The Impact of COVID-19 on the Pregnant Woman and the Fetus

This review presents the current incidence of COVID-19 and the impact of the SARS-CoV-2 virus on the course of pregnancy. The authors review the latest recommendations of obstetric and gynecological societies in Europe and the world regarding vaccination and the degree of vertical transmission of the infection and its impact on the pregnant woman, the fetus, and the mother

Relation between Chlamydia trachomatis, the trophoblast and preterm delivery

There is a connection between preterm labor and intrauterie infections which is well established in up to 40% of cases. Success of the interaction between the invading trophoblast at the maternal-fetal interface and the maternal immune system is an immunologically unique fact. In this process the trophoblast participates in both the immune suppression which is necessary for tolerance to the semialogenic fetus and the immune activation against damaging factors such as infections. Alterations in this type of cross-talk, as in the cases of infection-triggered inflammation by Chlamydia species, could result in pregnancy complications such as prematurity or spontaneous abortion.Related articles and clinical cases have been gathered and reviewed to establish the main mechanisms and to confirm the relationship between preterm labor and Chlamydia trachomatis infection

Top-quality embryo transfer is associated with lower odds of ectopic pregnancy

Introduction The incidence of ectopic pregnancy is up to four times higher after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) than in spontaneous pregnancies, and the risk of ectopic pregnancy is increased by tubal factor infertility and the transfer of multiple embryos. However, the effect of embryo quality on the probability of ectopic pregnancy has not been investigated until now and it is not clear whether ovarian stimulation parameters affect the incidence of ectopic pregnancy. Material and Methods An historical cohort study of 15 006 clinical pregnancies (diagnosed by ultrasound at 6-8 gestational weeks) after non-donor IVF/ICSI with fresh embryo transfer (n = 8952) or frozen-thawed embryo transfer (n = 6054). Treatments were performed during 2000-2017 in Finland. A total of 9207 (61.4%) single and 5799 (38.6%) double embryo transfers of no more than one top-quality embryo were evaluated. We analyzed the effects of multiple factors on ectopic pregnancy by logistic regression, including type of cycle (fresh vs. frozen embryo transfer), female age, number and quality of embryos transferred, tubal factor infertility and factors of ovarian response to gonadotropin stimulation. Results Ectopic pregnancy was observed in 2.3% of cycles. There was no significant difference in ectopic pregnancy rate after fresh embryo transfer and frozen embryo transfer (2.2% vs. 2.4%, p = 0.3). The ectopic pregnancy rate was lower in cycles with top-quality embryo transfer (1.9%) than of those where only non-top quality embryos were transferred (2.7%, p < 0.0001). Tubal factor infertility was diagnosed more often in ectopic pregnancy than in intrauterine pregnancies (21.2% vs. 11.0%, p < 0.0001). Logistic regression revealed lower odds for ectopic pregnancy after a top-quality embryo transfer than after transfer of a non-top quality embryo (odds ratio [OR] 0.72, 95% confidence interval [CI] 0.56-0.92, p = 0.007). Transfer of two vs. one embryo (OR 1.35, 95% CI 1.05-1.70, p = 0.02) and tubal factor infertility (OR 2.21, 95% CI 1.68-2.91, p < 0.0001) significantly increased the risk of ectopic pregnancy. Conclusions Transfer of non-top quality embryos is associated with a higher rate of ectopic pregnancy. This is particularly important to keep in mind in treatments with only non-top embryos available even in the absence of tubal factor infertility. To minimize the risk of ectopic pregnancy, the number of embryos transferred should be as low as possible.Peer reviewe

Top-quality embryo transfer is associated with lower odds of ectopic pregnancy

Introduction The incidence of ectopic pregnancy is up to four times higher after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) than in spontaneous pregnancies, and the risk of ectopic pregnancy is increased by tubal factor infertility and the transfer of multiple embryos. However, the effect of embryo quality on the probability of ectopic pregnancy has not been investigated until now and it is not clear whether ovarian stimulation parameters affect the incidence of ectopic pregnancy. Material and Methods An historical cohort study of 15 006 clinical pregnancies (diagnosed by ultrasound at 6-8 gestational weeks) after non-donor IVF/ICSI with fresh embryo transfer (n = 8952) or frozen-thawed embryo transfer (n = 6054). Treatments were performed during 2000-2017 in Finland. A total of 9207 (61.4%) single and 5799 (38.6%) double embryo transfers of no more than one top-quality embryo were evaluated. We analyzed the effects of multiple factors on ectopic pregnancy by logistic regression, including type of cycle (fresh vs. frozen embryo transfer), female age, number and quality of embryos transferred, tubal factor infertility and factors of ovarian response to gonadotropin stimulation. Results Ectopic pregnancy was observed in 2.3% of cycles. There was no significant difference in ectopic pregnancy rate after fresh embryo transfer and frozen embryo transfer (2.2% vs. 2.4%, p = 0.3). The ectopic pregnancy rate was lower in cycles with top-quality embryo transfer (1.9%) than of those where only non-top quality embryos were transferred (2.7%, p Conclusions Transfer of non-top quality embryos is associated with a higher rate of ectopic pregnancy. This is particularly important to keep in mind in treatments with only non-top embryos available even in the absence of tubal factor infertility. To minimize the risk of ectopic pregnancy, the number of embryos transferred should be as low as possible.</p

Ovarian Response, Embryo Quality and Ectopic Pregnancy // Овариален отговор, качество на ембрионите и извънматочна бременност

This thesis is based on retrospective and prospective analysis of 1077 pregnancies after 2602 non-donor IVF/ICSI fresh and frozen-thawed cycles, comparing two main groups according to the outcome of ART - 976 cases (91%) intrauterine pregnancy against 101 cases (9%) ectopic pregnancy. The applied methods were anamnesis, physical and gynaecological examination, laboratory methods, imaging methods, medical treatment and statistical methods. The study aimed to identify risk factors in the course of ART that increases the likelihood of ectopic pregnancy and propose approaches for risk calculation and prevention of complications. The results were presented in the relevant tables and figures. Relevant conclusions were made, and contributions of original and confirmatory nature were described.Направен е ретроспективен и проспективен анализ на 1077 бременности след 2602 не-донорски IVF/ICSI свежи и размразени цикли, като са сравнени две основни групи спрямо изхода от АРТ - 976 случая (91%) вътрематочна бременност срещу 101 случая (9%) извънматочна бременност. Приложените методики бяха анамнеза, физикален и гинекологичен преглед, лабораторни методи, образни методи, медикаментозно лечение и статистически методи. Целта на обследването беше да се определят рисковите фактори в хода на АРТ, които повишават вероятността за извънматочна бременност, както и да се предложат подходи за изчисление на риска и превенция на усложненията. Резултатите бяха изложени в съответните таблици и фигури. Направиха се съответните изводи и се описаха приносите с оригинален и потвърдителен характер

Top-quality embryo transfer is associated with lower odds of ectopic pregnancy

Abstract Introduction: The incidence of ectopic pregnancy is up to four times higher after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) than in spontaneous pregnancies, and the risk of ectopic pregnancy is increased by tubal factor infertility and the transfer of multiple embryos. However, the effect of embryo quality on the probability of ectopic pregnancy has not been investigated until now and it is not clear whether ovarian stimulation parameters affect the incidence of ectopic pregnancy. Material and Methods: An historical cohort study of 15 006 clinical pregnancies (diagnosed by ultrasound at 6–8 gestational weeks) after non-donor IVF/ICSI with fresh embryo transfer (n = 8952) or frozen–thawed embryo transfer (n = 6054). Treatments were performed during 2000–2017 in Finland. A total of 9207 (61.4%) single and 5799 (38.6%) double embryo transfers of no more than one top-quality embryo were evaluated. We analyzed the effects of multiple factors on ectopic pregnancy by logistic regression, including type of cycle (fresh vs frozen embryo transfer), female age, number and quality of embryos transferred, tubal factor infertility and factors of ovarian response to gonadotropin stimulation. Results: Ectopic pregnancy was observed in 2.3% of cycles. There was no significant difference in ectopic pregnancy rate after fresh embryo transfer and frozen embryo transfer (2.2% vs 2.4%, p = 0.3). The ectopic pregnancy rate was lower in cycles with top-quality embryo transfer (1.9%) than of those where only non-top quality embryos were transferred (2.7%, p &lt; 0.0001). Tubal factor infertility was diagnosed more often in ectopic pregnancy than in intrauterine pregnancies (21.2% vs 11.0%, p &lt; 0.0001). Logistic regression revealed lower odds for ectopic pregnancy after a top-quality embryo transfer than after transfer of a non-top quality embryo (odds ratio [OR] 0.72, 95% confidence interval [CI] 0.56–0.92, p = 0.007). Transfer of two vs one embryo (OR 1.35, 95% CI 1.05–1.70, p = 0.02) and tubal factor infertility (OR 2.21, 95% CI 1.68–2.91, p &lt; 0.0001) significantly increased the risk of ectopic pregnancy. Conclusions: Transfer of non-top quality embryos is associated with a higher rate of ectopic pregnancy. This is particularly important to keep in mind in treatments with only non-top embryos available even in the absence of tubal factor infertility. To minimize the risk of ectopic pregnancy, the number of embryos transferred should be as low as possible