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Objectives: The feasibility of vaginoscopic hysteroscopy combined with office endometrial biopsy after ultrasonography for management of post-menopausal vaginal bleeding (PMB). Materials and methods: A prospective observational study of with PMB whom attending the Outpatient Clinic of Kang Ning Hospital during a four months period (1st Feb to 31st May 2018) was included. Vaginoscopic hysteroscopy was performed with endometrial biopsy after the initial clinical pelvic examination and transvaginal ultrasound examination. Results: A total of 45 consecutive women with PMB was included. The hysteroscopy and endometrial biopsy were successful in 44 out of 45 (98%), a complete view in 82%, adequate tissue was in 91%, only one case was failed both procedures due to pain. The correlation between hysteroscopy and endometrial biopsy by was 100%. The mean operation time was 229 ± 68 s. The most common histological findings was atrophic endometrium 18 (42%). Five endometrial polyps and 2 submucosal leiomyomas were found. One rare case of endometrial carcinosarcoma (2%) was detected. Patients reported less pain for hysteroscopy than endometrial biopsy with rated VAS pain score was 3.5 ± 2.2, with 5 more score in 18%, and for endometrial biopsy 4.2 ± 2 and 33% respectively (p

Objective We present prenatal diagnosis and molecular genetic characterization of a de novo interstitial deletion of chromosome 20p (20p12-p13) and a literature review of prenatal diagnosis of Alagille syndrome (ALGS). Case report A 33-year-old woman underwent amniocentesis at 17 weeks of gestation because of an abnormal result of combined first-trimester screening. Her husband was 35 years old, and there was no family history of congenital malformations. Amniocentesis revealed a karyotype of 46,XY,del(20)(p12p13), and array comparative genomic hybridization analysis on uncultured amniocytes revealed a 3.749-Mb deletion at 20p13-p12.3 and a 1.84-Mb deletion at 20p12.2 encompassing the gene of JAG1 . The parental karyotypes were normal. Prenatal ultrasound findings were unremarkable. The fetus postnatally manifested characteristic facial features of ALGS. Postnatal molecular cytogenetic analysis of fetal tissues confirmed the prenatal diagnosis. Polymorphic DNA marker analysis revealed a paternal origin of the deletion. Conclusion A de novo interstitial 20p deletion can be caused by a paternal effect. Pregnancy with a fetus affected with ALGS may be associated with an abnormal result of combined first-trimester screening and manifest no detectable ultrasound abnormalities.

Previous work from our laboratory using heart rate variability (HRV) has demonstrated that women before menopause have a more dominant parasympathetic and less effective sympathetic regulations of heart rate compared with men. Because it is still not clear whether normal or preeclamptic pregnancy coincides with alternations in the autonomic functions, we evaluated the changes of HRV in 17 nonpregnant, 17 normotensive pregnant, and 11 preeclamptic women who were clinically diagnosed without history of diabetic neuropathy, cardiac arrhythmia, and other cardiovascular diseases. Frequency-domain analysis of short-term, stationary R-R intervals was performed to evaluate the total variance, low-frequency power (LF; 0.04–0.15 Hz), high-frequency power (HF; 0.15–0.40 Hz), ratio of LF to HF (LF/HF), and LF in normalized units (LF%). Natural logarithm transformation was applied to variance, LF, HF, and LF/HF for the adjustment of the skewness of distribution. We found that the normal pregnant group had a lower R-R value and HF but had a higher LF/HF and LF% compared with the nonpregnant group. The preeclamptic group had lower HF but higher LF/HF compared with either the normal pregnant or nonpregnant group. Our results suggest that normal pregnancy is associated with a facilitation of sympathetic regulation and an attenuation of parasympathetic influence of heart rate, and such alterations are enhanced in preeclamptic pregnancy.

Neonatal lupus erythematosus (NLE) is characterized by cutaneous lupus, isolated congenital heart block (CHB), and a variety of systemic and hematologic abnormalities. The incidence of NLE is about 5–10% in mothers with systemic lupus erythematosus (SLE) [1]. Neonatal cutaneous lupus is a benign and self-limiting condition when it presents in isolation. The presence of anti-Ro autoantibodies in the affected infant’s serum correlates with disease activity in the skin. The disease activity generally resolves by about the age of 6 months as the antibody titer decreases [2]. The mean time of detection of the skin rash ranges from birth to 20 weeks postpartum with a mean age at detection of 6 weeks. The rash is often exacerbated after exposure to UV light. In previous reports, only a minority (16–23%) of infants were found to have the rash at birth [2,3]. We report here a female baby who was born to an SLE mother with positive anti-Ro and anti-La; the baby already had an extensive skin rash at birth, suggesting that sun exposure was not a requirement for these skin lesions. A woman aged 32 years, gravida 3, para 2, gave birth to a female baby with an extensive skin rash. The delivery was by cesarean section at 39 +6 weeks of pregnancy because of breech presentation. The patient had been in good health until she was aged 31 years when, 3 months before this pregnancy, she developed a malar rash. An evaluation at a hospital led to the diagnosis of SLE. Low-dose prednisolone was administered but was discontinued by the patient herself after the pregnancy was diagnosed. Her obstetric history consisted of two normal spontaneous vaginal deliveries. Both female babies were normal. She had no other medical or surgical history, and did not take any medications after the pregnancy was detected. The whole course of the pregnancy was uneventful. There was no skin rash, arthralgia or myalgia during the pregnancy. An antenatal sonography at 20 weeks of pregnancy revealed no fetal cardiac arrhythmia. Her prenatal screening test for antibodies to rubella was positive and tests for syphilis and hepatitis B surface antigen were negative. Her laboratory tests at 39 +6 weeks of pregnancy showed positivity for antinuclear antibodies (ANA) (1/2,560, speckled pattern), anti-Ro (1/575) and anti-La (1/721), but were negative for anti-ribonucleoprotein (RNP) and anti-Sm. The female infant had a birth weight of 2,660 g, an Apgar score of 8 at 1 minute and 9 at 5 minutes. Meconium staining and an extensive skin rash were noted at birth. Widespread geographic erythematous annular and scaly plaques occurred over the face, scalp, trunk and legs, and were most marked on the face. The spectacle-like erythemas around her eyes gave a “mask” or “owl’s eye”-like appearance (Figure 1). Some petechiae were displayed in her inguinal areas. A geographic erythematous plaque was seen over the left upper abdomen (Figure 2). There was no involvement of the conjunctiva or the vaginal mucosae. A 12-lead electrocardiogram showed a normal sinus rhythm and

Abnormal uterine bleeding (AUB) is a common complaint in reproductive age women. The World Health Organization reported that in developing countries, 8-27% of women suffered heavy menstrual bleeding. (1) Hysterectomy remains the gold-standard treatment, but can be associated with significant morbidity. In the past gynecologists will be criticized for performing hysterectomies for women with AUB but without any uterine pathology. Over the past two decades, several non-invasive or minimally invasive procedures have emerged as alternative treatment modalities. But do these new treatments remain effective over time? In the present chapter, I discuss first generation hysteroscopic ablation techniques (EA), as an alternative to hysterectomy, that have been extensively studied over the last 20 years but are actually underused. Because a great number of valuable papers and books have already been published on this topic, for the sake of simplicity references have been kept to a minimum. Also I will share my personal experiences as a hysteroscopist who has performed more than 1000 cases of operative hysteroscopic surgery in Taiwan over the last 15 years.

Background. Although human papillomaviruses (HPV) are associated with cervical cancer, it has yet to be determined if specific HPV types have clinical or prognostic significance. Methods. Identification and typing of HPV were done by polymerase chain reaction (PCR) and restriction fragment length polymorphism. Results. Of the 43 cases of cervical cancer, 31 (72%) were HPV positive. The results of HPV typing in 40 cases of squamous cell carcinoma of the cervix revealed the presence of HPV-16 in 20 cases (50%), HPV-18 in 2 cases, HPV-11 in 1 case, HPV-33 in 1 case, HPV-52 in 1 case, HPV-58 in 1 case, and unidentified HPV types in 5 cases. Neither HPV-31 nor HPV-42 were present in our study. One case of squamous cell carcinoma had HPV-11 integration. Chi-square analysis revealed significant correlation between HPV genotypes and squamous cell patterns, no significant correlation between HPV genotypes and clinical stages, and cell differentiation of squamous cell carcinoma of cervix. Conclusions. These findings may contribute to understanding the role of HPV in cancer and the value of typing as a prognostic indicator.

Uterine incarceration is a rare event complicating pregnancy. Herein, we present a unique case of an asymptomatic term pregnancy with uterine incarceration; this patient had had an anterior myomectomy 3 years earlier. She had an asymptomatic antenatal course and incidental identification of uterine incarceration during cesarean section. We also address the importance of early recognition and appropriate management regarding this circumstance.

Summary Objective Treating menorrhagia in women of reproductive age by endometrial ablation (EA) decreases menstrual flow and increases quality of life. However, unexpected pregnancy and associated complications are challenges following EA. Materials and Methods From January 2000 to March 2008, a total of 356 women aged 26-45 years with persistent menorrhagia underwent total hysteroresectoscopic EA with follow-up at our hospital and were retrospectively evaluated. We also performed a literature search for articles reporting pregnancy after EA published between January 1983 and June 2008. Results Overall, 123 pregnancies after EA have been reported in the English literature, including five pregnancies among 356 women who underwent EA at our hospital. Fifty-nine (48%) of 123 pregnancies were terminated at the mother's request. The remaining 64 pregnancies were associated with spontaneous abortion (28%, 17/64), premature rupture of membranes (16%, 10/64), prematurity (31%, 19/64), cesarean section (44%, 27/64), and placental adherence complications (25%, 17/64) which necessitating hysterectomy in 10 women. Four tubal ectopic, two cornual and two cervical ectopic pregnancies were reported. The ectopic pregnancy rate was 6.5% (8/123). There were nine perinatal deaths, corresponding to a perinatal mortality rate of 14% (9/64). Five babies had congenital anomalies, including craniosynostosis (1 case), a set of twins with Down syndrome (1 case), agenesis of the corpus callosum (1 case), bilateral talipes (1 case), and one case of fetal malformation caused by intrauterine synechiae. The only maternal death was a 29-year-old woman with spontaneous rupture of her unscarred uterus and massive intraabdominal hemorrhage at 24 weeks of gestation. Conclusion Clinicians must recognize the potential complications associated with pregnancy after EA. Appropriate postoperative contraception and follow-up of menstrual patterns are strongly recommended.

Embryoscopic diagnosis of conjoined twins presenting with a missed abortion has never been reported. The morphological and pathological examinations, and the exact time of death in the conceptus of a missed abortion are seldom clearly delineated. The newly developed field of embryoscopy has created a new frontier in early embryonic/fetal visualization and is able to confirm the sonographic diagnosis. In this report, we used a transcervical endoscope to verify conjoined twins (thoraco-omphalopagus) in a 10-week missed abortion. Based on the size and the external features of the dead embryo, which exhibited developmental arrest at nine weeks and three days of menstrual age, we estimated that the embryo had died four days before examination. The whole procedure proceeded smoothly without any immediate complications.

Objective To assess plasma renin activity in a patient with severe ovarian hyperstimulation syndrome (OHSS) and internal jugular vein thrombosis. Design Case report. Setting University-affiliated infertility center. Patient(s) A 33-year-old woman with OHSS and internal jugular vein thrombosis. Intervention(s) Controlled ovulation hyperstimulation with recombinant FSH induction. Main outcome measure(s) Plasma renin activity (PRA), color Doppler ultrasound of the neck. Result(s) The patient had internal jugular vein thrombosis caused by severe OHSS. The PRA was significantly elevated during the acute stage and subsequently declined after resolution of the OHSS. Conclusion(s) In this patient elevated PRA appeared to be associated with the development of OHSS and thrombosis. The implication of the ovarian renin-angiotensin system in the development of OHSS and thrombosis is relevant.

Plasma glucose and insulin responses to a 75-g oral glucose load, and the steady-state plasma insulin (SSPI) and glucose (SSPG) concentrations after an infusion of somatostatin, insulin, and glucose, were determined 2 months after delivery in 26 women; 13 who had a normal pregnancy and 13 who developed preeclampsia. The plasma glucose response to oral glucose was not different in the two groups, but the plasma insulin response was significantly greater (P < .02) in those who had been preeclamptic. Although the mean (+/- SE) SSPI concentrations during the infusion study were similar in the two groups (51 +/- 2 v 56 +/- 2 microU/mL), the SSPG concentrations were significantly higher (P < .02) in those who developed preeclampsia (160 +/- 17 v 119 +/- 17 mg/dL). Thus, when studied 2 months after delivery, women who developed preeclampsia were relatively insulin resistant and hyperinsulinemic when compared to those who had an uncomplicated pregnancy.

Mullerian inhibiting substance (MIS) is a glycoprotein released from Sertoli cells or follicular cells of gonads, responsible for the regression of Mullerian ducts and/or Mullerian-derived tumor cells. Binding of MIS to target cells is essential for initiating regression. A human cervical carcinoma CaSki cell was examined by quantitative immunocytochemistry detected by anti-avian MIS antibody for MIS binding ability. Various treatments of WGA-peroxidase conjugate, enzyme digestion, sodium periodate or exogenous estrogen before antibody recognition were performed. It was found that the WGA partially blocked MIS binding to CaSki cell surfaces. Protease digestion of CaSki cell surfaces prior to addition of MIS or an anticervical carcinoma monoclonal antibody 1H10 (MAb 1H10), blocked the binding of MIS but not MAb 1H10 to cell surfaces. Sodium periodate and overnight exposure of CaSki cells to estrogen or diethylstilbestrol before or after fixation of the cells, did not influence MIS binding ability in vitro. MIS binding was higher on avian Mullerian duct compared with MIS binding to CaSki cells by quantitative immuno-gold labeling analysis. MAb 1H10 immuno-gold complexes binding to CaSki cells was also obtained and compared with MIS immuno-gold bindings. MIS binding site could be a polypeptide which survived sodium periodate treatment. The 'critical window' period, in which developing Mullerian ducts respond to exogenous estrogen protection from MIS regression, is possibly lost in CaSki cell.

Plasma 6-keto-prostaglandin F 1α and thromboxane B 2 , the metabolites of prostacyclin and thromboxane A 2 respectively, were measured in 12 women with pregnancy-induced hypertension, 12 agematched normotensive pregnant women and 8 non-pregnant women as controls. Pregnancy was divided into 3 stages, namely: 22–27, 28–32 and 33–39 weeks. The concentrations of thromboxane B 2 in the plasma of women with pregnancy-induced hypertension was 1.4–1.7 times greater than normotensive pregnant subjects at the same gestational stage, and 2 times higher than controls. Plasma levels of 6-keto-prostaglandin F 1α in normotensive pregnant women was 1.8 times greater than in those with pregnancy-induced hypertension at 28–32 and 33–39 weeks, and was significantly higher than control. The ratio of thromboxane B 2 to 6-keto-prostaglandin F 1α was markedly increased in the group of patients with pregnancy-induced hypertension at 28–32 and 33–39 weeks gestation. The ratio of the two metabolites in normotensive patients at each stage of gestation was similar to the control group. The ratio of circulating aggregated platelets in subjects with pregnancy-induced hypertension was significantly lower than in normotensive pregnant subjects at 33–39 weeks, implying increased turnover of platelets in pregnancy-induced hypertension. There was no significant difference in count of platelets, adenosine diphosphate threshold concentration and variables of platelet aggregation induced by adenosine diphosphate among the 3 groups. This longitudinal study showed that there is an imbalance between thromboxane A 2 and prostacyclin in the pathogenesis of pregnancy-induced hypertension, and that the imbalance was already significant at 28–32 weeks gestation. More studies will be needed to explain this imbalance and, hopefully, a therapeutic modality will be developed to counteract it.

The reproductive performance subsequent to operative removal of ectopic pregnancy was examined in 132 women. They represent 44.6% of 296 women admitted for ectopic pregnancy between 1981 and 1989. The follow-up period ranged from 6 months to 9 years, averaging 3.6 years. During the follow-up period, 69 (52.3%) pregnancies occurred. Among them, 60 (87%) were intrauterine and 9 (13% of the pregnant women) were repeated ectopic pregnancies. Full-term delivery was obtained in 73.9% of the pregnant patients. Forty of the 132 patients received conservative surgery and 92 patients received radical surgery for ectopic pregnancy. The operation method had no influence on subsequent fertility in women with an intact contralateral tube, who had significantly higher pregnancy (p less than 0.005) rate (3.8%) than women with an affected contralateral tube (39.5%, 47% and 41%, respectively). Compared with parous women (13.3%), the risk of repeated ectopic pregnancy was similar to nulliparous women (12.5%), but the nulliparous women had a slightly lower conception rate (40%) than parous women (54.8%). Unruptured ectopic pregnancies comprised 41.6% of our cases. There was no significant difference in fertility rate between ruptured and unruptured ectopic pregnancies in our study.

Small cell carcinomas are rare in cervical cancers and appear to be a heterogeneous group of tumors. Neuroendocrine carcinoma of the cervix, one subtype of small cell carcinomas of the cervix, can be identified by characteristic light and electron microscopic criteria. Two cases of neuroendocrine carcinomas associated with squamous cell carcinomas of the uterine cervix are reported in which electron microscopic studies were performed. The presence of small dense-core membrane-bound granules (120 to 160 nm) in cytoplasmic process under electron microscopic observation confirmed the diagnosis of neuroendocrine carcinoma of the cervix. The coexistence of electron dense-core membrane-bound granules, abundant tonofibrils, and desmosomes within the cancer cells, suggests that these tumors may have derived from the multipotential precursor cells with neuroendocrine and squamous differentiation. Because neuroendocrine carcinomas appear to have the highest incidence of recurrence and the poorest prognosis, it is necessary to distinguish these neoplasms from squamous cell carcinomas of the cervix. Literature about neuroendocrine carcinomas of the cervix is also reviewed.

Objective: This case report evaluates a 51-month follow-up of the hormonal profiles and the menopausal status after fresh autologous hemi-ovary transplantation to the Pfannenstiel incision site in a woman aged 32 years after a total hysterectomy and accidental bilateral salpingo-oophorectomy. Case Report: A 32-year-old, unmarried woman without sexual experience had undergone a total hysterectomy and accidental bilateral salpingo-oophorectomy for huge uterine fibroids and dense pelvic adhesion. A fresh autologous right normal hemi-ovary was transplanted into the adipose tissue on the right side of the Pfannenstiel incision site. During the 51-month follow-up after transplantation, a series of hormonal profiles for serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and progesterone were carried out, together with ultrasound detection of the presence of subcutaneous follicles and an analysis of menopausal symptoms. Postoperative hormone levels at months 14, 18, 22, 30 and 51 were as follows: (1) FSH, 17.06, 11.33, 51.44, 28.6 and 61.41 mIU/mL, respectively; (2) LH, 15.1, 6.7, 20.1, 15.7 and 28.9 mIU/mL, respectively; (3) E2, 79.7, 128, 55.9, 18.6 and < 10pg/mL, respectively; and (4) progesterone, 4.52, 9.51, 0.67, 0.45 and 0.25ng/mL, respectively. The hormonal levels after month 22 indicated a menopausal status. Ultrasound evidence of follicles was present until 30 months after transplantation. Conclusion: This case study showed a subcutaneous fresh autologous hemi-ovary transplant survived for at least 18 months after transplantation.

Corticosteroid therapy near term for mothers with immunologic thrombocytopenia has recently been suggested as a clinically useful method to prevent neonatal thrombocytopenia. The unreliability of this approach is illustrated by the case of an infant with a low platelet count delivered after the maternal administration of dexamethasone.