Efficiency and pregnancy outcome of serial intrauterine device-guided hysteroscopic adhesiolysis of intrauterine synechiae

Objective: To highlight the efficiency of intrauterine device (IUD) guidance during hysteroscopic adhesiolysis for severe intrauterine adhesions. Design: A prospective, randomized trial. Setting: Private tertiary and referral infertility clinic. Patient(s): Seventy-one subfertile patients who underwent hysteroscopic treatment of intrauterine synechiae or adhesions. Intervention(s): Thirty-six women in group 1 were initially examined by laparoscopy-hysteroscopy at first look, and an IUD was inserted during hysteroscopic adhesiolysis. The adhesions were further lysed by the guidance of IUD during the second-look office hysteroscopy, 1 week later. Patients were prescribed 2 months of estrogen as well as P therapy, and the IUD was removed by the end of this period. The uterine cavity was evaluated, and adhesions were further lysed by a third-look office hysteroscopy, 1 week after the removal of IUD. Thirty-five women in group 2 were similarly examined by first-look office hysteroscopy, and an IUD was inserted during hysteroscopic adhesiolysis. These patients did not undergo early intervention of office hysteroscopy, 1 week after the first procedure. They also used 2 months of estrogen and P therapy. The IUD was removed by the end of this period, and the uterine cavity was evaluated and adhesions were further lysed during a second-look office hysteroscopy. Main Outcome Measure(s): Pregnancy rate and live birth rate. Result(s): Spontaneous pregnancy rates after treatment were 17/36 (47.2%) and 11/35 (30%), and live birth rates were 10/36 (28%) and 7/35 (20%) in groups 1 and 2, respectively. These differences between the two groups were not statistically significant. Conclusion(s): The method described especially for early intervention may prevent complications during the treatment of severe intrauterine adhesions and may present a secure and effective alternative for constructive clinical outcomes. (Fertil Steril (R) 2008;90:1973-7. (C)2008 by American Society for Reproductive Medicine.

Gebelikte Akut Karın Nedeni Olarak Miyom Torsiyonu

Gebelikte akut karın tablosu, anatominin ve fi zyolojinin değişmesi nedeniyle, tanı ve tedavi basamaklarında klinik zorluk yaratmaktadır. Belirtiler değişmekte veya silikleşmekte, laboratuar incelemelerin sonucu gebelikteki fi zyolojik yanıtlarla karışabilmektedir. Karın ağrısı, obstetrik nedenlerle olabileceği kadar karın içi ve pelvis içi organlar nedeniyle de gelişebilmektedir. Leiomiyomlar geç üreme dönenimde sık rastlanan benin jinekolojik tümörlerdir. Çoğunlukla belirti vermezler. Miyom dejenerasyonu, saplı miyomun torsiyone olması veya kitle etkisine bağlı uterusun torsiyonuna yol açarak gebelikte ağrıya yol açabilir. Gebelikte akut karın tanısı ile cerrahi uygulanan torsiyone miyom olgusu tartışılmıştır. G1 P0 31 yaşında hasta, yirmi birinci gebelik haftasında karın ağrısı ile başvurdu. Fizik muayenede batın sağ kadranda defans ve rebaund mevcuttu. Ultrasonografi de ve Doppler incelemede her iki over normal olarak değerlendirildi. Akut appendisit ön tanısı ile eksploratif laparotomi uygulandı. İntraoperatif gözlemde uterus sağ lateral yüzde ince pediküllü subserozal miyomun torsiyone olduğu tespit edildi. Miyomektomi uygulandı. Gebelik normal seyrinde takip edildi

Antiphospholipid syndrome

Antifosfolipid sendromu, arteriyel ve venöz tromboz nedeniyle fetal ölüm ve tekrarlayan gebelik kayıplarına yol açan otoimmün klinik bir patolojidir. Gebelikde tromboz, felç, preeklampsi, fetüsde gelişme geriliği ve preterm eylem gibi potansiyel maternal ve fetal riskler taşımaktadır. Antifosfolipid sendromunun teşhisi, konsepsiyon öncesi ve sonrası hastaların detaylı bilgilendirilmesi, gebeliğin yakın takibi ve tedavisi anne ve fetüsün sağlığı için çok önemlidir. Bu derlemede, antifosfolipid sendromu tanısında kullanılan kriterler, obstetrik komplikasyonların patolojisi, antifosfolipid antikorlarının bakılmasını gerektiren endikasyonlar, gebelikde anne ve fetüs yönünden taşıdığı riskler, tedavi ve takip yönünden güncel yaklaşımlar özetlenmektedir.Antiphospholipid syndrome is an autoimmune clinic pathology that leads to fetal death and recurrent pregnancy loss due to arterial and venous thrombosis. The syndrome has potential maternal and fetal risks like thrombosis, stroke, preeclampsia, intrauterine growth retardation and preterm labor in pregnancy. Diagnosis of antiphospholipid syndrome, preconceptional and postconceptional consultation, follow-up of pregnancy and treatment of the syndrome are very crucial for fetomaternal health. The criteria for the diagnosis of antiphospholipid syndrome, pathology of obstetric complications, indications for screening antiphospholipid antibodies, fetomaternal risks in pregnancy, current diagnosis and treatment of the syndrome are summarized in the current review

Antiphospholipid syndrome

Antifosfolipid sendromu, arteriyel ve venöz tromboz nedeniyle fetal ölüm ve tekrarlayan gebelik kayıplarına yol açan otoimmün klinik bir patolojidir. Gebelikde tromboz, felç, preeklampsi, fetüsde gelişme geriliği ve preterm eylem gibi potansiyel maternal ve fetal riskler taşımaktadır. Antifosfolipid sendromunun teşhisi, konsepsiyon öncesi ve sonrası hastaların detaylı bilgilendirilmesi, gebeliğin yakın takibi ve tedavisi anne ve fetüsün sağlığı için çok önemlidir. Bu derlemede, antifosfolipid sendromu tanısında kullanılan kriterler, obstetrik komplikasyonların patolojisi, antifosfolipid antikorlarının bakılmasını gerektiren endikasyonlar, gebelikde anne ve fetüs yönünden taşıdığı riskler, tedavi ve takip yönünden güncel yaklaşımlar özetlenmektedir.Antiphospholipid syndrome is an autoimmune clinic pathology that leads to fetal death and recurrent pregnancy loss due to arterial and venous thrombosis. The syndrome has potential maternal and fetal risks like thrombosis, stroke, preeclampsia, intrauterine growth retardation and preterm labor in pregnancy. Diagnosis of antiphospholipid syndrome, preconceptional and postconceptional consultation, follow-up of pregnancy and treatment of the syndrome are very crucial for fetomaternal health. The criteria for the diagnosis of antiphospholipid syndrome, pathology of obstetric complications, indications for screening antiphospholipid antibodies, fetomaternal risks in pregnancy, current diagnosis and treatment of the syndrome are summarized in the current review

Comparison of the rates for reaching the blastocyst stage between normal and abnormal pronucleus embryos monitored by a time-lapse system in IVF patients

Objective: To compare the rates of blastocyst stage development between embryos fertilized after one (MPN) or more than two pronucleus (PN) (3PN, 4PN-multiPN) with those after 2PN in the same patients. Material and Methods: The embryos of patients who had both abnormal PN (MPN, 3PN or 4PN) and normal fertilized (2PN) embryos after intracytoplasmic sperm injection (ICSI) fertilization, were followed with a time-lapse system following the ICSI procedure. The rates of reaching the blastocyst stage were compared between normal and abnormally fertilized embryos. Results: One thousand eight hundred and twenty oocytes were collected from 140 patients and 1280 (70.3%) of them were fertilized. MPN, 2PN and 3PN, 4PN (multiPN) ratios of the embryos in the pronuclear stage were 11.4%, 83.13% and 5.47%, respectively. The rates of reaching the blastocyst stage among these embryos were 17.1%, 60.8% and 42.8% for MPN, 2PN and multiPN, respectively. The proportion reaching blastocyst development was significantly higher following 2PN compared to those after MPN and multiPN (p<0.05). Embryos developing after multiPN had significantly higher rates of reaching the blastocyst stage compared to those after MPN (p<0.01). Conclusion: The majority of abnormally pronucleated embryos arrest without reaching the blastocyst stage. MultiPN embryos have a higher rate of blastocyst development than MPN embryos

Endometrial Polyp in Early Pregnancy Ending with Term Labor

Endometrial polyps may be detected by transvaginal ultrasonography (TVS) in early pregnancy. These pregnancies may end with fetal demise. There are not enough data in literature defining term labor in pregnancy with endometrial polyp. The current case describes in detail, the progress of a pregnancy with endometrial polyp including fetal growth, regression of polyp, assessment of placental pathology and postpartum follow-up. Giant endometrial polyp protruding into the uterine cavity adjacent to the gestational sac was detected by TVS in a 31 year-old-primigravida. She delivered a healthy baby and the polyp regressed completely by the end of the pregnancy. Polyps detected in early pregnancy may regress without any effect on the fetal demise or placental insufficiency. Close antenatal follow-up is advised for the prognosis of these pregnancies

Comparison of the rates for reaching the blastocyst stage between normal and abnormal pronucleus embryos monitorized by time-lapse system in IVF patients

Objective: To compare the rates of blastocyst stage development between the embryos fertilizing after one (MPN) or more than two pronucleus (3PN, 4PN - MultiPN) with those after two pronucleus (2PN) in the same patients. The embryos were observed by the time-lapse system.Material and methods: As a total of 140 patients's embryos who had both abnormal PN (MPN, 3PN or 4PN) and normal fertilized (2PN) embryos after fertilization were followed with time-lapse system following ICSI procedure. The ratios for reaching the blastocyst stage were compared between normal and abnormally fertilized embryos.Results: 1820 oocytes were collected from 140 patients and 1280 (70.3%) of them were fertilized. MPN, 2 PN and 3PN, 4PN (MultiPN) ratios of the embryos in the pronuclear stage were 11.4%, 83.13% and 5.47%, respectively. The rates of reaching the blastocyst stage among these embryos were 17.1%, 60.8% and 42.8% for MPN, 2 PN and MultiPN, respectively. Rate of blastocyst development was significantly higher following 2PN compared to those after MPN and MultiPN (p<0,05). Embryos developing after MultiPN had significantly higher rates of reaching the blastocyst stage compared to those after the MPN (p<0.01).Conclusion: The majority of abnormally pronucleated embryos arrest without reaching the blastocyst stage. MultiPN embryos have higher ratios of blastocyst development than MPN embryos