Data from the United States showed a prevalence of celiac disease in 5.9% of patients with unexplained infertility [20], while a Brazilian study evaluated 170 infertile women screened for tissue transglutaminase antibodies followed by small bowel biopsies in serologically positive patients [ 21]. The serological screening for celiac disease in the general population (blood donors) and in some high-risk groups of adults (patients with autoimmune diseases, osteoporosis and infertility) in the Czech Republic.
Preeclampsia - What is to blame? The placenta, maternal cardiovascular system or both?
Abstract
MINIREVIEWS
In the United Kingdom, pulmonary embolism/eclampsia was the fourth leading cause of direct maternal death. Currently, in the United Kingdom, screening guidelines to identify people at high risk of developing pulmonary embolism are established in the first trimester and are based on maternal demographics and obstetric/medical risk factors[7].
PATHOPHYSIOLOGY - THE ROLE OF THE PLACENTA
The time of onset of PE is as diverse as the organ involvement and can occur from the end of the second. One possible reason for the development of PE is that there is a concurrent maladaptation of the mother's cardiovascular system, together with abnormal placentation, and this predisposes one to developing PE.
IS PE SOLELY DUE TO PLACENTAL DYSFUNCTION?
This would also explain why not all women with poor placentation and its consequences (such as fetal growth restriction) develop PE; their cardiovascular system adapts appropriately to ongoing pregnancy and associated hemodynamic changes.
CLINICAL EVIDENCE FOR THE AETIOLOGY OF PE
HO-1 has been shown to inhibit the release of sFlt-1[24,25] and it is possible that loss of HO-1 plays a role in the pathophysiology of PE. The biomarkers discussed above have been used in clinical trials as a potential screening tool for the detection of PE.
PATHOLOGICAL EVIDENCE FOR THE AETIOLOGY OF PE
There are no published studies examining differences in HO-1 expression in early- versus late-onset PE. Ogge et al.32 showed that the prevalence of placental hypoperfusion lesions was greatest in cases of premature pulmonary embolism (58%), compared with 33% in late-onset pulmonary embolism and 16% in term controls.
PATHOPHYSIOLOGY - THE ROLE OF THE CARDIOVASCULAR SYSTEM
Activation of these pathways was significantly higher in early PE than in late PE or controls. An interesting recent study examined placental perfusion using magnetic resonance imaging in early and late pulmonary embolism [34].
WHAT IS THE CARDIAC LEGACY OF HAVING PE?
Although some of the initial research on cardiac changes in pulmonary embolism produced conflicting results, more recent work has demonstrated a more consistent set of findings. They hypothesize that women with elevated IAP will have compromised venous return to the heart, resulting in reduced blood flow in the vascular beds of the placenta, uterus, kidneys and liver.
CONCLUSION
The consequence of this impaired blood flow and venous congestion will include placental ischemia, edema of the lower extremities, glomerulopathy associated with hypertension. Although this is supported by the observed increase in PE in women with certain pro-inflammatory systemic conditions (autoimmune disease, renal disease, etc.)[51], another, and we believe stronger, argument can be made for the role of the maternal cardiovascular system in the development of PE.
Are early and late preeclampsia different subclasses of the disease? What does the placenta reveal? Early and late preeclampsia: two different maternal hemodynamic states in the latent phase of the disease.
Universal screening for hemoglobinopathies in today's multi-ethnic societies: How and when
Core tip: All women in most modern countries are offered screening for rhesus antagonism and infectious diseases early in pregnancy. Hemoglobinopathy (HBP) screening done together with rhesus screening using an inexpensive routine high performance liquid chromatography or capillary electrophoresis analysis can identify all female carriers of the frequent characteristics associated with the severe forms of HBP. Subsequent partner analysis can identify all at-risk couples to be confirmed by molecular analysis in time for prenatal diagnosis when requested.
INTRODUCTION
Carriers of the common Hb variants (HbS, HbC, HbE and HbD) are identified at 100% sensitivity and over 95% specificity (Figure 1)[16]. This explains the normocytic normochromic state of the red blood cells and the abnormal HPLC/CE separation. Conversely, carriers of the common Hb variants that can be separated on HPLC or CE are not microcytic unless also carriers of coexisting alpha.
SCREENING WHEN
If αthal is suspected due to the CBC parameters in the absence of iron deficiency and low HbA2, molecular analysis is necessary to detect the common deletions or point mutations. At-risk couples should be made aware that the risk of 1 in 4 applies to each pregnancy and that having an affected child does not mean that the next 3 will be healthy. When the partner of a carrier of a relevant trait is found to be positive, the suspected risk couples should be confirmed at the molecular level and advised by a genetic counselor who is well informed about the severity of the diseases and the expected prognosis of the offspring. .
ACKNOWLEDGMENTS
There have been cases of pregnant HbS carriers who had a child affected by SCD because the father did not show up and left the mother alone to care for the sick child. It would therefore be ethically correct to offer prenatal diagnosis to female carriers even in the absence of the father, and especially when the presumed father belongs to an ethnic group with a high prevalence. Although conception is only possible on a few days of the cycle, emergency contraception is offered when indicated regardless of the timing of the menstrual cycle due to uncertainty about the timing of ovulation.
Emergency contraception: What is new?
Emergency contraception is defined as contraceptive methods used after unprotected intercourse or sexual assault and in cases of contraceptive failure. The main role of copper-induced intrauterine devices in emergency contraception is the prevention of conception[1]. While the possibility of pregnancy is higher on the day of ovulation, emergency contraception can be used at any time during the menstrual cycle.
COMBINED EMERGENCY
There is ample evidence to show that implantation of a fertilized egg cannot be prevented by emergency contraception. The possibility of getting pregnant after unprotected sex in the population of young couples in their mid-twenties varies between 12-30%, depending on the day of the menstrual cycle[2]. The most frequently used EC methods are summarized in Table 1. Indications for possible emergency contraception are [3]: if no contraception was used during sexual intercourse in the last 120 hours;
CONTRACEPTIVE PILLS (YUZPE REGIMEN)
Currently used emergency contraception methods are pills containing combined estrogen-progesterone, progestin only, antiprogestins and copper intrauterine devices. The most effective method is copper intrauterine devices, followed by anti-progestins and oral progestin-only pills. The main pathogenesis of emergency oral contraceptives is thought to be a delay or prevention of ovulation.
PROGESTIN-ONLY ECP
ANTIPROGESTINS
MIFEPRISTONE
ULLIPRISTAL
COPPER-INDUCED INTRAUTERINE DEVICES
OTHER INTRAUTERINE CONTRACEPTIVE METHODS
THE FACTORS CHANGING THE EFFICIENCY OF EMERGENCY
SIDE EFFECTS
EFFECTS ON PREGNANCY
USE IN LACTATION
DRUG INTERACTIONS
SAFETY
CONTRAINDICATIONS
PROCEEDING OR STARTING HORMONAL CONTRACEPTION
Low-dose mifepristone and two levonorgestrel regimens for emergency contraception: a WHO multicenter randomized trial. Comparative evaluation of the effectiveness and safety of two levonorgestrel regimens for emergency contraception in Nigerians. Effect on pregnancy rates of delay in administration of levonorgestrel for emergency contraception: a pooled analysis of four WHO trials.
ORIGINAL ARTICLE
Yona Nicolau, Austin Purkeypile, T. Allen Merritt, Mitchell Goldstein, Bryan Oshiro, Department of Pediatrics, Division of Neonatology, Loma Linda University Children's Hospital, Loma Linda, CA 92354, United States. Author Contributions: Nicolau Y conceived the study, performed the research, analyzed the data and wrote the article; Purkeypile A designed the study, performed the research and contributed to the analytical tools; Merritt TA designed the study, performed the research, analyzed the data, and wrote the article; Goldstein M designed the study, conducted the research and analyzed the data; Oshiro B conceived the study, performed the research and wrote the article. Correspondence: Yona Nicolau, MD, Department of Pediatrics, Department of Neonatology, Loma Linda University Children's Hospital, 11175 Campus St, Coleman Pavilion 11121, Loma Linda, CA 92354, United States.
Outcomes of surrogate pregnancies in California and hospital economics of surrogate maternity and newborn care
Yona Nicolau, Austin Purkeypile, T Allen Merritt, Mitchell Goldstein, Bryan Oshiro, Department of Obstetrics and Gynecology, Loma Linda University Children's Hospital, Loma Linda, CA 92354, United States. Yona Nicolau, Austin Purkeypile, T Allen Merritt, Mitchell Goldstein, Bryan Oshiro, Office of Finance, Loma Linda University Children's Hospital, Loma Linda, CA 92354, United States. Institutional Review Board Statement: The research was approved by the Institutional Review Board of the Loma Linda University School of Medicine.
Retrospective Cohort Study
In many countries and in some states of the United States, traditional surrogacy and gestational surrogacy are illegal. For example, in California, one of the most liberal states in the United States in this respect, the law allows both traditional surrogacy and surrogacy in exchange for payment, and appoints independent legal counsel for the surrogate mother and intended parents, and the conclusion of a contract. with judicial review and approval under the Uniform Parentage Act, as amended in 2012[4]. In 2012, the Society for Assisted Reproductive Technology reported that among 379 of its member clinics, 165,172 cycles or procedures involving in vitro fertilization were performed, and that infants conceived using in vitro fertilization procedures accounted for 1.5% of all births in the United States. States formed[6]. ].
MATERIALS AND METHODS
IVF pregnancies are considered high-risk pregnancies due to the increased risk of prematurity, pregnancy-related complications, and increased incidence of multiple pregnancies. For example, the cost of obtaining surrogate or gestational carrier women (often through the use of agencies that advertise for eligible women), lawyers specializing in the preparation of contracts between prospective parents and the surrogate, and other costs such as specialized social services , psychological counseling for the intended parents and often for the surrogate herself. We hypothesized that hospital costs for maternity and newborn care would be significantly greater for women who serve as surrogates than those who deliver after natural conception and that hospital costs for the babies would also be significantly greater than for babies delivered after natural conception and at term. born under natural conception. conceive babies
RESULTS
The mortality rate was 5.7% among infants born using assisted reproductive technology, compared to 0.7% of naturally conceived infants admitted for the first time to normal nursery. Compared to naturally conceived singleton or twin babies who were admitted to the normal nursery with an average length of stay of 2.1 days, babies born to a surrogate mother had a significantly longer length of stay. This longer length of stay was undoubtedly related to the greater number of children admitted to the NICU after delivery to a surrogate mother.
DISCUSSION
How much do intended parents want to know about possible newborn complications and the additional financial costs associated with a premature baby or multiple birth? An extension of the "moral hazard" concerns in surrogacy are the misunderstandings that arise between intended parents and surrogate mothers, and unforeseen events during such a pregnancy. Another aspect of the 'moral hazard' of surrogacy is that voluntary risk acceptance could increasingly come under extreme scrutiny.
COMMENTS
All of these dynamic considerations make it imperative that prospective parents and health care professionals fully understand the risks and often unforeseen costs associated with surrogacy decisions. In our single site, we document the extensive demands for neonatal intensive care and the associated increased hospital health care costs for both surrogate mothers (both gestational and traditional) and surrogate infants.
Ovarian simple cysts in asymptomatic postmenopausal women detected at transvaginal ultrasound: A review of
SYSTEMATIC REVIEWS
Core tip: The problem of ovarian simple cysts in asymptomatic postmenopausal women remains a controversial issue in gynecological practice. Data on the natural history of ovarian simple cysts in asymptomatic postmenopausal women follow. In this systematic review, we addressed the issue of ovarian simple cysts in asymptomatic postmenopausal women.
Use of hyaluronic acid for sperm immobilisation and selection before intracytoplasmic sperm injection: A systematic review
Hyaluronic acid (HA) occurs naturally in the reproductive tract of women and is part of the cumulus-oocyte complex. The primary endpoints of the current meta-analysis were defined as: fertilization rate, embryo quality and live birth rate. Forest plots were used to visually display the results of the meta-analysis.
