Delayed childbearing: effects on fertility and the outcome of pregnancy.

Purpose Of Review: The proportion of women who are intentionally delaying pregnancy beyond the age of 35 years has increased greatly in the past few decades because of the clash between the optimal biological period for women to have children with obtaining additional education and building a career. This article highlights the effects of delayed childbearing on fertility and obstetric and perinatal outcome.

Recent Findings: Demographic studies indicate that fertility rates are falling in many countries, Europe being the continent with lowest total fertility rate.

Efficacy of Cimicifuga racemosa, Hypericum perforatum and Agnus castus in the treatment of climacteric complaints: a systematic review.

Objective: The systematic review examines whether Cimicifuga racemosa (CR), Hypericum perforatum (HP), Agnus castus, vitamins and minerals, either as monotherapy or in combination, have an evidence-based impact on vasomotor, genital and psychological climacteric complaints. DATA SOURCES AND METHODS OF STUDY SELECTION: We searched in the databases EMBASE, OVID and PubMed using the keywords "vasomotor symptoms, hot flashes, vaginal atrophy, psychological problems, endometrium, sleep, concentration, cognition in combination with vitamins, multivitamins, minerals, multiminerals, black cohosh, Cimicifuga, Agnus castus, chasteberry, chaste tree, monk's pepper and menopause" for randomized controlled trials (RCT). Relevant studies were reviewed by four independent reviewers qualitatively.

Human chorionic gonadotrophin stimulation test as a predictor of ovarian response and pregnancy in IVF cycles stimulated with GnRH agonist gonadotrophin treatment: a pilot study.

Background: Recent evidence supports a specific and broad role of androgen produced by theca cells in reproductive physiology. This pilot study evaluated the usefulness of hCG theca stimulation test in predicting ovarian response and pregnancy.

Methods: Prospective cohort study including 80 infertile women treated with IVF/ICSI.

Human papillomavirus as a favorable prognostic biomarker in squamous cell carcinomas of the vagina.

Objective: Recent evidence has confirmed two independent pathways in the development of vaginal squamous cell carcinoma (VaSCC): one related to and the other independent of human papillomavirus (HPV). The aim of our study was to evaluate whether HPV status has prognostic significance in this neoplasm.

Methods: All confirmed primary VaSCCs diagnosed and treated from 1995 to 2009 in two institutions were retrospectively evaluated (n=57).

Perinatal outcomes and anomalies associated with fetal right aortic arch.

Objective: To evaluate the prenatal findings, associated anomalies, and prognosis of right aortic arch (RAA) anomalies.

Material And Methods: All cases referred for detailed ultrasonography and fetal echocardiography between October 2006 and July 2009 were systematically examined for aortic arch anomalies and associated cardiac and extracardiac anomalies. Prenatal findings of all cases with aortic arch anomalies and intracardiac and extracardiac findings were prospectively registered in an electronic database that included fetal echocardiography.

Prediction of metabolic syndrome in women with polycystic ovary syndrome.

Objective: To identify biochemical factors that serve as predictors for the metabolic syndrome (MetS) in patients with polycystic ovary syndrome (PCOS) and to investigate the value of adipocytokines in the prediction of metabolic syndrome.

Material And Methods: A total of 91 pre-menopausal women with PCOS diagnosed according to the Rotterdam consensus criteria were recruited as study subjects. Waist circumference, blood pressure, body mass index (BMI), fasting glucose, serum lipids, insulin, FSH, LH, E2, total testosteron, homeostatic model assessment-insulin resistance (HOMA-IR), serum leptin and adiponectin levels were evaluated for all patients.

Attitude of German gynecologists towards prescribing HRT before and after the WHI study.

Objective: The publication of the Women's Health Initiative (WHI) randomized, controlled trial in 2002 resulted in a critical discussion on the risks and benefits of hormone replacement therapy (HRT). The present study aims to evaluate the attitude of German gynecologists regarding changes in the prescription of HRT over recent years. Method A questionnaire was sent to all 9589 German gynecologists in private practice in November 2010.

Estimated weight centile as a predictor of perinatal outcome in small-for-gestational-age pregnancies with normal fetal and maternal Doppler indices.

Objective: To evaluate the risk of adverse perinatal outcome according to estimated fetal weight (EFW) in a cohort of term small-for-gestational-age (SGA) pregnancies with normal umbilical, fetal middle cerebral and maternal uterine artery Doppler indices.

Methods: A cohort of 132 term SGA fetuses with normal umbilical artery pulsatility index (PI), mean uterine artery PI and cerebroplacental ratio was compared to a control group of 132 appropriate-for-gestational-age babies, matched by gestational age at delivery. The capacity of the EFW percentile to predict Cesarean delivery, Cesarean delivery for non-reassuring fetal status (NRFS), neonatal acidosis and days of neonatal hospitalization was analyzed.

Dydrogesterone supplementation in women with threatened preterm delivery--the impact on cytokine profile, hormone profile, and progesterone-induced blocking factor.

Progesterone is indispensable in creating a suitable endometrial environment for implantation, and also for the maintenance of pregnancy. Successful pregnancy depends on an appropriate maternal immune response to the fetus. A protein called progesterone-induced blocking factor (PIBF) acts by inducing Th2-dominant cytokine production to mediate the immunological effects of progesterone.

Diagnosis and treatment of deep infiltrating endometriosis with bowel involvement: a case report.

Introduction: Deep infiltrating endometriosis is a form of endometriosis penetrating deeply under the peritoneal surface causing pain and infertility. Assessment of the pelvis by laparoscopy and histological confirmation of the disease is considered the golden standard of diagnosis.

Case Outline: We are presenting a patient diagnosed with deep infiltrating endometriosis by transvaginal ultrasound and treated with minimally invasive radical surgery including segmental resection of the bowel.

Risk of thromboembolic events after recurrent spontaneous abortion in antiphospholipid syndrome: a case-control study.

Objective: To investigate whether patients having antiphospholipid syndrome (APS) as the only aetiological factor for recurrent spontaneous abortion (RSA) are at increased risk of thrombosis later in life.

Methods: A case-control study at a tertiary university referral centre. The study group consisted of 57 primary APS and RSA women (APS-RSA group).

Quality of life in women with urinary incontinence.

Aim: To determine the characteristics of urinary incontinence and its impact on the quality of life in adult women with urinary incontinence who presented to a tertiary care clinic of Vojvodina from September 2008 to May 2009 for treatment

Methods: We used a prospective case-control study. Cases were defined as patients (47) with urinary incontinence symptoms. Controls (50) were defined as patients without urinary incontinence who presented to a tertiary care gynecology clinic for other reasons.

HELLP syndrome in pregnancies below 26th week.

Objective: To test the hypothesis that HELLP syndrome may be more likely to develop earlier, if a pregnant woman has aPL antibodies, and to observe clinical and laboratory factors preceding the occurrence of HELLP syndrome.

Materials And Methods: The study consisted in retrospective analysis, with updated verification, of HELLP syndrome in pregnancies below 26th week in our clinic in the years 1992-2010.

Results: HELLP syndrome, if it occurred before the 26th week, occurred only in women with preeclampsia superimposed on chronic hypertension and in women with aPL antibodies.

Does human papillomavirus infection imply a different prognosis in vulvar squamous cell carcinoma?

Background: Two independent pathways in the development of vulvar squamous cell carcinoma (VSCC) have been described, one related to and the other independent of high-risk human papillomavirus (HR-HPV). The aim of our study was to evaluate whether the HPV status has a prognostic significance or can predict response to radiotherapy.

Methods: All VSCC diagnosed from 1995 to 2009 were retrospectively evaluated (n=98).

Clinical, colposcopic and pathological characteristics of cervical and vaginal high-grade lesions negative for HPV by Hybrid Capture 2.

Objective: Less than 5% of women with cervical or vaginal biopsy proven high-grade squamous intraepithelial lesions (HG-SIL) show a negative Hybrid Capture 2 (HC2) result. We analyzed 1) human papillomavirus (HPV) genotypes by PCR in order to determine whether these cases represent infections by common or unusual types, and 2) the clinical, colposcopic and pathological differential characteristics of these patients.

Methods: 646 women with a histological diagnosis of HG-SIL and a HC2 test collected within 6 months prior to the diagnosis were identified.

Clinical and inflammatory markers in amniotic fluid as predictors of adverse outcomes in preterm premature rupture of membranes.

Objective: We sought to evaluate gestational age, cervical length, amniotic fluid interleukin (IL)-6, and selected proteomic biomarkers as independent predictors of adverse outcome in preterm premature rupture of membranes (PPROM).

Study Design: This was a prospective cohort study of 65 consecutive women with PPROM (20.0-34.

Ovarian cystectomy versus laser vaporization in the treatment of ovarian endometriomas: a randomized clinical trial with a five-year follow-up.

Objective: To investigate the effect of two laparoscopic techniques for treatment of ovarian endometriomas on recurrence rate.

Design: Prospective randomized clinical trial.

Setting: University teaching hospital.

Contemporary prediction of preeclampsia.

Purpose Of Review: To provide a concise review of advances in prediction of preeclampsia, highlighting the most important and interesting articles among the many published within the past months, making a clear distinction between early and late clinical forms of the condition.

Recent Findings: The performance of maternal levels of angiogenic factors to predict preeclampsia, especially early-onset preeclampsia, could be further improved by combining several markers and by evaluating the longitudinal changes between the first and second trimester. Combining first trimester angiogenic factors with maternal history, mean blood pressure and uterine artery Doppler achieves a detection rate of approximately 90% for an approximately 10% of false positives for early preeclampsia.

Fetal brain Doppler to predict cesarean delivery for nonreassuring fetal status in term small-for-gestational-age fetuses.

Objective: To estimate the value of fetal brain Doppler in predicting the risk of cesarean delivery for nonreassuring fetal status and neonatal acidosis after labor induction in small-for-gestational-age fetuses with normal umbilical artery Doppler.

Methods: Fetal brain Doppler parameters, including cerebral tissue perfusion measured by fractional moving blood volume, cerebroplacental ratio, and middle cerebral artery pulsatility index, were evaluated before labor induction in a cohort of 210 term small-for-gestational-age fetuses with normal umbilical artery Doppler and 210 control participants matched by gestational age. The value of the cerebral Doppler indices to predict the risk of cesarean delivery, cesarean delivery for nonreassuring fetal status, and neonatal acidosis was analyzed.

Delayed childbearing: effects on fertility and the outcome of pregnancy.

In modern societies, the proportion of women who delay childbearing beyond the age of 35 years has greatly increased in recent decades. They are falsely reassured by popular beliefs that advances in new reproductive technologies can compensate for the age-related decline in fertility. Yet age remains the single most important determinant of male and female fertility, either natural or treated.

Reduced plasma fibrinolytic potential in patients with recurrent implantation failure after IVF and embryo transfer.

Background: Recurrent implantation failure (RIF) following embryo transfer (ET) is a major continuing problem in IVF. Women with haemostatic defects may be at increased risk of miscarriage and preclinical pregnancy loss. The fibrinolytic system is considered, at present, the key to new thrombotic pathogenic mechanisms.

Isoflavones: effects on bone health.

Background: There are many effects described, both experimental and clinical, that assess the relationship between isoflavones and bone. It has been hypothesized that isoflavones may have a positive effect on bone health.

Objective: To review the effects of isoflavones on biochemical markers of bone remodeling, bone density and bone quality, and finally on fracture incidence.

Clinical and biochemical predictors of very preterm birth in twin-to-twin transfusion syndrome treated by fetoscopy.

Objective: To evaluate pre- and postoperative predictors of preterm birth in twin-to-twin transfusion syndrome treated with fetoscopic placental laser coagulation.

Study Design: Prospective cohort study (n = 166) assessing cervical length (pre and postoperatively), amniotic fluid interleukin-6, serum C-reactive protein and duration of surgery. Logistic regression was used to investigate associations with preterm delivery.