both PVI and PIO are viable options for luteal support.

To present a newly developed surgical intervention (clitoral subdermal hoodoplasty) for an asymmetrical clitoral prepucial thickness hypertrophy and to evaluate its applicability and outcomes.The study was conducted on 3 consecutive patients with symptomatic, asymmetrical-in-thickness clitoral prepucial hypertrophy. A clitoral subdermal hoodoplasty surgical technique for asymmetrical clitoral prepucial thickness hypertrophy has never been described before. An observational prospective, multiple time series clinical study was conducted. Primary outcome measures were to determine applicability, outcomes, and potential complications of the new surgical intervention. Data collected included demographics, patient selections, intraoperative and postoperative complications, and outcomes of the newly developed surgical intervention.All subjects demonstrated subdermal hypertrophy of the clitoral prepuce. The newly developed procedures were successfully applied. Complications were not observed. The surgical intervention resulted in resolving medical symptoms and signs and provided pleasing aesthetic outcomes. In this study the procedure was simple to execute and well-tolerated by all subjects, without short-term and long-term complications.Clitoral subdermal hoodoplasty is a useful method in the treatment of clitoral subdermal hypertrophy.

To evaluate the outcomes of midtrimester emergency cerclage and to find out the contributing factors.Twenty-five patients presenting with cervical dilation and effacement with the membranes at the level of the external os or prolapsed into the vagina were included in the study. At the time of the cervical cerclage placement, gestational age ranged from 14-26 weeks. A good outcome was defined as the take-home baby rate, but also the interval between the time of the cervical cerclage placement and delivery and the gestational age at delivery were discussed.The mean gestational age at the time of the cervical cerclage placement was 21.2 +/- 2.73 weeks, the mean gestational age at delivery was 29.4 +/- 5.37 weeks, and the mean birth weight was 1,511 g. Eighteen patients had McDonald type cerclage, and 7 patients had both McDonald and Saling type cerclages. The overall take-home baby rate was 64%. Patients presenting with membranes at the level of external os had a take-home baby rate of 68.8%, whereas patients presenting with membranes prolapsed into the vagina had a take-home baby rate of 31.3%.Cervical dilation at midtrimester has a poor outcome which can be improved with emergency cerclage. Patients presenting with membranes prolapsed into the vagina have a decreased success rate. Total closure of the cervix may improve results.

To evaluate the success of induction of labor in twin gestations using standard protocols for misoprostol and oxytocin designed for singleton gestations.This retrospective cohort study involved all diamniotic twin gestations that were induced at > or = 32 weeks' gestation with intact membranes. Two singleton pregnancies were matched for each twin pregnancy. Use of intravaginal misoprostol and low-dose intravenous oxytocin was based on ACOG management guidelines.A small proportion (40 of 430 [9.3%]) of twins met the inclusion criteria for an induction of labor. Misoprostol was utilized less frequently with twins than with singletons (55% vs. 78%, p = 0.02) because of the higher preinduction Bishop score. Doses of oxytocin were comparable between the 2 groups. A high rate of vaginal delivery was seen in the twin and singleton groups (85.0% vs. 80.0%, p = 0.62) with similar neonatal outcomes.A standard protocol of labor induction for singleton gestations would apply for twins with overall favorable intrapartum outcomes.

To test the association between insulinlike growth factor 2 (IGF2) ApaI and IGF2 receptor (IGF2R) Gly1619Arg gene polymorphisms and idiopathic male infertility.Polymerase chain reaction and restriction fragment length polymorphism methods were performed to detect the IGF2 ApaI and IGF2R Gly1619Arg genotypes in 98 Croatian men with idiopathic infertility and 113 fertile men.There were no significant differences between patients and controls according to genotype (chi2(IGF2) = 3.46, p = 0.177; chi2(IGF2R) = 1.12, p= 0.571, respectively) and allele frequencies (chi2(IGF2) = 3.23, p = 0.072; chi2(IGF2R) = 0.99, p = 0.319, respectively). Odds ratios for recessive, dominant and codominant models and association testing with each genotype combination revealed no difference between infertile men and controls.In this study we have shown that IGF2 ApaI and IGF2R Gly1619Arg gene polymorphisms are not associated with male infertility.