Urine Pregnancy Test Research Articles

Gestrinone Compared With Mifepristone for Emergency Contraception

To compare the efficacy of gestrinone with that of mifepristone for emergency contraception. A randomized double-blind trial was conducted in five family-planning clinics in China. We randomly assigned 998 healthy women with regular menstrual cycles and negative urine pregnancy tests who were requesting emergency contraception up to 72 hours after unprotected coitus to receive single-dose 10 mg gestrinone (n=499) or 10 mg mifepristone (n=499). We monitored them to 7 days after the expected first day of their next menstrual period. The study was powered to detect a 5% failure rate between the two regimens. The treatment groups did not differ significantly; posttreatment pregnancy rates were 2.4% in the gestrinone group compared with 1.8% in the mifepristone group (P=.51). The majority of women menstruated the first day of expected menses, and groups did not differ regarding side effects. The effectiveness of 10 mg gestrinone is not significantly different from 10 mg mifepristone as an emergency contraceptive method. ISRCTN Register, isrctn.org, ISRCTN87842530. I.

Pregnancy and Infant Outcomes in the Clinical Trials of a Human Papillomavirus Type 6/11/16/18 Vaccine

To present a combined analysis of the pregnancy outcomes for women aged up to 45 years enrolled in five phase III clinical studies of the prophylactic quadrivalent human papillomavirus 6/11/16/18 vaccine. Twenty thousand five hundred fifty-one women aged 15-45 years received quadrivalent HPV vaccine or placebo at day 1 and months 2 and 6. Urine pregnancy tests were performed immediately before each injection; participants testing positive were not vaccinated. Women who became pregnant after enrollment were discontinued from further vaccination until resolution of pregnancy. All pregnancies were followed for outcomes. During the studies, 1,796 vaccine and 1,824 placebo recipients became pregnant, resulting in 2,008 and 2,029 pregnancies with known outcomes. No significant differences were noted overall for the proportions of pregnancies resulting in live birth, fetal loss, or spontaneous abortion. A total of 40 neonates born to vaccinated women and 30 neonates born to women given placebo had one or more congenital anomalies (P=.20). The anomalies were diverse and consistent with those most commonly observed in the general population. The vaccine was well tolerated among women who became pregnant. Administration of quadrivalent human papillomavirus vaccine to women who became pregnant during the phase III clinical trials did not appear to negatively affect pregnancy outcomes. The vaccine is a U.S. Food and Drug Administration pregnancy category B medication (animal studies revealed no evidence of fetal harm, but there are no adequate and well-controlled studies in pregnant women); however, vaccination is not recommended during pregnancy. Postlicensure surveillance is ongoing. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00092521, NCT00092534, NCT00092495, NCT00092547 and NCT00090220. II.

Recurrent Ectopic Pregnancy in the Ipsilateral Oviduct After Prior Laparoscopic Partial Salpingectomy

Ectopic pregnancy occurs in approximately 2% of all pregnancies, and over 95% of ectopic pregnancies involve the oviduct. Ectopic pregnancy remains the major cause of first-trimester maternal death [1]. Tubal surgery is reported to be the greatest risk factor for ectopic pregnancy. Other important risk factors include a previous ectopic pregnancy, in utero diethylstilbestrol exposure, pregnancy with an intrauterine device in situ, documented tubal pathology, infertility, previous genital tract infection, and a history of multiple sexual partners [2]. Transvaginal ultrasonography has proven to be indispensable in the early diagnosis and localization of ectopic pregnancies [3]. Even in the absence of abnormal symptoms, patients with a history of prior ectopic pregnancies should undergo thorough transvaginal ultrasonography examinations when the confirmed pregnancies are detected. Here, we report a rare case of a patient with a recurrent ectopic pregnancy in the ipsilateral oviduct after prior laparoscopic partial salpingectomy. A 28-year-old, gravida 1, para 0, woman using no contraception presented to the emergency department, complaining of severe lower abdominal pain and vaginal bleeding that had lasted 5 hours. Five years earlier, the patient had undergone laparoscopic left partial salpingectomy for an ectopic gestation. The patient’s blood pressure was 97/55 mmHg and her pulse was 97 beats/min. Her abdomen was diffusely tender with rebound. A urine pregnancy test result was positive and her hemoglobin was 10.0 g/dL. A transvaginal sonogram demonstrated a 2 × 3 cm heterogeneous left adnexal

Ruptured Ectopic (Cornual) Pregnancy

A 38-year-old woman visited the emergency department with abdominal pain of 2-hour duration. She was anxious and pale with cold clammy skin; blood pressure was 80/40 mm hg, with a tachycardia of 100. A urinary pregnancy test produced positive findings and vaginal ultrasound showed hemoperitoneum without signs of an intrauterine pregnancy. A rupture of an ectopic pregnancy was suggested and the patient was prepared for surgical intervention. Emergency laparoscopy was performed, which showed a large amount of intraabdominal clots [1]. After evacuation of ap-

Unusual Case of Polypoid Mass in a Young Patient

Purpose: 22 yr old white female, G2P1A1 with no medical co-morbidities was referred for management of left adnexal mass and elevated CA 125 level. She presented with a 2 month history of abdominal bloating, indigestion and night sweats. She denied any history of sexually transmitted disease or usage of intrauterine contraceptive device. Examination revealed tenderness in the left-lower quadrant of the abdomen. Basic laboratory work up was unremarkable. CA-125 was elevated at 347 U/ml(<35). Urine pregnancy test was negative. CT Pelvis confirmed the presence of a unilocular cystic mass in the left pelvic adnexa measuring 6.5 cm diameter, consistent with a left ovarian cyst with an adjancent mass measuring 5.8 × 4.8 × 5.4 cm. Stool occult blood was positive. Colonoscopy showed a polypoid mass at 22 cm which was 6 mm in diameter with hairy extrusions. It appeared to be extra-intestinal eroding into the colon. Mass was biopsied but not snare resected. Subsequently, patient underwent a left salphingo-oophorectomy, sigmoid colectomy and primary colonic anastomosis. Pathology confirmed the diagnosis of tuboovarian abscess with sigmoid perforation. Patient had uneventful recovery. Discussion: Tubo-ovarian abscess (TOA) is one of the more severe complications of pelvic inflammatory disease. It is formed by an inflammatory mass involving the fallopian tube, ovary and often surrounding structures. We believe this is the first presentation of a tubo-ovarian abscess perforating into the sigmoid colon and appearing as a polypoid mass on colonoscopy. There are reports of colonic involvement with perforation in other gynecological pathologies which include endometriosis, pelvic actinomycosis and ovarian malignancies including psuedomyxoma peritonnei. Endoscopist should stay vigilent as colonic malignancy at times can masquerade as an abscess.FigureFigure

False-Negative Results from Point-of-Care Qualitative Human Chorionic Gonadotropin (hCG) Devices Caused by Excess hCGβ Core Fragment Vary with Device Lot Number

Recently, we reported that increased concentrations of human chorionic gonadotropin β core fragment (hCGβcf)1 can cause false-negative results on the OSOM® hCG Combo Test (Genzyme Diagnostics) and ICON® 25 hCG (Beckman Coulter) qualitative urine hCG devices (1). We reported that the hCG Combo SP® Brand Rapid Test device (SP® hCG Rapid Test; Cardinal Health), however, was not subject to the same effect. We demonstrate that the false-negative effect is observable with certain lots of the Combo SP devices. Approximately 9 months after our hospital system switched to the Combo SP Rapid Test device to avoid potential false-negative results in patients with high concentrations of urine hCGβcf, we encountered 2 patients with false-negative results. Patient 1 was 18 years of age with a live intrauterine pregnancy that was seen on ultrasound and estimated at 12 weeks gestation. She presented to the emergency department (ED) with abdominal pain (no bleeding). Her diagnosis at discharge was hyperemesis gravidarum and dehydration. Her urine was cloudy with a pH of 6.5, a specific gravity of 1.026, and a 1+ leukocyte esterase result. A point-of-care urine pregnancy test was performed in the ED (Combo SP Rapid Test …

Feasibility of telephone follow-up after medical abortion

Background This study was conducted to assess the feasibility of using telephone calls combined with high-sensitivity urine pregnancy testing as a primary method of follow-up after medical abortion. Methods We enrolled 139 women up to 63 days of gestation to receive mifepristone 200 mg orally and misoprostol 800 mcg vaginally or buccally, per their choice. Participants were contacted by phone one week after mifepristone administration and interviewed using standardized questions. If the subject or clinician thought the pregnancy was not expelled, the subject returned for an ultrasound examination. Otherwise, subjects performed high-sensitivity home urine pregnancy testing 30 days after the mifepristone and were called within 3 days of the test. Those with positive pregnancy tests returned for an ultrasound examination. Those with negative tests required no further follow-up. Results Six of the 139 (4.3%, 95% CI 1.6–9.1%) subjects presented prior to Phone Call 1 for an in-person visit. All 133 (100%, 95% CI 97.8–100%) subjects eligible for their first telephone follow-up were contacted. Eight of the 133 (6.1%, 95% CI 2.6–11.5%) women were asked to return for evaluation and all did so (100%, 95% CI 63.1–100%). Eight of the 133 women eligible for the 30 day phone call presented for an interim visit prior to the call. After 30 days, 116 of the 117 (99.1%, 95% CI 97.5–100%) eligible subjects were contacted. One subject was not reached for the day 30 phone call. Twenty-seven of the 116 (23.3%, 95% CI 15.6–31.0%) subjects had a positive pregnancy test and required follow-up. Two of these subjects (7.4%, 95% CI 1.0–24.2%) did not return for in-person follow-up. Two of the 116 (1.7%, 95% CI 0.2–6.1%) subjects had inconclusive pregnancy tests and were asked to return for follow-up. One of these subjects (50%, 95% CI 1.2–98.7%) did not return. Complete follow-up was achieved in 135 of the 139 subjects (97.1%, 95% CI 94.3–99.9%). None of the 26 women evaluated for a positive or inconclusive pregnancy test had a gestational sac or continuing pregnancy. Conclusion Telephone follow-up combined with urine pregnancy testing after medical abortion is a feasible alternative to routine ultrasonography or serial serum hCG measurements.

False-positive urine pregnancy test in a woman with adenomysosis

We present a case of a 39-year-old woman presenting to the emergency department with persistent vaginal bleeding with myoma and endometrium thickness. The qualitative urine human chorionic gonadotropin (hCG) showed positive result, however, the quantitative serum hCG had negative result. The negative serum hCG result suggests that the false-positive result was not caused by elevated circulating hCG. According to the urine hCG one-step pregnancy device, 1 mg/dL of hemoglobin may not interference the pregnancy result. Nevertheless, we found that the hemoglobin level was 40 mg/dL in the urine specimen. We designed a in vitro experiment to evaluate the effects of hemoglobin on urine pregnancy test. The concentrations of hemoglobin from 5 to 500 mg/dL did not yield a positive urine pregnancy test. On the basis of our findings, the false positive pregnancy test was not caused by hemoglobin. It is important to confirm a suspected false-positive urine hCG test using a quantitative serum hCG test. Although it is not certain the mechanism for false positive reaction in this peculiar sample, the ACON urine hCG one-step pregnancy will occasionally yield a false-positive result in this class of patients.

Tuberculous psoas abscess in obstetrics

We read with interest the article by Kumar et al. [1] regarding psoas abscess in obstetrics. Although rare, psoas abscess have been reported during pregnancy. Their subtle symptomatology evades detection clinically. We will like to share our experience of a case of psoas abscess diagnosed during an exploratory laparotomy for ruptured ectopic pregnancy. A para 1, 22-year-old woman presented with 2 months of amenorrhea and pain in abdomen. The pain had worsened in past 3 days and was now associated with vomiting and giddiness. Patient had severe palor, tachycardia and hypotension. On palpation of abdomen, Wndings were a Wxed dull to percussion mass felt in left lumbar region with mild tenderness and rigidity in right iliac fossa. Digital vaginal examination revealed an anteverted normal size uterus associated with cervical motion tenderness and a cystic mass about 4 £ 5 cm was palpable in right fornix extending to pouch of Douglas. The left lumbar abdominal mass was also tipped through left fornix. Blood chemistry revealed hemoglobin of 6 g%. Complete blood count, liver and kidney functions were normal. Urine pregnancy test was positive. On ultrasound evaluation, right adnexa revealed a ruptured ectopic gestational sac with Xuid in pouch of Douglas. Uterus was normal in size and endometrial cavity was empty. Left ovary was normally visualized. The left abdominal mass was suspected to be a psoas abscess extending into the hemipelvis. It was cystic with thick wall and few septations. Patient was taken for urgent laparotomy and right-sided salpingectomy for ruptured ectopic pregnancy. The left retroperitoneal cystic Xuctuant swelling measured approximately 10 £ 15 cm. It was suspected to be tuberculous psoas abscess in view of straw colored Xuid obtained on aspiration peroperatively. Fluid cytology revealed exudative nature with predominance of lymphocytes. The Gram stain and aerobic culture revealed no organisms. The aspirated Xuid investigated by PCR (polymerase chain reaction) tested positive for Mycobacterium. The radiographs of the spine, pelvis with both hips were normal. Computed tomography (CT) of spine and abdomen other than presence of left psoas abscess was also normal. The abscess was drained percutaneously under CT (Fig. 1) guidance postoperatively under cover of multidrug antitubercular chemotherapy. Serial ultrasound has shown remarkable response to the therapy. Psoas abscess is a rare manifestation in pregnancy. Only four cases of psoas abscess diagnosed during ongoing pregnancy have been reported in indexed English literature till date (Table 1) [1, 2]. Other reported cases have either been postabortal or post partum [2–5]. Kumar et al. describes the only other case of tubercular psoas abscess detected during pregnancy [1]. Our case is the Wrst report of psoas abscess diagnosed with ectopic pregnancy. Patient gave no history of previous tuberculosis or exposure on retrospective questioning. The psoas abscess seemed tubercular in view of straw colored Xuid obtained on aspiration peroperatively. There was a risk of tubercular Xare-up with the contamination of abdominal cavity. The percutaneous drainage under CT guidance was done under cover of antitubercular drugs a few weeks later. Wherever possible, percutaneous drainage is the preferred method of abscess drainage as it is much less invasive than open surgical technique. It is technically demanding and requires help of a trained radiologist. R. Agarwal · A. Suneja · S. Raina Department of Obstetrics and Gynaecology, University College of Medical Sciences, Guru Teg Bahadur Hospital, Shahdara, Delhi, India

Re: use of serum progesterone measurements to reduce need for follow‐up in women with pregnancies of unknown location

We read with great interest the paper by Day et al.1. We congratulate the authors on reducing the need for unnecessary follow-up. Specifically, Day et al. investigated the feasibility of a single-visit strategy in pregnancies of unknown location (PULs) which are at low risk of intervention. They concluded that a progesterone cut-off of < 10 nmol/L as the sole diagnostic test for spontaneously resolving PULs would eliminate the need for routine follow-up in nearly 50% of women. However, 12% of ectopic pregnancies which would eventually require intervention would be discharged. Any protocol which reduces the need for follow-up in PULs must be balanced against any possible harm, i.e. discharging women with potential ectopic pregnancies after a single visit without follow up. In 2003, we published on the use of the same single-visit protocol that is advocated by Day et al. in the management PULs2. In that study, we concluded that although 74.7% of low-risk PULs were correctly being discharged without further follow-up, this approach to the management of PULs was unsafe, with 49% of ectopic pregnancies being discharged. We believe that a single-visit strategy should not be used as an alternative to the current two-visit strategy which incorporates the human chorionic gonadotropin (hCG) 48 h/0 h ratio3-9. Even if 15% of ectopic pregnancies can be managed safely expectantly, i.e. the self-limiting forms of ectopic pregnancy, the rate of discharged ectopic pregnancies is still disproportionately high. In Day et al.'s study, approximately half of all interventions were surgical evacuations of miscarriages, the other half including either surgery or medical management of ectopic pregnancies. A significant proportion of PULs which developed into non-viable intrauterine pregnancies seemed to consist of incomplete miscarriages. In our experience, if a woman is classified on the primary ultrasound examination as having a PUL (i.e. no evidence of an intra- or extrauterine pregnancy and an absence of retained products in a woman with a positive urinary pregnancy test), it is unlikely that on subsequent scans she will have an incomplete miscarriage confirmed (i.e. with evidence of retained tissue on ultrasound). In Day et al.'s study, incomplete miscarriages at the first scan seem to have been pooled together with PULs. Incomplete miscarriages should not be managed as PULs with determination of serum progesterone/serial hCG levels. In summary, we agree with the philosophy of reducing intervention in the PUL population. This, however, must not be at the expense of maternal safety. In 2003, we published data2 on the use of the protocol advocated by Day et al. and in 2005, we published data on the use of a new single-visit strategy to manage women with a PUL9. In both of these studies, in which serum progesterone at presentation was used in combination with serum hCG, we concluded that a single-visit approach to the management of PUL was not safe practice. Based upon our previously published results, we believe this still to be the case. The results of the study of Day et al. should be interpreted with caution. T. Bignardi*, G. Condous*, * Early Pregnancy, Acute Gynaecology and Advanced Endosurgery Unit, Nepean Clinical School, University of Sydney, Sydney, Australia

Cervical intramural ectopic pregnancy

To describe a cervical intramural ectopic pregnancy. Case report. Maternity hospital. A 28-year-old multiparous woman was seen with vaginal bleeding and a positive urinary pregnancy test after delayed menstruation. Ultrasonography and pelvic examination revealed an empty uterine cavity and a hyperechoic focus within an enlarged cyanotic anterior cervical lip. Vaginal bleeding was controlled with aspiration curettage; however, macroscopic and ultrasonographic views of the cervix remained the same. One week later the anterior cervical lip was found to be ruptured. Decidual tissue was removed from the ruptured area. Histopathologic confirmation of chorionic villi and presence of a connection between the endocervix and the ruptured area. No connection was found with the endocervical channel when controlled with a 1-mm Hegar uterine dilator, and histopathologic examination of removed materials revealed chorionic villi. The cervical intramural ectopic pregnancy is an extraordinary clinical situation and might lead to diagnostic and therapeutic challenges.

Repeat Pregnancies Among HIV-Infected Women Enrolled in Clinical Trial PACTG1022

We evaluated the rate and potential predictors of repeat pregnancy during 2 years of postpartum follow-up among women enrolled to a clinical trial that compared 2 initial antiretroviral regimens in pregnancy. These women had intensive follow-up during and after pregnancy including extensive contraceptive counseling and were specifically counseled to avoid subsequent pregnancies on study. We hypothesized that occurrence of repeat pregnancies might be predicted by specific demographic and/or clinical characteristics. By identifying these characteristics we hoped to target HIV-infected women most at risk for repeat pregnancy with more focused contraceptive counseling. (excerpt)

Index of Suspicion

Index of Suspicion

Successful laparoscopic management of primary omental pregnancy

Omental pregnancy is an extremely rare type of ectopic pregnancy. We present a case in which a 26-year-old woman was admitted to the emergency room with abdominal pain. She was diagnosed with a ruptured ectopic pregnancy after a positive urinary pregnancy test and transvaginal ultrasound. Laparoscopic surgery showed intact pelvic organs and an ectopic mass on the omentum. The patient was treated successfully with laparoscopic partial omentectomy, and pathologic examination confirmed an omental pregnancy. As evidenced by this case, laparoscopy can be useful to diagnose and treat unusually located ectopic pregnancies.

Azithromycin Treatment Modulates Cytokine Production in Chlamydia trachomatis Infected Women

Chlamydial infection of the lower genital tract usually spreads to the upper genital tract and is then responsible for more serious consequences of chlamydial infection, such as infertility, ectopic pregnancy, pelvic pain and pelvic inflammatory disease [1]. Genital infection with Chlamydia trachomatis and the resulting cytokine environment largely determines the outcome of infection and disease [2–7]. Chlamydial infections are usually treated with Azithromycin or Doxycycline [8]. The immunomodulatory effects of macrolides have mainly been shown in vitro or in animal experiments. It has been reported that macrolide antibiotics can interfere with cytokine production in vitro [9–11]. Azithromycin has also been reported to inhibit the production of pro-inflammatory cytokines [12–17]. There is little evidence from the clinical arena that these immunomodulatory actions of antibiotics play a role in terms of outcome. Therefore, further studies to investigate the potential usefulness of azithromycin are necessary to elucidate its mechanism of action. The direct relevance of these findings for the treatment of infectious and inflammatory diseases will have to be tested in patients. The results of clinical trials have suggested that antibacterial activity of azithromycin is efficacious in the treatment of chlamydial cervical infection [18–20]. However, there are no human studies that have assessed antibacterial as well as anti-inflammatory effects of azithromycin treatment in different clinical conditions associated with the chlamydial infections. In a recent study on a Macaque model, azithromycin effectively prevented the progression of inflammation and fibrosis in both the lower and upper reproductive tract after repeated chlamydial infections suggesting that azithromycin may provide anti-inflammatory as well as antimicrobial properties and this combined activity may be particularly well-suited for the treatment of chlamydial infection [21]. Therefore, it might be possible that in immunopathological conditions like infertility and pelvic inflammatory disease, the anti-inflammatory property of azithromycin may act in the eradication of infection and disease. Hence, in the present study in order to examine the anti-inflammatory effects of azithromycin, we investigated the levels of interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-13, interferon-γ (IFN-γ) and tumour necrosis factor-α (TNF-α) in women representing different clinical conditions, that is, Chlamydiapositive fertile and infertile women with genital tract infection of C. trachomatis before and after treatment with azithromycin.

Hip Pain In A Cross Country Runner

HISTORY: An 18 year-old female cross-country runner presented with 6 weeks of left posterolateral hip pain of insidious onset. She initially had pain with running only but now has pain with ambulation. She denies back pain, radiation of her pain, numbness, tingling, or weakness in her hip or leg. She denies prior hip pain or injury. She reports secondary amenorrhea for 5 years. She denies sexual activity, acne, hursutism, anemia, disordered eating behaviors, and reports she is happy with her weight. She has a history of bilateral medial tibial stress syndrome but no known history of a stress fracture. PHYSICAL EXAMINATION: Her examination revealed a height of 5'3", weight of 98 pounds, BMI of 17, pulse of 60, and blood pressure of 98/86. She had no acne or signs of hursutism. Her back exam revealed a straight spine with no midline tenderness and full range of motion, and negative straight leg raise and FABER tests. She was tender over her left piriformis, proximal iliotibial band and lateral iliac crest. She had full range of motion of the left hip with no pain. Her hip and leg strength was 5/5 and she was neurovascularly intact. She had a negative fulcrum test but pain in her left hip with hopping on one leg. DIFFERENTIAL DIAGNOSIS: Piriformis syndrome Gluteus medius strain Stress fracture Labral tear/hip impingement Avulsion fracture Hip pointer Lumbar radiculopathy SI dysfunction Gluteal bursitis TEST AND RESULTS: • Laboratory evaluation: -Estradiol low at <12 and luteinizing hormone low at 0.9, both in prepubertal range. Free T3 index low at 75. -Normal hemoglobin, ferritin, thyroid-stimulating hormone, follice-stimulating hormone, and prolactin. Urine pregnancy test negative Left hip radiographs: normal; growth plates still open. MRI left hip: left iliac crest apophyseal avulsion CT pelvis without contrast: subacute left iliac crest apophyseal avulsion injury DXA scan: spine Z-score -2.4 FINAL WORKING DIAGNOSIS: 1. Left hip iliac crest apophyseal avulsion fracture 2. Functional hypothalamic secondary amenorrhea 3. Osteoporosis 4. Low T3 syndrome TREATMENT AND OUTCOMES: 1. Non-weight-bearing until no pain with ambulation. 2. Slow gradual return to activity. 3. Referral to registered dietitian. 4. Calcium and vitamin D supplementation. 5. Decision made to medically red-shirt her freshman year.

Sonographic diagnosis of ectopic pregnancy 2 years after total hysterectomy

We report a case of a 35-year-old multigravida with a chief complaint of 8 days of mild pain in the lower abdomen with history of vaginal hysterectomy 2 years prior. Ultrasonography and MRI showed a gestational sac-like structure with a fetal pole in the pelvis. Urine pregnancy test was positive with increased beta-HCG levels. Diagnosis of ectopic pregnancy was made. Surgical exploration and subsequent histopathology confirmed the sonographic findings.

25-Year-Old Woman With Increasing Abdominal Girth and Shortness of Breath

25-Year-Old Woman With Increasing Abdominal Girth and Shortness of Breath

REDUCED ANEMIA AND IMPROVED IRON AND FOLATE STATUS BEFORE AND AFTER PREGNANCY AMONG FEMALES IN RURAL BANGLADESH IS RELATED TO LENGTH OF AND ADHERENCE TO PERICONCEPTIONAL IRON AND FOLIC ACID SUPPLEMENTATION.

In 2007, Bangladesh's national strategy to reduce anemia included iron and folic acid (IFA) supplementation to adolescent girls and newly married females. We conducted a double‐blinded RCT among married, nulliparous females to determine the impact of daily periconceptional IFA Sprinkles® versus folic acid (FA) Sprinkles® on iron and folate status. Biochemical indices were collected at baseline and after a positive urine pregnancy test (~15 wks gestation), or after 9 mo of supplementation among non‐pregnant females (NPF). Among 88 pregnant females (PF), there was a significant interaction between treatment group and length of supplementation for Hb (p=0.01) and anemia (p=0.02). After 183 study days, IFA improved Hb (127.0 vs 112.5 g/L) and reduced anemia (22.2% vs 66.7%) compared to FA. Group differences for iron status were not significant. Among NPF (n=151), IFA reduced anemia by 81.4% (95% CI: 0.04, 0.90, p=0.04) and ID by 91.8% (95% CI: 0.01, 0.68, p=0.02). Improved ferritin levels were only observed among females in the highest quartile of adherence. Periconceptional FA improved folate status in both groups. Mean ( ±SD) plasma folate increased from 18.0 ( ±7.0) to 33.8 ( ±23.8) nmol/L after 140.3 ( ±65.5) days of supplementation among PF and from 16.6 ( ±6.8) to 31.4 ( ±18.8) nmol/L after 277.4 ( ±5.2) days of supplementation among NPF. Among NPF, adherence was significantly associated with improved plasma folate levels (p&lt;0.0001) and reduced folate deficiency (p=0.002). We conclude that periconceptional IFA supplementation with Sprinkles® significantly improves anemia and iron and folate status before and during pregnancy among females in rural Bangladesh.

Laparoscopic management of a primary omental pregnancy after clomiphene induction

To describe the successful laparoscopic management of a primary omental pregnancy. Case report. Department of Obstetrics and Gynecology, Dr. Sami Ulus Obstetrics, Gynecology and Children's Hospital, Ankara, Turkey. A 22-year-old patient with an omental pregnancy. Laparoscopic partial omentectomy. Successful laparoscopic management of an omental pregnancy. A 22-year-old woman presented to the emergency room with abdominal pain and vaginal spotting. She was undergoing clomiphene (CC) induction for infertility and had a positive urine pregnancy test at home. A right adnexal ectopic pregnancy was reported by ultrasonography. Due to increasing pain, laparoscopy was performed. The uterus and fallopian tubes appeared normal without any signs of pregnancy. A well-vascularized intact omental gestational sac was discovered in the right adnexal region in close proximity to the right ovary. By laparoscopy, the sac was resected with partial omentectomy. A primary omental pregnancy was confirmed by beta-hCG-positive trophoblast cells among omental fat cells. Omental pregnancy is rather difficult to identify due to localization. When in close proximity to the adnexal region, it may mimic a tubal ectopic pregnancy. Laparoscopy offers a minimally invasive method for diagnosis and therapy.