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Comorbidities such as endometriosis can confound the picture in patients with adenomyosis, a condition that may lead to poor IVF outcomes. This quiz goes over the major takeaways from our November 2018 article, 

1. Most cases of adenomyosis affect women aged: 

Please click here for answer, discussion, and next question.


	Approximately 20% of cases involve women younger than 40 and 80% are aged 40 to 50. 

2. Today, the diagnosis of adenomyosis can be suspected using: 

 histopathologic examination on hysterectomy


	Histopathologic examination on hysterectomy specimen was the traditional route of diagnosis, but has been supplanted by imaging today that can make the diagnosis with 80% to 90% accuracy without the need for excisional surgery. 

3. The consensus for diagnosis of adenomyosis is when the junctional zone (subendometrial myometrium) thickness is:
	


	Greater than 12 mm is the diagnostic threshold, but the disorder can be suspected when thickness is between 8 and 12 mm.

4. Adenomyosis is comorbid with pelvic endometriosis in over half of cases.
	A.


	There is a significant association between pelvic endometriosis and adenomyosis, with estimates indicating that it occurs in 54% to 90% of cases.

5. In women undergoing in vitro fertilization, adenomyosis has a detrimental effect on clinical outcomes, reducing:


	In addition to rates of implantation, clinical pregnancies per cycle, and live births, adenomyosis also affects clinical pregnancies per embryo transfer, and ongoing pregnancy rates after IVF.

6. Proposed mechanisms of infertility in patients with adenomyosis focus on which of the following pathways?


	Adenomyosis does not appear to affect folliculogenesis or oocyte quality/function, but it does appear to affect endometrial receptivity and implantation in addition to uterotubal transport. 

7. For patients with severe adenomyosis who want to retain fertility, a large prospective study showed that __________ was most effective. 

Gonadotrophin-releasing hormone agonist (GnRH-a) treatment 

 GnRH-a treatment plus conservative surgery

Answer D. GnRH-a treatment plus conservative surgery


	Combined GnRH-a treatment and conservative surgery, such as laparoscopic cytoreductive surgery, has been shown to lower symptom relapse rates and yield a trend toward improved reproductive outcomes.

Articles

This quiz goes over the major takeaways from the November 2018 article by Anthony N. Imudia, MD, and Rachel G. Sprague, MD

Quiz - Adenomyosis and its impact on fertility

Prenatal tetanus, diphtheria, acellular pertussis (Tdap) vaccination is not associated with an increased risk of autism spectrum disorder (ASD) in offspring, according to a study published in 

In response to rising incidence of pertussis (whooping cough), the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) recommended in October 2012 that all pregnant women, whether previously vaccinated or not, receive the Tdap vaccine between 27 and 36 weeks of gestation to prevent pertussis in their offspring. Pertussis is a highly contagious infection caused by 

that can lead to hospitalization and death in young infants. When given during pregnancy to mothers, the vaccine is 91.4% effective in offering some immunity to infants until they reach two months of age and are due to receive their first diphtheria-tetanus-acellular pertussis vaccine.

Previously, it had been found that Tdap vaccine does not increase the risk for a variety of maternal and pediatric outcomes, including small-for-gestational-age size, preterm delivery, or low birth weight. As there has been great speculation and concern among consumers about the potential of vaccines to cause ASD and limited data on vaccines given during pregnancy and autism risk, Kaiser Permanente Southern California Department of Research & Evaluation undertook the first-ever study examining any association between the two. 

The prenatal period is “strongly implicated” in the etiology of ASD, said the authors, who conducted a retrospective cohort study of mothers who delivered babies between January 1, 2011 and December 31, 2014 at Southern California hospitals within the Kaiser Permanente system. The population was restricted to pregnant women who conceived naturally and gave birth to live singleton infants at 22 to 45 weeks of gestation. The study included 81,993 children. In the 2012 birth cohort, 26% (5,407 of 20,553) of the children had mothers who had been vaccinated, whereas 79% (16,882 of 21,433) had vaccinated mothers in 2014. Most mothers were vaccinated at 28 to 29 weeks of pregnancy. The cohort was followed for 1.2 to 6.5 years. 

Compared to unvaccinated women, vaccinated women were more likely to be:

of Asian American or Pacific Islander descent

They were also more likely to have received the influenza vaccine prenatally and to have given birth at term, defined as >37 weeks of gestation. 

The incidence of ASD in the vaccinated group was 3.78 per 1,000 person-years versus 4.05 per 1,000 person-years in the unvaccinated group (unadjusted HR=0.98, 95% CI:0.88-1.09; adjusted HR=0.85, 95% CI=0.77-0.95). Most of the children with autism were diagnosed at 2 to 4 years of age. A decline in autism rates was noted from 1.8% to 1.2% in the vaccinated group and from 2.0% to 1.5% in the unvaccinated group across the birth years studied. The general autism rate in the United States was 1.7% of children. 

The results were consistent across all birth years included in the study and among first-born children. 

The authors suggested that more studies be conducted looking at additional birth years and with longer follow-up, but confirmed that prenatal Tdap vaccination is safe and desirable to protect vulnerable newborns from potentially deadly pertussis infection.

As consumers have expressed speculation and concern about the potential of vaccines to cause ASD, a recent study examined any association between the Tdap vaccine and autism.

Tdap vaccination in pregnant women and autism risk

This month's quiz goes over the key strategies to improve diagnoses and outcomes that were discussed in the article, "

Managing obstetric emergencies: Anaphylactoid syndrome of pregnancy (aka AFE)

This month's quiz goes over the key strategies to improve diagnoses and outcomes that were discussed in the article, "Managing obstetric emergencies: Anaphylactoid syndrome of pregnancy (aka AFE)" by Steven L. Clark, MD (July 2018).

Quiz - Managing obstetric emergencies: ASP

Mother-to-child transmission of HIV in the United States can be eliminated with the help of obstetricians. This quiz goes over the key strategies to improve outcomes that were discussed in the article, "

The obstetrician’s role in management of HIV in pregnancy

" by Laura E. Riley, MD, and Carey Eppes, MD, MPh.

Mother-to-child transmission of HIV in the United States can be eliminated with the help of obstetricians. Test your knowledge and ability to care for HIV patients.

Author | Nancy Monson

Articles

Quiz - Adenomyosis and its impact on fertility

Tdap vaccination in pregnant women and autism risk

Quiz - Managing obstetric emergencies: ASP

Quiz: The obstetrician’s role in management of HIV in pregnancy