Current Women's Health Reviews - Volume 5, Issue 1, 2009

According to UNICEF worldwide every 5th child is born by an adolescent mother and 80% of these so-called teenage pregnancies occur in third world countries. Pregnancies during early adolescence were commonly thought to represent special risks, such as preterm labor, urinary tract infections, anemia, pre-eclampsia, high rate of caesarean sections, preterm birth and low birth weight infants resulting in increased mortality and morbidity of mother and child. Therefore teenage pregnancies are listed among the most important public health problems of the 21st century. This view however was criticized recently. Data from developed countries suggest that an optimal prenatal care eliminates obstetrical risks among adolescent mothers and adverse pregnancy outcome is mainly due to socioeconomic cofactors. This is however not true of developing countries where the majority of teenage childbirths takes place. Teenage pregnancies however are not only of interest from a medical and a social point of view. Biological aspects such as somatic development and growth of the mothers and fetus should be considered. Additionally an evolutionary point of view should not be forgotten. In this review biomedical and social aspects of teenage pregnancies are presented, but also biological and evolutionary factors are discussed.

An acute hepatitis can have an onset during any trimester; it does not represent a risk for malformation in the baby, nor for the mother (with very rare exceptions). In fact, only hepatitis E virus poses a significantly increased risk to pregnant women. The most common scenario is a pregnancy in a women chronically infected with a hepatotropic virus. As far as the HBV is concerned, the majority of published studies reported no association with adverse pregnancy outcomes in HBsAg positive carriers. During pregnancy in chronic HCV infection a significant reduction in mean ALT levels has been reported, with a rebound during the post-partum period. In very few cases exacerbation of chronic hepatitis C has been reported in pregnancy. A co-factor which might play a role in the reduction of liver damage is the release of the endogenous IFN from the placenta. Observations regarding serum HCV-RNA concentration have been variable. In some women HCV-RNA levels rise toward the end of pregnancy. In general, pregnancy does not have a negative effect on either HBV or HCV infection. Conversely, chronic hepatitis does not appear to have an adverse effect on the course of pregnancy, or the birth weight of the newborn infant. The role of spontaneous abortion is approximately the same as in the general population. The overall rate of mother-to-child transmission for HCV is 1.7% if the mother is known to be anti-HCV positive only. If the mother is known to be viraemic, that is HCV-RNA-positive, the rate is 4.3%. Co-infection with HIV increases the rate of mother-to-child transmission up to 19.4%. Numerous risk factors for vertical transmission have been studied. In general, high viral load defined as at least 2.5 x 106 viral RNA copies/ml, HIV coinfection and invasive procedures are the most important factors. Both Interferon and Ribavirin are contraindicated during pregnancy. Viral clearance prior to pregnancy would increase the likelihood that a woman remains non-viraemic in pregnancy with a consequent reduced risk of vertical transmission.

Recurrent miscarriage (RM), defined as the loss of ≥3 pregnancies affects 1% of the population. Maternal age and previous reproductive history are independent risk factors for this condition. Traditionally, the aetiology of RM has been divided into chromosomal, anatomical, endocrinological, infective, environmental and immunological causes. Approximately 40% of couples investigated will have unexplained RM as no putative cause will be found after routine investigation. In the last decade, thrombophilia has emerged as aetiology of RM. The evidence for a thrombotic basis for RM comes from (i) histological evidence of placental infarction and intervillus thrombosis in products of conception from women with RM; (ii) the primary antiphospholipid syndrome - an acquired thrombophilia and (iii) the discovery of genetic thrombophilic mutations in the last decade and their variable association with RM. Factor V Leiden, Prothrombin G20210A and Methylenetetrahydrofolate reductase (MTHFR) C677T are the most common genetic thrombophilic mutations known. More recently, the concept of fetal thrombophilia in the aetiology of adverse pregnancy outcome has emerged. This review addresses the evidence pointing towards thrombophilia as an aetiological factor in RM, available prospective data and the emerging concept of the role of fetal thrombophilia and its association with adverse pregnancy outcome.

Transvaginal ultrasound will detect an intrauterine pregnancy, first seen as a visible gestational sac, as early as four weeks and 3-4 days (day 31-32 of the cycle) after the last menstrual period. However, our knowledge of ultrasonically detectable endometrial changes before the gestational sac visualization is minimal. With the recent introduction of a three-dimensional (3D) ultrasound with the Virtual Organ Computer-aided Analysis (VOCAL) software, it has become possible to measure endometrial volume, which, because of the shape of the endometrial cavity, was not feasible before. Theoretically, endometrial volume in conception cycles may vary according to patients' parity, and status of pregnancy, whether it is normal or abnormal; but it should be increased in pregnant compared to non-pregnant patients. Several studies have been published, investigating the endometrial thickness and volume in the luteal phase of the conception cycle, and finding that the above-mentioned is true. Endometrium does seem to be thicker in conception compared to non-conception cycles, and in normal pregnancy compared to abnormal pregnancy. However, at present there is no enough data to confirm that endometrial volume measurement will be powerful tool in differential diagnosis of early normal and abnormal pregnancy.

The expected postmenopausal lifetime of women in the western world is about 30 years. Hormones, such as estrogen and progestogen, may affect the quality of postmenopausal life and have been well studied. Androgens act on numerous tissues in the body, however little is known about their biological function in women and the possible effects of androgen insufficiency on women's health. Testosterone in women derives from direct ovarian production or from peripheral conversion of adrenal androgen precursors. Therefore loss of adrenal or ovarian function results in androgen deficiency. Oophorectomy reduces half the levels of testosterone in serum and may be associated with sexual problems and a decrease in psychological well-being. Several studies show positive effects of testosterone treatment on psychosexual function and physical as well as psychological well-being in women. Androgens also have positive metabolic effects on bone and body composition. According to a Cochrane review in 2005 there is evidence that the addition of testosterone to estrogen/progestogen therapy has a beneficial effect on sexual function in postmenopausal women. For pre- and perimenopausal women evidence is lacking. However there was a significant reduction of high density lipoprotein (HDL) cholesterol associated with the addition of testosterone to estrogen/progestogen regimens. Current testosterone replacement options differ between countries and so far only the testosterone patch has been approved by EMEA (European Medicines Agency) in 2006 for the treatment of sexual dysfunction in oophorectomized women. However, the definition of female androgen insufficiency, as provided by the Princeton consensus statement is being debated because the lack of a well-defined clinical syndrome and normative data on serum testosterone levels across the life span. The clinical guideline by the endocrine society in 2006 were against generalized use of testosterone because the indications are inadequate and long-term safety studies are lacking. Currently, testosterone therapy should be reserved for women with androgen deficiency due to low serum androgen levels and matching clinical signs and symptoms.

The objective of this investigation was to determine the long-term survival and cost of treatment in patients with Stage IIIC epithelial ovarian cancer. Response to therapy, overall survival, and cost of treatment were analyzed in 100 patients with surgically staged IIIC epithelial ovarian cancer treated initially by tumor debulking, and at least 6 cycles of intravenous platinum/paclitaxel chemotherapy. Residual disease after surgical cytoreduction was > 1 cm in 52 pts, 1-2 cm in 18 pts, and < 2 cm in 30 pts. Sixty-six patients had platinum-sensitive ovarian cancers, and 34 had platinumresistant tumors. Chemotherapy response and patient survival were related to the volume of residual disease after surgical cytoreduction, and to platinum sensitivity of the tumor. Patient survival was 66% at 2 years and 30% at 5 years, but only 9% of patients were free of disease > 5 years after treatment. The average cost of treatment was $211,940 per patient and included hospital charges: $127,365 (60%), pharmacy charges: $57,597 (27%), and physician charges: $26,978 (13%). In conclusion, aggressive surgical debulking followed by platinum/paclitaxel chemotherapy is associated with increased survival of patients with Stage IIIC epithelial ovarian cancer. However, long-term disease-free survival (< 5 years) is limited, and the financial cost of treatment is significant.

Cryobiology is an essential part of In Vitro Fertilisation programs. Indeed, cryopreservation of human zygote or embryos from the early cleaved-cell stage up to the blastocyst stage is a safe procedure, which has been carried out for the last 25 years. Experience with blastocyst cryopreservation is still limited and pregnancy rates after the use of frozen, thawed blastocysts vary extremely. Recently, vitrification has showed to potentially improve the success of embryo cryopreservation, compared to the slow freezing procedure. However, this technique cannot yet be considered as a routine procedure. This review aims to answer the optimal stage of freezing human embryos.