Multifetal gestations with assisted reproductive technique before the single-embryo transfer legislation: obstetric, neonatal outcomes and congenital anomalies

Objective: To compare perinatal, neonatal outcome and congenital anomalies of multiple gestations conceived by means of assisted reproductive techniques with spontaneously conceived multiples before the limitation of number of embryo transfer.Methods: Cases consisted of assisted reproductive technique (ART) multifetal gestations and control group comprised of spontaneously conceived multifetal gestations delivered in the same time period. Outcomes were perinatal, neonatal outcome, long-term outcomes and congenital anomalies of multiple gestations. There were 270 multifetal pregnancies for analysis, of which 137 were achieved by ART and 133 were spontaneous in this prospective study.Results: Incidences of preeclampsia, gestational diabetes, deep vein thrombosis, thrombocytopenia, intrahepatic cholestasis and preterm premature rupture of membranes were similar in ART and spontaneous groups. There was no difference in fetal malformation rates between ART and control group, but higher rates of central nervous system malformation were observed (4 (1.5%) in control, 0 in ART group, p=0.04) in spontaneous group. No difference was seen in the perinatal mortality.Conclusions: Neonatal and maternal outcomes are comparable between ART and spontaneous multifetal gestations. Congenital fetal malformation rates between ART and spontaneous multifetal pregnancies were similar except central nervous system malformation that was more likely in spontaneously conceived ones

Partial HELLP syndrome: Maternal, perinatal, subsequent pregnancy and long-term maternal outcomes

WOS: 000333615200005PubMed: 24612188AimsHemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome, in its complete form, is associated with increased risk of maternal mortality and increased rate of serious obstetric complications, such as acute renal failure, hepatic failure, abruptio placentae, pulmonary edema, sepsis, hemorrhage and disseminated intravascular coagulopathy. To compare maternal and perinatal outcomes, we investigated the subsequent pregnancy outcomes and long-term complications of women with partial HELLP (pHELLP) and complete HELLP (cHELLP) syndromes. Material and MethodsIn this retrospective study, patients complicated with HELLP between the years 2002 and 2007 were analyzed. cHELLP syndrome was defined by the presence of all of the three laboratory criteria according to the Tennessee Classification System. pHELLP syndrome was defined by the presence of one or two features of HELLP, but not the complete form. ResultsSixty-four patients had cHELLP syndrome and 67 had pHELLP syndrome. Maternal complications and neonatal outcomes of the indexed pregnancies were similar. The rate of blood product transfusion was significantly higher in the cHELLP group (P<0.0001). Twenty-eight patients within the cHELLP group and 26 within the pHELLP group had subsequent pregnancies with a mean interpregnancy interval of 2.91.5 years and 2.4 +/- 1.1 years, respectively. Elective termination of pregnancy (dilatation and curettage) was more frequent in the cHELLP group. Pre-eclampsia recurrence was higher in the pHELLP group than in the cHELLP group (7.1% vs 34.6%). ConclusionsPartial and complete HELLP syndrome are not distinct groups based on neonatal, long-term and subsequent pregnancy outcomes. They probably represent a continuum in the natural evolution of the same disease

Do we protect the pelvic floor with non-elective cesarean? A study of 3-D/4-D pelvic floor ultrasound immediately after delivery

WOS: 000333615200020PubMed: 24612399AimTo compare levator defect, loss of tenting, change in biometric measurements of the levator ani and genital hiatus according to the mode of delivery, length of the labor, Bishop score, birthweight and head circumference immediately after delivery. MethodsOne hundred and seventy-one primiparous women who delivered either by vaginal delivery or cesarean were prospectively evaluated. Two 3-D volumes (one at rest, one on Valsalva maneuver) were recorded in the supine position after voiding, and levator biometry, levator defect and loss of tenting were determined on the axial plane. ResultsOf 171 nulliparous women, 84 had vaginal delivery and 87 had cesarean delivery. All hiatal dimensions on resting and maximal Valsalva were found to be higher in the vaginal delivery group. Levator defect rate was found to be significantly higher in the vaginal delivery group (P<0.0001). We found a positive correlation with head circumference, fetal weight and first stage labor length in women who delivered vaginally. In the cesarean delivery group, mean fetal head circumference, fetal weight, length of first stage of labor and Bishop score were higher in women with levator ani defect. Loss of tenting rate was significantly higher in vaginal delivery women (P=0.03). ConclusionLabor itself, and factors such as fetal head circumference and fetal weight that cause prolongation of labor, can induce levator ani muscle defect or microtrauma which in turn can cause morphological alterations of the levator hiatus

Recurrent pyoderma gangrenosum after cesarean delivery successfully treated with vacuum-assisted closure and split thickness skin graft: A case report

We describe the case of a 32-year-old woman (gravidity: 4; parity: 2) who underwent cesarean delivery at 37 weeks of gestation and presented with dehiscence and infection of the surgical wound. She had a history of wound infection and dehiscence of the scar from a previous cesarean delivery and dehiscence in the dorsal side of her left hand at the site of intravenous catheterization. The patient was initially diagnosed with a skin infection and later with pyoderma gangrenosum. No evidence of any underlying disease was found. The lesions were treated with systemic corticosteroids and azathioprine, but the lesions were unresponsive to treatment. This complicated case of pyoderma gangrenosum after cesarean delivery, which initially mimicked wound infection, was successfully treated with vacuum-assisted closure and split-thickness skin graft. This synergistic approach with vacuum-assisted closure could be an important treatment option for aggressive and slow-healing lesions

Liposarcoma: Atypical Spread with Intraperitoneal and Vertebral Metastasis in a Young Female

Myxoid and round cell liposarcoma commonly occur in the thigh and retroperitoneum, and an intraperitoneal location and bony spread are rare. A young woman was admitted with the complaint of right thigh pain. Tru-cut biopsy revealed well-differentiated myxoid and round cell liposarcoma. Following chemoradiotherapy, the mass was removed with wide local excision. A vertebral metastasis at the 11th thoracic vertebra was discovered 11 months later. Following chemoradiotherapy, the corpus of the 11th thoracic vertebra was excised, and an implant was placed. Six months later, abdominopelvic magnetic resonance imaging (MRI) demonstrated a giant pelvic mass. Hysterectomy, lower anterior resection of the sigmoid colon, and removal of 8 cm of jejunum were performed. After 4 months, masses in the left abdominal wall, left axilla, and nearby pancreas were detected. Pathology was low-grade myxoid liposarcoma. This uncommon pattern of spread should certainly be taken into account when determining prognosis