| Current
Women's Health Reviews
ISSN: 1573-4048
Current Women’s Health
Reviews
Volume 1, Number 1, January 2005
Contents
Three-Dimensional Ultrasound in Gynecology: Current
Status and Future Perspectives Pp.1-14
Juan Luis Alcazar
[Abstract] [Full
text article]
New Actors for the Immunological Mechanisms
Involved in the Materno-Fetal Tolerance Pp.15-20
Rosanna E. Ramhorst and Leonardo Fainboim
[Abstract] [Full
text article]
Induced Abortion and Increased Risk of Substance
Abuse: A Review of the Evidence Pp.21-34
Priscilla K. Coleman
[Abstract] [Full
text article]
Toll-Like Receptors in the Cycling Female Reproductive
Tract and During Pregnancy Pp.35-42
Vikki M. Abrahams
[Abstract] [Full
text article]
Twin-to-Twin Transfusion Syndrome: Diagnosis and
Treatment Pp.43-47
Bettina Paek and Laurence E. Shields
[Abstract] [Full
text article]
Follicular Immunology Environment and the Influence
on In Vitro Fertilization Outcome Pp.49-60
Sanja Vujisic and Snjezana Zidovec
[Abstract] [Full
text article]
What Characterizes Endothelial Dysfunction in
Preeclampsia? –The Action of NO and the Production of
Prostacyclin is Reduced, While EDHF is Preserved in Omental
Resistance Arteries in Preeclamptic Women Pp.61-65
Yoshikatsu Suzuki, Tamao Yamamoto, Yoshimasa Watanabe
and Takeo Itoh
[Abstract] [Full
text article]
Implications for Endothelium-Derived Hyperpolarizing
Factor (EDHF) in Women’s Cardiovascular Health Pp.67-78
Leonid Luksha and Karolina Kublickiene
[Abstract] [Full
text article]
Cervical Cancer Prevention: More than Just a Pap
in a Diverse Urban Community Pp.79-83
Josephine R Fowler and Raja Sayegh
[Abstract] [Full
text article]
Elective Cesarean Section- the Right Choice for
Whom? Pp.85-88
H.P. Dietz
[Abstract] [Full
text article]
Abstracts
[Back to top]
Three-Dimensional Ultrasound in Gynecology: Current
Status and Future Perspectives
Juan Luis Alcazar
[Full text
article]
Three-dimensional ultrasound (3D US) is a new imaging modality,
which is being introduced into clinical practice. Although
this technique is unlikely to replace two-dimensional ultrasound,
it is being increasingly used. It has been reported that 3D
US is a high reproducible technique which has many applications
in the field of Gynecology, as supported by a steady increase
in the number of papers published in this area in the last
few years. These applications include: imaging of the uterus,
uterine cavity, adnexa and pelvic floor, as well as very interesting
applications using threedimensional power-Doppler ultrasound.
The aim of this work is to address some technical aspects
of 3D US, to review critically its current status in clinical
practice, and to project future perspectives of its use.
[Back to top]
New Actors for the Immunological Mechanisms Involved
in the Materno-Fetal Tolerance
Rosanna E. Ramhorst and Leonardo Fainboim
[Full text
article]
Tolerance to the semi-allogeneic fetal graft by the maternal
immune system is the consequence of a wide panel of mechanisms
that may be interconnected. In the present work we discuss
the participation of new actors that might contribute to the
materno-fetal tolerance and their involvement in the failure
of a successful pregnancy occurring in patients with recurrent
spontaneous abortions (RSA). The presence of blocking factors
(BF) of the maternal allogeneic response in the sera of fertile
women is usually associated with a successful pregnancy. In
this context, Galectin-1 (a β-galactoside-binding
protein expressed at sites of T-cell activation and immune
privilege) and RANTES (regulated on activated normal T cells,
expressed and secreted) are able to immunosuppress the allogeneic
response. This effect induces a significant increase of the
apoptosis of CD45R0+ cells and is accompanied by
caspases activation and Bcl-2 down regulation.
Moreover, trying to identify reliable markers for RSA diagnosis,
we investigated some activation markers like CD69 (an early
activation marker), SLAM (signaling lymphocytic activation
molecule) and the pattern of Th1/Th2 cytokine expression in
the preimplantation endometrium and in the peripheral blood
from fertile and RSA women.
Finally, as a treatment for RSA patients, we evaluated the
effectiveness of the alloimmunization, with paternal leukocyte
and investigated the immunomodulation induced by this treatment
on RANTES, and the subpopulations of CD3+CD69+
and CD3+SLAM+ T cells in RSA patients.
[Back to top]
Induced Abortion and Increased Risk of Substance Abuse: A
Review of the Evidence
Priscilla K. Coleman
[Full text
article]
Research conducted over the last few decades has revealed
an association between induced abortion history and substance
abuse. The experience of induced abortion may be associated
with psychological discomfort in some women and substance
use offers a convenient remedy for alleviating the negative
emotions without the necessity of disclosing the source of
the discomfort. On the other hand, many characteristics related
to the choice to abort are also systematically related to
the likelihood of using substances (e.g., relationship difficulties,
pre-existing emotional problems, a tendency to engage in risk-taking
behavior, etc.) and the correlations observed in the literature
may be due to the presence of uncontrolled third variables.
Therefore, the general purpose of this review is to critically
evaluate the available evidence linking induced abortion and
substance abuse with sensitivity to the contextual complexity
of both variables. Specific objectives include the following:
1) provision of an overview of substance use disorders in
women, 2) review of evidence for a causal model, highlighting
methodological deficiencies in the published literature, 3)
identification of process mechanisms (direct and indirect)
through which induced abortion may enhance risk for substance
abuse, 4) provision of recommendations for further research,
and 5) consideration of practice implications of the available
findings.
[Back to top]
Toll-Like Receptors in the Cycling Female Reproductive Tract
and During Pregnancy
Vikki M. Abrahams
[Full text
article]
For many years it was thought that the female reproductive
tract was a sterile environment, devoid of immune cells or
pathogens. We now know that the immune system represents an
important component of reproductive tissues, influencing many
of its biological functions. Similarly, bacteria are present
within the female reproductive tract as a normal component.
Therefore, the female reproductive tract must promote a certain
level of host protection against pathogens whilst maintaining
commensal flora, in addition to facilitating normal menstrual
cycling, successful fertilization and implantation. Furthermore,
during pregnancy, the human endometrium becomes an immunologically
unique site that again, must maintain host defense against
an array of microbial pathogens, but must also sustain the
semiallogeneic fetus and placenta. In addition to the cells
of the immune system, the mucosal epithelium of the female
reproductive tract, as well as tissues of the maternal-fetal
interface, may actively participate in the control of pathogens,
however, the precise mechanisms by which this occurs are poorly
understood. Toll-like receptors (TLR) are key components of
the innate immune system which recognize conserved sequences
on the surface of microorganisms and trigger effector cell
functions. We and others have shown the expression of Toll-like
receptors in epithelial cells of female reproductive tissues
and at the maternal-fetal interface, suggesting that these
specialized cells can recognize and respond to the presence
of microorganisms and coordinate an immune response. Clinical
studies have shown a strong association between intrauterine
infections and fertility problems as well as certain pregnancy
complications. Therefore, innate immune responses within the
female reproductive tract against microorganisms may have
a significant impact on implantation and on the success of
a pregnancy. This review will discuss the role of Toll-like
receptors in the normal cycling female reproductive tract
and at the maternal-fetal interface during pregnancy.
[Back to top]
Twin-to-Twin Transfusion Syndrome: Diagnosis and Treatment
Bettina Paek and Laurence E. Shields
[Full text
article]
Almost all monochorionic twin pregnancies have a shared placental
circulation. Twenty-five percent of these have an imbalance
of blood flow leading to chronic shunting of blood from one
twin to the other. Severe Twin-to-Twin Transfusion Syndrome
(TTTS) develops in up to half of these pregnancies. Prenatal
diagnosis relies on findings of oligo/anhydramnios with a
decompressed bladder in the donor twin and polyhydramnios
and full bladder in the recipient twin. Progressive decompensation
is manifested as increasing polyhydramnios leading to preterm
delivery, measurable changes in umbilical artery and ductus
venosus Doppler velocimetry, fetal hydrops and eventually
demise. Historically outcomes without treatment have been
poor with a perinatal survival around 10% to 20% with a rate
of neurological damage of 20-40% in survivors. Traditionally,
treatment has involved repeated reduction amniocenteses to
delay early delivery due to polyhydramnios. Lasering of communicating
placental vessels has emerged as a new treatment option. A
recent randomized controlled trial in Europe comparing endoscopic
laser surgery with serial amnioreduction demonstrated an increased
perinatal survival, higher gestational age at delivery and
a better neurological outcome at 6 months of age in those
fetuses randomized to treatment by laser. Endoscopic laser
surgery for TTTS is currently only offered at select centers
and its technique is still evolving and is the subject of
a large multicenter NIH sponsored randomized trial in the
United States. Research investigating the use of therapeutic
ultrasound for non-invasive coagulation of communicating placental
vessels may provide new treatment options in the future.
[Back to top]
Follicular Immunology Environment and the Influence
on In Vitro Fertilization Outcome
Sanja Vujisic and Snjezana Zidovec
[Full text
article]
The influence of the immune system on ovarian physiology
has been extensively studied. A large number of studies evaluated
the association between different immunological parameters
and follicle development, ovulation, luteinization, oocyte
quality and fertilization. Numerous cytokines and lymphocyte
subpopulations present in the follicular fluid or the surrounding
tissue have been evaluated as possible predictors of in
vitro fertilization-embryo transfer procedure outcomes.
The purpose of this review is to provide a brief summary of
the extensive literature dealing with cytokines, lymphocyte
subpopulations and immunoglobulins in the follicular fluid
and to discuss the possible contribution of cellular and humoral
immunity to the reproduction in general.
[Back to top]
What Characterizes Endothelial Dysfunction in Preeclampsia?
–The Action of NO and the Production of Prostacyclin
is Reduced, While EDHF is Preserved in Omental Resistance
Arteries in Preeclamptic Women
Yoshikatsu Suzuki, Tamao Yamamoto, Yoshimasa
Watanabe and Takeo Itoh
[Full text
article]
Vascular endothelial cells release vasorelaxing factors (endothelium-derived
relaxing factor; EDRF), such as nitric oxide (NO), prostacyclin
and endothelium-derived hyperpolarizing factor (EDHF), and
these play an important role in the regulation of vascular
tone, vascular permeability and blood coagulation, thus helping
to maintain circulatory homeostasis.
Preeclampsia is characterized by marked increases in peripheral
vascular resistance and vascular permeability together with
a disturbance of blood coagulation. It has been suggested
that an abnormality in the role played by EDRF in resistance
arteries may be involved in the pathogenesis and/or development
of preeclampsia.
In vitro investigation of characteristic changes
in preeclampsia using vascular strips of omental resistance
artery obtained from preeclamptic women, revealed that; 1)
the action of endothelial NO is reduced not due to decrease
in the production of NO in the endothelium but rather to reduced
action of guanosine-3’,5’-cyclic monophosphate
(cGMP; a second messenger of NO) itself and/or downstream
of cGMP, 2) reduced production of prostacyclin in endothelium
and, 3) reservation of EDHF action. Taken together, it was
suggested that EDHF might compensate for both the reduced
action of endothelial NO and the reduced production of prostacyclin
in resistance arteries. In this review the new observation
of functional changes in endothelium seen in preeclampsia
is important information of obstetricians.
[Back to top]
Implications for Endothelium-Derived Hyperpolarizing
Factor (EDHF) in Women’s Cardiovascular Health
Leonid Luksha and Karolina Kublickiene
[Full text
article]
Several clinical conditions related to women’s cardiovascular
health strongly correlates with endothelial dysfunction, which
is conventionally associated with alterations in synthesis,
release or bioavailability of endotheliumderived nitric oxide
(NO). Current review pays attention to rapidly growing evidence
about the importance of Endothelium-Derived Hyperpolarizing
Factor (EDHF). EDHF-mediated action is pertinent to resistance
circulation where EDHF overcomes NO contribution, while in
large conduit vessels endothelium-dependent dilatation is
predominantly conferred by NO. This indicates that changes
in synthesis, release, or pharmacological manipulation of
EDHF is of critical importance in the maintenance of organ
perfusion, peripheral resistance and blood pressure, the disturbances
in which distinctively predispose the development of cardiovascular
disorders. This review describes current knowledge about EDHF,
including nature and characterization of its action, alterations
in the mechanisms of EDHF contribution to endothelium-dependent
relaxation with particular focus on preeclampsia, gender differences
and cardiovascular complications after menopause. The distinction
in the relative contribution of NO versus EDHF and estrogen-related
regulation of EDHF-mediated responses are highlighted. The
indications that EDHF-mediated response accounts for different
chemical mediator or electrical transmission depending on
species, vascular bed and healthy or diseased condition are
discussed paying attention to women’s cardiovascular
health and future therapeutic implications.
[Back to top]
Cervical Cancer Prevention: More than Just a Pap in a Diverse
Urban Community
Josephine R Fowler and Raja Sayegh
[Full text
article]
Cervical cytologic screening and early management of abnormal
pap smears played an important role in reducing invasive cervical
cancer incidence and mortality over the past decades. Despite
widely available cost effective screening for cervical cancer
in the United States, women in lower socioeconomic groups
and minorities continue to suffer from a higher incidence
and mortality from cervical cancer and national goals have
not been met. The biological, psychosocial, and cultural barriers
that contribute to these disparities will be reviewed. This
article also reviews current screening methodologies, treatment
algorithms and newer developments that hold additional promise
for the future of cervical cancer prevention.
[Back to top]
Elective Cesarean Section- the Right Choice for Whom?
H.P. Dietz
[Full text
article]
Cesarean section rates continue to rise. Reasons include
changing demographics, altered clinical practice, and an increasing
awareness of traumatic childbirth amongst the public, resulting
in the phenomenon of ‘Cesarean Section on demand’.
Obstetricians are involved in an increasingly acrimonious
discussion, without having access to data that would allow
true ‘informed consent’ regarding the choice of
delivery mode. There are no scientific grounds for identifying
an ‘appropriate’ level for Cesarean section rates,
and no data to help us in counselling women who ask for elective
Cesarean delivery.
A ‘Term Cephalic Trial’ may provide such information,
but poses major logistic and ethical challenges. The key to
a successful resolution of this issue may lie in individualized
risk assessment. This has now become possible. Maternal age,
a history of Cesarean Section in the parturient’s mother,
maternal body mass index, cervical length and/ or Bishop score,
pelvic organ mobility and engagement of the fetal head are
some of the factors that have recently been shown to be associated
with delivery mode in nulliparous women.
Individual risk assessment may soon allow us to construct
intervention trials that will be ethically sound, logistically
feasible and resource- neutral. Even more importantly, we
may eventually be able to provide true ‘informed consent’
to women considering elective Cesarean delivery.
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