Role of ovum in reproductive outcomes

The ovary is one of the most dynamic organs in the human body. Ovaries have a finite pool of follicles during fetal life. On-going follicular atresia significantly contributes to a quantitative and qualitative decline in ovarian reserve. Only a tiny number of follicles are released between puberty and menopause in the form of ovulation. Reproductive outcome following assisted conception significantly depends upon the quality and quantity of oocytes. Ovarian reserve is a significant predictor of ovarian response during the assisted conception treatment cycle. It not only determines the number of oocytes to be collected but also controls the pregnancy outcome. The first two publications evaluate the prediction of ovarian reserve and management of the poor ovarian reserve. The third and fourth publications analyse use of donor oocyte as a treatment option and the pregnancy complications associated with donor oocyte. The fifth publication examines the factors affecting fertilisation rates in assisted conception and strategies to improve the fertilisation process. Poor quality oocytes and the resultant poor-quality embryo is one of the primary causes for miscarriage in natural and assisted conception. The sixth and seventh publications discuss the diagnosis and management of miscarriages. These publications have significant clinical and research implications which are discussed in results and discussion chapter. Especially sixth publication contributed to changing the national guideline on the diagnosis of missed miscarriage. Recent research updates that occurred after our research period are discussed in a separate chapter. Further research is required to manage the reproductive outcomes related to the poor quantity and quality of oocytes

Predicting Postpartum Hemorrhage (PPH) during Cesarean Delivery Using the Leicester PPH Predict Tool: A Retrospective Cohort Study.

Objective: The aim of the present study was to develop a toolkit combining various risk factors to predict the risk of developing a postpartum hemorrhage (PPH) during a cesarean delivery. Study Design: A retrospective cohort study of 24,230 women who had cesarean delivery between January 2003 and December 2013 at a tertiary care teaching hospital within the United Kingdom serving a multiethnic population. Data were extracted from hospital databases, and risk factors for PPH were identified. Hothorn et al recursive partitioning algorithm was used to infer a conditional decision tree. For each of the identified combinations of risk factors, two probabilities were calculated: the probability of a patient producing ≥1,000 and ≥ 2,000 mL blood loss. Results: The Leicester PPH predict score was then tested on the randomly selected remaining 25% (n = 6,095) of the data for internal validity. Reliability testing showed an intraclass correlation of 0.98 and mean absolute error of 239.8 mL with the actual outcome. Conclusion: The proposed toolkit enables clinicians to predict the risk of postpartum hemorrhage. As a result, preventative measures for postpartum hemorrhage could be undertaken. Further external validation of the current toolkit is required