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Abdallah A, Depret-Bixio L, El Khouri K, Pourkaram N, El Shmoury M, Fakih M. Previous mode of delivery and pregnancy outcomes after single euploid embryo transfer: A retrospective study. Eur J Obstet Gynecol Reprod Biol 2024; 296:221-226. [PMID: 38479207 DOI: 10.1016/j.ejogrb.2024.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/26/2024] [Accepted: 02/27/2024] [Indexed: 04/19/2024]
Abstract
RESEARCH QUESTION Are the pregnancy outcomes (clinical, biochemical and ectopic pregnancies) of women with a history of vaginal birth and women with a history of caesarean section who underwent single euploid embryo transfer at Fakih IVF Fertility Centre comparable? DESIGN This retrospective cross-sectional chart review with multi-variate analysis, including 1157 women, compared pregnancy outcomes between women with a history of caesarean section and women with a history of vaginal birth who underwent in-vitro fertilization (IVF) at Fakih IVF Fertility Centre. All women who underwent single euploid frozen embryo transfer were included. Fresh and multiple embryo transfers were excluded. The primary outcome was clinical pregnancy, and the secondary outcomes were biochemical and ectopic pregnancies. RESULTS Regarding pregnancy outcomes, the caesarean section group had fewer clinical pregnancies than the vaginal birth group [299 (61.1 %) vs 417 (67.3 %); p = 0.0346]. The rate of ectopic pregnancy did not differ significantly between the two groups (p = 0.4320). Similarly, there was no significant difference between the two groups regarding biochemical pregnancy [caesarean section group 22 (4.3 %) vs vaginal birth group 26 (4.0 %); p = 0.8122]. CONCLUSION This study showed a decreased likelihood of clinical pregnancy in women with a history of caesarean section. No significant differences in biochemical or ectopic pregnancies were observed between the groups. These findings have practical clinical implications for counselling patients on the impact of prior caesarean sections in assisted reproduction.
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Affiliation(s)
| | | | | | | | | | - Michael Fakih
- Fakih IVF Fertility Centre, Dubai, United Arab Emirates
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Feng S, Wang B, Chen S, Xie Q, Yu L, Xiong C, Wang S, Huang Z, Xing G, Li K, Lu C, Zhao Y, Li Z, Wu Q, Huang J. Association between proliferative-to-secretory endometrial compaction and pregnancy outcomes after embryo transfer: a systematic review and meta-analysis. Hum Reprod 2024; 39:749-759. [PMID: 38323525 DOI: 10.1093/humrep/deae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 01/03/2024] [Indexed: 02/08/2024] Open
Abstract
STUDY QUESTION Does the change in endometrial thickness (EMT) from the end of the follicular/estrogen phase to the day of embryo transfer (ET) determine subsequent pregnancy outcomes? SUMMARY ANSWER Endometrial compaction from the late-proliferative to secretory phase is not associated with live birth rate (LBR) and other pregnancy outcomes. WHAT IS KNOWN ALREADY Endometrial compaction has been suggested to be indicative of endometrial responsiveness to progesterone, and its association with ET outcome has been investigated but is controversial. STUDY DESIGN, SIZE, DURATION A systematic review with meta-analysis was carried out. PubMed, EMBASE, and Web of Science were searched to identify relevant studies from inception to 18 November 2022. The reference lists of included studies were also manually screened for any additional publications. PARTICIPANTS/MATERIALS, SETTING, METHODS Cohort studies comparing ET pregnancy outcomes between patients with and without endometrial compaction were included. A review of the studies for inclusion, data extraction, and quality assessment was performed by two independent reviewers. The effect size was synthesized as odds ratio (OR) with 95% CI using a random-effects model. Heterogeneity and publication bias were assessed by the I2 statistic and Egger's test, respectively. The primary outcome was LBR. Secondary outcomes included biochemical pregnancy rate (BPR), clinical pregnancy rate (CPR), miscarriage rate (MR), ongoing pregnancy rate (OPR), and ectopic pregnancy rate (EPR). MAIN RESULTS AND THE ROLE OF CHANCE Seventeen cohort studies involving 18 973 ET cycles fulfilled the eligibility criteria. The pooled results revealed that there were no significant differences between endometrial compaction and non-compaction groups in LBR (crude OR (cOR) = 0.95, 95% CI 0.87-1.04; I2 = 0%; adjusted OR (aOR) = 1.02, 95% CI 0.87-1.19, I2 = 79%), BPR (cOR = 0.93, 95% CI 0.81-1.06; I2 = 0%; aOR = 0.88, 95% CI 0.75-1.03, I2 = 0%), CPR (cOR = 0.98, 95% CI 0.81-1.18; I2 = 70%; aOR = 0.86, 95% CI 0.72-1.02, I2 = 13%), MR (cOR = 1.09, 95% CI 0.90-1.32; I2 = 0%; aOR = 0.91, 95% CI 0.64-1.31; I2 = 0%), and EPR (cOR = 0.70, 95% CI 0.31-1.61; I2 = 61%). The OPR was marginally higher in crude analysis (cOR = 1.48, 95% CI 1.01-2.16; I2 = 81%) among women with compacted endometrium, but was not evident in adjusted results (aOR = 1.36, 95% CI 0.86-2.14; I2 = 84%). Consistently, the pooled estimate of LBR remained comparable in further subgroup and sensitivity analyses according to the degree of compaction (0%, 5%, 10%, 15%, or 20%), type of ET (fresh, frozen, or euploid only), and endometrial preparation protocol (natural or artificial). No publication bias was observed based on Egger's test. LIMITATIONS, REASONS FOR CAUTION Although the number of included studies is sufficient, data on certain measures, such as EPR, are limited. The inherent bias and residual confounding were also inevitable owing to the observational study design. Furthermore, inconsistent definitions of pregnancy outcomes may affect the accuracy of our pooled analysis. WIDER IMPLICATIONS OF THE FINDINGS Given the lack of prognostic value, assessing endometrial compaction or repeated EMT measurement on the day of ET may not be necessary or warranted. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by Natural Science Foundation of Jiangxi Province (20224BAB216025), National Natural Science Foundation of China (82260315), and Central Funds Guiding the Local Science and Technology Development (20221ZDG020071). The authors have no conflicts of interest to declare. REGISTRATION NUMBER CRD42022384539 (PROSPERO).
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Affiliation(s)
- Shenghui Feng
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang Medical College, Nanchang, China
- Department of Clinical Medicine, School of Queen Mary, Nanchang University, Nanchang, China
| | - Bangqi Wang
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang Medical College, Nanchang, China
- Department of Clinical Medicine, School of Queen Mary, Nanchang University, Nanchang, China
| | - Shen Chen
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang Medical College, Nanchang, China
- Department of Clinical Medicine, School of Queen Mary, Nanchang University, Nanchang, China
| | - Qiqi Xie
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang Medical College, Nanchang, China
| | - Lamei Yu
- Department of Obstetrics, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang University School of Medicine, Nanchang, China
| | - Chaoyi Xiong
- Department of Pathology, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang University School of Medicine, Nanchang, China
| | - Shuang Wang
- Department of Gynecology, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang University School of Medicine, Nanchang, China
| | - Zhihui Huang
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang Medical College, Nanchang, China
| | - Gengbao Xing
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang Medical College, Nanchang, China
| | - Ke Li
- Department of Clinical Medicine, School of Queen Mary, Nanchang University, Nanchang, China
| | - Chuming Lu
- Department of Clinical Medicine, School of Queen Mary, Nanchang University, Nanchang, China
| | - Yan Zhao
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang Medical College, Nanchang, China
| | - Zengming Li
- Key Laboratory of Women's Reproductive Health of Jiangxi Province, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang University School of Medicine, Nanchang, China
| | - Qiongfang Wu
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang Medical College, Nanchang, China
| | - Jialyu Huang
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, Jiangxi Branch of National Clinical Research Center for Obstetrics and Gynecology, Nanchang Medical College, Nanchang, China
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Michelson KA, Rees CA, Florin TA, Bachur RG. Emergency Department Volume and Delayed Diagnosis of Serious Pediatric Conditions. JAMA Pediatr 2024; 178:362-368. [PMID: 38345811 PMCID: PMC10862268 DOI: 10.1001/jamapediatrics.2023.6672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/14/2023] [Indexed: 02/15/2024]
Abstract
Importance Diagnostic delays are common in the emergency department (ED) and may predispose to worse outcomes. Objective To evaluate the association of annual pediatric volume in the ED with delayed diagnosis. Design, Setting, and Participants This retrospective cohort study included all children younger than 18 years treated at 954 EDs in 8 states with a first-time diagnosis of any of 23 acute, serious conditions: bacterial meningitis, compartment syndrome, complicated pneumonia, craniospinal abscess, deep neck infection, ectopic pregnancy, encephalitis, intussusception, Kawasaki disease, mastoiditis, myocarditis, necrotizing fasciitis, nontraumatic intracranial hemorrhage, orbital cellulitis, osteomyelitis, ovarian torsion, pulmonary embolism, pyloric stenosis, septic arthritis, sinus venous thrombosis, slipped capital femoral epiphysis, stroke, or testicular torsion. Patients were identified using the Healthcare Cost and Utilization Project State ED and Inpatient Databases. Data were collected from January 2015 to December 2019, and data were analyzed from July to December 2023. Exposure Annual volume of children at the first ED visited. Main Outcomes and Measures Possible delayed diagnosis, defined as a patient with an ED discharge within 7 days prior to diagnosis. A secondary outcome was condition-specific complications. Rates of possible delayed diagnosis and complications were determined. The association of volume with delayed diagnosis across conditions was evaluated using conditional logistic regression matching on condition, age, and medical complexity. Condition-specific volume-delay associations were tested using hierarchical logistic models with log volume as the exposure, adjusting for age, sex, payer, medical complexity, and hospital urbanicity. The association of delayed diagnosis with complications by condition was then examined using logistic regressions. Results Of 58 998 included children, 37 211 (63.1%) were male, and the mean (SD) age was 7.1 (5.8) years. A total of 6709 (11.4%) had a complex chronic condition. Delayed diagnosis occurred in 9296 (15.8%; 95% CI, 15.5-16.1). Each 2-fold increase in annual pediatric volume was associated with a 26.7% (95% CI, 22.5-30.7) decrease in possible delayed diagnosis. For 21 of 23 conditions (all except ectopic pregnancy and sinus venous thrombosis), there were decreased rates of possible delayed diagnosis with increasing ED volume. Condition-specific complications were 11.2% (95% CI, 3.1-20.0) more likely among patients with a possible delayed diagnosis compared with those without. Conclusions and Relevance EDs with fewer pediatric encounters had more possible delayed diagnoses across 23 serious conditions. Tools to support timely diagnosis in low-volume EDs are needed.
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Affiliation(s)
- Kenneth A. Michelson
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Chris A. Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Todd A. Florin
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard G. Bachur
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
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Liu J, Liang Y, Su Y, Lilenga HS, Zhai J. Reasons, experiences and expectations of women with delayed medical care for ectopic pregnancies in Chinese urban edges: a qualitative study. BMJ Open 2024; 14:e076035. [PMID: 38553063 PMCID: PMC10982742 DOI: 10.1136/bmjopen-2023-076035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE To explore the experiences of patients with ectopic pregnancies with delayed medical care, with the goals to promote timely access to care, reduce subsequent physical and psychological impacts, and provide recommendations for improved management of ectopic pregnancies. DESIGN A qualitative study. SETTING A 1000-bed urban edge hospital located in the suburban area of Guangzhou, China, between December 2022 and February 2023. PARTICIPANTS 21 patients with delays in seeking medical care for ectopic pregnancy. PRIMARY AND SECONDARY OUTCOME MEASURES Semistructured, in-depth, face-to-face interviews were conducted to understand the experience and expectations of these women. RESULTS Three main themes emerged, including delaying medical care, physical and psychological experiences, and expectations of their healthcare providers. Each of these main themes had several subthemes. The central theme of reasons for delaying medical care had five subthemes, including lack of knowledge on early symptoms of ectopic pregnancy, family dynamics and circumstances, traditional fertility ideology and intentions, avoidance of medical treatment behaviour, and medical delays. The main theme of physical and psychological experiences had two subthemes, including learnings from the experiences and negative impacts of the experiences. The main theme of expectations of their healthcare providers included three subthemes that were reducing the length of outpatient examinations and waiting times, increasing public understanding of early symptoms of ectopic pregnancy and increasing male awareness of safe contraceptive methods. CONCLUSIONS A lack of knowledge about the early symptoms of ectopic pregnancy was the main reason for delays in seeking medical care and had a dual impact on patients' physical and mental health, affecting their recovery and future healthcare. A collective effort from patients, families, healthcare providers and medical institutions is required for better medical education, family support, specialised professional training and local fertility policy to decrease the incidence of delayed medical care and achieve satisfactory pregnancy outcomes.
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Affiliation(s)
- Jing Liu
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
- Department of Obstetrics and Gynecology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yulian Liang
- Department of Obstetrics and Gynecology, Guangzhou University of Traditional Chinese Medicine Dongguan Hospital, Dongguan, Guangdong, China
| | - Yinzhi Su
- Department of Obstetrics and Gynecology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | | | - Jinguo Zhai
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
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Jeong HG, Cho S, Ryu KJ, Kim T, Park H. Effect of weight loss before in vitro fertilization in women with obesity or overweight and infertility: a systematic review and meta-analysis. Sci Rep 2024; 14:6153. [PMID: 38486057 PMCID: PMC10940611 DOI: 10.1038/s41598-024-56818-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
The effect of weight loss before in vitro fertilization (IVF) procedures on pregnancy outcomes in women with overweight or obesity and infertility remains controversial. In this systematic review and meta-analysis, we investigated whether weight loss before IVF in these women affected the IVF results and reproductive outcomes. PubMed, Embase, and the Cochrane Library databases were searched from the inception dates until December 2022, using combinations of relevant keywords. Only six randomized controlled trials, including 1627 women with obesity or overweight, were analyzed. The weight change in the intensive care group, compared to the control group who underwent IVF without weight loss was - 4.62 kg (mean difference; 95% confidence interval [CI] - 8.10, - 1.14). Weight loss before IVF did not significantly increase the live birth rate in women with obesity or overweight and infertility (odds ratio, 1.38; 95% CI 0.88, 2.10). The clinical pregnancy, miscarriage, ongoing pregnancy, and ectopic pregnancy rates did not differ between the weight loss and control groups before IVF. This meta-analysis demonstrated that even significant weight loss before IVF in women with obesity or overweight and infertility did not improve the live birth, clinical pregnancy, ongoing pregnancy, or ectopic pregnancy rates. PROSPERO Registration Number: CRD42023455800.
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Affiliation(s)
- Hye Gyeong Jeong
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Sumin Cho
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ki-Jin Ryu
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyuntae Park
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
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Ge C, Zhang B, Mao Y, Hong Z, Zhou C, Wang Y, Wang M, Ma L. Effects of atosiban on clinical outcome in frozen-thawed embryo transfer: a propensity score matching study. Arch Gynecol Obstet 2024; 309:1101-1106. [PMID: 38240770 DOI: 10.1007/s00404-023-07289-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/06/2023] [Indexed: 02/16/2024]
Abstract
PURPOSE To evaluate the effects of atosiban on clinical outcomes in patients undergoing frozen-thawed embryo transfer. METHODS The clinical data of 1093 infertile patients who underwent frozen-thawed embryo transfer in our center from January 2019 to December 2020 were retrospectively analyzed (control, 418; atosiban, 675). Propensity score matching (PSM) analysis identified 400 matched pairs of patients. The implantation rate, clinical pregnancy rate, live birth rate, biochemical pregnancy rate, abortion rate, multiple pregnancy rate, and ectopic pregnancy rate between the two groups were compared. RESULTS Before PSM, patients differed by infertility factors, number of transferred embryos, and endometrial preparation protocol (P < 0.05). After PSM, characteristics were similar in corresponding patients of the atosiban and control groups. After propensity score matching, we found that there was no significant difference in the implantation rate, clinical pregnancy rate, live birth rate, biochemical pregnancy rate, abortion rate, multiple pregnancy rate, and ectopic pregnancy rate in atosiban and control group (P > 0.05). CONCLUSION Atosiban did not improve the clinical outcomes of infertile patients with frozen-thawed embryo transfer.
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Affiliation(s)
- Caiyun Ge
- Reproductive Medicine Center, Zhongnan Hospital of Wuhan University, Hubei Province, No. 169, Wuchang District, East Lake Road, Wuhan City, 430071, China
| | - Bo Zhang
- Reproductive Medicine Center, Zhongnan Hospital of Wuhan University, Hubei Province, No. 169, Wuchang District, East Lake Road, Wuhan City, 430071, China
| | - Yanhong Mao
- Reproductive Medicine Center, Zhongnan Hospital of Wuhan University, Hubei Province, No. 169, Wuchang District, East Lake Road, Wuhan City, 430071, China
| | - Zhidan Hong
- Reproductive Medicine Center, Zhongnan Hospital of Wuhan University, Hubei Province, No. 169, Wuchang District, East Lake Road, Wuhan City, 430071, China
| | - Chun Zhou
- Reproductive Medicine Center, Zhongnan Hospital of Wuhan University, Hubei Province, No. 169, Wuchang District, East Lake Road, Wuhan City, 430071, China
| | - Yan Wang
- Reproductive Medicine Center, Zhongnan Hospital of Wuhan University, Hubei Province, No. 169, Wuchang District, East Lake Road, Wuhan City, 430071, China
| | - Mei Wang
- Reproductive Medicine Center, Zhongnan Hospital of Wuhan University, Hubei Province, No. 169, Wuchang District, East Lake Road, Wuhan City, 430071, China
| | - Ling Ma
- Reproductive Medicine Center, Zhongnan Hospital of Wuhan University, Hubei Province, No. 169, Wuchang District, East Lake Road, Wuhan City, 430071, China.
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Elshamy E, Zakaria Y, Alajami F, Fathy M. Expectant management versus systemic methotrexate in the management of persistent pregnancy of unknown location, a seven-year retrospective analysis. Arch Gynecol Obstet 2024; 309:1035-1041. [PMID: 38194091 DOI: 10.1007/s00404-023-07332-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/01/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE To compare Expectant management to systemic methotrexate in the management of persistent pregnancy of unknown location with beta-hCG levels below the discrimination zone. METHODS A retrospective cohort study was conducted on 71 women with persistent pregnancy of unknown location. They were divided into two groups according to the applied management; Group 1, (n = 40) who were managed expectantly and Group 2 (n = 31) who were given a single dose of methotrexate. Data variables were collected and analyzed to evaluate whether expectant management was as effective as methotrexate. RESULTS There was no significant difference between the two groups regarding age, parity, gestational age, body mass index and day seven beta-hCG. Success rates were (32 patients (80%) and 28 patients (90.3%) in expectant management and methotrexate groups, respectively (P > 0.05). The mean values for day zero and day four beta-hCG were significantly higher and the mean duration for complete recovery was statistically shorter in the methotrexate group (P < 0.05). There were no significant differences between the two groups regarding prior ectopic, percentage of beta-hCG level drop on day four and day seven, success rate, occurrence of sequelae and patient satisfaction that area under the curve (AUC) for group 1 (expectant management) is 0.566 at 95% Confidence Interval of (0.388: 0.745). CONCLUSION Expectant management is an effective and safe alternative to single-dose methotrexate for persistent PUL with beta-hCG levels below the discrimination zone.
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Affiliation(s)
- Elsayed Elshamy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Shibin El-Kom, Egypt.
- Department of Obstetrics and Gynecology, King Abdul-Aziz Airbase Hospital, 041/9 Prince Sattam Street, Al-Khobar, Saudi Arabia.
| | - Yahya Zakaria
- Department of Obstetrics and Gynecology, King Abdul-Aziz Airbase Hospital, 041/9 Prince Sattam Street, Al-Khobar, Saudi Arabia
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Faiyum, Egypt
| | - Feryal Alajami
- Department of Obstetrics and Gynecology, King Abdul-Aziz Airbase Hospital, 041/9 Prince Sattam Street, Al-Khobar, Saudi Arabia
| | - Mahmoud Fathy
- Department of Obstetrics and Gynecology, King Abdul-Aziz Airbase Hospital, 041/9 Prince Sattam Street, Al-Khobar, Saudi Arabia
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
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Wen W, Shi J, Liu X. What is the optimal means of preparing the endometrium in frozen-thawed embryo transfer cycles among anovulatory women? A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2024; 294:79-83. [PMID: 38218163 DOI: 10.1016/j.ejogrb.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/06/2023] [Accepted: 01/05/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE Different endometrial preparation protocols are used prior to frozen-thawed embryo transfer (FET). It is not clear whether letrozole-stimulated cycles are beneficial for anovulatory women compared to artificial cycles (AC) in anovulatory women. Our objective was to investigate whether clinical outcomes following frozen-thawed embryo transfer in letrozole-stimulated cycles differ from artificial cycles in anovulatory women. STUDY DESIGN This is a retrospective cohort study conducted in a public fertility center in China comparing letrozole-stimulated and artificial cycles during FET. A total of 5,322 anovulatory women undergoing the first cycle of FET between January 2020 and December 2021. The primary outcome was the live birth rate. The secondary outcomes included biochemical pregnancy, clinical pregnancy, ongoing pregnancy, miscarriage, and ectopic pregnancy. RESULTS The live birth rates were significantly higher in the letrozole compared with AC (49.57 % vs. 45.22 %) both in the crude (odds ratio [OR] 1.19, 95 % confidence interval [CI] 1.01-1.40) and adjusted analysis (aOR 1.27, 95 %CI 1.08-1.50). After controlling for potential covariates, the adjusted probability of biochemical pregnancy (65.71 % vs. 63.25 %, aOR 1.20, 95 %CI: 1.01-1.43), clinical pregnancy (61.53 % vs. 58.79 %, aOR 1.20, 95 %CI: 1.02-1.43), and ongoing pregnancy (50.14 % vs. 45.66 %, aOR 1.28, 95 %CI: 1.08-1.51) were higher among those using letrozole-stimulated cycles than among those undergoing artificial cycles. The miscarriage rate was lower following letrozole compared with artificial cycles (aOR 0.59, 95 %CI: 0.43-0.80). The ectopic pregnancy in the letrozole group was similar to that in the artificial cycles. CONCLUSIONS Letrozole-stimulated FET was significantly associated with higher rates of biochemical pregnancy, clinical pregnancy, ongoing pregnancy and live birth, and with a lower rate of miscarriage, compared with artificial cycles.
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Affiliation(s)
- Wen Wen
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Juanzi Shi
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Xitong Liu
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China.
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Kyriacou C, Kapur S, Jeyapala S, Parker N, Yang W, Pikovsky M, Bobdiwala S, Barcroft J, Maheetharan S, Sur S, Stalder C, Gould D, Syed S, Tan T, Bourne T. Beta-human chorionic gonadotrophin point of care testing for the management of pregnancy of unknown location. Reprod Biomed Online 2024; 48:103643. [PMID: 38262209 DOI: 10.1016/j.rbmo.2023.103643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 01/25/2024]
Abstract
RESEARCH QUESTION Does a commercially available quantitative beta-human chorionic gonadotrophin (BHCG) point of care testing (POCT) device improve workflow management in early pregnancy by performing comparably to gold standard laboratory methods, and is the performance of a validated pregnancy of unknown location (PUL) triage strategy maintained using POCT BHCG results? DESIGN Women classified with a PUL between 2018 and 2021 at three early pregnancy units were included. The linear relationship of untreated whole-blood POCT and serum laboratory BHCG values was defined using coefficients and regression. Paired serial BHCG values were then incorporated into the validated M6 multinomial logistic regression model to stratify the PUL as at high risk or at low risk of clinical complications. The sensitivity and negative predictive value were assessed. The timings required for equivocal POCT and laboratory care pathways were compared. RESULTS A total of 462 PUL were included. The discrepancy between 571 laboratory and POCT BHCG values was -5.2% (-6.2 IU/l), with a correlation coefficient of 0.96. The 133 PUL with paired 0 and 48 h BHCG values were compared using the M6 model. The sensitivity for high-risk outcomes (96.2%) and negative predictive values (98.5%) was excellent for both. Sample receipt and laboratory processing took 135 min (421 timings), compared with 12 min (91 timings) when using POCT (P < 0.0001). CONCLUSIONS POCT BHCG values correlated well with laboratory testing measurements. The M6 model retained its performance when using POCT BHCG values. Using the model with POCT may improve workflow and patient care without compromising on effective PUL triage.
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Affiliation(s)
- Christopher Kyriacou
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shikha Kapur
- Gynaecology Emergency Unit, Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College London, London, UK
| | - Sobanakumari Jeyapala
- Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Hillingdon Hospital, London, UK
| | - Nina Parker
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Wei Yang
- Biochemistry unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Margaret Pikovsky
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shabnam Bobdiwala
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Jennifer Barcroft
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shanuja Maheetharan
- Biochemistry unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Shyamaly Sur
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Catriona Stalder
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Deborah Gould
- Gynaecology Emergency Unit, Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College London, London, UK
| | - Shabana Syed
- Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Hillingdon Hospital, London, UK
| | - Tricia Tan
- Biochemistry unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Tom Bourne
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
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10
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Liu X, Shi J. Female obesity increases the risk of preterm birth of single frozen-thawed euploid embryos: a retrospective cohort study. Gynecol Endocrinol 2024; 40:2324995. [PMID: 38439198 DOI: 10.1080/09513590.2024.2324995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/05/2023] [Indexed: 03/06/2024] Open
Abstract
INTRODUCTION Obesity has been associated with an increased risk of reproductive failure, especially preterm birth. As preimplantation genetic testing for aneuploidies (PGT-A) is increasingly used worldwide, however, it is still unclear whether body mass index (BMI) has an effect on the preterm birth rate in patients undergoing in vitro fertilization (IVF) with PGT-A when transferring a single euploid blastocyst. MATERIALS AND METHODS This retrospective, single-center cohort study included 851 women who underwent the first cycle of frozen-thawed single euploid blastocyst transfer with PGT-A between 2015 and 2020. The primary outcome was the preterm birth rate. Secondary outcomes were clinical pregnancy, miscarriage, ectopic pregnancy, pregnancy complications, and live birth. RESULTS Patients were grouped by World Health Organization (WHO) BMI class: underweight (<18.5, n = 81), normal weight (18.5-24.9, n = 637), overweight (25-30, n = 108), and obese (≥30, n = 25). There was no difference in the clinical pregnancy, miscarriage, ectopic pregnancy, pregnancy complication, and live birth by BMI category. In multivariate logistic regression analysis, preterm birth rates were significantly higher in women with overweight (adjusted odds ratio [aOR] 3.18; 95% confidence interval [CI], 1.29-7.80, p = .012) and obese (aOR 1.49; 95% CI, 1.03-12.78, p = .027) compared with the normal weight reference group. CONCLUSION Women with obesity experience a higher rate of preterm birth after euploid embryo transfer than women with a normal weight, suggesting that the negative impact of obesity on IVF and clinical outcomes may be related to other mechanisms than aneuploidy.
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Affiliation(s)
- Xitong Liu
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Juanzi Shi
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
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11
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Haziza R, Margueritte F, Labaye S, Fauconnier A, Bailleul A. [Role of endometrial thickness in managing pregnancy unknow location]. Gynecol Obstet Fertil Senol 2024; 52:114-115. [PMID: 38145742 DOI: 10.1016/j.gofs.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Affiliation(s)
- Roxane Haziza
- Service de Gynécologie-Obstétrique, Centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France
| | - François Margueritte
- Service de Gynécologie-Obstétrique, Centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France; Équipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Solene Labaye
- Service de Gynécologie-Obstétrique, Centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France
| | - Arnaud Fauconnier
- Service de Gynécologie-Obstétrique, Centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France; Équipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Alexandre Bailleul
- Service de Gynécologie-Obstétrique, Centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France; Équipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France.
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12
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James AH, James PD. What do we know about why women bleed and what do we not know? J Thromb Haemost 2024; 22:315-322. [PMID: 37709147 DOI: 10.1016/j.jtha.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/07/2023] [Accepted: 08/31/2023] [Indexed: 09/16/2023]
Abstract
Women or people with a uterus are vulnerable to both normal and abnormal bleeding. During the reproductive years, the uterus is prepared physiologically to accept an embryo and support its growth and development during pregnancy, or in the absence of implantation of an embryo, recycle through the process of menstruation and accept an embryo a month or so later. If fertilization takes place and an embryo or embryos implant in the uterus, the fetal trophoblast, or outer cell layer of the embryo, invades and dilates the maternal spiral arteries and forms the placenta. No matter when in gestation a pregnancy ends, at the conclusion of pregnancy, the placenta should separate from the wall of the uterus and be expelled. Abnormal bleeding occurs during pregnancy or after delivery when the normal uteroplacental interface has not been established or is interrupted; during miscarriage; during ectopic pregnancy; during premature separation of the placenta; or during postpartum hemorrhage. Heavy menstrual bleeding, a subset of abnormal menstrual bleeding, can be quantitatively defined as >80 mL of blood loss per cycle. Unlike postpartum hemorrhage, heavy menstrual bleeding is significantly associated with an underlying bleeding disorder. While there is other reproductive tract bleeding in women, notably bleeding at the time of ovulation or with a life-threatening ruptured ectopic pregnancy, the unique bleeding that women experience is predominantly uterine in origin. Many of the unique aspects of uterine hemostasis, however, remain unknown.
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Affiliation(s)
- Andra H James
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, Durham, USA; Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, Durham, USA.
| | - Paula D James
- Departments of Medicine and Pathology & Molecular Medicine, Queen's University, Kingston, Ontario, Canada
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Teh HE, Pung CK, Arasoo VJT, Yap PSX. A Landscape View of the Female Genital Tract Microbiome in Healthy Controls and Women With Reproductive Health Conditions Associated With Ectopic Pregnancy. Br J Biomed Sci 2024; 80:12098. [PMID: 38283642 PMCID: PMC10811206 DOI: 10.3389/bjbs.2023.12098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024]
Abstract
Disruption of the female genital microbiome is associated with several pregnancy complications, including miscarriage, preterm onset of labour, and tubal pregnancy. Ectopic pregnancy is a known cause of maternal morbidity and mortality, but early diagnosis and treatment of ectopic pregnancy remain a challenge. Despite growing established associations between genital microbiome and female reproductive health, few studies have specifically focused on its link with ectopic pregnancy. Therefore, the current review aims to provide a comprehensive account of the female genital microbiome in healthy and fertile women compared to those in ectopic pregnancy and its associated risk factors. The microbial diversity from various sites of the female genital tract was explored for a reliable proxy of female reproductive health in sequencing-based ectopic pregnancy research. Our report confirmed the predominance of Lactobacillus in the vagina and the cervix among healthy women. The relative abundance decreased in the vaginal and cervical microbiome in the disease state. In contrast, there were inconsistent findings on the uterine microbiome across studies. Additionally, we explore a spectrum of opportunities to enhance our understanding of the female genital tract microbiome and reproductive conditions. In conclusion, this study identifies gaps within the field and emphasises the need for visionary solutions in metagenomic tools for the early detection of ectopic pregnancy and other gynaecological diseases.
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Affiliation(s)
| | | | | | - Polly Soo Xi Yap
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
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14
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Rogne T, Gill D, Liew Z, Shi X, Stensrud VH, Nilsen TIL, Burgess S. Mediating Factors in the Association of Maternal Educational Level With Pregnancy Outcomes: A Mendelian Randomization Study. JAMA Netw Open 2024; 7:e2351166. [PMID: 38206626 PMCID: PMC10784860 DOI: 10.1001/jamanetworkopen.2023.51166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/20/2023] [Indexed: 01/12/2024] Open
Abstract
Importance Lower educational attainment is associated with increased risk of adverse pregnancy outcomes, but it is unclear which pathways mediate this association. Objective To investigate the association between educational attainment and pregnancy outcomes and the proportion of this association that is mediated through modifiable cardiometabolic risk factors. Design, Setting, and Participants In this 2-sample mendelian randomization (MR) cohort study, uncorrelated (R2 < 0.01) single-nucleotide variants (formerly single-nucleotide polymorphisms) associated with the exposure (P < 5 × 10-8) and mediators and genetic associations with the pregnancy outcomes from genome-wide association studies were extracted. All participants were of European ancestry and were largely from Finland, Iceland, the United Kingdom, or the US. The inverse variance-weighted method was used in the main analysis, and the weighted median, weighted mode, and MR Egger regression were used in sensitivity analyses. In mediation analyses, the direct effect of educational attainment estimated in multivariable MR was compared with the total effect estimated in the main univariable MR analysis. Data were extracted between December 1, 2022, and April 30, 2023. Exposure Genetically estimated educational attainment. The mediators considered were genetically estimated type 2 diabetes, body mass index, smoking, high-density lipoprotein cholesterol level, and systolic blood pressure. Main Outcomes and Measures Ectopic pregnancy, hyperemesis gravidarum, gestational diabetes, preeclampsia, preterm birth, and offspring birth weight. Results The analyses included 3 037 499 individuals with data on educational attainment, and those included in studies on pregnancy outcomes ranged from 141 014 for ectopic pregnancy to 270 002 with data on offspring birth weight. Each SD increase in genetically estimated educational attainment (ie, 3.4 years) was associated with an increased birth weight of 42 (95% CI, 28-56) g and an odds ratio ranging from 0.53 (95% CI, 0.46-0.60) for ectopic pregnancy to 0.81 (95% CI, 0.71-0.93) for preeclampsia. The combined proportion of the association that was mediated by the 5 cardiometabolic risk factors ranged from -17% (95% CI, -46% to 26%) for hyperemesis gravidarum to 78% (95% CI, 10%-208%) for preeclampsia. Sensitivity analyses accounting for pleiotropy were consistent with the main analyses. Conclusions and Relevance In this MR cohort study, intervening for type 2 diabetes, body mass index, smoking, high-density lipoprotein cholesterol level, and systolic blood pressure may lead to reductions in several adverse pregnancy outcomes associated with lower levels of education. Such public health interventions would serve to reduce health disparities attributable to social inequalities.
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Affiliation(s)
- Tormod Rogne
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Zeyan Liew
- Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Xiaoting Shi
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Vilde Hatlevoll Stensrud
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tom Ivar Lund Nilsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Anesthesia and Intensive Care, St Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stephen Burgess
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
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15
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Di Serio M, Dall'Asta A, Ghi T. 16-Weeks' Tubal Ectopic Pregnancy With Secondary Abdominal Growth. Journal of Obstetrics and Gynaecology Canada 2024; 46:102089. [PMID: 36871892 DOI: 10.1016/j.jogc.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 03/06/2023]
Affiliation(s)
- Maurizio Di Serio
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Andrea Dall'Asta
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Tullio Ghi
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
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16
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Al Wattar BH, Solangon SA, de Braud LV, Rogozińska E, Jurkovic D. Effectiveness of treatment options for tubal ectopic pregnancy: A systematic review and network meta-analysis. BJOG 2024; 131:5-14. [PMID: 37443463 DOI: 10.1111/1471-0528.17594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Tubal ectopic pregnancy (TEP) is a common gynaecological emergency. Several medical and surgical treatment options exist, but it is not clear which is the safest and most effective treatment. OBJECTIVES To compare the effectiveness of expectant, medical and surgical treatment options for TEP using a systematic review and network meta-analysis. SEARCH STRATEGY MEDLINE, EMBASE, and CENTRAL from inception till September 2022. SELECTION CRITERIA Randomised trials that evaluated any treatment option for woman with a TEP. DATA COLLECTION AND ANALYSIS We performed pairwise and network meta-analyses using a random effect model. We assessed the studies' risk of bias, heterogeneity and network inconsistency. We reported primarily on TEP resolution and treatment failure using relative risk (RR) and 95% confidence-intervals (CI). MAIN RESULTS We included 31 randomised trials evaluating ten treatments (n = 2938 women). Direct meta-analysis showed no significant benefit for using methotrexate compared to expectant management for TEP resolution. Network meta-analysis showed similar effect-size for most conservative treatment options compared to expectant management for TEP resolution (glucose intra-sac instillation vs. expectant RR 0.84, 95% CI 0.63-1.12; methotrexate intra-sac instillation vs. expectant RR 0.91, 95% CI 0.75-1.10; multi-dose methotrexate vs. expectant RR 1.00, 95% CI 0.88-1.15; prostaglandin intra-sac instillation vs. expectant RR 0.75, 95% CI 0.53-1.07; salpingotomy vs. expectant RR 0.99, 95% CI 0.84-1.16; single dose methotrexate vs. expectant RR 0.97, 95% CI 0.85-1.10; single dose methotrexate + mifepristone vs. expectant RR 1.09, 95% CI 0.89-1.33). All treatment options showed a higher risk of failure compared to salpingectomy. CONCLUSIONS There is insufficient evidence to support the use of any medical treatment option for TEP over expectant management.
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Affiliation(s)
- Bassel H Al Wattar
- Beginning Assisted Conception Unit, Epsom and St Helier University Hospitals, London, UK
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Sarah A Solangon
- Women's Health Department, University College London Hospitals, London, UK
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK
| | - Lucrezia V de Braud
- Women's Health Department, University College London Hospitals, London, UK
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK
| | - Ewelina Rogozińska
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Davor Jurkovic
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK
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17
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Xin X, Dong L, Guan L, Wang Y, Li J, Lian F. Effect of human chorionic gonadotropin injection before frozen-thawed embryo transfer: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e35658. [PMID: 38050223 PMCID: PMC10695501 DOI: 10.1097/md.0000000000035658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/25/2023] [Indexed: 12/06/2023] Open
Abstract
The aim of this study is to investigate the effect of human chorionic gonadotropin (hCG) in hormone replacement regimen for frozen-thawed embryos. We performed a retrospective cohort study and included patients who underwent frozen embryo transfer (FET) between January 1, 2020 and May 31, 2022. According to the protocols for the FET cycle, the patients were divided into control (n = 238) and hCG groups (n = 216). The clinical pregnancy rate, live birth rate, early abortion rate, late abortion rate, and ectopic pregnancy rate were compared between the 2 groups. There was a significant difference in clinical pregnancy rate between the hCG and control groups (55.1% vs 45.8%, P = .048). The ectopic pregnancy rate decreased (5.0% vs 6.4%, P = .654), while the live birth rate increased (36.1% vs 29.0%, P = .105) in the hCG group. However, these differences were not statistically significant. The administration of hCG injection in HRT-FET cycles alone was also found to be associated with clinical pregnancy by logistic regressive analysis. HCG injection in the hormone replacement regimen for FET increased the clinical pregnancy rate.
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Affiliation(s)
- Xin Xin
- Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, China
| | - Li Dong
- Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, China
| | - Lu Guan
- Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, China
| | - Yixuan Wang
- Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, China
| | - Jiaxi Li
- Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, China
| | - Fang Lian
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, China
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Shetty M. Acute Pelvic Pain: Role of Imaging in the Diagnosis and Management. Semin Ultrasound CT MR 2023; 44:491-500. [PMID: 37832696 DOI: 10.1053/j.sult.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Acute pelvic pain is defined as a new symptom that has been present for less than 3 months. It is a common symptom seen in 15%-24% of women and is the indication for 20% of laparoscopies and 2%-10% of outpatient gynecologic visits. The pregnancy status and correlation of the physical symptoms with clinical findings are important. Ultrasound is the imaging modality of choice, not only to diagnose gynecological causes, but also bowel or urinary tract related causes of pelvic pain. When an ultrasound scan is inconclusive, a computed tomography scan is the preferred means of additional imaging and is particularly useful in gastrointestinal and urogenital causes of pelvic pain. Gynecological causes of acute pelvic pain include uterine, tubal, or ovarian pathology; non-gynecological causes include bowel diseases, such as appendicitis and diverticulitis; urogenital causes such as ureteral, bladder stones, and urinary tract infection as well as vascular causes. Ultrasound imaging alone may provide a definitive diagnosis in underlying conditions that require prompt medical or surgical intervention in gynecological conditions, such as ovarian torsion, ectopic pregnancy, and non-gynecological condition, such as in acute appendicitis.
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Affiliation(s)
- Mahesh Shetty
- Department of Radiology, Baylor College of Medicine, Houston, TX.
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Celik HG, Celik E, Buyru F, Bastu E. Cornual Pregnancy Reaching Eight Weeks of Gestation without Uterine Rupture. J Minim Invasive Gynecol 2023; 30:857-858. [PMID: 37422050 DOI: 10.1016/j.jmig.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Hale Goksever Celik
- Department of Obstetrics and Gynecology, Acibadem Mehmet Ali Aydinlar University, Faculty of Medicine, Acibadem Fulya Hospital, Istanbul, Turkey.
| | - Engin Celik
- Department of Gynecologic Oncology, University of Health Sciences, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Faruk Buyru
- Department of Obstetrics and Gynecology, Acibadem Fulya Hospital, Istanbul, Turkey
| | - Ercan Bastu
- Department of Obstetrics and Gynecology, Biruni University, Istanbul, Turkey
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Smith KA, Parvinian A, Ainsworth AJ, Shenoy CC, Packard AT. Normal and Abnormal Appearances of the Ovaries during Assisted Reproduction: Multimodality Imaging Review. Radiographics 2023; 43:e230089. [PMID: 37883303 DOI: 10.1148/rg.230089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Infertility is a common diagnosis that prompts many couples and individuals to seek assisted reproductive technology (ART) for assistance with conception. These technologies have become increasingly used in the United States in the past several decades, with 326 468 ART cycles performed in 2020, resulting in 75 023 live births. This ubiquity of ART also increases the likelihood that radiologists will encounter both normal and abnormal imaging findings associated with these treatments. Thus, radiologists of all subspecialties should be familiar with the multimodality appearance of the ovaries and pelvis in patients undergoing ART treatments. Furthermore, it is imperative that radiologists understand the appearance expected during different stages of the ART process. During stimulated ovulatory cycles, it is normal and expected for the ovaries to appear enlarged and to contain numerous cystic follicles, often with a small to moderate volume of pelvic free fluid. After oocyte retrieval, hemorrhagic ovarian follicles and a small to moderate volume of blood products in the cul-de-sac can be expected to be seen. Multiple nonemergency and emergency complications are related to ART, many of which can be seen at imaging. The most encountered emergency complications of ART include ovarian hyperstimulation syndrome, ectopic pregnancy, heterotopic pregnancy, multiple gestations, ovarian torsion, and procedural complications related to oocyte retrieval. These complications have important clinical implications, thus necessitating accurate and timely detection by the radiologist and the clinical team. ©RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Katherine A Smith
- From the Departments of Radiology (K.A.S., A.P., A.T.P.) and Obstetrics and Gynecology (A.J.A., C.C.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Ahmad Parvinian
- From the Departments of Radiology (K.A.S., A.P., A.T.P.) and Obstetrics and Gynecology (A.J.A., C.C.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Alessandra J Ainsworth
- From the Departments of Radiology (K.A.S., A.P., A.T.P.) and Obstetrics and Gynecology (A.J.A., C.C.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Chandra C Shenoy
- From the Departments of Radiology (K.A.S., A.P., A.T.P.) and Obstetrics and Gynecology (A.J.A., C.C.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Ann T Packard
- From the Departments of Radiology (K.A.S., A.P., A.T.P.) and Obstetrics and Gynecology (A.J.A., C.C.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
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21
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Nash Z, Aslam N, Jurkovic D. Pseudoaneurysm complicating expectantly managed tubal ectopic pregnancy. Ultrasound Obstet Gynecol 2023; 62:749-750. [PMID: 37340628 DOI: 10.1002/uog.26286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Z Nash
- Gynaecology Diagnostic and Outpatient Treatment Unit, University College London Hospital, London, UK
| | - N Aslam
- Gynaecology Diagnostic and Outpatient Treatment Unit, University College London Hospital, London, UK
| | - D Jurkovic
- Gynaecology Diagnostic and Outpatient Treatment Unit, University College London Hospital, London, UK
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22
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Laschi S, Sfragano PS, Ranaldi F, Palchetti I. Progesterone and β-hCG Determination Using an Electrochemical Combo-Strip for Pregnancy Monitoring. Int J Mol Sci 2023; 24:15381. [PMID: 37895061 PMCID: PMC10607536 DOI: 10.3390/ijms242015381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/06/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
The development of analytical devices that can allow an easy, rapid and cost-effective measurement of multiple markers, such as progesterone and β-hCG, could have a role in decreasing the burden associated with pregnancy-related complications, such as ectopic pregnancies. Indeed, ectopic pregnancies are a significant contributor to maternal morbidity and mortality in both high-income and low-income countries. In this work, an effective and highly performing electrochemical strip for a combo determination of progesterone and β-hCG was developed. Two immunosensing approaches were optimized for the determination of these two hormones on the same strip. The immunosensors were realized using cost-effective disposable electrode arrays and reagent-saving procedures. Each working electrode of the array was modified with both the IgG anti-β-hCG and anti-progesterone, respectively. By adding the specific reagents, progesterone or β-hCG can then be determined. Fast quantitative detection was achieved, with the analysis duration being around 1 h. Sensitivity and selectivity were assessed with a limit of detection of 1.5 × 10-2 ng/mL and 2.45 IU/L for progesterone and β-hCG, respectively. The proposed electrochemical combo-strip offers great promise for rapid, simple, cost-effective, and on-site analysis of these hormones and, thus, for the development of a point-of-care diagnostic tool for early detection of pregnancy-related complications.
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Affiliation(s)
- Serena Laschi
- Department of Chemistry “Ugo Schiff”, University of Florence, 50019 Florence, Italy; (S.L.); (P.S.S.)
| | - Patrick Severin Sfragano
- Department of Chemistry “Ugo Schiff”, University of Florence, 50019 Florence, Italy; (S.L.); (P.S.S.)
| | - Francesco Ranaldi
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50139 Florence, Italy;
- “Nanobiosens” Joint Lab, University of Florence, 50139 Florence, Italy
| | - Ilaria Palchetti
- Department of Chemistry “Ugo Schiff”, University of Florence, 50019 Florence, Italy; (S.L.); (P.S.S.)
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23
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Manciulli T, Marangoni D, Salas-Coronas J, Bocanegra C, Richter J, Gobbi F, Motta L, Minervini A, Bartoloni A, Zammarchi L. Diagnosis and management of complicated urogenital schistosomiasis: a systematic review of the literature. Infection 2023; 51:1185-1221. [PMID: 37466786 PMCID: PMC10545601 DOI: 10.1007/s15010-023-02060-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/31/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Currently, there are no standardized guidelines for the diagnosis or management of the complications of urogenital schistosomiasis (UGS). This systematic review of the literature aims to investigate the state of the art in reference to diagnostic approaches and the clinical management of this condition. METHODS A systematic review of literature published between January 1990 and January 2021 was conducted in the MEDLINE database, scoping for articles regarding diagnostic means or therapeutic options for the complications of UGS, namely obstructive uropathy, bladder cancer, abortion, ectopic pregnancy, infertility, kidney failure, urolithiasis and the need for invasive procedures. Relevant data were then extracted from the articles deemed eligible according to the inclusion criteria. MAIN RESULTS In total, 3052 articles were identified by the research query, of which 167 articles fulfilling inclusion criteria after title/abstract screening and full-text evaluation were included, 35% on both diagnostic and therapeutic aspects, and 51% on diagnosis and 14% on therapy. Ultrasound was the most frequently tool employed for the diagnosis of UGS complications showing a good performance. Concerning the management of hydronephrosis, the majority of available evidences came from community-based studies where universal treatment with praziquantel was used leading to decrease of prevalence of obstructive uropathy. Concerning studies on surgical procedures, laser endoureterotomy followed by stenting was mostly employed in adult patients leading to a crude cure rate of 60% (43 of 71 patients). In the case of severe hydronephrosis, surgery consisting of ureteral re-implantation showed excellent results with a crude cure rate of 98% (157 cured patients of 160 treated). Concerning bladder cancer, data on 93 patients with a clear diagnosis of UGS-related bladder were available reporting a variable and sometime combined approach based on disease stage. Available data on diagnosis and management of abortion, ectopic pregnancy, infertility, kidney failure, urolithiasis and the need for invasive procedures due to UGS are also presented. CONCLUSIONS The review produced a complete picture of the diagnostic and therapeutic options currently available for complicated UGS. These results can be useful both for guiding clinicians towards correct management and for tracing the direction of future research.
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Affiliation(s)
- Tommaso Manciulli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Davide Marangoni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Cristina Bocanegra
- Tropical Medicine and International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Joachim Richter
- Institute of Tropical Medicine and International Health, Charité Universitätsmedizin, Corporate Member of Free University and Humboldt University Berlin and Berlin Health Institute, Berlin, Germany
| | - Federico Gobbi
- Infectious-Tropical Diseases and Microbiology Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - Leonardo Motta
- Infectious-Tropical Diseases and Microbiology Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Infectious and Tropical Diseases, Azienda Ospedaliero Universitaria Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
- Department of Infectious and Tropical Diseases, Azienda Ospedaliero Universitaria Careggi, Largo Giovanni Alessandro Brambilla, 3, 50134, Florence, Italy.
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Lavanderos S, Dauelsberg H, Muñoz F, Muñoz C, Rodríguez G, Lira J. Successful Hysteroscopic Management of Cesarean Scar Defect Pregnancy. J Minim Invasive Gynecol 2023; 30:771-773. [PMID: 37315892 DOI: 10.1016/j.jmig.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Sebastián Lavanderos
- School of Medicine, Faculty of medicine, Diego Portales University (Drs. Lavanderos, F Muñoz, and C Muñoz) Santiago, Chile; OBGYN Department (Drs. Lavanderos, Dauelsberg, Rodríguez, and Lira), Santiago Oriente, Dr. Luis Tisné Brousse Hospital, Peñalolén, Chile.
| | - Heinz Dauelsberg
- School of Medicine, Faculty of medicine, Diego Portales University (Drs. Lavanderos, F Muñoz, and C Muñoz) Santiago, Chile; OBGYN Department (Drs. Lavanderos, Dauelsberg, Rodríguez, and Lira), Santiago Oriente, Dr. Luis Tisné Brousse Hospital, Peñalolén, Chile
| | - Fernanda Muñoz
- School of Medicine, Faculty of medicine, Diego Portales University (Drs. Lavanderos, F Muñoz, and C Muñoz) Santiago, Chile; OBGYN Department (Drs. Lavanderos, Dauelsberg, Rodríguez, and Lira), Santiago Oriente, Dr. Luis Tisné Brousse Hospital, Peñalolén, Chile
| | - Camila Muñoz
- School of Medicine, Faculty of medicine, Diego Portales University (Drs. Lavanderos, F Muñoz, and C Muñoz) Santiago, Chile; OBGYN Department (Drs. Lavanderos, Dauelsberg, Rodríguez, and Lira), Santiago Oriente, Dr. Luis Tisné Brousse Hospital, Peñalolén, Chile
| | - Gabriela Rodríguez
- School of Medicine, Faculty of medicine, Diego Portales University (Drs. Lavanderos, F Muñoz, and C Muñoz) Santiago, Chile; OBGYN Department (Drs. Lavanderos, Dauelsberg, Rodríguez, and Lira), Santiago Oriente, Dr. Luis Tisné Brousse Hospital, Peñalolén, Chile
| | - José Lira
- School of Medicine, Faculty of medicine, Diego Portales University (Drs. Lavanderos, F Muñoz, and C Muñoz) Santiago, Chile; OBGYN Department (Drs. Lavanderos, Dauelsberg, Rodríguez, and Lira), Santiago Oriente, Dr. Luis Tisné Brousse Hospital, Peñalolén, Chile
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25
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Yang F, Yang X, Jing H, Wang X, Gong Z, Deng C, Wang F, Shuai Y, Wang Z, Lai H. MRI-based scoring model to predict massive hemorrhage during dilatation and curettage in patients with cesarean scar pregnancy. Abdom Radiol (NY) 2023; 48:3195-3206. [PMID: 37358602 DOI: 10.1007/s00261-023-03968-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To construct a scoring model based on MRI signs to predict massive hemorrhage during dilatation and curettage in cesarean scar pregnancy (CSP) patients. MATERIALS AND METHODS The MRIs of CSP patients admitted to a tertiary referral hospital between February 2020 and July 2022 were retrospectively reviewed. The included patients were randomly assigned to the training and validation cohorts. The univariate and multivariate logistic regression analyses were adopted to identify the independent risk factors for massive hemorrhage (the amount of bleeding ≥ 200 ml) during the dilatation and curettage. A scoring model predicting intraoperative massive hemorrhage was established where each positive independent risk factor was assigned 1 point, and the predictive power of this model was evaluated both in the training and validation cohorts via the receiver operating characteristic curve. RESULTS A total of 187 CSP patients were enrolled, who were divided into the training cohort (31 in 131 patients had massive hemorrhage) and validation cohort (10 in 56 patients had massive hemorrhage). The independent risk factors for intraoperative massive hemorrhage included cesarean section diverticulum area (OR = 6.957, 95% CI 1.993-21.887; P = 0.001), uterine scar thickness (OR = 5.113, 95% CI 2.086-23.829; P = 0.025) and gestational sac diameter (OR = 3.853, 95% CI 1.103-13.530; P = 0.025). A scoring model with a total point of 3 was developed and the CSP patients were divided into low-risk (Total points < 2) and high-risk groups (Total points ≥ 2) for intraoperative massive hemorrhage accordingly. This model possessed high prediction performance both in the training cohort (area under the curve [AUC] = 0.896, 95% CI 0.830-0.942) and validation cohort (AUC = 0.915, 95% CI 0.785-1.000). CONCLUSION We first constructed a MRI-based scoring model for predicting intraoperative massive hemorrhage in CSP patients, which could help the decision-making of the patients' therapy strategies. Low-risk patients can be cured by D&C alone to reduce the financial burden, while high-risk patients require more adequate preoperative preparation or consideration of changing surgical approaches to reduce bleeding risk.
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Affiliation(s)
- Fengleng Yang
- Department of Radiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xilin Yang
- Department of Radiation Oncology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Huaibo Jing
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaodan Wang
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhaolin Gong
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Chen Deng
- Department of Radiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Fang Wang
- Department of Radiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yongzhong Shuai
- Department of Radiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhigang Wang
- Department of Radiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, China.
| | - Hua Lai
- Department of Radiology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, China.
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Abstract
PURPOSE OF REVIEW This review introduces the recognized body of evidence on social determinants of health, which continue to show that a person's health is determined by their broader environmental and social context and that societal inequities harm health and healthcare outcomes. An area of inequity is race, which, although a social construct, has a significant impact on a person's morbidity and mortality as well as their access and experience of healthcare. Racial disparities in maternal and perinatal outcomes are widely recognized. Therefore, this review focuses on the less commonly addressed early pregnancy setting. RECENT FINDINGS Health inequities are present in the early pregnancy setting, as racial disparities exist in early pregnancy presentations and outcomes. Black women have a higher incidence of miscarriage, ectopic pregnancy and poorer survival rates from gestational trophoblastic neoplasms. Asian women have a statistically significantly higher incidence of gestational trophoblastic disease. SUMMARY The findings support the need for more consistent and detailed research on the impact of race on early pregnancy outcomes and increasing ethnic diversity among study populations for trials to ensure meaningful and applicable data. Raising awareness of this racial health inequity in early pregnancy is the first step clinicians can take to tackle this issue.
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Affiliation(s)
- Oluremi Mogekwu
- Department of Obstetrics and Gynecology, Early Pregnancy and Acute Gynaecology, Royal London Hospital, Whitechapel Road, London
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Khajoei Nejad F, Rafati F, Rafati S, Dastyar N. The association between sexual function, quality of marital relationship and associated factors in women with a history of ectopic pregnancy: a cross-sectional study in Iran. BMC Womens Health 2023; 23:506. [PMID: 37735651 PMCID: PMC10512585 DOI: 10.1186/s12905-023-02635-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/04/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Ectopic pregnancy (EP) has many adverse effects on the relationship between couples. The present study aims to assess the association between sexual function (SF), quality of marital relationship (QMR) and associated factors in women with a history of EP. METHOD This cross-sectional study was performed on 220 women with a history of EP in Kerman in 2022. Convenience sampling method was applied. Data were collected using the female sexual function index (FSFI) and the perceived relationship quality components scale (PRQC) questionnaires and were analyzed with descriptive and inferential statistics (median regression) in Stata software version 17. A P-value < 0.05 was considered statistically significant. RESULTS Of the female participants, 20.4% had sexual dysfunction (SD). Longer duration of marriage (P = 0.045) and increase in the number of EPs (P < 0.001) were associated with a decrease in SF. A quarter of women experienced poor QMR. Increase in spouse age (P = 0.047), longer duration of marriage (P = 0.028), and increase in the number of EPs (P < 0.001) were associated with a decrease in QMR. There was a significant direct relationship between SF and the QMR (r = 0.857; P < 0.001). CONCLUSION The present study showed a significant relationship between SF and the QMR in women with a history of EP. Therefore, SF and the QMR are necessary to be considered in future health promotion programs of these women.
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Affiliation(s)
- Fateme Khajoei Nejad
- Midwifery Department, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Foozieh Rafati
- School of Nursing and Midwifery, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Shideh Rafati
- Social Factors in Health Promotion Research Center, Hormozgan Health Research Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Neda Dastyar
- Student Research Committee, Jiroft University of Medical Sciences, Jiroft, Iran.
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Lama P, Jha G, Amatya IP. Primary Ovarian Pregnancy after Bilateral Tubal Sterilization. J Nepal Health Res Counc 2023; 21:181-183. [PMID: 37742170 DOI: 10.33314/jnhrc.v21i1.3913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 09/10/2023] [Indexed: 09/25/2023]
Abstract
Tubal sterilization is considered a permanent method of contraception because it is highly effective. However, pregnancy can still occur following a successful procedure and such pregnancies are likely to be ectopic. Primary ovarian pregnancy is one of the rarest forms of ectopic pregnancy having incidence of 1/7000-1/40,000 in live births and 0.5-3% of all ectopic gestations. In this paper, we report a rare case of ovarian pregnancy after tubal sterilization. All women who are offered this procedure should always be educated about its failure rate. And in women presenting with acute abdomen, a prior history of tubal sterilization doesn't preclude the possibility of ectopic pregnancy. Keywords: Contraception; ovarian pregnancy; tubal sterilization.
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Affiliation(s)
- Poonam Lama
- Department of Obstetrics and Gynecology, Kapilvastu District Hospital, Kapilvastu, Nepal
| | - Gautam Jha
- Deparment of General Practice, Patan Academy of Health Sciences, Kathmandu, Nepal
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29
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Gao J, Yuan Y, Li J, Tian T, Lian Y, Liu P, Li R, Qiao J, Long X, Wang H. Sequential embryo transfer versus double cleavage-stage embryo or double blastocyst transfer in patients with recurrent implantation failure with frozen-thawed embryo transfer cycles: a cohort study. Front Endocrinol (Lausanne) 2023; 14:1238251. [PMID: 37745696 PMCID: PMC10515716 DOI: 10.3389/fendo.2023.1238251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Background Recurrent implantation failure (RIF) is more common among patients receiving assisted reproductive treatment. Many efforts have been made to increase the incidence of clinical pregnancy among patients with RIF. The effect of the sequential transfer procedure, a two-step interval transfer of a cleavage-stage embryo followed by a blastocyst in one transfer cycle, on the clinical outcomes of RIF patients remains controversial. Methods In total, 1774 frozen-thawed embryo transfer (FET) cycles in RIF patients were included. Of these cycles, 302 were sequential embryo transfer (ET) cycles, 979 were double day 3 cleavage-stage ET cycles, and 493 were double blastocyst ET cycles. The primary outcomes were the rates of implantation, clinical pregnancy and multiple pregnancy, and the secondary outcomes were the rates of hCG positive, early miscarriage and ectopic pregnancy. Results The implantation, hCG positive, and clinical pregnancy rates in the sequential ET group (32.1%, 58.9%, 50.7%) were significantly higher than those in the day 3 cleavage-stage ET group (24.9%, 46.5%, 40.4%) and were similar to those in the blastocyst transfer group (30.1%, 56.4%, 47.1%). The early miscarriage rate in the blastocyst transfer group was significantly higher than that in the cleavage-stage ET group (17.2% vs. 8.1%, P <0.05), while the ectopic pregnancy rate in the blastocyst transfer group was significantly lower than that in the cleavage-stage ET group (0.4% vs. 3.0%, P <0.05). The multiple pregnancy rate in the sequential ET group was significantly lower than that in the cleavage-stage ET group (17.0% vs. 25.5%, P <0.05) and the blastocyst transfer group (17.0% vs. 27.6%, P <0.05). When cycles of blastocyst culture failure were excluded, the clinical pregnancy rate was significantly higher (55.7% vs. 47.1%, P <0.05), and the early miscarriage rate and multiple pregnancy rate were significantly lower (8.5% vs. 17.2%, 17.7% vs. 27.6%; P <0.05, respectively) in the sequential ET group than in the double blastocyst ET group. Conclusions Sequential embryo transfer in FET cycles could improve the clinical outcomes of patients with RIF.
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Affiliation(s)
- Jiangman Gao
- State Key Laboratory of Female Fertility Promotion, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Yifeng Yuan
- State Key Laboratory of Female Fertility Promotion, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Jia Li
- State Key Laboratory of Female Fertility Promotion, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Tian Tian
- State Key Laboratory of Female Fertility Promotion, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Ying Lian
- State Key Laboratory of Female Fertility Promotion, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Ping Liu
- State Key Laboratory of Female Fertility Promotion, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Rong Li
- State Key Laboratory of Female Fertility Promotion, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Jie Qiao
- State Key Laboratory of Female Fertility Promotion, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Xiaoyu Long
- State Key Laboratory of Female Fertility Promotion, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Haiyan Wang
- State Key Laboratory of Female Fertility Promotion, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
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Nancarrow L, Tempest N, Lane S, Homburg R, Russell R, Hapangama DK. Four-dimensional ultrasound guided embryo transfers improve live birth rates when compared to the clinical touch technique: a randomised controlled trial. Sci Rep 2023; 13:14875. [PMID: 37684296 PMCID: PMC10491625 DOI: 10.1038/s41598-023-41313-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Most aspects of in-vitro fertilisation (IVF) have changed dramatically since introduction, but embryo transfer (ET) technique remains largely unaltered. We aimed to determine whether four-dimensional ultrasound guided embryo transfers (4D UGET) could improve pregnancy rates when compared with clinical touch technique (CTT). This was a single centre open labelled randomised controlled trial in a tertiary fertility centre in the UK. 320 women were randomised on the day of single ET. The primary outcome was clinical pregnancy rate (CPR), secondary outcomes included live birth rate (LBR), biochemical pregnancy rate (BPR), miscarriage, pregnancy of unknown location (PUL) and ectopic pregnancy. 4D-UGET resulted in significantly higher CPR [50% vs 36% p = 0.02, OR 1.78 (1.12-2.84)] and LBR [41% vs 28%, p = 0.02, OR 1.77 (1.09-2.87)] when compared to CTT technique. Miscarriage (p = 0.49), PUL (p = 0.14) and ectopic pregnancy (p = 0.96) were similar between the two groups. LBR, from this trial, are significantly higher than the current UK average (41% vs 24%). 4D UGET allows for superior imaging of the uterine cavity, whilst tailoring the embryo deposition point specifically to the patient. Further RCTs are required to determine if these results can be replicated in other units and whether 4D UGET is superior to 2D UGET.
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Affiliation(s)
- L Nancarrow
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Centre for Women's Health Research, Member of Liverpool Health Partners, University of Liverpool, Liverpool, L8 7SS, UK
- Hewitt Centre for Reproductive Medicine, Liverpool Women's NHS Foundation Trust, Liverpool, L8 7SS, UK
| | - Nicola Tempest
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Centre for Women's Health Research, Member of Liverpool Health Partners, University of Liverpool, Liverpool, L8 7SS, UK.
- Hewitt Centre for Reproductive Medicine, Liverpool Women's NHS Foundation Trust, Liverpool, L8 7SS, UK.
- Liverpool Women's NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool, L8 7SS, UK.
| | - S Lane
- Department of Biostatistics, Institute of Life Course and Medical Sciences, Member of Liverpool Health Partners, University of Liverpool, Liverpool, UK
| | - R Homburg
- Hewitt Centre for Reproductive Medicine, Liverpool Women's NHS Foundation Trust, Liverpool, L8 7SS, UK
| | - R Russell
- Hewitt Centre for Reproductive Medicine, Liverpool Women's NHS Foundation Trust, Liverpool, L8 7SS, UK
- Liverpool Women's NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool, L8 7SS, UK
| | - D K Hapangama
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Centre for Women's Health Research, Member of Liverpool Health Partners, University of Liverpool, Liverpool, L8 7SS, UK
- Liverpool Women's NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool, L8 7SS, UK
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Song L, Bu Z, Sun Y. Endometrial thickness and early pregnancy complications after frozen-thawed embryo transfers. Front Endocrinol (Lausanne) 2023; 14:1066922. [PMID: 37670886 PMCID: PMC10475533 DOI: 10.3389/fendo.2023.1066922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/02/2023] [Indexed: 09/07/2023] Open
Abstract
Background The relationship between endometrial thickness and pregnancy safety after in vitro fertilization treatment is an important topic that should provoke attention. The aim of this study was to demonstrate the relationship between endometrial thickness on day of embryo transfer and early pregnancy complications, including ectopic pregnancy and early miscarriage, in frozen thawed embryo transfer (FET) cycles. Methods Patients undergoing their first FET cycles were included into this study from January 2010 to December 2021. Patients were divided into three groups according to endometrial thickness on day of embryo transfer: Thin, ≤ 7 mm; Medium, 7-14 mm; Thick, ≥ 14 mm. Ectopic pregnancy and early miscarriage were the two primary outcomes. Endometrial thickness was the main measured variable. The risk factors of these two compilations were determined based on univariate analysis and multivariate logistic regression analysis. Results A total of 11138 clinical pregnancies were included. The overall ectopic pregnancy and early spontaneous miscarriage rates were 2.62% and 13.40%. The ectopic pregnancy and early spontaneous miscarriage rates were significantly higher in patients with thin endometrium as compared with those in the other two groups (ectopic pregnancy rate: 5.06% vs. 2.62% vs. 1.05%; P < 0.001; early spontaneous miscarriage rate: 15.18% vs. 13.45% vs. 11.53%; P < 0.001). In multivariate logistic regression analysis, thin endometrium was an independent factor to predict ectopic pregnancy [adjusted odds ratio (aOR): 5.62; 95% confidence interval (CI): 2.51-12.58, P < 0.001], and to predict early spontaneous miscarriage rate (aOR: 1.57; 95% CI: 1.21-1.74, P < 0.001). Conclusion Thin endometrium on day of embryo transfer in FET cycles is an independent predictor for early pregnancy compilations, including ectopic pregnancy and early spontaneous miscarriage.
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Affiliation(s)
- Lin Song
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhiqin Bu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingpu Sun
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Engineering Laboratory of Preimplantation Genetic Diagnosis and Screening, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Cutting E, Horta F, Dang V, van Rumste MM, Mol BWJ. Intracytoplasmic sperm injection versus conventional in vitro fertilisation in couples with males presenting with normal total sperm count and motility. Cochrane Database Syst Rev 2023; 8:CD001301. [PMID: 37581383 PMCID: PMC10426261 DOI: 10.1002/14651858.cd001301.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
BACKGROUND Starting over 40 years ago, in vitro fertilisation (IVF) has become the cornerstone for fertility treatment. Since then, in 1992, Palermo and colleagues successfully applied the technique intracytoplasmic sperm injection (ICSI) to benefit couples where conventional in vitro fertilisation (c-IVF) and sub-zonal insemination (SUZI) proved unsuccessful. After this case report, ICSI has become the treatment of choice for couples with severe male factor subfertility. Over time, ICSI has been used in the treatment of couples with mild male and even unexplained infertility. This review is an update of the review, first published in 1999, comparing ICSI with c-IVF for couples with males presenting with normal total sperm count and motility. OBJECTIVES To evaluate the effectiveness and safety of ICSI relative to c-IVF in couples with males presenting with normal total sperm count and motility. SEARCH METHODS We searched the following databases and trial registers: Cochrane Central Register of Controlled Trials (CENTRAL), Embase (excerpta Medica Database), MEDLINE (Medical Literature Analysis and Retrieval System Online) and PsycINFO (Psychological literature database) for articles between January 2010 and 22 February 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared ICSI with c-IVF in couples with males presenting with normal total sperm count and motility. DATA COLLECTION AND ANALYSIS We used standard methodical procedures recommended by Cochrane. The primary review outcomes were live birth and adverse events. Secondary outcomes included clinical pregnancy, viable intrauterine pregnancy and miscarriage. MAIN RESULTS The original review published in 2003 included one RCT. In this 2023 update, we identified an additional two RCTs totalling a cohort of 1539 couples, comparing ICSI with c-IVF techniques. Two studies reported on live birth. Using the GRADE method, we assessed the certainty of evidence and reported evidence as low-certainty for live birth. We are uncertain of the effect of ICSI versus c-IVF for live birth rates (risk ratio (RR) 1.11, 95% confidence interval (CI 0.94 to 1.30, I2 = 0%, 2 studies, n = 1124, low-certainty evidence). The evidence suggests that if the chance of live birth following c-IVF is assumed to be 32%, the chance of live birth with ICSI would be between 30% and 41%. For adverse events; multiple pregnancy, ectopic pregnancy, pre-eclampsia and prematurity, there was probably little or no difference between the two techniques. No study reported the primary outcome stillbirth. For secondary outcomes, we are uncertain of the effect of ICSI versus c-IVF for clinical pregnancy rates (RR 1.00, 95% CI 0.88 to 1.13, I2 = 45%, 3 studies, n = 1539, low-certainty evidence). Comparison of viable intrauterine pregnancy rates showed probably little or no difference between ICSI and c-IVF (RR 1.00, 95% CI 0.86 to 1.16, I2=75%, 2 studies, n = 1479 couples, moderate-certainty evidence). The high heterogeneity may have been caused by one older study conducted when protocols were less rigorous. The evidence suggests that if the chance of viable intrauterine pregnancy following c-IVF is assumed to be 33%, the chance of viable intrauterine pregnancy with ICSI would be between 28% and 38%. Miscarriage rates also showed probably little or no difference between the two techniques. AUTHORS' CONCLUSIONS The current available studies that compare ICSI and c-IVF in couples with males presenting with normal total sperm count and motility, show neither method was superior to the other, in achieving live birth, adverse events (multiple pregnancy, ectopic pregnancy, pre-eclampsia and prematurity), also alongside secondary outcomes, clinical pregnancy, viable intrauterine pregnancy or miscarriage.
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Affiliation(s)
- Elizabeth Cutting
- Department of Obstetrics and Gynaecology, School of Clinical Science, Monash University, Melbourne, Australia
| | - Fabrizzio Horta
- Department of Obstetrics and Gynaecology, School of Clinical Science, Monash University, Melbourne, Australia
- City Fertility, Notting Hill, Australia
- Monash Data Futures Institute, Monash University, Clayton, Australia
| | - Vinh Dang
- HOPE Research Centre, My Duc Hospital, Ho Chi Minh, Vietnam
| | | | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, School of Clinical Science, Monash University, Melbourne, Australia
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Frasca DJ, Jarrio CE, Perdue J. Evaluation of Acute Pelvic Pain in Women. Am Fam Physician 2023; 108:175-180. [PMID: 37590858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Acute pelvic pain is defined as noncyclic, intense pain localized to the lower abdomen and/or pelvis, with a duration of less than three months. Signs and symptoms are often nonspecific. The differential diagnosis is broad, based on the patient's age and pregnancy status and gynecologic vs. nongynecologic etiology. Nongynecologic etiologies include gastrointestinal, urinary, and musculoskeletal conditions. Urgent gynecologic conditions include ectopic pregnancy, ruptured ovarian cyst, adnexal torsion, and pelvic inflammatory disease. Approximately 40% of ectopic pregnancies are misdiagnosed at the presenting visit. Urgent nongynecologic conditions include appendicitis and pyelonephritis. Less urgent etiologies include sexually transmitted infections, pelvic floor myofascial pain, dysmenorrhea, and muscle strain. Approximately 15% of untreated chlamydia infections lead to pelvic inflammatory disease. History and physical examination findings guide laboratory testing. Questions should focus on the type, onset, location, and radiation of pain; timing and duration of symptoms; aggravating and relieving factors; and associated symptoms. Performing a urine pregnancy test or beta human chorionic gonadotropin test is an important first step for sexually active, premenopausal patients. Imaging options should be considered, with transvaginal ultrasonography first, followed by computed tomography. Magnetic resonance imaging can be useful if ultrasonography and computed tomography are nondiagnostic.
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Affiliation(s)
- D Jason Frasca
- Virginia Commonwealth University Riverside Family Medicine Residency Program, Newport News, Virginia
| | - Caitlyn E Jarrio
- Dwight D. Eisenhower Army Medical Center Family Medicine Residency Program, Fort Gordon, Georgia
| | - Justin Perdue
- 1st Battalion 5th Infantry Regiment, 1st Brigade 11th Airborne Division, Fort Wainwright, Alaska
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Tipiani-Rodríguez O, Elías-Estrada JC, Bocanegra-Becerra YL, Ponciano-Biaggi MA. Treatment of ectopic pregnancy implanted on cesarea scar: cohort study 2018-2022, Lima, Peru. Rev Colomb Obstet Ginecol 2023; 74:15-30. [PMID: 37253244 PMCID: PMC10237182 DOI: 10.18597/rcog.3958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/21/2023] [Indexed: 06/01/2023]
Abstract
Objectives To describe the clinical characteristics and treatment of ectopic pregnancy arising in the cesarean section scar, as well as its complications and obstetric prognosis. Material and methods Retrospective cohort study of pregnant women with the diagnosis of a scar pregnancy in accordance with Maternal-Fetal Medicine Society criteria, seen between January 2018 and March 2022 in two high complexity institutions of the social security system, located in Lima, Peru. Consecutive sampling was used. Baseline sociodemographic and clinical variables were measured, including diagnosis, type of treatment, complications and obstetric prognosis. A descriptive analysis was performed. Results Out of 29,919 deliveries, 17 patients were included. Of these, 41.2 % received medical management and the rest were treated surgically. Successful management with intra-gestational sac methotrexate was performed in two patients with ectopic pregnancy type 2. Four patients required total hysterectomy. Six patients became pregnant after the treatment and 4 completed their pregnancy with healthy mother and neonate pairs. Conclusions Ectopic pregnancy implanted in a cesarean section scar is an infrequent occurrence for which medical and surgical management options are available with apparently good outcomes. Further studies of better methodological quality and random assignment are needed in order to help characterize the safety and effectiveness of the various therapeutic options for women with suspected scar pregnancy.
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Huchon C, Drioueche H, Koskas M, Agostini A, Bauville E, Bourdel N, Fernandez H, Fritel X, Graesslin O, Legendre G, Lucot JP, Panel P, Raiffort C, Giraudet G, Bussières L, Fauconnier A. Operative Hysteroscopy vs Vacuum Aspiration for Incomplete Spontaneous Abortion: A Randomized Clinical Trial. JAMA 2023; 329:1197-1205. [PMID: 37039805 PMCID: PMC10091175 DOI: 10.1001/jama.2023.3415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/22/2023] [Indexed: 04/12/2023]
Abstract
Importance Vacuum aspiration is commonly used to remove retained products of conception in patients with incomplete spontaneous abortion. Scarring of the uterine cavity may occur, potentially impairing future fertility. A procedural alternative, operative hysteroscopy, has gained popularity with a presumption of better future fertility. Objective To assess the superiority of hysteroscopy to vacuum aspiration for subsequent pregnancy in patients with incomplete spontaneous abortion who intend to have future pregnancy. Design, Setting, and Participants The HY-PER randomized, controlled, single-blind trial included 574 patients between November 6, 2014, and May 3, 2017, with a 2-year duration of follow-up. This multicenter trial recruited patients in 15 French hospitals. Individuals aged 18 to 44 years and planned for surgery for an incomplete spontaneous abortion with plans to subsequently conceive were randomized in a 1:1 ratio. Interventions Surgical treatment by hysteroscopy (n = 288) or vacuum aspiration (n = 286). Main Outcomes and Measures The primary outcome was a pregnancy of at least 22 weeks' duration during 2-year follow-up. Results The intention-to-treat analyses included 563 women (mean [SD] age, 32.6 [5.4] years). All aspiration procedures were completed. The hysteroscopic procedure could not be completed for 19 patients (7%), 18 of which were converted to vacuum aspiration (8 with inability to completely resect, 7 with insufficient visualization, 2 with anesthetic complications that required a shortened procedure, 1 with equipment failure). One hysteroscopy failed due to a false passage during cervical dilatation. During the 2-year follow-up, 177 patients (62.8%) in the hysteroscopy group and 190 (67.6%) in the vacuum aspiration (control) group achieved the primary outcome (difference, -4.8% [95% CI, -13% to 3.0%]; P = .23). The time-to-event analyses showed no statistically significant difference between groups for the primary outcome (hazard ratio, 0.87 [95% CI, 0.71 to 1.07]). Duration of surgery and hospitalization were significantly longer for hysteroscopy. Rates of new miscarriages, ectopic pregnancies, Clavien-Dindo surgical complications of grade 3 or above (requiring surgical, endoscopic, or radiological intervention or life-threatening event or death), and reinterventions to remove remaining products of conception did not differ between groups. Conclusions and Relevance Surgical management by hysteroscopy of incomplete spontaneous abortions in patients intending to conceive again was not associated with more subsequent births or a better safety profile than vacuum aspiration. Moreover, operative hysteroscopy was not feasible in all cases. Trial Registration ClinicalTrials.gov Identifier: NCT02201732.
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Affiliation(s)
- Cyrille Huchon
- Department of Gynecology and Obstetrics, APHP, Hopital Lariboisière, University of Paris Cité, Paris, France
- Université Paris-Saclay, UVSQ, Unité de Recherche 7285, Risques Cliniques et Sécurité en Santé des Femmes et en Santé Périnatale (RISCQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, CHI Poissy-St-Germain, Poissy CEDEX, France
| | - Hocine Drioueche
- Department of Clinical Research, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France
| | - Martin Koskas
- Université Paris-Saclay, UVSQ, Unité de Recherche 7285, Risques Cliniques et Sécurité en Santé des Femmes et en Santé Périnatale (RISCQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, APHP, Hôpital Bichat, Paris, France
| | - Aubert Agostini
- Department of Gynecology and Obstetrics, Hôpital La Conception, Marseille CEDEX 5, France
| | - Estelle Bauville
- Department of Gynecology and Obstetrics, Rennes University Hospital, Rennes CEDEX 2, France
| | - Nicolas Bourdel
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand CEDEX 1, Faculty of Medicine, ISIT – Université d’Auvergne, Clermont-Ferrand, France
| | - Hervé Fernandez
- Department of Gynecology and Obstetrics, AP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, 94270, France
- Centre for Epidemiology and Population Health-INSERM U1018, Université Paris Sud, Le Kremlin Bicêtre, France
| | - Xavier Fritel
- Department of Gynecology and Obstetrics, CHU de Poitiers, Université de Poitiers, Faculté de Médecine et Pharmacie, Inserm CIC1402, Poitiers, France
| | - Olivier Graesslin
- Department of Gynecology and Obstetrics, Hôpital Alix de Champagne, CHU de Reims, Reims, France
| | - Guillaume Legendre
- Department of Gynecology and Obstetrics, CHU d’Angers, Angers CEDEX 01, France
| | - Jean-Philippe Lucot
- Department of Gynecology and Obstetrics, Hôpital Jeanne-de-Flandre, CHRU de Lille, Lille, France
| | - Pierre Panel
- Department of Gynecology and Obstetrics, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Cyril Raiffort
- Department of Gynecology and Obstetrics, APHP, Hôpital Louis Mourier, Département Hospitalier Universitaire Risque et Grossesse, Colombes, University of Paris Cité, Paris, France
| | - Géraldine Giraudet
- Department of Gynecology and Obstetrics, Hôpital Jeanne-de-Flandre, CHRU de Lille, Lille, France
| | - Laurence Bussières
- Clinical Unit Research/Clinic Investigation Center, Paris Descartes, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Arnaud Fauconnier
- Université Paris-Saclay, UVSQ, Unité de Recherche 7285, Risques Cliniques et Sécurité en Santé des Femmes et en Santé Périnatale (RISCQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, CHI Poissy-St-Germain, Poissy CEDEX, France
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Wenzhi X, Xin X, Ping Z, Hanglin W, Xiaona L. A meta-analysis of obstetric and neonatal outcomes in patients after treatment of hysteroscopic adhesiolysis. Front Endocrinol (Lausanne) 2023; 14:1126740. [PMID: 37033233 PMCID: PMC10080075 DOI: 10.3389/fendo.2023.1126740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/15/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Hysteroscopic adhesiolysis is widely performed in women with intrauterine adhesions. Small observational studies have reported the obstetric and neonatal outcomes, but studies with larger sample sizes are few. The aim of this study is to evaluate the obstetric and neonatal outcomes in women after hysteroscopic adhesiolysis. Methods We conducted a literature search in July 2022 using the PubMed, Embase, the Cochrane Library, and Web of Science databases, and finally, 32 studies (N = 3812) were included. We did a meta-analysis to estimate the prevalence of placenta-related disorders, including placenta previa, placental abruption, placenta accreta, placenta increta, and retained placenta. We also included other obstetric and neonatal outcomes like postpartum hemorrhage, ectopic pregnancy, oligohydramnios, gestational hypertension, gestational diabetes mellitus, and intrauterine growth restriction. The results were presented as odds ratios (ORs) with 95% confidence intervals (CIs) in studies with a control group, but otherwise as prevalence (%) with 95% confidence intervals (CIs). Results The overall pregnancy and live birth rates were 58.97% and 45.56%, respectively. The prevalence of placenta previa differed in pregnant women who underwent hysteroscopic adhesiolysis compared with those who did not (OR, 3.27; 95% CI, 1.28-8.36). In studies without a comparative group, the pooled rate of placenta accreta was 7% (95% CI, 4-11) in 20 studies; placenta increta was 1% (95% CI, 0-4) in 5 studies; a retained placenta was 11% (95% CI, 5-24) in 5 studies; postpartum hemorrhage was 12% (95% CI, 8-18) in 12 studies; ectopic pregnancy was 1% (95% CI, 0-2) in 13 studies; oligohydramnios was 3% (95% CI, 1-6) in 3 studies; intrauterine growth restriction was 3% (95% CI, 1-8) in 3 studies; gestational hypertension was 5% (95% CI, 2-11) in 4 studies; and diabetes mellitus was 4% (95% CI, 2-7) in 3 studies. Discussion Due to the paucity of good quality comparative data, the question of whether there is an increased prevalence of obstetric and neonatal complications in women after hysteroscopic adhesiolysis compared with the general population remains unanswered. The findings from this review will provide a basis for more well-designed studies in the future. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=364021, identifier [CRD42022364021].
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Affiliation(s)
- Xu Wenzhi
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xu Xin
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhou Ping
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wu Hanglin
- Department of Obstetrics and Gynecology, Hangzhou Women’s Hospital, Hangzhou, China
| | - Lin Xiaona
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
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Sonalkar S, Gilmore E. A fresh look at treatment for ectopic pregnancy. Lancet 2023; 401:619-620. [PMID: 36738758 DOI: 10.1016/s0140-6736(23)00181-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 02/04/2023]
Affiliation(s)
- Sarita Sonalkar
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Emma Gilmore
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
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Tellum T, Bracco B, De Braud LV, Knez J, Ashton‐Barnett R, Amin T, Chaggar P, Jurkovic D. Reproductive outcome in 326 women with unicornuate uterus. Ultrasound Obstet Gynecol 2023; 61:99-108. [PMID: 36099518 PMCID: PMC10107309 DOI: 10.1002/uog.26073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/27/2022] [Accepted: 09/05/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To study the reproductive outcomes of women with a unicornuate uterus and compare them to those of women with no congenital uterine anomaly. METHODS This was a single-center, retrospective cohort study. Cases were women aged at least 16 years who were diagnosed with a unicornuate uterus on transvaginal/transrectal ultrasound between January 2008 and September 2021. Controls were women with no congenital uterine anomaly matched 1:1 by age and body mass index. The primary outcome was live-birth rate. Secondary outcomes were pregnancy loss (miscarriage, ectopic pregnancy, termination of pregnancy), preterm delivery, mode of delivery and concomitant gynecological abnormalities (endometriosis, adenomyosis, fibroids). RESULTS Included in the study were 326 cases and 326 controls. Women with a unicornuate uterus had a significantly lower live-birth rate (184/388 (47.4%) vs 229/396 (57.8%); P = 0.004) and higher rates of overall miscarriage (178/424 (42.0%) vs 155/465 (33.3%); adjusted odds ratio (aOR), 2.21 (95% CI, 1.42-3.42), P < 0.001), ectopic pregnancy (26/424 (6.1%) vs 11/465 (2.4%); aOR, 2.52 (95% CI, 1.22-5.22), P = 0.01), preterm delivery (45/184 (24.5%) vs 17/229 (7.4%); aOR, 3.04 (95% CI, 1.52-5.97), P = 0.001) and Cesarean delivery (116/184 (63.0%) vs 70/229 (30.6%); aOR, 2.54 (95% CI, 1.67-3.88), P < 0.001). Rudimentary-horn pregnancies accounted for 7/26 (26.9%) ectopic pregnancies in the study group. Women with a unicornuate uterus were more likely to have endometriosis (17.5% vs 10.7%; P = 0.018) and adenomyosis (26.7% vs 15.6%; P = 0.001), but were not more likely to have fibroids compared with controls. Women with a functional rudimentary horn were more likely to have pelvic endometriosis compared to those without (odds ratio, 2.4 (95% CI, 1.4-4.1), P = 0.002). CONCLUSIONS Pregnant women with a unicornuate uterus should be classified as high risk. Removal of a functional rudimentary horn should be discussed with the patient to prevent a rudimentary-horn ectopic pregnancy. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T. Tellum
- Institute for Women's Health, Faculty of Population Health SciencesUniversity College LondonLondonUK
- Department of GynecologyOslo University HospitalOsloNorway
| | - B. Bracco
- Institute for Women's Health, Faculty of Population Health SciencesUniversity College LondonLondonUK
| | - L. V. De Braud
- Institute for Women's Health, Faculty of Population Health SciencesUniversity College LondonLondonUK
| | - J. Knez
- Clinic for GynecologyUniversity Medical Centre MariborMariborSlovenia
| | - R. Ashton‐Barnett
- Institute for Women's Health, Faculty of Population Health SciencesUniversity College LondonLondonUK
| | - T. Amin
- Institute for Women's Health, Faculty of Population Health SciencesUniversity College LondonLondonUK
| | - P. Chaggar
- Institute for Women's Health, Faculty of Population Health SciencesUniversity College LondonLondonUK
| | - D. Jurkovic
- Institute for Women's Health, Faculty of Population Health SciencesUniversity College LondonLondonUK
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Martucci J. "It Gives the Mother the Best Chance for Her Life": U.S. Catholic Health Care and the Treatment of Ectopic Pregnancy. Bull Hist Med 2023; 97:48-56. [PMID: 38588203 DOI: 10.1353/bhm.2023.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
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Botsyurko R, Smoligová V. Bilateral tubal ectopic pregnancy after spontaneous conception. Ceska Gynekol 2023; 88:287-290. [PMID: 37643910 DOI: 10.48095/cccg2023287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Presentation of a case report of a rare case of bilateral tubal pregnancy in a female patient after spontaneous conception. OBSERVATION We present a case of a 26-year-old female patient first hospitalized in the Gynecology Obstetrics Clinic of the Pilsen University Hospital, where a laparoscopy was indicated for suspicion of ectopic tubal pregnancy during which a left-sided salpingectomy was performed for a macroscopically clear finding of a tubal pregnancy on the left side, this finding was also confirmed histologically. Subsequently, the patient was discharged to home care. During a follow-up examination by a district gynaecologist, the patient complained of a recurrence of pain in the lower abdomen, on collection of hCG (human chorionic gonadotropin) its increase was detected and the patient was sent for a control gynaecological examination to Mulacova Hospital in Pilsen. On the examination in the outpatient clinic, she reported significant lower abdominal pain and collapsed during transvaginal ultrasound and was hospitalized. Subsequently, diagnostic laparoscopy was indicated during hospitalization, during which tubal pregnancy on the right and hemoperitoneum were macroscopically evident. A right-sided salpingectomy was performed for this finding with subsequent hCG drop, resolution of the discomfort and histological confirmation of tubal pregnancy on the right. CONCLUSION The incidence of such cases without prior ovulation stimulation is 1 out of 200,000 pregnancies and an estimated 1 out of 725 to 1 out of 1,580 ectopic pregnancies. Even so, bilateral tubal or heterotopic ectopic pregnancy should be considered in the differential diagnosis, as both conditions can be immediately life-threatening.
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Zheng YJ, Chen Q, Li S, Yan XT, Zhu T, He Z. Cesarean Scar Pregnancies Treated by Uterine Artery Chemotherapy Embolization Combined With Ultrasound-Guided Dilation and Curettage: A Retrospective Study. J Ultrasound Med 2023; 42:27-33. [PMID: 35778904 DOI: 10.1002/jum.16050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 05/03/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To explore the effect of cesarean scar pregnancy (CSP) treatment by comparing uterine artery chemotherapy embolization (UACE) combined with dilation and curettage (D&C) with or without ultrasound guidance. METHODS CSP patients treated with UACE combined with D&C from January 2013 to December 2020 at Shuguang Hospital, affiliated to Shanghai University of Traditional Chinese Medicine were included in this retrospective study. The patients were divided into groups A and B according to whether D&C was guided by ultrasound. RESULTS Forty-eight patients with CSP diagnosed by transvaginal ultrasound were included in this study, whose gestational age was <8 weeks. There were no significant differences in the basic clinical characteristics of the two groups. The success rates of the 2 groups were no significant difference, 100% (27/27) in group A and 85.7% (18/21) in group B. The maximal intraoperative blood loss of group A was 100 mL and that of group B was 150 mL. There was no uterine perforation during the operation. Ultrasound guidance can shorten the D&C operation time, reduce intraoperative bleeding during D&C, and decrease the residual rate of trophoblastic tissue after D&C. CONCLUSIONS Ultrasound guidance can improve the safety and efficiency of UACE combined with D&C in the treatment of CSP and reduce its complications. We believe it is an optimal treatment for CSP patients who do not plan to have children in the future.
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Affiliation(s)
- Yi-Jun Zheng
- Department of Ultrasound, Shuguang Hospital affiliated to Shanghai Universtity of Traditional Chinese Medicine, Shanghai, China
| | - Qing Chen
- Department of Ultrasound, Shuguang Hospital affiliated to Shanghai Universtity of Traditional Chinese Medicine, Shanghai, China
| | - Sheng Li
- Department of Ultrasound, Shuguang Hospital affiliated to Shanghai Universtity of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-Tong Yan
- Department of Gynecology, Shuguang Hospital affiliated to Shanghai Universtity of Traditional Chinese Medicine, Shanghai, China
| | - Ting Zhu
- Department of Gynecology, Shuguang Hospital affiliated to Shanghai Universtity of Traditional Chinese Medicine, Shanghai, China
| | - Zheng He
- Department of Ultrasound, Shuguang Hospital affiliated to Shanghai Universtity of Traditional Chinese Medicine, Shanghai, China
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Shen L. Effects of Pelvic Floor Muscle Massage on the Pregnancy Outcome of Frozen Embryo Transfer in Patients with Thin Endometrium. Comput Math Methods Med 2022; 2022:2803363. [PMID: 35813410 PMCID: PMC9259337 DOI: 10.1155/2022/2803363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022]
Abstract
Objective To observe the effects of pelvic floor muscle mass on the priority outcome of frozen embryo transfer in patients with thin endometrium. Methods The patients who were prepared for freeze-thaw embryo transfer were randomly divided into the study group and control group. Both groups of patients began to take estradiol valerate tablets 3 mg on the third day of menstrual cycle and added progesterone for luteal support after 14 days. Both groups selected high-quality embryos for embryo transfer on the day of embryo transfer. The basic information, embryo transfer, intimal thickness, intimal type, clinical pregnancy rate, and early abortion rate of the two groups were compared. Results The intimal thickness of patients in the control group and the study group on the second day of menstruation was (0.49 ± 0.03) and (0.45 ± 0.02) and that before progesterone was (1.17 ± 0.03) and (1.20 ± 0.04), respectively (P < 0.05). At the same time, the number of excellent embryos in the study group was significantly higher than that in the control group (P < 0.05), but there was no significant difference in the number of transplants between the two groups (P > 0.05). The proportion of intimal blood flow of type III + II in the study group was significantly higher than that in the control group (P < 0.05). The main adverse pregnancy outcomes of the whole group included biochemical pregnancy, early abortion, and ectopic pregnancy. The incidence of biochemical pregnancy in the control group and the study group was 63.3% (38/60) and 40.0% (24/60), respectively. The incidence of biochemical pregnancy in the control group was significantly higher than that in the study group, but there was no significant difference in the incidence of early abortion and ectopic pregnancy between the two groups (P > 0.05). Conclusion Pelvic floor muscle massage can improve endometrial thickness and subendometrial blood flow, so as to improve the pregnancy rate of frozen thawed embryo transfer patients.
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Affiliation(s)
- Longying Shen
- Kuishan Health Center of Rizhao Economic and Technological Development Zone, China
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Alabiad MA, Said WMM, Gad AH, Sharaf ElDin MTA, Khairy DA, Gobran MA, Shalaby AM, Samy W, Abdelsameea AA, Heraiz AI. Evaluation of Different Doses of the Aromatase Inhibitor Letrozole for the Treatment of Ectopic Pregnancy and Its Effect on Villous Trophoblastic Tissue. Reprod Sci 2022; 29:2983-2994. [PMID: 35701686 PMCID: PMC9537218 DOI: 10.1007/s43032-022-00993-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 05/29/2022] [Indexed: 11/26/2022]
Abstract
Letrozole, an aromatase inhibitor, has recently been introduced as a favorable medical treatment for ectopic pregnancy. We aimed at evaluating the effects of different doses of letrozole for termination of ectopic pregnancy and study their effects on villous trophoblastic tissue. Sixty patients with undisturbed ectopic pregnancy were classified into three equal groups. Group I: the control group that contained women who underwent laparoscopic salpingectomy, Group II: patients who received letrozole (5 mg day−1) for 10 days, and Group III: patients who received letrozole (10 mg day−1) for 10 days. Subsequently, the β-hCG levels were determined on the first day and after 11 days of treatment. Group IV consisted of patients of GII and GIII; their β-hCG did not drop below 100 mIU/ml within 11 days, and underwent salpingectomy. Placental tissues from patients undergoing salpingectomy either from the control group or GIV were processed for the evaluation of estrogen (ER) and progesterone (PR) receptors, vascular endothelial growth factor (VEGF), and cleaved caspase 3 (CC-3) expression. Cases exposed to high dose letrozole 10 mg day−1 resulted in a higher ectopic pregnancy resolution rate of 85% (17/20), while the resolution rate of the low dose letrozole-treated group (5 mg day−1) was 65% (13/20), and also showed a significant reduction in β-hCG levels on the 11th day, 25.63 ± 4.29 compared to the low dose letrozole group 37.91 ± 7.18 (P < 0.001), Meanwhile, the letrozole-treated group GIV showed markedly reduced expression of ER, PR, and VEGF and a significant increase in the apoptotic index cleaved caspase-3 compared to the control group (P < 0.001). The utilization of letrozole at a dose of 10 mg day−1 for medical treatment of ectopic pregnancy results in a high-successful rate without any severe side effects. Letrozole depriving the placenta of estrogen that had vascular supporting signals resulted in destroying the vascular network with marked apoptosis.
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Affiliation(s)
- Mohamed Ali Alabiad
- Department of Pathology, Faculty of Medicine, Zagazig University, Zagazig, 44519 Egypt
| | - Warda M. M. Said
- Department of Pathology, Faculty of Medicine, Benghazi University, Benghazi, Libya
| | - Abdalla Hassan Gad
- Department of Gynecology and Obstetrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Dina Ahmed Khairy
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mai Ahmed Gobran
- Department of Pathology, Faculty of Medicine, Zagazig University, Zagazig, 44519 Egypt
| | - Amany Mohamed Shalaby
- Department of Histology and Cell Biology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Walaa Samy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Ahmed Ismail Heraiz
- Department of Gynecology and Obstetrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Xu L, Gao S, Jiang J, Sun M, Sheng Y, Tang R. Outcomes of embryo vitrification at different developmental stages: Evaluation of 2412 warming cycles. Medicine (Baltimore) 2022; 101:e29233. [PMID: 35583531 PMCID: PMC9276305 DOI: 10.1097/md.0000000000029233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 03/16/2022] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Advances in cell culture media have led to a shift from cleavage stage embryo transfer to blastocyst stage transfer. Extended embryo culture to the blastocyst stage provides some theoretical advantages and disadvantages. There has been controversy. This study is sought to evaluate the clinical outcomes of vitrified-warmed cleavage-stage and blastocyst-stage embryo transfers in patients undergoing Artificial Reproductive Technique treatments. MATERIAL AND METHOD The study was performed on 2740 women undergoing frozen embryo thawing transfer. Patients' basic situation, status of frozen embryo transfer cycle, clinical pregnancy rate, early abortion rate, sex ratio of birth, and birth weight were retrospectively analyzed. We compared the main clinical results of recovery of frozen embryo on the cleavage stage and blastocyst stage. Furthermore, we evaluated the clinical outcomes of blastocyst cryopreservation on Day 5, 6, or 7 after oocyte retrieval according to the day of blastocyst expansion were evaluated. RESULTS The implantation ratio of cleavage stage embryos was 21.62% compared with 43.52% on D5 (P < .05). The D5, D6, and D7 implanting rates were statistically different. The pregnancy rates were 57.56%, 51.76%, and 35.95% versus 37.79%, respectively for embryos cryopreserved on D5, D6, D7, and D3. The ectopic pregnancy rate and early abortion rate were statistically different between D5 and D3. The sex ratio, the birth weight, and birth defect were not statistically different among the four groups. CONCLUSIONS Blastocyst transfer achieved a higher implantation rate than vitrified cleavage stage embryo and decreased ectopic pregnancy rate. With increased incubation days before expansion blastocyst formed, the implantation rate is reduced and the early abortion rate increases.
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Affiliation(s)
- Lizhen Xu
- Department of Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200001, China
| | - Shanshan Gao
- Center for Reproductive Medicine, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Jingjing Jiang
- Center for Reproductive Medicine, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Mei Sun
- Center for Reproductive Medicine, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Yan Sheng
- Center for Reproductive Medicine, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Rong Tang
- Center for Reproductive Medicine, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
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Wang Y, Yang J, Butts S, Zhu Y. Elevated hCG Concentration in a Patient after an Unsuccessful in vitro Fertilization. Ann Clin Lab Sci 2022; 52:484-487. [PMID: 35777793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A patient had a positive serum human chorionic gonadotropin (hCG) 22 days after a failed in vitro fertilization (IVF). The result was confirmed by repeating the test using quantitative and qualitative assays after 48 hours, but the quantitative result did not double compared to the previous concentration. Heterophilic antibody interference was ruled out. The above results indicated true-positive hCG, but inconsistent with normal pregnancy. Medical history excluded hCG produced by pituitary gland, malignancy and exogenous hCG use. Ectopic pregnancy (EP) was suspected and methotrexate was initiated. Ultrasound showed periadnexal fluid suggesting separation phenomenon on the right adnexal EP and hCG was decreased one weeks after the treatment. Two weeks later, hCG became negative. The above data suggest that the elevated hCG was most likely due to EP following IVF.
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Affiliation(s)
- Ying Wang
- Department of Pathology and Laboratory Medicine and Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Jianbo Yang
- Department of Pathology and Laboratory Medicine and Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Samantha Butts
- Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Yusheng Zhu
- Department of Pathology and Laboratory Medicine and Pennsylvania State University College of Medicine, Hershey, PA, USA
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Zhang D, Zhu Q, Xia W, Zhu C, Zhao X, Zhang Y, He C, Ji S, Li X, Zhang J. The role of SK3 in progesterone-induced inhibition of human fallopian tubal contraction. Reprod Biol Endocrinol 2022; 20:73. [PMID: 35488306 PMCID: PMC9052544 DOI: 10.1186/s12958-022-00932-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/22/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Normal motor activity of the fallopian tube is critical for human reproduction, and abnormal tubal activity may lead to ectopic pregnancy (EP) or infertility. Progesterone has an inhibitory effect on tubal contraction; however, the underlying mechanisms remain unclear. Small-conductance calcium-activated K+ channel 3 (SK3) is abundantly expressed in platelet-derived growth factor receptor α positive (PDGFRα+) cells and was reported to be important for the relaxation of smooth muscle. The present study aims to explore the expression of SK3 in the human fallopian tube and its role in progesterone-induced inhibition of tubal contraction. METHODS We collected specimens of fallopian tubes from patients treated by salpingectomy for EP (EP group) and other benign gynecological diseases (Non-EP group). The expression of SK3 was detected by quantitative real-time polymerase chain reaction, western blot, immunocytochemistry, and immunohistochemistry analyses. Isometric tension experiments were performed to investigate the role of SK3 in progesterone-induced inhibition of tubal contraction. RESULTS The baseline amplitude and frequency of human fallopian tube contraction were both statistically lower in the EP group compared with the non-EP group. The expression levels of SK3 in different portions of fallopian tubes from the non-EP group were significantly higher than in those from the EP group. Progesterone had an inhibitory effect on tubal contraction, mainly on the amplitude, in both groups, and SK3 as well as other calcium-activated K+ channels may be involved. SK3-expressing PDGFRα (+) cells were detected in the human fallopian tube. CONCLUSIONS The expression of SK3 is lower in the EP group, and SK3 is involved in the progesterone-induced inhibition of human fallopian tube contraction.
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Affiliation(s)
- Duo Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Qian Zhu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Wei Xia
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Chenfeng Zhu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Xiaoya Zhao
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Yiqin Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Chuqing He
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Sifan Ji
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Xiaocui Li
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
| | - Jian Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200030, China.
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China.
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Düz SA. FERTILITY OUTCOMES AFTER MEDICAL AND SURGICAL MANAGEMENT OF TUBAL ECTOPIC PREGNANCY. Acta Clin Croat 2022; 60:347-353. [PMID: 35282476 PMCID: PMC8907964 DOI: 10.20471/acc.2021.60.03.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/23/2021] [Indexed: 11/24/2022] Open
Abstract
The objective was to investigate whether the method of treatment (surgical or medical) affects achieving a new pregnancy, as well as the time to and prognosis of the new pregnancy, in women with ectopic pregnancy (EP). Information on patients treated in our hospital between 2013 and 2014 for EP was retrieved from the computerized patient records. Data on whether these patients achieved pregnancy after EP treatment, time from treatment to new pregnancy, and prognosis of pregnancy were collected by phone interviews. A total of 101 women were analyzed. In addition to descriptive analysis, the χ2-test and Kruskal Wallis test were used to compare the groups. A new pregnancy was present in 84 (83.2%) of the women after EP treatment. There was no significant difference among the women having undergone medical treatment (methotrexate), surgical treatment, medical treatment followed by surgical treatment, or observational management approach in terms of achieving a new pregnancy after treatment and time to and prognosis of the new pregnancy. The study could not determine which treatment method would be superior in women with EP and in planning future pregnancy, but concluded that close clinical and laboratory monitoring is appropriate before deciding on aggressive interventions.
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Affiliation(s)
- Senem Arda Düz
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Inonu University Faculty of Medicine, Malatya, Turkey
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Zhang-Rutledge K, Pinson K, Perez M, Adami RR, Melber D, Jacobs M, Parast M, Lamale-Smith L, Averbach S, Hahn M, Pretorius D, Ballas J. FundAl Retroflexion (FAR) Angle is a Novel Sonographic Marker Associated With Cesarean Scar Pregnancies in the First Trimester: A Case-Control Study. J Ultrasound Med 2022; 41:327-333. [PMID: 33769573 DOI: 10.1002/jum.15704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/05/2021] [Accepted: 03/13/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Early diagnosis of Cesarean scar pregnancies (CSP) remains difficult. This study describes a novel sonographic marker, the FundAl Retroflexion (FAR) angle, that may be used in the first trimester. The objective of the study is to compare the FAR angle between CSP and normal pregnancies. METHODS For this case-control study, we reviewed images from our institution's database that were acquired from January 2016 to December 2019. All cases of CSP and randomly selected controls, defined as patients with history of Cesarean delivery and normal implantation, that underwent ultrasound evaluation at <14 weeks were included. The FAR angle, defined as the acute angle created between the endometrial echo and cervical canal, was measured. The mean FAR angle was then compared between the two groups and a receiver operating characteristic (ROC) curve was generated. RESULTS We identified 15 cases of CSP during the study period and were able to measure the FAR angle in 14 of the cases. The mean FAR angle was larger in CSP than in normal control pregnancies (45° versus 27°, respectively, P < 0.001). Using an ROC curve, a FAR angle cut off of 40° maximizes the ability to distinguish between CSP from normal pregnancies. CONCLUSIONS The FAR angle provides an easily obtainable and numerical measurement. CSP have larger FAR angle compared to normal controls with a distinguishing cut off of 40°. Larger studies are needed to determine if using the FAR angle can improve first trimester diagnosis for CSP.
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Affiliation(s)
- Kathy Zhang-Rutledge
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, La Jolla, California, USA
| | - Kelsey Pinson
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, La Jolla, California, USA
| | - Mishella Perez
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, La Jolla, California, USA
| | - Rebecca R Adami
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, La Jolla, California, USA
| | - Dora Melber
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, La Jolla, California, USA
| | - Marni Jacobs
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, La Jolla, California, USA
| | - Mana Parast
- Department of Pathology, University of California, La Jolla, California, USA
| | - Leah Lamale-Smith
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, La Jolla, California, USA
| | - Sarah Averbach
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, La Jolla, California, USA
| | - Michael Hahn
- Department of Radiology, University of California, La Jolla, California, USA
| | - Dolores Pretorius
- Department of Radiology, University of California, La Jolla, California, USA
| | - Jerasimos Ballas
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, La Jolla, California, USA
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49
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Neo DT, Samoff E, Cope A. Pelvic Inflammatory Disease Trends Among Emergency Department Visits in North Carolina, 2008 to 2017. Sex Transm Dis 2022; 49:43-49. [PMID: 34264903 PMCID: PMC8665106 DOI: 10.1097/olq.0000000000001514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Pelvic inflammatory disease (PID) is an infection of the upper female reproductive organs that can lead to infertility and ectopic pregnancies. It is a reportable condition in North Carolina (NC) but is likely underreported. We aimed to quantify PID diagnoses in NC emergency department (ED) visits. METHODS The NC Disease Event Tracking and Epidemiology Collection Tool tracks all ED visits in NC. We identified PID diagnoses among women of reproductive age (15-44 years) between 2008 and 2017 using International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification codes, and calculated the yearly proportion with PID diagnoses. We assessed the number of PID visits per patient each year, and the proportion of ED visits with a PID diagnosis by age, proportion of the patient's ZIP code living below the poverty line, insurance coverage, and NC provider region. RESULTS The percent of women with PID decreased from 6189 (1.0%) in 2008 to 4337 (0.58%) in 2016 before increasing slightly to 4371 (0.61%) in 2017. We identified 54,502 (0.45%) ED visits among 51,847 (0.76%) women with ≥1 PID diagnosis code. Most (95.5%) women with PID had one ED visit during the calendar year. Each year, the proportion with PID was highest among women aged 20 to 24 years, covered under public insurance, from the most impoverished areas, and whose provider was in the Coastal region of NC. CONCLUSIONS The percent with PID among women visiting EDs decreased between 2008 and 2017 in NC. Although this decline was observed across all demographics, disparities associated with PID continued to persist over time.
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Affiliation(s)
- Dayna T. Neo
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Public Health
| | - Erika Samoff
- North Carolina Department of Health and Human Services, Division of Public Health
| | - Anna Cope
- North Carolina Department of Health and Human Services, Division of Public Health
- Centers for Disease Control and Prevention-Division of STD Prevention
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50
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Zhao Y, Liu D, Liu N, Li Y, Yao Z, Tian F, Xu A, Li Y. An Endometrial Thickness < 8 mm Was Associated With a Significantly Increased Risk of EP After Freeze-Thaw Transfer: An Analysis of 5,960 Pregnancy Cycles. Front Endocrinol (Lausanne) 2022; 13:884553. [PMID: 35813636 PMCID: PMC9261458 DOI: 10.3389/fendo.2022.884553] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Endometrium characteristics that are most likely to induce ectopic pregnancy were investigated on the basis of the data of 5,960 pregnant freeze-thaw cycles. METHODS A total of 5,960 pregnancy cycles after freeze-thaw embryos transfer were included, with the number of intrauterine and ectopic pregnancies being 5,777 and 183, respectively. Ectopic pregnancy was the primary outcome. Endometrial thickness was the main measured variable. The risk factors of ectopic pregnancy were eventually determined based on univariate analysis and subsequent multiple-stepwise logistic regression analysis. RESULTS 1. After adjusting for confounders, endometrial thickness could independently predict ectopic pregnancy. The adjusted odd ratios for women with endometrial thickness in the ranges of < 8 mm, 8-9.9 mm, and 10-11.9 mm were 3.270 [95% confidence interval (CI), 1.113-9.605, P = 0.031], 2.758 (95% CI, 0.987-7.707, P = 0.053), and 1.456 (95% CI, 0.502-4.225, P = 0.489), respectively, when compared with those having an endometrial thickness of 12-13.9 mm. 2. Endometrial type and preparation protocol were however not identified as risk factors for ectopic pregnancy. DISCUSSION 1. After freeze-thaw embryo transfer, risks of ectopic pregnancy were significantly higher when the endometrial thickness was < 8 mm. 2. A thin endometrial thickness could be linked with abnormal endometrial peristaltic waves or abnormal endometrial receptivity. 3. Adequate attention should therefore be paid to patients with a thin endometrial thickness to prevent EP or to achieve early diagnosis during the peri-transplantation period.
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Affiliation(s)
- Ying Zhao
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Dong’e Liu
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
| | - Nenghui Liu
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
| | - Yumei Li
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
| | - Zhongyuan Yao
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
| | - Fen Tian
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
| | - Aizhuang Xu
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
- *Correspondence: Yanping Li, ; Aizhuang Xu,
| | - Yanping Li
- Department of Reproductive Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Women’s Reproductive Health in Hunan Province, Hunan, China
- *Correspondence: Yanping Li, ; Aizhuang Xu,
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