Young Nulliparous Women Research Articles

Ectopic pregnancy at Usmanu Danfodiyo University Teaching Hospital Sokoto: A ten year review

Background: Ectopic pregnancy continues to be a life threatening gynaecological emergency. Objective: To determine the incidence, pattern of presentation and management of ectopic pregnancy in UDUTH Sokoto. Materials and Methods: This is a retrospective study of cases of ectopic pregnancy managed in the gynaecological unit of UDUTH from 1 st January 2002 to 31 st December 2011. Results: During the period, there was a total of 20,095 deliveries and 7,254 gynaecological admissions in the centre. Two hundred and ninety eight (298) patients had ectopic pregnancy accounting for 1.5% of all deliveries and 4.1% of all gynaecological admissions. Most of the affected patients were young nulliparous women. Abdominal pain, amenorrhoea, vaginal bleeding and cervical excitation tenderness were the most common clinical features amongst patients. The ampulla of the fallopian tube was the commonest site of implantation (59.7%) and majority of the cases (70.1%) were already ruptured at the time of presentation. The main mode of treatment was unilateral salpingectomy (76.3%) However, 3.8% of the patients benefited from medical treatment using methotrexate. The case fatality rate was 1.4%. Conclusion : The rate of ectopic pregnancy in the centre is relatively high. Majority of the patients presented late with the ruptured variety. Improvement in health seeking behaviour among our populace coupled with high index of suspicion and use of modern diagnostic techniques by the clinicians will assist in early diagnosis and treatment prior to tubal rupture which will ultimately lead to reduction in maternal morbidity and mortality associated with the condition.

P4-11-12: Molecular Phenotype of Breast Cancers in a Large Cohort of Young Women According to Time Interval Since Pregnancy.

Abstract Background: The increase in breast cancer risk during pregnancy and post partum is well recognized. The cross-over to protective effect does not occur until many years later and varies with age at first birth. Recently, a genomic signature specific to the pregnant compared with the non-pregnant breast has been identified; this signature remains present in the postmenopausal parous breast. Given this, we investigated whether time interval since pregnancy affects the phenotype of breast cancers arising in young women compared with nulliparous women. Methods: We examined molecular phenotype, according to histologic grade and biomarker status, in relation to time since pregnancy in an ongoing prospective cohort study (n=355) of young women (≤40yrs) with breast cancer. Medical records were reviewed for tumor stage and receptor status. Parity was ascertained from questionnaires completed within 9 months of diagnosis. Tumor grade was determined by central pathology review. Using tumor grade and biomarker expression, cancers were categorized as luminal A (ER+ and/or PR+, HER2−, histologic grade 1 or 2); luminal B ( ER+ and/or PR+, HER2+, or ER and/or PR+, HER2− and grade 3); HER2 type (ER-, PR-, HER2+); and triple negative (ER-, PR-, HER2−). Results: The median age of the study population is 37 years (range 17–40). Overall, 80% of women had stage 1 or 2 disease; 67% of cancers were ER positive and 32% showed HER2 overexpression. The distribution of breast cancer molecular phenotypes by time interval since last pregnancy is shown in the table. Distribution of molecular phenotype by interval between last pregnancy and diagnosis In our large cohort of parous young women, we found no differences in the distribution of molecular phenotype according to time interval since pregnancy. However, nulliparous young women were more likely to develop luminal A cancers compared to parous women (40% vs. 29%; unadjusted chi square p-value=0.03) and appeared less likely to develop HER2−type and triple negative cancers (7% vs. 13%, p-value=0.09 and 17% vs. 23%, p-value=0.22 respectively). There were no differences in the distribution of luminal B cancers. Conclusions: The distribution of molecular phenotypes is similar among parous young women regardless of the time interval since parturition. Nulliparous young women appear more likely to develop luminal A cancers compared to parous women. Whether the difference in molecular phenotypes of pregnancy-associated breast cancers vs. cancers arising in nulliparous women is due to the effects of genomic alteration remains to be investigated. Effects of a prior pregnancy appear consistent across a 5-year period, in keeping with the concept of genomic alterations identified in the normal pregnant breast and thereafter. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-11-12.

Recent developments in the clinical use of the levonorgestrel‐releasing intrauterine system

This overview focuses on recent developments in the clinical use of the levonorgestrel- releasing intrauterine system (LNG-IUS) on established indications. Recent studies confirm that the LNG-IUS is safe and equally effective for all age groups of women. All available studies showed that intrauterine contraception is more effective when compared to non-intrauterine contraceptive methods to prevent repeat abortions. Furthermore, insertion in young nulliparous women is acceptable in the majority of women and associated with high continuation rates. The effectivity of LNG-IUS appears to be similar in women with chronic medical conditions, including HIV infection or coagulation disorders, and healthy women. More and most importantly, it has no adverse effect on the underlying condition. We also discuss effects of LNG-IUS on bone mineral density, vaginal flora, cardiovascular risk factors and breast cancer. In treatment of heavy menstrual bleeding, the LNG-IUS appears to be one of the most effective and cost-effective methods.

Effects of multidimensional pelvic floor muscle training in healthy young women

Cross-sectional and interventional study to assess pelvic floor muscle (PFM) function in healthy young nulliparous women and to determine the effects of a 3-month PFM training program with emphasis on co-contraction of PFM and anterolateral abdominal muscles and on correctly performed coughing patterns. PFM function was assessed by digital vaginal palpation in 40 volunteers and graded according to the 6-point Oxford grading scale. The PFM training program was comprised theoretical instruction, as well as verbal feedback during hands-on instruction and repeated training sessions focussing on strengthening PFM and anterolateral abdominal muscle co-contraction during forced expiration and coughing. At baseline, 30 women (75%) were able to perform normal PFM contractions at rest (Oxford scale score ≥ 3); only 4 of them (10%) presented additional involuntary PFM contractions before and during coughing. The remaining 10 women (25%) were unable to perform voluntary or involuntary PFM contractions. Mean Oxford scale score in the whole group was 3.3 ± 1.7. After completing the PFM training program, 29 women (72.5%) performed cough-related PFM contractions and group mean Oxford scale score increased significantly to 4.2 ± 1.0. The study shows that PFM dysfunction may be detected even in healthy young women. Multidimensional training, however, may significantly improve PFM function.

An Unusual Cause of Fibrostenotic Terminal Ileal Disease

Question: A 47-year-old woman was hospitalized for a 6-month history of episodic right-sided abdominal pain, nausea, and vomiting. Pain episodes occurred every month on an average, lasted for few hours at a time, and required 3 hospital admissions. As symptoms progressed, she developed diarrhea, described as 3–4 episodes of loose, watery bowel movements per day. Her medical history included hypertension controlled with medications, hysterectomy, and cholecystectomy. Physical examination was significant only for mild tenderness on the right lower abdomen, with no hepatosplenomegaly, masses, or peritoneal signs. Liver function tests, amylase, and lipase levels were normal. Abdominal ultrasonography showed no biliary dilatation. Upper endoscopy and colonoscopy (with terminal ileal intubation) were normal. Abdominal computed tomography (CT; Figure A) showed thickening of the distal ileuma a few centimeters proximal to the ileocecal valve with mild dilation of mid distal ileum proximally. Fecal material was seen in the small bowel, indicative of stasis. A clinical diagnosis of fibrostenotic Crohn's disease involving the terminal ileum was made. She underwent laparoscopic resection of the terminal ileum and cecum. Gross specimen (Figure B) showed a strictured terminal ileal segment approximately 5-cm long (arrow), with a tortuous ileum with prominent mucosal folds. On sectioning (Figure C), several hemorrhagic foci (arrow) within the thickened bowel wall were seen. Microscopic examination (Figure D; stain: hematoxylin and eosin; original magnification, 10×) revealed thickened muscularis propria, lamina propria, and subserosa with benign endometrial glands and stroma located within the muscularis propria of the thickened segment. What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Endometriosis, defined as presence of functional endometrial glands and stroma in locations outside the uterus, can involve intraperitoneal or extraperitoneal sites. The most common site of involvement is the ovaries. It affects up to 5%–10% women of menstruating age.1Olive D.L. Schwartz L.B. Endometriosis.N Engl J Med. 1993; 328: 1759-1769Crossref PubMed Scopus (755) Google Scholar Typical symptoms include pelvic pain, infertility, and dyspareunia. Although symptoms of early disease are usually cyclical, occurring during menstruation, they may become persistent with progressive disease or with involvement of other organs. The diagnosis is based on a high clinical suspicion and a typical histology. Endometriosis of the gastrointestinal tract affects 3%–37% women with this condition and most commonly involves the rectosigmoid region.2De Ceglie A. Bilardi C. Blanchi S. et al.Acute small bowel obstruction caused by endometriosis: a case report and review of the literature.World J Gastroenterol. 2008; 14: 3430-3434Crossref PubMed Scopus (79) Google Scholar Less commonly, it involves other colonic segments, small bowel, or the appendix. Symptoms related to gastrointestinal involvement depend on the site of involvement and vary from abdominal pain, abdominal distention, tenesmus, constipation, and diarrhea. Endometriosis rarely affects mucosal surfaces making endoscopic biopsies insufficient for diagnosis.2De Ceglie A. Bilardi C. Blanchi S. et al.Acute small bowel obstruction caused by endometriosis: a case report and review of the literature.World J Gastroenterol. 2008; 14: 3430-3434Crossref PubMed Scopus (79) Google Scholar Terminal ileal involvement from endometriosis is uncommon and occurs in 1%–7% of all patients with intestinal endometriosis.2De Ceglie A. Bilardi C. Blanchi S. et al.Acute small bowel obstruction caused by endometriosis: a case report and review of the literature.World J Gastroenterol. 2008; 14: 3430-3434Crossref PubMed Scopus (79) Google Scholar Patients with terminal ileal involvement are usually young nulliparous women who present with intermittent or persistent abdominal pain. Patients with significant involvement of the terminal ileum, like our patient, can present with symptoms and imaging evidence of obstruction.3Orbuch I.K. Reich H. Orbuch M. et al.Laparoscopic treatment of recurrent small bowel obstruction secondary to ileal endometriosis.J Minim Invasive Gynecol. 2007; 14: 113-115Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar In the setting of obstruction, medical therapy with danazol or gonadotropin releasing hormones serve only as temporizing measures,3Orbuch I.K. Reich H. Orbuch M. et al.Laparoscopic treatment of recurrent small bowel obstruction secondary to ileal endometriosis.J Minim Invasive Gynecol. 2007; 14: 113-115Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar and definitive treatment requires surgical resection of the involved segment of the bowel. In conclusion, endometriosis should be considered in the differential diagnosis of a young patient presenting with terminal ileal disease mimicking Crohn's disease.

1867 LOWER URINARY TRACT SYMPTOMS AND PELVIC PAIN IN YOUNG WOMEN AND THE EFFECTS OF PEDIATRIC VOIDING DYSFUNCTION

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology1 Apr 20111867 LOWER URINARY TRACT SYMPTOMS AND PELVIC PAIN IN YOUNG WOMEN AND THE EFFECTS OF PEDIATRIC VOIDING DYSFUNCTION W. Stuart Reynolds, Roger Dmochowski, and Harriette Scarpero W. Stuart ReynoldsW. Stuart Reynolds Nashville, TN More articles by this author , Roger DmochowskiRoger Dmochowski Nashville, TN More articles by this author , and Harriette ScarperoHarriette Scarpero Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1949AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Little is known about pelvic floor symptoms in young nulliparous women, particularly related to etiology and associated conditions. We performed an email-based survey at our institution collecting information on lower urinary tract (LUTS) and pelvic symptoms specifically in young women ascertaining the prevalence of pelvic symptoms (specifically frequency-urgency, urinary incontinence and pelvic pain or painful urination) and associated conditions. We hypothesized that women with pelvic floor symptoms would have an increased rate of childhood voiding and elimination disorders. METHODS Women older than 18 were anonymously recruited to complete an online questionnaire circulated by email to faculty, staff and students at our university medical center. Information regarding demographic information, medical and gynecologic history, voiding and pelvic symptoms and quality of life was obtained. RESULTS 811 respondents, aged 18–40, were analyzed for this study. Overall, 474 (58%) have symptoms either “frequently” or “all the time” and were considered to have pelvic floor dysfunction (PFD): 59 (7%) experience frequency/urgency; 334 (41%) experience urinary incontinence; and 81 (10%) experience pelvic pain. Of those with incontinence, 23% reported pure stress incontinence, 11% pure urge incontinence, and 14% mixed incontinence. Overall, 299 (37%) women reported a history of pediatric voiding or elimination dysfunction, either bedwetting (8%), frequency/incontinence (3%), urinary tract infections (17%), or constipation/encopresis (9%). 208 (44%) of patients with PFD had a history of pediatric dysfunction while only 91 (27%) with no PFD had a similar history (p<0.001). Patients with PFD vs. without PFD more frequently reported childhood bedwetting (9% vs. 7%), frequency/incontinence (4% vs. 1%), UTI (20% vs.12%), and constipation (11% vs.7%) [p<0.001]. A history of any pediatric dysfunction was associated with an increased prevalence of PFD (adjusted OR 1.94, 95% CI [1.42, 2.63]), when corrected for overall health, mode of delivery, exercise and endometriosis on multivariate regression analysis. CONCLUSIONS Pelvic symptoms (LUTS and pelvic pain) are common in women aged 18–40 years and appear to be associated with a history of childhood voiding and elimination disorders. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e749 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information W. Stuart Reynolds Nashville, TN More articles by this author Roger Dmochowski Nashville, TN More articles by this author Harriette Scarpero Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

What Knowledge and Expectations are Ethiopian Girls Bringing with Them into Parenthood?

Background Because of rapid population growth, many countries now have very large cohorts of young people. Despite the population health importance of early child feeding practices, little work has explored the knowledge and expectations about infant feeding that youth bring with them as they transition into parenthood. Objective To examine adolescent girls' perceptions of infant and young child feeding practices in their communities, and to assess their knowledge and expectations regarding infant and young child feeding practices and explore their overlap with current feeding recommendations. Methods Cross-sectional data were obtained from a random sample of 1,018 girls 13 to 17 years of age living in rural, semiurban, and urban sites in southwestern Ethiopia. Surveys were used to collect information on respondents' attitudes, expectations, and perceptions within the domain of infant and young child feeding practices. Descriptive and bivariate statistics were used to describe the data. Results A total of 1,018 girls aged 13 to 17 years were interviewed. The girls were able to report the age at which infants in their communities were provided liquids, semisolids, and solids as well as the perceived duration of breastfeeding in their communities. The girls were generally able to report when they themselves planned to provide liquids and solids to their infants and their expected duration of breastfeeding. The girls' attitudes and expectations were not consistent with exclusive breastfeeding to 6 months, and planned durations of breastfeeding were shorter than they currently perceived in their communities. Conclusions Young nulliparous Ethiopian women have well-formed attitudes and expectations about infant and young child feeding. These are unlikely to promote currently accepted best practices. Our results suggest both the potential that suboptimal feeding practices will be reproduced and novel intervention points.

An exploration of knowledge and attitudes related to pre-pregnancy care in women with diabetes.

Pre-pregnancy care optimizes pregnancy outcome in women with pre-gestational diabetes, yet most women enter pregnancy unprepared. We sought to determine knowledge and attitudes of women with Type 1 and Type 2 diabetes of childbearing age towards pre-pregnancy care. Twenty-four women (18 with Type 1 diabetes and six with Type 2 diabetes) aged 17-40 years took part in one of four focus group sessions: young nulliparous women with Type 1 diabetes (Group A), older nulliparous women with Type 1 diabetes (Group B), parous women with Type 1 diabetes (Group C) and women with Type 2 diabetes of mixed parity (Group D). Content analysis of transcribed focus groups revealed that, while women were well informed about the need to plan pregnancy, awareness of the rationale for planning was only evident in parous women or those who had actively sought pre-pregnancy advice. Within each group, there was uncertainty about what pre-pregnancy advice entailed. Despite many women reporting positive healthcare experiences, frequently cited barriers to discussing issues around family planning included unsupportive staff, busy clinics and perceived social stereotypes held by health professionals. Knowledge and attitudes reported in this study highlight the need for women with diabetes, regardless of age, marital status or type of diabetes, to receive guidance about planning pregnancy in a motivating, positive and supportive manner. The important patient viewpoints expressed in this study may help health professionals determine how best to encourage women to avail of pre-pregnancy care.

Regularidade de ciclos e padrão ovulatório em jovens portadoras de anemia falciforme Regularity of cycles and ovulatory pattern in young women with sickle cell anemia

to evaluate the characteristics of the menstrual cycle and to identify the occurrence of ovulation in nulliparous young women with sickle cell anemia (SCA). we conducted a case-control study including 26 nulliparous women of reproductive age, divided into two groups: "cases", consisting of 13 women with SCA, and "Control" Group, consisting of 13 healthy women with the same interval since menarche. The characteristics of the menstrual cycle were reported by the participants, who were also submitted to measurements of serum progesterone, basal body temperature curves and transabdominal ultrasound in three consecutive cycles (total: 78 cycles) in order to identify the occurrence of ovulation. The results were compared between groups using the nonparametric Mann-Whitney or Kruskal Wallis tests, and the differences were considered significant when p-value < 0.05. no significant difference was found in mean chronological age between the two groups (p = 0.2) in the pattern of the menstrual cycle when duration of flow (p = 0.4) and interval between cycles (p = 0.3) were compared. There was no difference between groups in age at menarche (p = 0.05). Mean hemoglobin value was 8.4 g/dL (± 0.9) in the group of women with SCA and 12.6 g/dL (± 0.8) in the control group (p < 0.01). The frequency of ovulatory cycles was similar for cases (76.9%) and controls (92.3%) (p = 0.5), with a predominance of individuals with three ovulatory cycles in the control group (84.6%) compared to 23.1% in the case group (p = 0.04). the findings justify the need for effective guidance for patients with SCA regarding sexual activity, the possibility of pregnancy and the alternatives for contraception.

Peripartum hysterectomies at the korle-bu teaching hospital: a review of 182 consecutive cases.

The main objectives of this study were to determine the incidence, maternal characteristics, indications, the maternal and perinatal outcomes and the complications of emergency peripartum hysterectomies done at the Korle-Bu Teaching Hospital. This is a retrospective descriptive study covering the period January 1, 2000 to June 30, 2003. Maternity Unit of the Korle-Bu Teaching Hospital The incidence of peripartum hysterectomy during the study period was 4.34/1000 deliveries. The main indication was severe uterine bleeding from uterine rupture 89 (48.9%), uterine atony 60 (33%), placenta accreta 20 (11%) and post caesarean uterine wound sepsis and necrosis 11 (6%). The average blood loss was 2.02 (SD 0.86) L and all patients received blood transfusion. The mean age of the patients was 31.6 (SD 5.3) years and the mean parity was 2.7 (SD 1.7). Complications occurred in 28 (19.8%) patients. The stillbirth rate was 483.5/1000 deliveries and the maternal mortality was 12.9%. The average duration of hospital stay was 11 (SD 8) days. The incidence of emergency peripartum hysterectomy is high. It is performed for young nulliparous women through to elderly grand-multiparous women. The surgery is associated with significant maternal and perinatal morbidity and mortality. Timely expert management in a well resourced centre is advocated.

Experience seeking abortion among unmarried young women in Bihar and Jharkhand, India: delays and disadvantages

Studies suggest that the experiences of unmarried young women seeking abortion in India differ from those of their married counterparts, but the evidence is limited. Research was undertaken among nulliparous young women aged 15–24 who had abortions at the clinics of a leading NGO in Bihar and Jharkhand. Over a 14-month period in 2007–08, 246 married and 549 unmarried young abortion seekers were surveyed and 26 who were unmarried were interviewed in depth. Those who were unmarried were far more likely to report non-consensual sexual relations. As many as 25% of unmarried young women, compared to only 9% of married young women, had had a second trimester abortion. The unmarried were far more likely to report non-consensual sexual relations leading to pregnancy. They were also more likely to report such obstacles to timely abortion as failure to recognise the pregnancy promptly, exclusion from abortion-related decision-making, seeking confidentiality as paramount in selection of abortion facility, unsuccessful previous attempts to terminate the pregnancy, and lack of partner support. After controlling for background factors, findings suggest that unmarried young women who also experienced these obstacles were, compared to married young women, most likely to experience second trimester abortion. Programmes need to take steps to improve access to safe and timely abortion for unmarried young women.

Breathing with the pelvic floor? Correlation of pelvic floor muscle function and expiratory flows in healthy young nulliparous women

The aim of this cross-sectional study was to determine correlations between pelvic floor muscle (PFM) function and expiratory function in healthy young nulliparous women. In 40 volunteers, PFM function was assessed by vaginal palpation. Forced expiration patterns were evaluated visually and by palpation of the suprapubic insertion region of the anterolateral abdominal muscles. Forced vital capacity (FVC) and forced expiratory flows (FEF) were determined by spirometry. Incremental positive correlation was found between voluntary PFM contraction strength and forced expiratory flow at 25%, 50% and 75% (FEF(25%), FEF(50%), FEF(75%)) of the FVC, respectively. Positive correlation was also found between PFM contraction strength and forced expired volume in 1 s (FEV(1)). No correlation was found between PFM contraction strength and FVC or peak expiratory flow (PEF). Despite some limitations of this study, the observed correlation between PFM contraction strength and forced expiratory flows may serve as theoretical background for a potential role of coordinated abdominal and PFM training in diseases with expiratory flow limitations.

Fertility‐sparing treatment in young women with endometrial cancer or atypical complex hyperplasia: a prospective single‐institution experience of 21 cases

We conducted a prospective study of conservative treatment in 21 young nulliparous women with grade (G)1 endometrial cancer stage IA (11) or atypical complex hyperplasia (10). All were treated with a low-dose cyclic natural progestin therapy (200 mg/day from day 14-25) and encouraged to attempt pregnancy immediately. No adverse therapy-related effects were recorded. Overall response rate to progestin therapy was 57%. Nine women conceived (43%). There were 13 pregnancies, of which 13 were spontaneous and 8 were in women with persistent disease or partial response to hormonal treatment. Three additional complete responses were observed after delivery. Only women with known primary infertility or severe polycystic ovary syndrome showed inadequate pregnancy rate. Fifteen women underwent definitive surgery after enrolment (median 27 months, range 3-56 months). All 21 women are alive and disease free after a median follow up of 98 months.

The urethral motion profile: A novel method to evaluate urethral support and mobility

Urethral hypermobility is one of the theories developed to explain stress urinary incontinence. Traumatic damage to urethral supports during vaginal childbirth may be an important contributor. To establish a methodology to study urethral mobility, to determine the urethral motion profile in a cohort of young nulliparous women, and to determine changes in urethral mobility after childbirth. Ultrasound volume datasets of 44 nulligravidae and the 4D antepartum and post-partum datasets of 73 nulliparous women were assessed using post-processing software. Volumes were acquired translabially, at rest and on Valsalva, after voiding while supine. We marked six equidistant points from bladder neck to external urethral meatus and determined the position of these points relative to the inferoposterior symphyseal margin. Mobility vector distances for these points were determined by the formula radical{(Vy - Ry)(2)+ (Vx - Rx)(2)} (V = Valsalva; R = rest). Reproducibility was determined in a test-retest series of 21 patients. Changes in urethral mobility after delivery were determined by comparing antepartum and post-partum mobility vectors. The method was highly reproducible, with an intraclass correlation coefficient of 0.80 (confidence interval 0.73-0.86) for mobility vectors. The distal urethra was consistently found to be less mobile than the proximal part (P < 0.001). After childbirth, urethal mobility was significantly increased in five out of six segments. There was a trend towards more marked changes in mobility after vaginal operative delivery. Urethral mobility can be studied using 3D/4D translabial ultrasound. There is an increase in urethral mobility after childbirth, especially after instrumental delivery, suggesting an alteration in urethral support. This increase in mobility seems to affect the entire urethra.

Striae Distensae After Subfascial Breast Augmentation

Striae distensae or stretch marks after breast augmentation are a rare complication. To date, 10 cases have been published. In seven of these cases, the implant was placed in a subglandular position and in the other three cases, placement was submuscular. Two cases of stretch marks in two young nulliparous women who underwent subfacial breast augmentation are presented. To the best of the authors' knowledge, this is the first report of striae distensae after subfascial breast augmentation.

Muscular fatigue in the pelvic floor muscles after strenuous physical activity

It is not clear why young nulliparous women may leak urine during exercise. The aim of this study was to investigate whether strenuous physical activity can produce pelvic floor muscle fatigue. Participants in this crossover study included 12 nulliparous women with mild symptoms of stress urinary incontinence during strenuous physical activity. Participants were randomized to start with either the intervention (a 90-min interval training program) or the control period (rest in sitting position for 90 min). Maximal voluntary contraction pressure (cm H(2)O), vaginal resting pressure (cm H(2)O), and holding time (s) were measured before and after intervention and rest by a fiberoptic microtip transducer connected to a balloon catheter inserted into the vagina. Mean age of the group was 24 years (+/-1.7). The mean maximal voluntary contraction pressure decreased 20% (+/-24.4) after physical activity. The mean difference in maximal voluntary contraction pressure was significantly larger after physical activity than after rest (-4.4 versus 0.6 cm H(2)O difference, respectively, p<0.01). There were no statistically significant differences in resting pressure or holding time. In young nulliparous women with symptoms of mild stress urinary incontinence, strenuous physical exercise results in lower maximal voluntary vaginal contraction pressure, indicating pelvic floor muscle fatigue. Further research is needed to understand the long-term impact of this finding.

Hospitalization for Pelvic Inflammatory Disease: A Cost-Effectiveness Analysis

Nulliparous women are frequently hospitalized for treatment of pelvic inflammatory disease (PID). The goal of this study was to determine the economic feasibility of hospitalizing adolescents and young women for PID. The authors conducted a Markov decision model, estimating the cost-effectiveness of hospitalization compared with outpatient therapy for mild to moderate PID for adolescents and young women, calculating costs per quality-adjusted life-year (QALY) gained under various assumptions about hospitalization effects on complications. If hospitalization decreases PID complications by 10%, 20%, or 30%, the cost/QALY gained is 145,000 dollars, 67,400 dollars, or 42,400 dollars, respectively, compared with outpatient therapy. Assumptions about hospitalization effects on the development of chronic pelvic pain heavily weight the analysis; costs/QALY gained by hospitalization increase considerably if chronic pain is unaffected. Hospitalization for PID treatment to possibly preserve fertility in nulliparous young women and adolescents is unlikely to be economically reasonable even if substantial improvements in PID complication rates are assumed.

A Successful Live Birth Through in vitro Fertilization Program After Conservative Treatment of FIGO Grade I Endometrial Cancer

Infertile women with chronic anovulation are prone to be exposed to unopposed estrogen stimulation and have the high risk of being suffering from endometrial hyperplasia or even endometrial carcinoma. A few reports have suggested that nulliparous young women (under 40 yr of age) with endometrial carcinoma could be treated conservatively to preserve fertility and succeed the live birth. We report on a 36-yr-old woman who received conservative treatment of endometrial carcinoma (stage I, grade 1) by curettage and progestin. After megestrol medication of total 71,680 mg during 24 weeks, we found the regression of endometrial lesion by curettage and hysteroscopic examination. Then we decided to perform in vitro fertilization program. Two embryos were transferred and heterotypic pregnancy was diagnosed 27 days after embryo transfer. After right salpingectomy, she received routine obstetrical care and delivered by cesarean section at 38 weeks in gestational periods. Two years after delivery, she is healthy without any evidence of recurrent disease. The fertility preserving treatment is an option in endometrial cancer patients if carefully selected, and assisted reproductive technologies would be helpful.

Prevalence of rectocele in young nulliparous women

It is generally assumed that fascial defects in the rectovaginal septum are the result of childbirth. However, rectoceles do occur in women who have never delivered vaginally. To determine the incidence of rectocele in a cohort of asymptomatic, young nulliparous women. Observational cohort study on 178 nulliparous caucasian women (aged 18-24) recruited for a twin study of pelvic floor dysfunction. All women were interviewed and examined by translabial ultrasound, supine and after voiding. In 52 women, 3D imaging was obtained and 171 datasets were complete and available for analysis. Ultrasound findings were reviewed for rectovaginal septal integrity by an assessor blinded against interview and demographic data for rectovaginal septal integrity. A discontinuity of the anterior rectal wall with extrusion of rectal mucosa or contents (depth of >or= 10 mm) was observed in 21/171 (12%). The depth of this herniation ranged from 10 to 25 mm and was filled with stool (n = 10) or rectal mucosa (n = 11). Defects were associated with a higher BMI (P = 0.049), with the complaint of constipation (P = 0.049) and non-significantly with straining at stool (P = 0.09). Descent of the ampulla to beyond the level of the symphysis pubis without fascial defect, that is, significant perineal relaxation, was observed in 23/171 (13%). Twelve percent of 171 young nulligravid caucasian women showed a defect of the rectovaginal septum. Associations were observed with higher body mass index and a history of constipation. It is hypothesised that in some women defects of the rectovaginal septum and perineal hypermobility may be congenital in nature.

P14.04: TVT and Monarc suburethral slings: a case control trial

Results: Defects of the anorectal muscularis, implying a true rectocele, were identified in 2 out of 68 women before and in 8 out of 52 women after childbirth (P = 0.02). In those two women in whom defects were diagnosed before childbirth, they had deepened from 14 to 23 mm and from 15 to 18 mm. After childbirth, the ampulla or rectal contents descended over 22 mm further than before (P < 0.0001 on paired ttest). Symptoms regarded as typical for a rectocele, ie., digitation (n = 2), straining at stool (n = 10) and incomplete emptying (n = 11), were not uncommon 2–6 months postpartum; but out of 8 rectoceles, 4 were asymptomatic. Conclusions: As shown previously, defects of the rectovaginal septum, i.e., ‘true rectoceles’ occur in young nulliparous women. However, childbirth is associated with an increase in prevalence and size of such defects, and it seems to cause increased downwards displacement of the rectal ampulla, ie., perineal hypermobility.