| Current
Women's Health Reviews
ISSN: 1573-4048
Current Women’s Health
Reviews
Volume 3, Number 4, November 2007
Contents
Recurrent Pregnancy Losses Pp. 217-227
Murat Ulukus and Aydin Arici
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Preeclampsia: Placental Origins, New Predictors and
New Therapeutic Strategies Pp. 228-234
Berthold Huppertz and Bruce B. Feinberg
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Issue/Articles]
Cholestasis During Pregnancy: Aetiopathogenesis, Foetal
Maternal Repercussions and Pharmacological Treatments
Pp. 235-247
Jose J.G. Marin, Rocio I.R. Macias, Oscar Briz, Maria
J. Perez, Alba G. Blazquez, Marco Arrese and Maria A. Serrano
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Malformations of the Female Genital Tract and Embryological
Bases Pp. 248-288
Pedro Acién and Maribel Acién
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Causes of Impaired Fertility in Women with Polycystic
Ovary Syndrome Pp. 289-292
Eric D. Levens and Alan H. DeCherney
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Abstracts
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Recurrent Pregnancy Losses
Murat Ulukus and Aydin Arici
Recurrent pregnancy loss is classically described as three
or more consecutive miscarriages occuring before the 20th
weeks of gestation. The overall incidence of spontaneous miscarriage
varies between 15% and 25%, whereas recurrent miscarriage
affects around 1% of fertile couples. First trimester losses
consist of 75% of recurrent miscarriages and second trimester
losses the remaining 25%. Genetic, anatomical, endocrine,
immune, infective and environmental factors are believed to
play important roles in the pathophysiology of recurrent pregnancy
losses. However, the majority of recurrent miscarriage cases
are idiopathic and no identifiable cause is found. In this
review we aim to summarize the identifiable causes of recurrent
pregnancy losses and discuss the current treatment modalities.
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Preeclampsia: Placental Origins, New Predictors and
New Therapeutic Strategies
Berthold Huppertz and Bruce B. Feinberg
The multifactorial etiology of preeclampsia is contrasted
by the fact that at the same time the presence of the placenta
is a prerequisite for its development. Preeclampsia is related
to a failure of the differentiation pathway of the villous
trophoblast leading to an abnormal release of material into
the maternal circulation. These factors shed from the placenta
are involved in finally causing an inflammatory response of
the mother. But the underlying cause and the developmental
changes within the placenta leading to the placental dysfunction
are unclear. Here we want to shed light on putative placental
origins of preeclampsia, new markers that may be able to predict
this syndrome already in the first trimester of pregnancy,
and new strategies for putative therapeutics. These new therapies
may be used to reduce the severity of the syndrome or even
to stop the development of the clinical symptoms. Preeclampsia
is a disease of placentation with a cause somewhen very early
in gestation and the maternal systemic inflammatory response
is the subject of clear debate and has led to the proposal
of new treatment paradigms.
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Cholestasis During Pregnancy: Aetiopathogenesis, Foetal
Maternal Repercussions and Pharmacological Treatments
Jose J.G. Marin, Rocio I.R. Macias, Oscar Briz, Maria
J. Perez, Alba G. Blazquez, Marco Arrese and Maria A. Serrano
The lack of elimination of potentially toxic compounds due
to impaired bile formation by the maternal liver results in
deleterious effects for the trio formed by the foetal liver,
the placenta and the maternal liver, which constitutes a key
excretory pathway during gestation. One of the most frequent
causes of this condition is intrahepatic cholestasis of pregnancy
(ICP). This is a pregnancy-specific disorder that mainly occurs
during the third trimester of pregnancy and is characterised
primarily by pruritus, altered serum levels of liver enzymes
and, less frequently, jaundice. ICP has been associated with
spontaneous preterm labour and increased foetal morbidity
and mortality. Although the pathogenesis of the disease remains
obscure, significant advances have been made. These include
the investigation of the repercussions of the accumulation
of biliary compounds on the structure and function of the
foetal liver, the placenta and the maternal liver. The present
review provides an overview of current information on this
topic as well as on the pharmacological remedies used to treat
these patients.
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Malformations of the Female Genital Tract and Embryological
Bases
Pedro Acién and Maribel Acién
Female genital tract malformations are frequently a cause
of reproductive problems. Besides, complex malformations also
frequently generate serious gynecological problems, often
ones with inappropriate surgical solutions, as the gynecologist
does not think of the malformation as either the cause of
the symptoms or of its embryonary origin. Apart from analyzing
the embryological bases in the development of the female genital
tract and insisting on the well known müllerian origin
of the uterus, the ratification of the embryological hypothesis
about the origin of the human vagina from the Wolff ducts
and the Müller tubercle allows us to not only advance
in knowledge but to use that knowledge for better clinical
management of the problems generated by the complex malformations
of the female genital tract.
In this review we study the methods and means for the diagnosis
of female genital-urinary malformations, their classification
and clinical findings, and especially those cases involving
unilateral renal agenesis, vaginal ectopic ureter and other
complex malformations. We also analyze the related obstetric
and gynecologic pathology, and especially that cases of complex
genital malformations. We review the related literature and
some interesting case reports, as well as our experimental
studies in rats. After re-asserting our hypothesis about the
embryology of the human vagina as derived from the Wolff ducts
and the Müller tubercle, we suggest different recommendations
for a better approach and management of the malformations
of the female genital tract according to the findings observed
in different diagnostic procedures.
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Causes of Impaired Fertility in Women with Polycystic
Ovary Syndrome
Eric D. Levens and Alan H. DeCherney
Objective: To review recent literature regarding
the potential causes of impaired fertility in women with polycystic
ovary syndrome.
Design: Medline review and cross-reference
of published literature.
Results: The underlying pathophysiology of
polycystic ovary syndrome has significant negative impact
on reproductive potential. Yet no single pathogenic alteration
can completely account for its negative reproductive impact.
Excessive LH secretion increases the follicular androgen concentration
and in combination with hyperinsulinemia alters the follicular
fluid microenvironment. These endocrine aberrations may result
in a reduction in oocyte quality.
Conclusion: Infertile PCOS patients have
unique alterations in the underlying physiology that results
in impaired fertility. Recent data from ART cycles is leading
to an improved understanding of the underlying abnormalities
and may direct future therapy to improve reproductive outcomes
among these patients.
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