The hypothalamic-pituitary-ovarian (HPO) axis is a tightly regulated system controlling female reproduction. HPO axis dysfunction leading to ovulation disorders can be classified into three categories defined by the World Health Organization (WHO). Group I ovulation disorders involve hypothalamic failure characterized as hypogonadotropic hypogonadism. Group II disorders display a eugonadal state commonly associated with a wide range of endocrinopathies. Finally, group III constitutes hypergonadotropic hypogonadism secondary to depleted ovarian function. Optimal evaluation and management of these disorders is based on a careful analysis tailored to each patient. This article reviews ovulation disorders based on pathophysiologic mechanisms, evaluation principles, and currently available management options.
INTRODUCTION:
Chronotype or circadian propensity to be a “morning person” or “evening person” has been predictive of adverse health outcomes in the non-pregnant population. Unfortunately, data regarding chronotype and pregnancy complications including diabetes and hypertension remain limited.
METHODS:
IRB approved prospective cohort of patients with a singleton pregnancy and no history of pre-existing diabetes were recruited at Augusta University Medical Center. Patients were consented if they were less than 28 weeks gestation and had not yet had a glucose tolerance test (GTT). Chronotype was assessed by a validated Horne-Ostberg Morningness-Evenings Questionnaire (MEQ). The MEQ consisted of 19 questions about preferred sleep time and daily performances. Scores ranged from 16-86 and based on results patients were categorized as being morning (59-86), intermediate (42-58), or evening (16-41) type. Data was subsequently obtained on pregnancy outcomes.
RESULTS:
Between 11/2018-05/2019, outcome data was obtained from 309 women who completed the MEQ. 34.6%, 45.6%, and 19.8% of women were identified as having morning, intermediate, and evening chronotype respectively. Baseline demographics between groups were comparable. Although, the “evening” type group had a lower proportion of GDM there was no statistical difference between chronotype and development of GDM (P=.457). Furthermore, no statistical significance exists between chronotype and the development of GHTN (P=.813) or PE (P=.768).
CONCLUSION:
To date, this is the first study to examine this association between chronotype and pregnancy complications. While chronotype is not associated with adverse pregnancy outcomes, further studies with larger sample sizes may provide an insight on circadian rhythms in predicting adverse outcomes.
Cystic lesions located in the paravaginal region are rare. When present, paravaginal cysts are typically benign and are incidentally found on routine gynecological exams; however, rarely they can be malignant. Treatment options for paravaginal cancers are not well studied and early diagnosis may help improve prognosis in these patients. Our case describes a 55-year-old female with a recurrent paravaginal cyst that was remarkable for serous papillary adenocarcinoma despite biopsy and fluid cytology negative for malignancy. This case demonstrates that malignancy should be considered highly with a recurrent paravaginal cyst, especially when present over a short interval.
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