ObjectiveTo study whether maternal cigarette smoking during pregnancy is associated with alterations in the growth of fetal lungs, kidneys, liver, brain, and placenta.DesignA case-control study, with operators performing the image analysis blinded.SettingStudy performed on a research-dedicated magnetic resonance imaging (MRI) scanner (1.5 T) with participants recruited from a large teaching hospital in the United Kingdom.ParticipantsA total of 26 pregnant women (13 current smokers, 13 non smokers) were recruited; 18 women (10 current smokers, 8 nonsmokers) returned for the second scan later in their pregnancy.MethodsEach fetus was scanned with MRI at 22–27 weeks and 33–38 weeks gestational age (GA).Main outcome measuresImages obtained with MRI were used to measure volumes of the fetal brain, kidneys, lungs, liver and overall fetal size, as well as placental volumes.ResultsExposed fetuses showed lower brain volumes, kidney volumes, and total fetal volumes, with this effect being greater at visit 2 than at visit 1 for brain and kidney volumes, and greater at visit 1 than at visit 2 for total fetal volume. Exposed fetuses also demonstrated lower lung volume and placental volume, and this effect was similar at both visits. No difference was found between the exposed and nonexposed fetuses with regards to liver volume.ConclusionMagnetic resonance imaging has been used to show that maternal smoking is associated with reduced growth of fetal brain, lung and kidney; this effect persists even when the volumes are corrected for maternal education, gestational age, and fetal sex. As expected, the fetuses exposed to maternal smoking are smaller in size. Similarly, placental volumes are smaller in smoking versus nonsmoking pregnant women.

BackgroundEndometriosis is a common condition associated with growth of endometrial-like tissue beyond the uterine cavity. Previous reports have suggested a role for uNK cells in the pathogenesis of endometriosis postulating that survival and accumulation of menstrual endometrial tissue in the peritoneal cavity may relate to a reduction in the cytotoxic activity of peripheral blood NK cells. We aimed to assess the differences in percentage of uNK cells and their phenotypical characterization in eutopic and ectopic endometrial samples from women with and without endometriosis and baboons with induced endometriosis.MethodsEutopic and ectopic endometrial samples from 82 women across the menstrual cycle with/without endometriosis and from 8 baboons before and after induction of endometriosis were examined for CD56 and NKp30 expression with immunohistochemistry, quantified using computer assisted image analysis. Curated secretory phase endometrial microarray datasets were interrogated for NK cell receptors and their ligands. In silico data was validated by examining the secretory phase eutopic endometrium of women with and without endometriosis (n = 8/group) for the immuno-expression of BAG6 protein.ResultsThe percentage of uNK cells increased progressively from the proliferative phase with the highest levels in the late secretory phase in the eutopic endometrium of women with and without endometriosis. The percentage of uNK cells in ectopic lesions remained significantly low throughout the cycle. In baboons, induction of endometriosis increased the percentage of uNK in the ectopic lesions but not NKp30. Published eutopic endometrial microarray datasets demonstrated significant upregulation of NKp30 and its ligand BAG6 in women with endometriosis compared with controls. Immunohistochemical staining scores for BAG6 was also significantly higher in secretory phase eutopic endometrium from women with endometriosis compared with the endometrium of healthy women (n = 8/group).ConclusionsThe dynamic increase in the percentage of uNK cells in the secretory phase is preserved in the endometrium of women with endometriosis. The low number of uNK cells in human and baboon ectopic lesions may be due to their exaggerated reduction in hormonal responsiveness (progesterone resistance).Electronic supplementary materialThe online version of this article (10.1186/s12958-018-0385-3) contains supplementary material, which is available to authorized users.

With advances occurring in medicine on a daily basis, it was only a matter of time before essential gynecological investigations, such as ultrasound, were modified. Many clinicians remain unconvinced by its reputed advantages and 3D ultrasound is not without disadvantages. These mainly relate to the cost implications and training requirements. 3D ultrasound imaging is still at a relatively early stage in terms of its role as a day-to-day imaging modality in gynecology and reproductive medicine. 3D imaging has several obvious benefits that relate to an improved spatial orientation and the demonstration of multiplanar views, of which the coronal plane is particularly useful. It offers a more objective and reproducible measurement of volume and vascularity of the region of interest, and an improved assessment of normal and pathological pelvic organs through further postprocessing modalities, including tomographic ultrasound imaging and various rendering modalities. It also has the benefit of offering reduced scanning time, the option of teleconsultation and storage of images for re-evaluation. However, other than its application in the assessment and differentiation of uterine anomalies, there is very little evidence demonstrating that 3D ultrasound results in a clinically relevant benefit or negates the need for further investigation. Future work should ensure that 3D ultrasound is compared with conventional imaging in randomized trials where the observer is blind to the outcome, only after which will we truly be able to evaluate its role in an evidence-based manner.With advances occurring in medicine on a daily basis, it was only a matter of time before essential gynecological investigations, such as ultrasound, were modified. 2D ultrasound has been one of the key modes of investigation for years, but recent developments have seen the introduction of 3D ultrasound. This review focuses on the current role of 3D imaging in the field of gynecology and reproductive medicine, and outlines how our practice may change in the future as a result. However, very few studies have truly compared conventional ultrasound with 3D ultrasound and the following article appraises the current evidence, which is often derived from observational studies.What is 3D ultrasound? Conventional (2D) ultrasound is the most widely available modality at present. 2D ultrasound essentially provides us with 2D images of 3D structures, which appear as real-time crosssectional slices through the organ/structures being examined. The views can, at times, be restricted owing to limited scan planes. By contrast, 3D ultrasound techniques rely upon the production of a composite of multiple 2D scan images. Computing software is then used to fill in the gaps or 'interpolate' between these images to produce a solid volume. The acquired 3D ultrasound volume can then be displayed collectively in a variety of imaging modalities. Several viewing modalities are available to maximize the display of the acquired 3D images. The render mode shows a single image repre...

The specifics of inflammation created by infection with Chlamydia trachomatis could be favourable to the genesis of endometriosis. To investigate this hypothesis, we studied the association between Chlamydia trachomatis specific IgG and IgA antibodies in serum and the peritoneal fluid of 51 women undergoing laparoscopic surgery. There was no significant difference between women with and without endometriosis with respect to the incidence of IgG and IgA in serum or the peritoneal fluid. The results of our preliminary study did not show any significant link between past infection with Chlamydia trachomatis and the presence of endometriosis.

The seventh edition of this classic book has been updated to cover the ever-expanding curriculum in the world of obstetrics and gynaecology. Don't be put off by the rather uninspiring front cover, as the contents more than make up for it. This book covers everything from revision of clinical anatomy and maternal physiology to antenatal care for normal and high-risk pregnancies, as well as common topics in gynaecology and subspecialty topics such as assisted reproduction. There are even chapters devoted to ethical dilemmas, legal issues and domestic violence.With over 60 contributors to this edition, trainees will be able to revise from this book confident that they are reading up-to-date information provided by specialists with expertise in their particular area. The chapters are clearly laid out, with subheadings to direct the reader to the relevant part of the chapter, and references are provided at the end of each chapter, as an aid to further study. Each chapter is illustrated with graphs, tables, diagrams and relevant clinical illustrations such as ultrasound scan images. There is an excellent section devoted to colour images of a range of conditions, from commonly encountered skin conditions such as lichen sclerosis, to the macroscopic appearance of complete hydatidiform mole. The only downside is that this does highlight that this book could have been even better had colour images been included throughout the text: the black and white pages could become a little dull during prolonged periods of revision! The chapter on obstetric emergencies is particularly good as it provides the reader with a 'pathway of care' in the form of a flow diagram, which is clear, concise, easy to follow and a perfect revision aid. There is also a detailed chapter on hysteroscopy and laparoscopy, which is very informative and a topic that is not always covered in similar textbooks. This book is suitable for senior house officers and specialty registrars in obstetrics and gynaecology, both during their exam preparation and ongoing training. Having not yet sat my MRCOG Part 2 examination, I can only imagine that this book will be a perfect companion when starting my revision and would definitely recommend it. Reviewer Lucy Coyne BM BS Senior House Officer in Obstetrics and Gynaecology King's Mill Hospital, Mansfield, UK Blackwell Publishing, 2007 ISBN 9781405133555 Hardcover, 717 pages, £99.95