Comprehensive Amniotic Fluid Cytokine Profile Evaluation in Women with a Short Cervix: which Cytokine(s) Correlates Best with Outcome?

OBJECTIVE: The objective of this study was to determine whether an expanded amniotic fluid cytokine profile predicts spontaneous preterm birth in patients with short cervix in the midtrimester. STUDY DESIGN: Amniocentesis was performed on singleton gestations between 16-24 weeks with a cervical length RESULTS: Forty-four amniotic fluid samples were analyzed. After stepwise regression, only monocyte chemotactic protein-1 remained significant and was the most predictive of early delivery. With a cutoff of 1320 pg/mL, monocyte chemotactic protein-1 had a 69% sensitivity, 83% specificity, 36% positive predictive value, and 87% negative predictive value to predict spontaneous preterm birth within 1 week of amniocentesis (P = .015). CONCLUSION: Among 25 cytokines, monocyte chemotactic protein-1 was most predictive of spontaneous preterm birth

Salpingectomy improves outcome in the presence of a unilateral hydrosalpinx in a donor oocyte recipient: a case report.

PURPOSE: To determine if unilateral salpingectomy for hydrosalpinx can improve fecundity in a woman with many cycles of failure to conceive despite the fertilization of donor oocytes and subsequent embryo transfer. METHODS: Salpingectomy performed after failure to conceive despite IVF-ET with the patient\u27s own oocytes (n=5) or transfer of donor embryos (n=2) or embryo transfer cycles as a donor oocyte recipient (n=5). RESULTS: The patient conceived three of four times following salpingectomy. Transfer of four frozen-thawed donor embryos and two frozen-thawed embryos of her own led to a successful delivery. In one of two cycles as a donor oocyte recipient she had a successful delivery and subsequently, the transfer of cryopreserved/thawed embryos from a previous donor oocyte cycle led to a chemical pregnancy. CONCLUSION: Unilateral hydrosalpinx can be a cause of recalcitrant failure to conceive despite assisted reproductive technology. Salpingectomy can restore fecundity

Ovarian cancer in a woman previously diagnosed with endometriosis and an extremely high serum CA-125 level.

PURPOSE: Follow-up of a woman with a serum CA-125 level \u3e 1000 U/mL where laparoscopy only found endometriosis. METHODS: Case report-- re-evaluation several years later. RESULTS: Extensive clear-cell carcinoma of ovary with metastases leading to death. CONCLUSION: This case suggests that bilateral oophorectomy should be performed in women not desiring any more children if the serum CA- 125 level is very high even if only endometriosis is found initially

A Randomized Trial of Cerclage vs. 17 Alpha-Hydroxyprogesterone Caproate for Treatment of Short Cervix.

OBJECTIVE: To determine pregnancy outcome in patients with short cervix on transvaginal ultrasound between 16 and 24 weeks\u27 gestation treated with McDonald cerclage compared to weekly intramuscular injections of 17 alpha-hydroxyprogesterone caproate (17OHP-C). METHODS: From November 2003 through December 2006, asymptomatic, singleton pregnancies were screened with transvaginal ultrasound between 16-24 weeks\u27 gestation. Patients with a cervical length (CL) \u3c or =25 mm were offered enrollment. Patients were randomly assigned to treatment with McDonald cerclage or weekly intramuscular injections of 17OHP-C. The primary outcome was spontaneous preterm birth (PTB) prior to 35 weeks\u27 gestation. RESULTS: Seventy-nine patients met inclusion criteria; 42 were randomly assigned to the cerclage and 37 to 17OHP-C. Spontaneous PTB prior to 35 weeks\u27 gestation occurred in 16/42 (38.1%) of the cerclage group and in 16/37 (43.2%) of the 17OHP-C group (relative risk, 1.14 95% CI, 0.67, 1.93). A post hoc analysis of patients with a prior PTB showed no difference in spontaneous PTBCL\u3c or =15 mm showed a reduction in spontaneous PTB CONCLUSION: Women with CL \u3c or =25 mm in the second-trimester appear to have similar risks of delivering prior to 35 weeks\u27 gestation when treated with 17OHP-C or McDonald cerclage. However, cerclage may be more effective in preventing spontaneous PTB in women with CL\u3c or =15 mm