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1.  Intrauterine pregnancy following low-dose gonadotropin ovulation induction and direct intraperitoneal insemination for severe cervical stenosis 
Background
We present a case of primary infertility related to extreme cervical stenosis, a subset of cervical factor infertility which accounts for approximately 5% of all clinical infertility referrals.
Case presentation
A 37 year-old nulligravida was successfully treated with ovulation induction via recombinant follicle stimulating hormone (FSH) and direct intraperitoneal insemination (IPI). Anticipating controlled ovarian hyperstimulation with in vitro fertilization/embryo transfer (IVF), the patient underwent hysteroscopy and cervical recanalization, but safe intrauterine access was not possible due to severe proximal cervical stricture. Hysterosalpingogram established bilateral tubal patency and confirmed an irregular cervical contour. Since the cervical canal could not be traversed, neither standard intrauterine insemination nor transcervical embryo transfer could be offered. Prepared spermatozoa were therefore placed intraperitoneally at both tubal fimbria under real-time transvaginal sonographic guidance using a 17 gage single-lumen IVF needle. Supplementary progesterone was administered as 200 mg/d lozenge (troche) plus 200 mg/d rectal suppository, maintained from the day following IPI to the 8th gestational week. A singleton intrauterine pregnancy was achieved after the second ovulation induction attempt.
Conclusions
In this report, we outline the relevance of cervical factor infertility to reproductive medicine practice. Additionally, our andrology evaluation, ovulation induction approach, spermatozoa preparation, and insemination technique in such cases are described.
doi:10.1186/1471-2393-2-9
PMCID: PMC139980  PMID: 12450413
cervical factor infertility; intraperitoneal insemination; ovulation induction
2.  Pregnant women become insensitive to cold stress 
Background
The function of the hypothalamic-pituitary-adrenal (HPA) axis is known to be altered during pregnancy, but it has not been tested with a natural stressor.
Methods
A group of pregnant women (n = 10) were tested towards the end of pregnancy (mean 36.8 ± 2.5 weeks gestation) and about 8 weeks postpartum (mean 7.8 ± 1.5 weeks), together with a matched control group, with a one minute cold hand stressor test. Saliva samples were collected before and 10 and 20 minutes after the test, and stored for later radioimmunoassay of cortisol.
Results
The control group showed a highly significant response to the test. The pregnant group showed no response, and the postpartum group a variable but non significant one
Conclusions
This shows that the HPA axis becomes hypofunctional to a natural stressor at the end of pregnancy. It is suggested that one possible evolutionary function for this is to protect the fetus from the stress responses of the mother.
doi:10.1186/1471-2393-2-8
PMCID: PMC137604  PMID: 12437774
3.  A criterion audit of women's awareness of blood transfusion in pregnancy 
Background
In the Confidential Enquiry into Maternal Deaths (CEMD) Report, the very high risk of mortality in women who refuse blood transfusions is highlighted. The objectives were to establish current knowledge about, and views of transfusion in our pregnant population and to establish the level of compliance with the set audit standard.
Method
Questionnaire survey of 228 women, including both high and low risk pregnancies, attending ante-natal clinic between 2–9 May 2000 at the North Staffordshire Maternity Hospital, Stoke on Trent.
Results
The response rate was 100%. Only 43% were aware of the possible need for blood transfusion in pregnancy. If a blood transfusion was required, 92% stated that they would accept a blood transfusion in pregnancy. Four percent stated that they would not accept a transfusion because of religious reasons and risk of infection and the remaining four percent did not declare a reason.
Conclusions
This short survey identified that 57% of women were not aware of the possible need for blood transfusion during pregnancy. There is a need for more information to be shared on this subject with all antenatal women. Women who would refuse a transfusion need to be identified at booking and be referred for counselling and a management plan made for pregnancy, labour and delivery.
doi:10.1186/1471-2393-2-7
PMCID: PMC131039  PMID: 12323080
blood transfusion; pregnancy; refuse
4.  Humoral immune response to an allogenic foetus in normal fertile women and recurrent aborters 
Background
Several humoral immune factors are responsible for a successful pregnancy. There are a few studies, which demonstrate the role of antipaternal cytotoxic antibodies (APCA) and mixed lymphocyte reaction blocking factor (MLR-Bf) in the maintenance of pregnancy. However, these factors have not been studied in women with history of recurrent spontaneous abortion (RSA). We designed this study to review the role of APCA and MLR-Bf in normal pregnancy as well as in women with a history of RSA.
Methods
One hundred and five women with unexplained recurrent spontaneous abortion were included in the present study. These women were screened for all other known causes of recurrent abortion. We also included 60 normal fertile women, fifteen from each trimester and fifteen women during the post partum period (up to six months). RSA and controls (normal pregnancy) were matched for age, caste, and socio economic background and also for parity. APCA and MLR-Bf were evaluated in all the groups. All women with RSA who conceived during the study period were on follow up.
Results
We have analyzed the status of APCA and MLR-Bf in normal pregnancy (different gestational periods and during post partum), and in women with history of RSA. Our results show that APCA was significantly higher in controls as compared to RSA women. MLR-Bf was directed against the husbands' cells in normal pregnancy and was virtually absent in RSA women.
Conclusion
Our results indicate that there is a significantly low titer of APCA and MLR-Bf in women with recurrent spontaneous abortion. This highlights the role of these factors in the maintenance of successful pregnancy.
doi:10.1186/1471-2393-2-6
PMCID: PMC122080  PMID: 12162792
5.  Discordance between physical symptoms versus perception of severity by women with nausea and vomiting in pregnancy (NVP) 
Background
Nausea and vomiting in pregnancy (NVP) is a multifaceted condition that affects more than half of pregnant women and can range in severity from mild nausea to severe dehydration. Presently physicians evaluate mostly physical symptoms of NVP in trying to assess the severity of the condition. The objective of this study was to investigate how factors, other than the physical morbidity of nausea and vomiting, influence self-perception of NVP by affected women.
Methods
Five hundred women with NVP calling a 1–800 NVP Healthline were asked to rate their NVP severity and report their nausea duration and number of vomiting/retching episodes.
Results
Nausea and vomiting/retching correlated significantly but very poorly with self-assessment of NVP severity. There was also a correlation between nausea duration and vomiting/retching frequency however the correlations were weak and overall physical symptoms could only explain 14% of the variability of women's feelings and perceptions through multivariate analysis.
Conclusions
Physical symptoms weakly correlate with self-assessment of NVP severity. Other aspects of this condition, most probably psychosocial, influence women's perception of NVP severity.
doi:10.1186/1471-2393-2-5
PMCID: PMC117801  PMID: 12153704
6.  Quantitative analysis of DNA levels in maternal plasma in normal and Down syndrome pregnancies 
Background
We investigated fetal and total DNA levels in maternal plasma in patients bearing fetuses affected with Down syndrome in comparison to controls carrying fetuses with normal karyotype.
Methods
DNA levels in maternal plasma were measured using real-time quantitative PCR using SRY and β-globin genes as markers. Twenty-one pregnant women with a singleton fetus at a gestational age ranging from 15 to 19 weeks recruited before amniocentesis (carried out for reasons including material serum screening and advanced material age), and 16 pregnant women bearing fetuses affected with Down syndrome between 17 to 22 weeks of gestation were involved in the study.
Results
The specificity of the system reaches 100% (no Y signal was detected in 14 women pregnant with female fetuses) and the sensitivity 91.7% (SRY amplification in 22 of 24 examined samples). The median fetal DNA levels in women carrying Down syndrome (n=11) and the controls (n=13) were 23.3 (range 0–58.5) genome-equivalents/ml and 24.5 (range 0–47.5) genome-equivalents/ml of maternal plasma, respectively (P = 0.62). The total median DNA levels in pregnancies with Down syndrome and the controls were 10165 (range 615–65000) genome-equivalents/ml and 7330 (range 1300–36750) genome-equivalents/ml, respectively (P = 0.32). The fetal DNA proportion in maternal plasma was 0%-6 % (mean 0.8%) in women carrying Down syndrome and 0%-2.6 % (mean 0.7 %) in the controls, respectively (P=0.86).
Conclusions
Our study revealed no difference in fetal DNA levels and fetal DNA: maternal DNA ratio between the patients carrying Down syndrome fetuses and the controls.
doi:10.1186/1471-2393-2-4
PMCID: PMC116571  PMID: 12057009
7.  Drug therapy and adverse drug reactions to terbutaline in obstetric patients: a prospective cohort study in hospitalized women 
Background
Adverse drug reactions (ADR's) could be expected more frequently in pregnant women. This study was performed in order to identify ADR's to tocolytic drugs in hospitalised pregnant women.
Methods
A prospective cohort study was performed in two General Hospitals of the Instituto Mexicano del Seguro Social (IMSS) in Mexico City. Two hundred and seven women undergoing labor, premature labor, threatened abortion or suffering any obstetric related disease were included. Drug prescription and signs and symptoms of any potential ADR were registered daily during the hospital stay. Any potential ADR to tocolytic drugs was evaluated and classified by three of the authors using the Kramer's algorithm.
Results
Of the 207 patients, an ADR was positively classified in 25 cases (12.1%, CI95% 8.1 to 17.5%). All ADR's were classified as minor reactions. Grouping patients with diagnosis of threatened abortion, premature labor or under labor (n= 114), 24 ADR's were related to terbutaline, accounting for a rate of 21.1 ADR's per 100 obstetric patients. Obstetric patients suffering an ADR were older than obstetric patients without any ADR. However, the former received less drugs/day × patient-1 and had a shorter hospital stay (p < 0.05) whereas the dose of terbutaline was similar between the two groups. Terbutaline inhibited uterine motility in women with and without any ADR at a similar rate, 70 and 76% respectively (x2 = 0.07; p = 0.8).
Conclusion
Terbutaline, used as a tocolytic drug, was related to a high frequency of minor ADRs and to a high rate of effcicacy.
doi:10.1186/1471-2393-2-3
PMCID: PMC107840  PMID: 11934352
8.  Elevated serum immunoglobulin E to Cryptomeria japonica pollen in rats exposed to diesel exhaust during fetal and neonatal periods 
Background
The possible participation of diesel exhaust inhalation during the fetal period in the elevation of IgE against pollen in postnatal life was investigated.
Method
The experiment was conducted using rat pups. Group I; exposed to clean air (Control). Group 2, 3; exposed to total or filtered diesel exhaust during the fetal period (Total-C-C, Filtered-C-C). Group 4, 5; exposed to total or filtered diesel exhaust during the suckling period (C-Total-C, C-Filtered-C). Group 6,7; exposed to total or filtered diesel exhaust during the weaning period (C-C-Total, C-C-Filtered). Total diesel engine exhaust contained 1.73 mg/m3 particulate matter and 0.79 ppm nitrogen dioxide; filtered exhaust contained the same gases as the total exhaust without particulate matter. Intraperitoneal injection of 5 mg crude cedar pollen was performed at 2-week intervals from the 49th day after birth.
Results
The mean IgE titers measured by the P-K reaction in the Control, Total-C-C, Filtered-C-C, C-Total-C, C-Filtered-C, C-C-Total and C-C-Filtered were 64.0 ± 2.7, 469.5 ± 1.6, 332.0 ± 1.7, 380.4 ± 1.7, 394.8 ± 1.7, 115.9 ± 1.3 and 57.0 ± 2.8 respectively after the fourth immunization. There were significant differences between Total-C-C, Filtered-C-C, C-Total-C, C-Filtered-C and Control (p < 0.01, p < 0.01, p < 0.05, p < 0.01, respectively). The mean IgE titers by ELISA were 0.47 ± 0.06, 0.79 ± 0.35, 0.86 ± 0.46, 0.80 ± 0.22, 0.56 ± 0.08, 0.46 ± 0.04 and 0.45 ± 0.03, respectively. IgE titers in Filtered-C-C and C-Total-C were significantly higher than in Control (p < 0.05 for each).
Conclusions
Inhalation of diesel exhaust during differentiation of the immune system accelerated the elevation of IgE against pollen.
doi:10.1186/1471-2393-2-2
PMCID: PMC101391  PMID: 11914142
9.  Prenatal diagnosis of Neu-Laxova syndrome: a case report 
Background
Neu-Laxova syndrome is a rare congenital abnormality involving multiple systems. We report a case of Neu-Laxova syndrome (NLS) diagnosed prenatally by ultrasound examination.
Case presentation
A 29-year-old gravida 3, para 2 woman was first seen in our antenatal clinic at 38 weeks' pregnancy. Except for the consanguinity and two previous abnormal stillborn babies her medical history was unremarkable. On ultrasound examination microcephaly, flat forehead, micrognathia, intrauterine growth restriction, generalized edema of the skin, hypoplastic chest, excessive soft tissue deposition of hands and feet, joint contractures and a penis without scrotal sacs were detected. She delivered a 2000 g male fetus. He died five minutes after delivery. Postmortem examination confirmed the diagnosis of Neu-Laxova syndrome.
Conclusion
Because of the autosomal recessive inheritance of Neu-Laxova syndrome genetic counseling and early-serial ultrasound examination should be performed at risk families. Early diagnosis of the disease may offer termination of the pregnancy as an option.
doi:10.1186/1471-2393-2-1
PMCID: PMC88995  PMID: 11895570

Results 1-9 (9)