This 1995 case was probably the first one with a pregnancy after repositioning of the ovaries in Europe and perhaps even in the world.
Abstract
Pregnancy after transposition and repositioning of the ovaries in a patient with clear-cell adenocarcinoma, Revue française de gynécologie et d’obstétrique, NCBI PubMed PMID: 8677407, 1995 Dec.
A young woman with a history of in utero exposure to distilbestrol was diagnosed with vaginal clear-cell adenocarcinoma. Management consisted of limited excision of the tumor followed by brachytherapy after transposition of the ovaries.
The patient had a successful pregnancy after reimplantation of the ovaries in their normal position and right adnexectomy for Chlamydia infection. The child was delivered by cesarean section.
This is probably the first case with a pregnancy after repositioning of the ovaries in Europe and perhaps even in the world.
Full examination of the DES-exposed pregnant patients is advised, including colposcopy and hysterosalpingography.
Abstract
Refocusing on the gynecological and obstetrical consequences of intrauterine exposure to diethylstilbestrol (DES), Nederlands tijdschrift voor geneeskunde, NCBI PubMed PMID: 1996166, 1991 Jan.
The oncological and obstetrical follow-up is described of 321 patients who presented between 1981 and 1988 in the St Radboud Hospital with a history of intrauterine diethylstilbestrol (DES) exposure.
In 45 out of 321 cases cytological abnormalities were found including 20 cases of cervical intraepithelial neoplasia (CIN). No relation could be established between CIN and the extension of the cervical adenosis.
Twenty-two percent of 87 evaluable pregnancies terminated in spontaneous abortion, 13 percent of the patients delivered immaturely and 27 percent prematurely. These percentages were significantly higher than in the rest of the hospital population.
The consequences of intrauterine exposure to DES are discussed. Full examination of the patients is advised, including colposcopy and hysterosalpingography. If abnormalities are present it is advised to offer a timelycerclage in case of pregnancy.
A cerclage in early pregnancy should be a strong consideration for some DES Daughters only ; routine cerclage placement is not recommended for all the DES affected.
Abstract
Cervical cerclage in early pregnancy, Journal of perinatology : official journal of the California Perinatal Association, NCBI PubMed PMID: 1919825, 1991 Sep.
A retrospective review of 33 patients who underwent transvaginal cervical cerclage for the treatment of an incompetent cervix from June 1984 through July 1987 was conducted. A total of 38 transvaginal cerclages were placed.
For the purposes of comparison, the patients were divided into three groups according to gestational age at the time of cerclage:
group 1 less than or equal to 13 weeks;
group 2 greater than 13 weeks, but less than 18 weeks;
group 3 greater than or equal to 18 weeks.
There was no difference among groups in mean age, gravidity, history of diethylstilbestrol exposure (DES), prior pregnancy loss at or before 20 weeks, or prior dilation and curettage procedure. There were 24 modified McDonald and 14 modified Shrodkar procedures performed.
The mean gestational age of cerclage placement in group 1 was earlier than in group 2 and group 3 by 3.5 and 10.5 weeks, respectively. There were no major surgical complications in any of the three groups.
The overall incidence of preterm labor and preterm birth were 48.6% and 37.8%, respectively. Analysis of variance demonstrated a trend toward differences in the incidence of preterm labor, preterm birth, and estimated gestational age at delivery, with the earlier group favored. None of these, however, reached the level of statistical significance.
Estimated blood loss, obstetric complications, mean birthweight, and mean gestational age at delivery were not statistically different for the three study groups.
The above data are discussed and support given for the safety and efficacy of cervical cerclage placement in early pregnancy when compared with the more standard recommendations of placement at from 14 to 17 weeks’ gestational age.
This 1990 study concluded that implantation and pregnancy outcome are impaired in DES-exposed women after Iin vitro fertilization.
Abstract
Are implantation and pregnancy outcome impaired in diethylstilbestrol-exposed women after in vitro fertilization and embryo transfer? Fertility and sterility, NCBI PubMed PMID: 2379627, 1990 Aug.
Forty-six infertile women with a history of diethylstilbestrol (DES) exposure in utero underwent 149 stimulation attempts for in vitro fertilization (IVF). The mean (+/- SE) number of preovulatory oocytes harvested at retrieval and transferred was 3.9 +/- 3.3 (536/138) and 2.6 +/- 1.4 (328/124).
When compared with patients with tubal factor infertility and less than or equal to 4 pre-embryos transferred, the clinical pregnancy rate (15.3% versus 22%) was not statistically different. However, the term/ongoing pregnancy rate was significantly lower in the study group (8% versus 16%). Comparison of the IVF outcome with different uterine anomalies as detected by hysterosalpingogram (n = 29) showed a trend for a worse prognosis in women with constrictions and a combination of T-shape and constrictions.
It is concluded that implantation and pregnancy outcome are impaired in DES-exposed women after IVF.
Knowledge of the ultrasound criteria for diagnosing cervical incompetency is required.
Abstract
Ultrasound surveillance of the cervix during pregnancy in diethylstilbestrol-exposed offspring, Obstetrics and gynecology, NCBI PubMed PMID: 2643065, 1989 Feb.
Twenty-three diethylstilbestrol (DES)-exposed patients were evaluated through 27 pregnancies to determine their eligibility for admission to a prospective protocol that combined serial ultrasound surveillance of the lower uterine segment-cervical complex with periodic pelvic examinations to diagnose cervical incompetency.
Of these, 21 pregnant women, including seven vaginectomy patients, were matched to 84 low-risk controls to determine the following:
the effect of DES exposure on reproductive performance,
the efficacy of ultrasound selection of cerclage candidates,
and the influence of previous partial vaginectomy on reproductive outcome.
Five DES-exposed patients were diagnosed as having cervical incompetency and had cerclages placed. There were no missed diagnoses of cervical incompetency.
The DES-exposed patients delivered statistically earlier in gestation than did controls (268 +/- 13 versus 276 +/- 10 days). It was not evident that this difference was important clinically, as there were no neonatal deaths, very low birth weight infants, second-trimester losses, or deliveries before 252 days (36 weeks) among the study patients.
Previous vaginectomy did not affect the frequency of the diagnosis of cervical failure or the neonatal outcome. After ultrasound surveillance and treatment for incompetent cervix, a majority of our patients delivered at term without cerclage placement. Therefore, routine cerclage placement is not recommended.
Knowledge of the ultrasound criteria for diagnosing cervical incompetency is required.
A comparison of the DES-exposed pregnancy experience in France and in the United States, by the CNGOF – Collège National des Gynécolgues et Obstétriens Français.
Abstract
Outcome of pregnancy in patients exposed in utero to diethylstilbestrol. Survey by the National College of French Gynecologists and Obstetricians, Journal de gynécologie, obstétrique et biologie de la reproduction, NCBI PubMed PMID: 3294279, 1988.
This study analyses the outcome of 110 pregnancies that occurred in 57 patients who were exposed to DES (DiEthylStilboestrol) during their fetal life.
The quantities of Distilbene that were received in the first trimester of the pregnancy were the same in France and in the United States.
The obstetrical complications of exposure in utero to DES were identically the same in France and in the United States.
Of particular note is the high level of extra-uterine pregnancies (15%)
and of 1st and 2nd trimester miscarriages (42%).
Only 41% of the population exposed to DES delivered a live baby.
It is estimated that 80,000 women were exposed to it in France. Exposure in utero to DES has given rise to a public health problem.
Both exposed women and their physicians should be aware of the possible relationship between maternal exposure to DES and late adverse outcomes of pregnancy
Abstract
Adverse outcomes of pregnancy in women exposed to diethylstilbestrol in utero, The Journal of reproductive medicine, NCBI PubMed PMID: 3351803, 1988 Jan.
We analyzed data collected by interview and medical record review for 200 women exposed to diethylstilbestrol (DES) and 12,240 unexposed women to evaluate the relation between maternal DES exposure and outcomes of pregnancy.
Low birth weight, short gestation, bleeding in the first trimester, toxemia, breech presentation and premature rupture of the membranes occurred more often among the exposed women.
These relationships remained statistically significant after the use of linear regression and logistic regression analyses to control for multiple confounding factors.
Both exposed women and their physicians should be aware of the possible relationship between maternal exposure to DES and late adverse outcomes of pregnancy. Close medical supervision of these women throughout pregnancy and delivery is recommended.
This GIFT reproductive technique, tested here in 1988, may prove to be an effective treatment for some of the DES-exposed women.
Abstract
Pregnancy after gamete intrafallopian transfer in a woman with primary infertility and in utero exposure to diethylstilbestrol. A case report, The Journal of reproductive medicine, NCBI PubMed PMID: 3290479, 1988 May.
In utero exposure to diethylstilbestrol (DES) has an adverse effect on reproductive performance and may be associated with infertility.
Gamete intrafallopian transfer (GIFT) is a new reproductive technique that has been advocated as an alternative to in vitro fertilization in women with at least one normally functioning fallopian tube. The process involves the translaparoscopic placement of oocytes and sperm into the fallopian tube. The technique has been successful in treating infertility due to endometriosis, male factors and immunologic factors as well as unexplained infertility.
We accomplished the first successful GIFT procedure in a woman with significant uterine effects from prenatal DES exposure. This technique may prove to be an effective treatment for infertile women with DES exposure who have no adequate explanation for their infertility.
This 1987 study said that the placement of a cerclage early in pregnancy should be a strong consideration for DES Daughters. Pregnant Wife.
Abstract
Management of the diethylstilbestrol-exposed pregnant patient: a prospective study, American journal of obstetrics and gynecology, NCBI PubMed PMID: 3631167, 1987 Sep.
Over a 5-year period we have managed 63 diethylstilbestrol-exposed pregnant patients with a standardized protocol requiring weekly cervical examination and decreased physical activity of the patient.
Twenty-six patients (42%) underwent a prophylactic cerclage for a history of second-trimester loss or a hypoplastic cervix on initial clinical examination (group I).
Thirty-six patients (58%) were followed expectantly (group II).
Sixteen patients (44%) in group II demonstrated cervical change and required an emergency cerclage.
Twenty-one patients were managed expectantly with no cerclage.
The gestational age at delivery for group I was 37.7 +/- 2.80 versus 34.5 +/- 6.9 weeks for patients without a cerclage (p = 0.04).
There were no perinatal deaths if a cerclage was performed, whereas there were five deaths (24%) in the group without cerclage.
The five deaths occurred at a mean gestational age of 24.40 +/- 4.0 weeks and a mean birth weight of 614.00 +/- 441.73 gm.
Patients with a hypoplastic cervix or prior reproductive loss had a better outcome with early cerclage than patients with a normal cervix followed expectantly.
We presently lack a reliable method to detect the diethylstilbestrol-exposed patient at greatest risk for perinatal loss. Based on our experience we believe that placement of a cerclage early in pregnancy should be a strong consideration.
There were four pregnancies in 17 patients after 21 cycles of embryo transfers, for a pregnancy rate of 23.5% per patient, or 19% per embryo transfer.
Abstract
Experience with diethylstilbestrol-exposed infertile women in a program of in vitro fertilization, Fertility and sterility, NCBI PubMed PMID: 6724012, 1984 Jul.
Twenty infertile women with a history of diethylstilbestrol exposure in utero were seen in Norfolk for the purpose of in vitro fertilization.
Seventeen patients had undergone 25 stimulated cycles with harvest of oocytes by laparoscopy. The serum estradiol response to stimulation in these patients and the number and quality of oocytes retrieved did not differ significantly from those of patients with infertility due to blocked fallopian tubes.
There were four pregnancies in 17 patients after 21 cycles of embryo transfers, for a pregnancy rate of 23.5% per patient, or 19% per embryo transfer.
Two of the pregnant patients have had a term delivery,
one has had a preclinical abortion,
and one has a single intrauterine gestation in progress.
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