Variation in Stability of Endogenous Reference Genes in Fallopian Tubes and Endometrium from Healthy and Ectopic Pregnant Women

RT-qPCR is commonly employed in gene expression studies in ectopic pregnancy. Most use RN18S1, β-actin or GAPDH as internal controls without validation of their suitability as reference genes. A systematic study of the suitability of endogenous reference genes for gene expression studies in ectopic pregnancy is lacking. The aims of this study were therefore to evaluate the stability of 12 reference genes and suggest those that are stable for use as internal control genes in fallopian tubes and endometrium from ectopic pregnancy and healthy non-pregnant controls. Analysis of the results showed that the genes consistently ranked in the top six by geNorm and NormFinder algorithms, were UBC, GAPDH, CYC1 and EIF4A2 (fallopian tubes) and UBC and ATP5B (endometrium). mRNA expression of NAPE-PLD as a test gene of interest varied between the groups depending on which of the 12 reference genes was used as internal controls. This study demonstrates that arbitrary selection of reference genes for normalisation in RT-qPCR studies in ectopic pregnancy without validation, risk producing inaccurate data and should therefore be discouraged

Unilateral ureteric endometriosis at the pelvic brim resulting in complete loss of renal function

Deep infiltrating endometriosis of the urinary tract is rare but can result in ureteric obstruction, hydroureteronephrosis and renal failure. Ureteric endometriosis usually affects the distal third of the left ureter among women of reproductive age. Greater awareness of ureteric endometriosis and a multidisciplinary approach in the management is essential to achieve optimal outcomes. We present an atypical case of right ureteric obstruction due to endometriosis at the pelvic brim resulting in complete loss of renal function and necessitating nephroureterectomy

Sleep quality and endometriosis: a group comparison study

Introduction: Endometriosis affects around 10% of women of reproductive age with symptoms of pelvic pain, dysmenorrhoea, dyspareunia, dyschezia, and infertility. Current research highlights a possible relationship between endometriosis and poor sleep quality. The aim of this study was to assess the relationship between sleep quality and endometriosis. Outcomes measured included sleep quality and quality of life and pain score. Methods: Thirty women with a histological diagnosis of endometriosis and 30 control patients completed an online questionnaire that assessed sleep quality (Pittsburgh Sleep Quality Index) and quality of life (WHO-QOL-BREF). Pain scores within the endometriosis group were evaluated using a visual analogue scale. Results: Women with endometriosis had significantly poorer sleep quality (80% vs 50%, p = 0.015) and lower quality of life scores when compared to the control group. Within the endometriosis group, there were trends between poor sleep, a reduced quality of life, and higher pain scores; however, these did not reach statistical significance. Discussion: Sleep quality and quality of life were significantly reduced in women with endometriosis when compared to controls

Effect of retaining the uterus during anterior resection for rectosigmoid bowel endometriosis

Objective: The goal of this research was to report the efficacy and morbidity of anterior resection for rectosigmoid bowel endometriosis and to compare outcomes between women who underwent hysterectomy and those who did not. Materials and Methods: This was a retrospective cohort study of women who underwent anterior resection for endometriosis at an Australian tertiary center within 5 years, from January 2013 to December 2017. Results: During the study period, 33 women underwent anterior resection. Of these patients, 17 underwent hysterectomy and 16 retained their fertility. There were 32 laparoscopic cases, 3 of which were converted to laparotomy, and 1 case was intended to be managed with a laparotomy. The length of stays (LOS) ranged from 4 to 32 days (mean: 8 days). Postoperative complications included voiding dysfunction requiring temporary self-catheterization (9.1%), anastomotic leaks (6.1%), ileus managed conservatively (6.1%), readmission for conservative management of gastrointestinal symptoms (6.1%), and pancreatitis (3%). All women with or without hysterectomy reported either complete resolution of or reduced pain symptoms at follow-up appointments, 8 women (24.2%) reported altered bowel habits, for which 2 women underwent colonoscopy with normal findings. All women with altered bowel habits were managed conservatively. Retaining the uterus did not affect the postoperative complication rate. Conclusions: Anterior resection for bowel endometriosis was effective for addressing endometriosis-related pain. However, 24.2% of women developed altered bowel habits and 6.1% of cases were complicated with anastomotic leaks associated with extended LOS. The incidence of surgical morbidity for bowel procedures poses a therapeutic dilemma. A rationale behind the management plan for each patient and careful preoperative counseling is essential

Does the length of second stage of labour or second stage caesarean section in nulliparous women increase the risk of preterm birth in subsequent pregnancies?

Short communication: This study aimed to investigate the role of prolonged second stage of labour and second stage caesarean section on the risk of spontaneous preterm birth (sPTB) in a subsequent pregnancy. Objectives and Methods This was a retrospective cohort study of nulliparous women with two consecutive singleton deliveries between 2014 and 2017 at a tertiary centre. In the vaginal delivery cohort, subsequent pregnancy outcomes for women with a prolonged second stage (>2\ua0h) were compared with those with a normal second stage (≤2\ua0h). In the caesarean delivery cohort, women with a first stage or a second stage were compared with the vaginal delivery cohort. The primary outcome was subsequent sPTB. Results A total of 821 women met inclusion criteria, of which 74.8% (614/821) delivered vaginally and 25.2% (207/821) delivered by caesarean section. There was no association between a prolonged second stage in the index pregnancy and subsequent sPTB (aOR 0.70, 95% CI 0.13-3.83, p=0.7). The risk of subsequent sPTB was threefold for those with a second stage caesarean section; however this did not reach statistical significance. Conclusions A prolonged second stage of labour in the index pregnancy is not associated with an increased risk of subsequent sPTB. A second stage caesarean section in the index pregnancy may be associated with an increased risk of subsequent sPTB, however there was no statistically significant difference. These findings are important for counseling and suggest that the effects of these factors are not clinically significant to justify additional interventions in the subsequent pregnancy