Object

Title: Estimation of obstetric historyk women treated because of endometriosis

Abstract:

Endometriosis is disease, which name was proposed and defined in 1921 by Sampson. Endometriosis is the presence of ectopic tissues, witch have structure and function of uterine endometrium. The most wildly used classification is classification of American Fertility Society - AFS created in 1979 and modified in 1985 - rAFS. Endometriosis is occurring in 10% women in reproductive period. Statistical data indicate that endometriosis is most often surgical disease and main cause of pain in pelvis minor and infertility in women in reproductive period. Endometriosis was discovered in women aged from 10,5 to 76 years. Clinical signs joined with endometriosis depend most from localization and biological activity of disaease. Typical clinical signs are: dysmenorrhea, pelvipathia vegetativa, dyspareunia and sterility. Ineffective reproductive function of woman and man can depend on difficulty or impossibility to fertilize and implant of oocyte (sterility) and impossibility to carry to term and deliver health baby (infertility). Sterility in marriage is diagnosed after one year of normal coition. It’s accepted, that about 15-20% marriages are sterile. Fertility disturbance in female partner is responsible in 50% for marital sterility. Endometriosis may result in subfertility for a variety of reasons. Folliculogenesis is often impaired, especially in advanced stage endometriosis. Po ; or quality oocytes may subsequently compromise both fertilization and implantation rates. Both the inflammatory follicular fluid and peritoneal fluid milieu may also contribute fertilization/implantation defects. Nowadays good quality oocytes, especially in patients with advanced endometriosis can help to overcome the defects here described. Endometriosis concerns about 15% of fertile women and to 50% of infertile women. Endometriosis seems to be related to spontaneous abortions. The aim of my work is to estimate obstetric history in women treated because of endometriosis dependent on: a. stage according to rAFS -I and II -III and IV b. localization -peritoneal endometriosis -ovarian endometriosis -rectovaginal endometriosis c. form -endometrioid cyst -endometriosis focuses on the ovary and other organs in the pelvis According to Ulcova -Gallova et al. patients with lesions of endometriosis stage I-II have more antoantibodies to antigens relevant to reproduction than those with stage III-IV. They investigated the humoral immune response in the women with endometriosis in serum and peritoneal fluid. They compared 7 (seven) antiphospholipid antibodies (aPLs) against cardiolipin, L-phosphatidyl-serine, ph- glycerol, ph-inositol, ph-ethanolamine, phosphatidic (ph)-acid, against beta2-glycoprotein I and antizona pellucida antibodies (aZP), sperm antibodies. Endometriosis I-II were ; associated with higher serum and peritoneal fluid levels of aPLs against inositol, cardiolipin, ethanolamine, and beta2-glycoprotein I. Forty five percent of patients were positive for aZPA. In my group of patients: 1. infertility rate was statistical significant higher in patients with stage I-II (55%) than III-IV (22%) 2. nullipara rate was higher in patients with stage I-II (70%) than III- IV (56%) but the difference was not statistical significant 3. number of pregnancy in patients with stage III-IV (0,75+7-1,00) was higher then in stage I-II (0,54+/-0,71) but the difference was not statistically significant 4. spontaneous abortion rate in patients with stage I-II (40%) was statistical significant higher than with III-IV (17%). Peritoneal endometriosis , the different aspects (black, red and white) of which represent distinctive steps in evolutionary process, can be explained by the transplantation theory. Red lesions are the most active and most highly vascularised lesions and are considered to be the first stage of peritoneal endometriosis. Celomic metaplasia of invaginated epithelial inclusions could be responsible for the development of ovarian endometriosis. The epithelium covering the ovary, which originally derive from the celomic epithelium, has great metaplastic potential and provokes epithelial inclusion cysts by invagination. Under the influence of unknown grow ; th factors, these inclusions could be transformed into intraovarian endometrosis by metaplasia. The rectovaginal endometriotic nodule is an adenomyotic nodule whose histopathogenesis is not related to the implantation of regurgitated endometrial cells but to metaplasia of mullerian remnants located in the rectovaginal septum. Metaplastic changes of mullerian rests into endometriotic glands involving the rectovaginal septum are responsible for the proliferation of the smooth muscle, creating an adenomyomatous appearance similar to that of adenomiosis in the endometrium. In my group of patients: 1. infertility rate in patients with peritoneal endometriosis (66%) was statistical significant higher than with ovarian endometriosis (24%) and rectovaginal endometriosis (23%); infertility rate in patients with ovarian and rectovaginal endometriosis were similar 2. nullipara rate in patients with peritoneal endometriosis (89%) was statistical significant higher than with ovarian endometriosis (55%) and rectovaginal endometriosis (38%); nullipara rate in patients wiyh ovarian endometriosis was higher than with rectovaginal endometriosis but the difference was statistical not significant 3. number of pregnancy in patients with peritoneal endometriosis (0,34+/-0,64) was statistical significant lower than with ovarian (0,75+/-1 ,00) and rectovaginal endometriosis (0,92+/-0,95); number of pr ; egnancy in patients with ovarian endometriosis was lower than with rectovaginal endometriosis but the difference was not statistical significant 4. spontaneous abortion rate in patients with peritoneal endometriosis (58%) was statistical significant higher than with ovarian endometriosis (22%), in patients with rectovaginal endometriosis there was no spontaneous abortion. Comparing immunohistological studies of endometrial focuses and cysts sugest, that different genes are involved in development of these two forms. In my group of patients: 1. infertility rate in patients with endometriosis focuses (54%) was statistical significant higher than in patients with cysts (18%) 2. nullipara rate in patient with endometriosis focuses (65%) was higher than in patients with cysts (55%) but the difference was not statistical significant 3. pregnancy rate in patients with endometriosis focuses (0,54+/-0,72) was lower than in patients with cysts (0,78+/-1,03) but the difference was not statistical significant 4. spontaneous abortion rate in patients with endometriosis focuses (40%) was statistical significant higher than in patients with cysts (14%). Endometriosis does not appear to influence the outcome of pregnancy among those who manage to conceive. There are little data on obstetric outcome women with endometriosis. Kortelahti et al (2003) compared the course and outcome of pregnancy ; in 137 women with endometriosis and equal number of matched controls. In the study group in comparison with controls the results showed no significant differences in reproductive risk factors between the two groups. The course and outcome of pregnancy were similar in both grups. They suggest, that there is no need for increased fetal surveillance in women with endometriosis, what my data confirm.

Place of publishing:

Kraków

Level of degree:

2 - studia doktoranckie

Degree discipline:

ginekologia ; położnictwo

Degree grantor:

Wydział Lekarski

Promoter:

Klimek, Marek

Date issued:

2005

Identifier:

oai:dl.cm-uj.krakow.pl:1217

Call number:

ZB-102109

Language:

pol

Access rights:

nieograniczony

Object collections:

Last modified:

Apr 20, 2022

In our library since:

Nov 21, 2012

Number of object content hits:

811

Number of object content views in PDF format

1

All available object's versions:

http://dl.cm-uj.krakow.pl:8080/publication/1217

Show description in RDF format:

RDF

Show description in OAI-PMH format:

OAI-PMH

Edition name Date
ZB-102109 Apr 20, 2022
×

Citation

Citation style:

This page uses 'cookies'. More information