Formation of vesicovaginal fistula after modified McDonald cerclage placement: a case report with literature review

Cervical cerclage is a common procedure employed to prevent preterm birth in women with cervical insufficiency. Complications such as injuries to the cervix and bladder, and premature membrane rupture are well-documented, while genitourinary fistulas are a rare occurrence. This article reports a rare case of vesicovaginal fistula (VVF) formation in a 27-year-old woman following the placement of a McDonald cervical cerclage. The patient presented with continuous watery vaginal leakage, which began during the last 2 months of her pregnancy. Clinical and cystoscopic examinations revealed the presence of a VVF, which was further confirmed through voiding cystourethrography and perineal magnetic resonance imaging. Notably, the patient had undergone the cerclage procedure 18 months prior to the onset of symptoms, making this case particularly unusual. We believe that the VVF formation was associated with the use of Mersilene tape, which may have slowly eroded through the cervix and subsequently breached the urothelium. This case underscores the importance of considering cerclage-related genitourinary fistulas as potential complications, especially when evaluating and counseling patients who have undergone cervical procedures like the McDonald technique. In conclusion, this case highlights the need for vigilant monitoring and a high index of suspicion in patients presenting with symptoms of genitourinary fistulas after such procedures. Further research and awareness in this area are warranted to better understand the risk factors and mechanisms underlying this unusual complication

Effect of long and short umbilical cord on perinatal outcome

Background: Most of umbilical cords are 50 to 60 cm long, and very few are abnormally short or long. Short cord is defined as <35 cm and long cord >80 cm. Short cords maybe associated with adverse perinatal outcomes such as IUGR, congenital malformation, intrapartum distress and 2 fold. Cord length is influenced positively by both the volume of amniotic fluid and fetal mobility. Objective was to determine the association between abnormal umbilical cord length and perinatal outcome.Methods: A retrospective cohort study, conducted at McGill University, using the computerized MOND database. All Term singleton deliveries between 2001 and 2007 were included. We based our population according to the length of the umbilical cord following delivery: Normal cord length (measured length 35-80 cm), short cord (<35 cm) and long cord (>80 cm). Admission to the Neonatal Intensive Care Unit (NICU) was compared to the normal cord group.Results: Of the 14,873 deliveries included, 13518 (90.9 %) had normal cord lengths, 980 (6.6 %) had short cords, and 375 (2.5%) long cords. Maternal age, gravidity, birth weights, and rate of male gender babies were all increased in the long cord group and decreased in the short cord group (all p<0.05). NICU admissions were more common in the short cord group (OR 1.9; 95%, CI 1.4-2.6) but not in the long cord group. Babies in both the short and long cord groups had higher rates of Apgar score <7 (OR 1.3, 95% CI 1.1-1.7 and OR 1.7, 95% CI 1.2-2.3, respectively) with no significant difference in cord pH. Gravidity and abnormal cord length were independent predictors of NICU admission.Conclusions: Short umbilical cord is associated with higher rates of NICU admissions and low Apgar scores

Effect of long and short umbilical cord on perinatal outcome

Background: Most of umbilical cords are 50 to 60 cm long, and very few are abnormally short or long. Short cord is defined as <35 cm and long cord >80 cm. Short cords maybe associated with adverse perinatal outcomes such as IUGR, congenital malformation, intrapartum distress and 2 fold. Cord length is influenced positively by both the volume of amniotic fluid and fetal mobility. Objective was to determine the association between abnormal umbilical cord length and perinatal outcome.Methods: A retrospective cohort study, conducted at McGill University, using the computerized MOND database. All Term singleton deliveries between 2001 and 2007 were included. We based our population according to the length of the umbilical cord following delivery: Normal cord length (measured length 35-80 cm), short cord (<35 cm) and long cord (>80 cm). Admission to the Neonatal Intensive Care Unit (NICU) was compared to the normal cord group.Results: Of the 14,873 deliveries included, 13518 (90.9 %) had normal cord lengths, 980 (6.6 %) had short cords, and 375 (2.5%) long cords. Maternal age, gravidity, birth weights, and rate of male gender babies were all increased in the long cord group and decreased in the short cord group (all p<0.05). NICU admissions were more common in the short cord group (OR 1.9; 95%, CI 1.4-2.6) but not in the long cord group. Babies in both the short and long cord groups had higher rates of Apgar score <7 (OR 1.3, 95% CI 1.1-1.7 and OR 1.7, 95% CI 1.2-2.3, respectively) with no significant difference in cord pH. Gravidity and abnormal cord length were independent predictors of NICU admission.Conclusions: Short umbilical cord is associated with higher rates of NICU admissions and low Apgar scores

Androgen and Progesterone Receptors Are Targets for Bisphenol A (BPA), 4-Methyl-2,4-bis-(P-Hydroxyphenyl)Pent-1-Ene--A Potent Metabolite of BPA, and 4-Tert-Octylphenol: A Computational Insight.

Exposure to toxic industrial chemicals that have capacity to disrupt the endocrine system, also known as endocrine disrupting chemicals (EDCs), has been increasingly associated with reproductive problems in human population. Bisphenol A (BPA; 4,4'-(propane-2,2-diyl)diphenol) and 4-tert-octylphenol (OP; 4-(1,1,3,3-tetramethylbutyl)phenol) are among the most common environmental contaminants possessing endocrine disruption properties and are present in plastics, epoxy resins, detergents and other commercial products of common personal and industrial use. A metabolite of BPA, 4-Methyl-2,4-bis(4-hydroxyphenyl)pent-1-ene (MBP) is about 1000 times more biologically active compared to BPA. Epidemiological, clinical, and experimental studies have shown association of BPA and OP with adverse effects on male and female reproductive system in human and animals. The endocrine disruption activity can occur through multiple pathways including binding to steroid receptors. Androgen receptor (AR) and progesterone receptor (PR) are critical for reproductive tract growth and function. Structural binding characterization of BPA, MBP, and OP with AR and PR using molecular docking simulation approaches revealed novel interactions of BPA with PR, and MBP and OP with AR and PR. For BPA, MBP, and OP, five AR interacting residues Leu-701, Leu-704, Asn-705, Met-742, and Phe-764 overlapped with those of native AR ligand testosterone, and four PR interacting residues Leu-715, Leu-718, Met-756, and Met-759 overlapped with those of PR co-complex ligand, norethindrone. For both the receptors the binding strength of MBP was maximum among the three compounds. Thus, these compounds have the potential to block or interfere in the binding of the endogenous native AR and PR ligands and, hence, resulting in dysfunction. The knowledge of the key interactions and the important amino-acid residues also allows better prediction of potential of xenobiotic molecules for disrupting AR- and PR-mediated pathways, thus, helping in design of less potent alternatives for commercial use

Spontaneous preterm birth and single nucleotide gene polymorphisms: a recent update

Abstract Background Preterm birth (PTB), birth at <37 weeks of gestation, is a significant global public health problem. World-wide, about 15 million babies are born preterm each year resulting in more than a million deaths of children. Preterm neonates are more prone to problems and need intensive care hospitalization. Health issues may persist through early adulthood and even be carried on to the next generation. Majority (70 %) of PTBs are spontaneous with about a half without any apparent cause and the other half associated with a number of risk factors. Genetic factors are one of the significant risks for PTB. The focus of this review is on single nucleotide gene polymorphisms (SNPs) that are reported to be associated with PTB. Results A comprehensive evaluation of studies on SNPs known to confer potential risk of PTB was done by performing a targeted PubMed search for the years 2007–2015 and systematically reviewing all relevant studies. Evaluation of 92 studies identified 119 candidate genes with SNPs that had potential association with PTB. The genes were associated with functions of a wide spectrum of tissue and cell types such as endocrine, tissue remodeling, vascular, metabolic, and immune and inflammatory systems. Conclusions A number of potential functional candidate gene variants have been reported that predispose women for PTB. Understanding the complex genomic landscape of PTB needs high-throughput genome sequencing methods such as whole-exome sequencing and whole-genome sequencing approaches that will significantly enhance the understanding of PTB. Identification of high risk women, avoidance of possible risk factors, and provision of personalized health care are important to manage PTB

The human progesterone receptor (PR) residues interacting with 4-tert-octylphenol (OP) are listed with the number of hydrophobic interactions and loss in Accessible Surface Area (ΔASA).

<p>The ranking of residues on the basis of ΔASA is indicated by superscripts with the value of ΔASA.</p

Human progesterone receptor (PR) is illustrated in cartoon representation and bisphenol A (BPA), methylbishydroxyphenylpentene (MBP), 4-tert-octylphenol (OP), and the bound ligand norethindrone (NET) are in stick representation in different colors.

<p>Human progesterone receptor (PR) is illustrated in cartoon representation and bisphenol A (BPA), methylbishydroxyphenylpentene (MBP), 4-tert-octylphenol (OP), and the bound ligand norethindrone (NET) are in stick representation in different colors.</p

The human progesterone receptor (PR) residues interacting with bisphenol A metabolite methylbishydroxyphenylpentene (MBP) are listed with the number of hydrophobic interactions and loss in Accessible Surface Area (ΔASA).

<p>The ranking of residues on the basis of ΔASA is indicated by superscripts with the value of ΔASA.</p