A rare case of endometriosis in Turner's syndrome

Endometriosis is defined by the presence of functional endometrial tissue outside the uterine cavity and musculature. It has a prevalence rate as high as 35e50% in women experiencing pain or infertility [1] and sometimes has a peculiar and rare onset [2,3]. Endometriosis is a common disease in menstruating women [4,5] but has also been reported in postmenopausal or surgically castrated women on hormone replacement therapy (HRT) [6]. The common denominator of all such cases is exposure to female hormones [7]. However, endometriosis, a common and important clinical problem in women of reproductive age, has rarely been described in prepubertal girls. In patients with Turner's syndrome or other ovarian dysgenesis, endometriosis is very rare. Some cases are subclinical, and endometriosis is an incidental finding during routine examination. Although endometriosis was described in the medical literature at the end of the 19th century, and the first theories regarding its hystogenesis were developed at the beginning of the 20th century, the real pathogenesis of endometriosis remains unknown. Most studies about the etiology of endometriosis claim that the main possible causes of endometriosis are probably multifactorial. Three theories of histogenesis have been proposed. (1) The metastatic theory [8] proposes the transplantation of endometrial tissue via retrograde menstrual implantation, vascular/lymphatic spread, and intraoperative implantation. (2) The coelomic metaplastic theory [9] suggests that the germinal epithelium of the ovary can be transformed by metaplasia into endometrium. This theory, which initially explained only ovarian endometriosis, has since been extended to the peritoneal serosa, as embryologic studies have indicated that Mullerian ducts, th

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6+/-9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; pPeer reviewe

Fertility and reproductive outcome after tubal ectopic pregnancy: comparison among methotrexate, surgery and expectant management

PURPOSE:To compare fertility and reproductive outcome after surgical, medical, and expectant management for tubal ectopic pregnancy (EP). METHODS:133 of 228 patients, who were managed between January 2012 and December 2017 for a tubal EP, tried to conceive immediately after treatment: 86 out of 173 (49.7%) underwent surgical treatment; 38 (21.9%) were treated with methotrexate (MTX), and 49 (28.3%) had expectant management. Clinical data were retrieved by medical records, fertility outcomes were obtained by phone follow-up. The cumulative incidence (CI) of intrauterine clinical pregnancy (CP), miscarriage, live birth (LB), and recurrent EP, and the time between treatment and first intrauterine CP were compared between women treated with MTX, surgery and expectant management. RESULTS:The CI of intrauterine CP starting from 12 months after the EP was 65.3% for the expectant management, 55.3% for the MTX group, and 39.5% for surgery (p\u2009=\u20090.012). Post-hoc analysis showed expectant management having higher intrauterine CP and LB, and shorter time between treatment and first intrauterine CP compared to surgery (p\u2009<\u20090.05). The CI of recurrent EP was comparable between the 3 groups. The analysis stratified per \u3b2hCG cut-off of 1745 mUI/mL and EP mass cut-off of 25 mm reported consistent results. CONCLUSIONS:Women successfully managed by expectation appear to have better reproductive outcomes compared to women who underwent surgery, with the shortest time to achieve a subsequent intrauterine CP. Therefore, if safely applicable the expectant management should be considered in the case of tubal EP. The fact that the chosen treatment was primarily guided by the \u3b2hCG value and EP mass diameter based on the protocol, which is intrinsically related to the characteristics of the EP, represents the main limitation of the present study. Indeed, we cannot completely exclude that the observed differences between treatments are related to the EP itself instead of the treatment

Maternal and Perinatal Outcomes of Pregnant Women with SARS-COV-2 infection

To evaluate maternal and perinatal outcomes of pregnant women affected by SARS-COV-2