Nulligravid Women Research Articles

Severe hydronephrosis secondary to uterine artery pseudoaneurysm in the early second trimester of pregnancy: A case report

BackgroundUterine artery pseudoaneurysm (UAP) normally presents genital bleeding in the puerperal period, and severe hydronephrosis rarely presents during pregnancy. We report a rare case of severe ureteral obstruction accompanied by uterine artery pseudoaneurysm in the early second trimester of pregnancy, which was successfully treated by surgical intervention.Case presentationA 42-year-old nulligravid woman who had undergone myomectomy 3 years earlier was referred to our hospital for acute left abdominal pain at the 17th week of gestation. Ultrasonography showed severe left hydronephrosis and a 6-cm mass in the parauterine space. Color Doppler ultrasonography revealed a spinning turbulent flow pattern inside the mass lesion. Contrast-enhanced computed tomography revealed the left uterine artery feeding blood flow to the mass and left ureteral obstruction by the mass. These results indicated left hydronephrosis secondary to left uterine artery pseudoaneurysm. To resolve the problem, laparotomy was performed. As uterine artery isolation was impossible, ligation of the left internal iliac artery and releasing of the ureteral obstruction were carried out. The hydronephrosis and abdominal pain promptly resolved after the surgery. Thereafter, fetal development proceeded normally in the remaining months of the pregnancy. A healthy baby was delivered through cesarean section at 36 weeks gestational age. At the cesarean section, the left lower uterine segment where the UAP had been present was not visible because of the firm adhesion in around it.ConclusionsUterine artery pseudoaneurysm can cause hydronephrosis in the early second trimester of pregnancy. Ligation of the unilateral internal iliac artery is a safe and effective intervention to block the blood flow to the uterine artery pseudoaneurysm during pregnancy, when uterine artery ligation seems not possible. In the pregnancy after previous surgical procedures to the uterus, uterine artery pseudoaneurysm should be considered in the differential diagnosis of symptomatic hydronephrosis.

Age and fecundability in a North American preconception cohort study

There is a well-documented decline in fertility treatment success with increasing female age; however, there are few preconception cohort studies that have examined female age and natural fertility. In addition, data on male age and fertility are inconsistent. Given the increasing number of couples who are attempting conception at older ages, a more detailed characterization of age-related fecundability in the general population is of great clinical utility. The purpose of this study was to examine the association between female and male age with fecundability. We conducted a web-based preconception cohort study of pregnancy planners from the United States and Canada. Participants were enrolled between June 2013 and July 2017. Eligible participants were 21-45 years old (female) or ≥21 years old (male) and had not been using fertility treatments. Couples were followed until pregnancy or for up to 12 menstrual cycles. We analyzed data from 2962 couples who had been trying to conceive for ≤3 cycles at study entry and reported no history of infertility. We used life-table methods to estimate the unadjusted cumulative pregnancy proportion at 6 and 12 cycles by female and male age. We used proportional probabilities regression models to estimate fecundability ratios, the per-cycle probability of conception for each age category relative to the referent (21-24 years old), and 95% confidence intervals. Among female patients, the unadjusted cumulative pregnancy proportion at 6 cycles of attempt time ranged from 62.0% (age 28-30 years) to 27.6% (age 40-45 years); the cumulative pregnancy proportion at 12 cycles of attempt time ranged from 79.3% (age 25-27 years old) to 55.5% (age 40-45 years old). Similar patterns were observed among male patients, although differences between age groups were smaller. After adjusting for potential confounders, we observed a nearly monotonic decline in fecundability with increasing female age, with the exception of 28-33 years, at which point fecundability was relatively stable. Fecundability ratios were 0.91 (95% confidence interval, 0.74-1.11) for ages 25-27, 0.88 (95% confidence interval, 0.72-1.08) for ages 28-30, 0.87 (95% confidence interval, 0.70-1.08) for ages 31-33, 0.82 (95% confidence interval, 0.64-1.05) for ages 34-36, 0.60 (95% confidence interval, 0.44-0.81) for ages 37-39, and 0.40 (95% confidence interval, 0.22-0.73) for ages 40-45, compared with the reference group (age, 21-24 years). The association was stronger among nulligravid women. Male age was not associated appreciably with fecundability after adjustment for female age, although the number of men >45 years old was small (n=37). In this preconception cohort study of North American pregnancy planners, increasing female age was associated with an approximately linear decline in fecundability. Although we found little association between male age and fecundability, the small number of men in our study >45 years old limited our ability to draw conclusions on fecundability in older men.

Preference for cesarean section in young nulligravid women in eight OECD countries and implications for reproductive health education

BackgroundEfforts to reduce unnecessary Cesarean sections (CS) in high and middle income countries have focused on changing hospital cultures and policies, care provider attitudes and behaviors, and increasing women’s knowledge about the benefits of vaginal birth. These strategies have been largely ineffective. Despite evidence that women have well-developed preferences for mode of delivery prior to conceiving their first child, few studies and no interventions have targeted the next generation of maternity care consumers. The objectives of the study were to identify how many women prefer Cesarean section in a hypothetical healthy pregnancy, why they prefer CS and whether women report knowledge gaps about pregnancy and childbirth that can inform educational interventions.MethodsData was collected via an online survey at colleges and universities in 8 OECD countries (Australia, Canada, Chile, England, Germany, Iceland, New Zealand, United States) in 2014/2015. Childless young men and women between 18 and 40 years of age who planned to have at least one child in the future were eligible to participate. The current analysis is focused on the attitudes of women (n = 3616); rates of CS preference across countries are compared, using a standardized cohort of women aged 18–25 years, who were born in the survey country and did not study health sciences (n = 1390).ResultsOne in ten young women in our study preferred CS, ranging from 7.6% in Iceland to 18.4% in Australia. Fear of uncontrollable labor pain and fear of physical damage were primary reasons for preferring a CS. Both fear of childbirth and preferences for CS declined as the level of confidence in women’s knowledge of pregnancy and birth increased.ConclusionEducation sessions delivered online, through social media, and face-to-face using drama and stories told by peers (young women who have recently had babies) or celebrities could be designed to maximize young women’s capacity to understand the physiology of labor and birth, and the range of methods available to support them in coping with labor pain and to minimize invasive procedures, therefore reducing fear of pain, bodily damage, and loss of control. The most efficacious designs and content for such education for young women and girls remains to be tested in future studies.

Dynamic 3T pelvic floor magnetic resonance imaging in women progressing from the nulligravid to the primiparous state.

The objective was to prospectively characterize dynamic pelvic 3-Tesla magnetic resonance imaging (dp3T MRI) findings in nulligravida women and characterize changes 6months after delivery in the same woman. In this prospective study, nulligravida women seeking assisted reproductive technology for pregnancy were recruited. After physical examination by Pelvic Organ Prolapse Quantification (POP-Q), Brink assessment and measures including the Pelvic Floor Distress Inventory-20 and Pelvic Floor Impact Questionnaire-7, pre-pregnancy dp3T MRI at rest, with strain, and evacuation were performed. Assessments were repeated ≥6months postpartum. Analysis included Welch and paired t tests for continuous variables, Fisher's exact test for differences in categorical outcomes, and paired t tests for postpartum symptoms. Nineteen subjects (mean±SD age, 31±5years) completed baseline clinical and dp3T MRI studies, 15 delivered and 10 (30.5±3years) completed pre-pregnancy and post-delivery clinical and dp3T MRI assessments. There were no significant changes in scores of validated questionnaires (all p>0.05) or on POP-Q measures post-delivery. Two (20%) subjects without pre-pregnancy levator tears had tears on MRI post-delivery. MRI measures of pelvic organ descent were increased post-delivery. Seventeen pelvic soft-tissue parameters increased by greater than 10% post-delivery, including 5 out of 70 (7.1%), 17 out of 110 (15.5%), and 50 out of 110 (45.5%) values exceeding thresholds at rest, strain, and evacuation respectively. Dynamic pelvic 3T MRI detected levator tears and increased pelvic organ descent, which can be directly attributed to pregnancy and delivery.

Infertility & mortality

Epidemiologic studies have suggested that nulligravid women have a shorter life span than their parous counterparts. The effect of infertility, as opposed to elective nulligravidity, on mortality is unclear. Our objective was to determine the association of a history of infertility with all-cause mortality. Retrospective cohort study This study included women (age 55-74) who were prospectively enrolled in the Prostate Lung, Colorectal, and Ovarian (PLCO) Cancer screening trial from 1992-2001 and followed for health-related outcomes including cause of death. We examined the effect of self-reported infertility (inability to conceive for one year or greater) on all-cause mortality and primary cause of death, as established by the National Center for Health Statistics. Outcomes were analyzed using multivariable linear, logistic, and cox regression modeling as appropriate with stepwise backward selection to adjust for relevant confounders. A total of 78,214 women from the PLCO database were included and followed for 13 years or until study withdrawal or death, 75,784 of which had data on fertility history. Infertility was reported in 14.5% (n=11,006) of the study population. At the completion of follow up, infertile women were more likely to be deceased when compared to fertile women (HR1.10, 95%CI 1.03, 1.17, p=0.005), however women from each cohort died at a similar age (Fertile: 73.83±5.70 years, Infertile: 73.79±5.88 years; p=0.424). When examining primary cause of death, women with infertility were more likely to die from diabetes (HR 1.69, 95%CI 1.15, 2.49, p=0.007) as compared to their fertile counterparts despite having a comparable prevalence of diabetes (Fertile: 6.34% (N=4082), Infertile: 6.80% (N=745). Infertility was not associated with an increased risk of ovarian cancer (HR 1.12, 95%CI 0.87, 1.45, p=0.381) or greater risk of death from ovarian (HR 1.28, 95%CI 0.91, 1.80, p=0.155) or endometrial cancers (HR 0.97, 95%CI 0.49, 1.93, p=0.939). Notably, patients with infertility were 43% more likely to die of breast cancer (HR 1.43, 95%CI 1.06, 1.94, p=0.019). Subfertility may be a harbinger of disease later in life. The present large retrospective study demonstrates increased risk of death from endocrine related diseases including diabetes and breast cancer among the infertile population. While these associations need to be confirmed in prospective studies, routine infertility care may present an opportunity for early screening and intervention for long-term health outcomes.

Case report: term birth after fertility-sparing treatments for stage IB1 small cell neuroendocrine carcinoma of the cervix

BackgroundAdvances in cervical cancer management for childbearing women have led to less radical approaches. Use of fertility-sparing treatment to treat small cell neuroendocrine carcinoma (SCNEC) is challenging owing to the aggressive nature of the disease, even in early stage disease.Case presentationA 25-year-old nulligravida woman presented with malodorous vaginal discharge and was diagnosed to have an exophytic cervical SCNEC. A magnetic resonance image scan showed no evidence of parametrial invasion or distant metastasis. Clinical staging allocated her to stage IB1 disease. She underwent radical abdominal trachelectomy for reproductive purpose. Preoperative and postoperative chemotherapy with ifosfamide/etoposide/cisplatin combining gonadotropin-releasing hormone agonist were administered. She had a spontaneous, uneventful pregnancy and successfully delivered a term baby via cesarean section 7 years after treatment.ConclusionTo our knowledge, we describe the first success in offering a fertility-preserving multimodality strategy to present favorable oncologic, reproductive, and obstetric outcomes in a fertile woman of stage I SCNEC. Individualized multimodality therapy may be utilized in specific patients with early-stage cervical cancer to preserve their fertility.

Successful fertility‐sparing surgery and chemotherapy for stage IC3 ovarian cancer with the postoperative use of the traditional Japanese herbal formulation hachimijiogan: A case report

ABSTRACTCaseA 32‐year old, unmarried, nulligravida woman was diagnosed as having ovarian cancer stage IC3. The patient received six cycles of carboplatin and paclitaxel every 4 weeks after surgery. She was given a gonadotropin‐releasing hormone agonist as an ovarian safeguard while receiving treatment with anticancer agents.OutcomeAfter treatment with the traditional Japanese herbal formulation hachimijiogan and oral contraceptives, the patient spontaneously became pregnant and gave birth to a healthy baby at 40 gestational weeks.ConclusionA hachimijiogan treatment may be effective for treating decreased ovarian function following chemotherapy.

Congenital Unilateral Fallopian Tube and Renal Agenesis in a Patient with Primary Infertility

A 35-year-old nulligravid normo-ovulatory woman presented for the evaluation of primary infertility. Hysterosalpingography revealed normal filling (Fig. 1A) and intraperitoneal spillage of radiographic contrast through the right fallopian tube (Fig. 1B). No fill or spillage of contrast was noted through the left fallopian tube. A diagnostic hysteroscopy confirmed the presence of the right ostium (Fig. 2A); the left ostium was visually absent (Fig. 2B). Magnetic resonance imaging was subsequently performed, which showed blunting of the endometrium within the left cornua at the level of the uterotubal junction. There was no evidence of a kidney in the left renal fossa or within the pelvis (Fig. 2C). These findings indicated the congenital absence of the left fallopian tube and kidney. The patient underwent ovulation induction with intrauterine insemination and conceived in her second cycle. Fig. 2(A) Diagnostic hysteroscopy confirming the presence of the right ostium (white arrow). (B) Hysteroscopy indicating the absence of the left ostium (white X). (C) Single-shot fast spin echo magnetic resonance imaging confirming the presence of the right kidney (dotted white circle) in a coronal section. The same section shows an absent left kidney (white X). View Large Image Figure Viewer Download Hi-res image

Associations of combined polymorphisms of the platelet membrane glycoproteins Ia and IIIa and the platelet-endothelial cell adhesion molecule-1 and P-Selectin genes with IVF implantation failures

The aim of the study was to investigate the combined impact of the genetic heterogeneity of the glycoproteins Ia (GpIa) and IIIa (GpIIIa) and the platelet-endothelial cell adhesion molecule-1 (PECAM-1) and P-Selectin genes on IVF embryo transfer implantation failures (IVF-ET failures). Sixty nulligravida women with previous IVF-ET failures and 60 fertile controls were genotyped for the GpIa-C807T, GpIIIa-PlA1/PA2, PECAM-1-C373G (Leu125Val) and P-Selectin-A37674C (Thr715Pro) polymorphisms by pyrosequencing. Compared with wild-type combined homozygotes, carriers of combinations of risk alleles in two gene loci were at significantly increased risk for IVF-ET failure, whereas carriers of the combination of GpIa-807T, GpIIIa-PlA2 and PECAM-1-373G alleles had OR = 52.50 (95%CI: 4.05–680.95, p < .001). The area under the receiver-operating characteristic curve (AUC) based on the number of polymorphisms and the number of risk alleles per subject was 75.4% (95%CI: 66.7%–82.8%, p < .001) and 72.5% (95%CI: 63.6%–80.3%, p < .001), respectively. The OR per polymorphism and risk allele increase was 4.26 (95%CI: 2.15–8.41, p < .001) and 2.85 (95%CI: 1.71–4.76, p < .001), respectively. The above associations were more robust among younger women. The combined analysis of these polymorphisms revealed strong association of combined carriers with IVF-ET failures especially for younger women and provided a genetic risk score with good diagnostic accuracy in the prediction of IVF-ET failures.

Symplastic Leiomyoma of the Uterus-Case Report

Abstract We present a case of a twenty-four-year old, nulligravid woman with suspicionof molar pregnancy and admittedat the University Clinic of Obstetrics and Gynecology in Skopje. On bimanual examination uniformly enlarged uterus was detected. Ultrasonography revealed snow storm echo signal in the uterine cavity. Dilation and curettage were performed and only a slight quantity of material was obtained. Serum bHCG was negative. MRI revealed a finding of the tumorous formation on the anterior wall of the uterus deforming and dislocating the uterus without any additional information. Open surgery was planned and tumorectomy was performedinour hospital. Histopathology analysis of the obtained material revealed symplastic myoma of the uterus. The patient got spontaneously pregnant later, but the pregnancy finished as a spontaneous missed abortion and instrumental revision was performed. Five months later the patient got pregnant again. She had regular pregnancy course and delivery at 37.5 gestational week.

Pregnancy persistently affects memory T cell populations

Pregnancy is an immune challenge to the maternal immune system. The effects of pregnancy on maternal immunity and particularly on memory T cells during and after pregnancy are not fully known. This observational study aims to show the short term and the long term effects of pregnancy on the constitution, size and activation status of peripheral human memory T-lymphocyte populations. Effector memory (EM) and central memory (CM) T-lymphocytes were analyzed using flow cytometry of peripheral blood from 14 nulligravid, 12 primigravid and 15 parous women that were on average 18 months postpartum. The short term effects were shown by the significantly higher CD4+ EM cell and activated CD4+ memory cell proportions in primigravid women compared to nulligravid women. The persistent effects found in this study were the significantly higher proportions of CD4+ EM, CD4+ CM and activated memory T cells in parous women compared to nulligravid women. In contrast to CD4+ cells, activation status of CD8+ memory cells did not differ between the groups. This study shows that pregnancy persistently affects the pre-pregnancy CD4+ memory cell pool in human peripheral blood. During pregnancy, CD4+ T-lymphocytes might differentiate into EM cells followed by persistent higher proportions of CD4+ CM and EM cells postpartum. The persistent effects of pregnancy on memory T cells found in this study support the hypothesis that memory T cells are generated during pregnancy and that these cells could be involved in the lower complication risks in multiparous pregnancies in humans.

Enlarged uterine corpus volume in women with endometriosis: Assessment using three-dimensional reconstruction of pelvic magnetic resonance images.

To assess and compare the uterine volume and endometrium length between women with and without endometriosis, using pelvic magnetic resonance imaging scans. In this case-control study, a total of 75 nulligravid women (aged 20-45 years) with regular menstrual cycles whose uterus were free of any surgically confirmed lesions were enrolled. The endometriosis group underwent surgery for endometrioma (n = 39), and the control group underwent surgery for non-endometrioma ovarian cysts (n = 36). The primary outcome was uterine corpus volume, which was assessed using three-dimensional reconstructions of preoperative pelvic magnetic resonance imaging scans. The mean uterine volume was significantly larger in the endometriosis group than in the control group (mean ± standard deviation, 50.9 ± 14.4 cm3 vs 41.7 ± 14.3 cm3 ; P < 0.01). The longitudinal length and transverse diameter of the corpus and the longitudinal length of the endometrium were also significantly greater in the endometriosis group (all, P < 0.01). An increase in uterine volume and endometrium length was observed in women with endometriosis.

Sigmoid colon volvulus immediately after ultrasound-guided simple ovarian cyst aspiration: a case report

Abstract Introduction This report describes sigmoid volvulus in an otherwise healthy young patient with a large ovarian cyst that was drained under ultrasound guidance. We report this case to draw attention to the fact that decompressing of a large pelvic mass might predispose to sigmoid volvulus. As far as we know there are no other reported cases showing sigmoid volvulus happening immediately after aspiration of a pelvic cyst. Case presentation A 23-year-old, nulligravid woman underwent an Ultrasound-Guided aspiration of a simple Rt. ovarian cyst measuring 8 cm that persisted for 2 months. About 30 min after the procedure she reported abdominal pain moderate in severity, given analgesia and was sent home; several hours later she reported no improvement and attended to the emergency room, and CT scan was done that showed a sigmoid volvulus that was managed by sigmoidoscopy after which the she reported a sudden relieve of her pain and constipation. Conclusion Clinicians should bear in mind such complication(Sigmoid volvulus) while draining a pelvic cyst as this procedure is adapted by some clinician as it is less invasive than surgical management of persistent simple ovarian cyst.

Ovarian Endometrioma Cystectomy with Low Pressure (7 mmHg) MicroLaparoscopy (3 mm)

A 28-year-old nulligravida woman complained about pelvic pain and intense dysmenorrhea since two years. Ultrasound revealed an 8-centimeter right ovarian mass, which had the characteristics of an endometrioma. Microlaparoscopy was performed with 3-millimeter instruments and low pressure pneumoperitoneum (7 mmHg). Pelvic exploration confirmed the right ovarian endometrioma. First, total adhesiolysis of the pelvic area was performed. Ovarian cystectomy was achieved, without the need to increase the pressure. Major advantage of low pressure is decrease of shoulder postoperative pain. The patient had no complication, and was discharged the same day following surgery. She was totally asymptomatic three months after surgery.

EP31.04: Comparative assessment of levator ani muscle injury among nulligravid, primiparous and multiparous women using 3D transperineal ultrasound

EP31.04: Comparative assessment of levator ani muscle injury among nulligravid, primiparous and multiparous women using <scp>3D</scp> transperineal ultrasound

Pregnancy derived from human zygote pronuclear transfer in a patient who had arrested embryos after IVF

Nuclear transfer of an oocyte into the cytoplasm of another enucleated oocyte has shown that embryogenesis and implantation are influenced by cytoplasmic factors. We report a case of a 30-year-old nulligravida woman who had two failed IVF cycles characterized by all her embryos arresting at the two-cell stage and ultimately had pronuclear transfer using donor oocytes. After her third IVF cycle, eight out of 12 patient oocytes and 12 out of 15 donor oocytes were fertilized. The patient's pronuclei were transferred subzonally into an enucleated donor cytoplasm resulting in seven reconstructed zygotes. Five viable reconstructed embryos were transferred into the patient's uterus resulting in a triplet pregnancy with fetal heartbeats, normal karyotypes and nuclear genetic fingerprinting matching the mother's genetic fingerprinting. Fetal mitochondrial DNA profiles were identical to those from donor cytoplasm with no detection of patient's mitochondrial DNA. This report suggests that a potentially viable pregnancy with normal karyotype can be achieved through pronuclear transfer. Ongoing work to establish the efficacy and safety of pronuclear transfer will result in its use as an aid for human reproduction.

Perceived Costs and Benefits of Early Childbearing: New Dimensions and Predictive Power.

Understanding the causes of early childbearing is important for reducing the persistently high rates of early births in the United States. Perceptions of possible benefits may contribute to these rates, while high opportunity costs may dissuade women from early childbearing. Perceptions of costs and benefits of pregnancy, as well as later experiences of pregnancy, were assessed for 701 nulligravid women aged 18-22 who entered the Relationship Dynamics and Social Life study in 2008-2009 and were interviewed weekly for up to 30 months. Bivariate t tests, chi-square tests and multivariable discrete-time event history analyses were used to assess associations of perceived personal consequences of childbearing (e.g., predicted financial costs), goals in potentially competing domains (opportunity costs) and social norms with subsequent pregnancy. Twenty percent of women reported that early childbearing would have more positive than negative personal consequences. Compared with other women, those who had a pregnancy during follow-up had, at baseline, more positive perceptions of the personal consequences of pregnancy and of their friends' approval of pregnancy, and greater desire for consumer goods. In multivariable analyses, only the scales assessing perceived personal consequences of childbearing and friends' approval of childbearing were associated with pregnancy (odds ratios, 2.0 and 1.2, respectively). Goals in potentially competing domains were not associated with pregnancy. Young women's perceptions of consequences of early childbearing predict subsequent pregnancy. That these perceptions are distinct from childbearing desires and from other dimensions of costs and benefits illustrates the complex attitudinal underpinnings of reproductive behavior.

Continued Compliance and Degree of Satisfaction in Nulligravida and Parous Women with Intrauterine Contraceptive Devices.

To evaluate the compliance and degree of satisfaction of nulligravida (has not given birth) and parous (had already given birth) women who are using intrauterine devices (IUDs). A cross-sectional cohort study was conducted comparing nulligravida and parous women who had had an IUD inserted between July 2009 and November 2011. A total of 84 nulligravida women and 73 parous women were included. Interviews were conducted with women who agreed to participate through telephone contact. Statistical analysis was performed with Student's t-test and Mann-Whitney test for numeric variables; Pearson's chi-square test to test associations; and, whenever pertinent, Fisher's exact test for categorical variables. A survival curve was constructed to estimate the likelihood of each woman continuing the use of the IUD. A significance level of 5% was established. When compared with parous women, nulligravida women had a higher education level (median: 12 vs. 10 years). No statistically significant differences were found between the nulligravida and parous women with respect to information on the use of the IUD, prior use of other contraceptive methods, the reason for having chosen the IUD as the current contraceptive method, reasons for discontinuing the use and adverse effects, compliance, and degree of satisfaction. The two groups did not show any difference in terms of continued use of the IUD (p = 0.4). There was no difference in compliance or the degree of satisfaction or continued use of IUDs between nulligravida and parous women, suggesting that IUD use may be recommended for women who have never been pregnant.

Effects of Self-Efficacy and Locus of Control on Future Preconception Counseling Plans of Adult Women With Type 1 Diabetes.

Objective. The American Diabetes Association (ADA) recommends that women with diabetes attend preconception counseling and improve blood glucose levels before pregnancy to decrease risks of adverse outcomes. However, two-thirds of women with diabetes do not plan their pregnancies. Research has examined views regarding preconception counseling of pregnant women with diabetes, but perceptions of women with diabetes who have never been pregnant have not been explored. The purpose of this study was to examine the relationship between women’s locus of control, self-efficacy, and outcome expectations of preconception counseling.Design and Methods. A sample of 147 nulligravid women with type 1 diabetes (mean age 25.9 years) was recruited online to complete a self-report survey. Measures included a sociodemographics form, a study-specific questionnaire regarding diabetes management and education, the Reproductive Health Attitudes and Behaviors instrument, and the Diabetes-Specific Locus of Control measure.Results. A standard multiple linear regression analysis indicated that self-efficacy was positively associated with expectations of preconception counseling (P <0.001), whereas self-blame was negatively associated (P = 0.001). Three-fourths of the women reported not receiving preconception counseling from health care providers.Conclusion. Self-efficacy was positively associated with women’s expectation of preconception counseling usefulness, whereas self-blame for poor disease management was inversely related. The low reported rates of preconception counseling demonstrate that ADA recommendations for starting preconception counseling at puberty have not been followed uniformly. Women with diabetes should be provided education to increase their belief that they have control over their disease, which may lead to positive perceptions of preconception counseling and healthier pregnancies.

Transvaginal sonographic features of diffuse adenomyosis in 18-30-year-old nulligravid women without endometriosis: association with symptoms.

To investigate whether there are sonographic features of diffuse adenomyosis in 18-30-year-old nulligravid women without endometriosis and to examine their association with symptoms of dysmenorrhea and abnormal uterine bleeding. This was a prospective observational study including women referred from a gynecology outpatient center to our university hospital for ultrasound examination. Inclusion criteria were age between 18 and 30 years, regular menstrual cycle and nulligravid status. Exclusion criteria were a past or current history of endometriosis, fibroids, ovarian cysts or lesions, endometrial pathology, current use of hormonal treatments or medications that would affect the menstrual cycle, previous uterine surgery and history of infertility. Women underwent a detailed clinical assessment and a two- (2D) and three-dimensional (3D) transvaginal ultrasound (TVS) examination. 2D-TVS features associated with diffuse adenomyosis were predefined as: (1) heterogeneous myometrium; (2) hypoechoic striation in the myometrium; (3) myometrial anechoic lacunae or cysts; (4) asymmetrical myometrial thickening of the uterine walls with the presence of straight vessels, extending into the hypertrophic myometrium, on power Doppler examination. On 3D-TVS, endomyometrial junctional zone (JZ) was measured as the distance from the basal endometrium to the internal layer of the outer myometrium on coronal section at any level of the uterus, and the smallest (JZmin) and largest (JZmax) JZ thicknesses and their difference (JZdiff) were recorded. 3D-TVS evaluation was considered suggestive for adenomyosis when JZmax ≥ 8 mm and/or JZdiff ≥ 4 mm. The presence of associated symptomatology represented our main outcome: the amount of menstrual loss was assessed by a pictorial blood loss analysis chart (PBAC) and painful symptoms were evaluated using a visual analog scale (VAS). During the observation period, 205 women (median age, 24 (interquartile range, 23-27) years) were enrolled into the study and 156 met the inclusion criteria. According to the 2D-TVS criteria, diffuse adenomyosis was found in 53 (34.0%) women and asymmetrical myometrial thickening of the uterine walls was the most common sonographic feature observed. ANOVA showed a significant relationship between the number of 2D-TVS features of diffuse adenomyosis and VAS score for dysmenorrhea (P = 0.005) as well as PBAC score for menstrual loss (P = 0.03). 3D-TVS showed that women with 2D-TVS features of diffuse adenomyosis had a significantly higher value of JZmax (6.38 ± 2.30 mm, P < 0.001), JZmin (2.07 ± 0.43 mm, P = 0.002) and JZdiff (4.33 ± 1.99 mm, P < 0.001) than did women without these features. Women with sonographic features of diffuse adenomyosis were symptomatic in 83% of cases, reported dysmenorrhea in 79.2% and showed a higher incidence of heavy bleeding than did those without these features (18.9% vs 2.9%; P = 0.001). Sonographic features suggestive of diffuse adenomyosis may develop earlier in reproductive life than previously thought, and may occur in association with dysmenorrhea and abnormal uterine bleeding in nulligravid women. Their observation in these women should therefore warrant further gynecological investigation.