Broad ligament ectopic pregnancy: a dilemma to diagnose

Broad ligament ectopic pregnancy is a rare and serious form of extrauterine pregnancy with a high risk of maternal mortality. There are no specific clinical features. Ultrasonography may help in diagnosis but definitive diagnosis is made only during surgery. A 20-year-old woman with previous 2 abortions presented with acute abdomen. She had no history of amenorrhoea but there was history of two episodes of bleeding in the last month at an interval of 14 days, each episode lasting for two-three days. The last episode of bleeding was 10 days back. Her urine pregnancy test was done and it was positive. There was marked abdominal tenderness with guarding and rigidity. Per vaginal examination revealed marked tenderness in the right fornix and cervical motion tenderness, uterus size could not be assessed due to tenderness.  It was diagnosed as a case of ruptured ectopic pregnancy. Since she was haemodynamically unstable, emergency laparotomy was done. She had a right sided broad ligament ectopic pregnancy which had ruptured. The tissue was completely removed and haemostatic sutures were taken. High index of clinical suspicion, early diagnosis and prompt surgery is the key to management

Comparison of clinical outcomes in clomiphene citrate resistant infertile polycystic ovarian syndrome women after treatment with laparoscopic ovarian drilling (LOD) versus gonadotropins

Background: Infertility is the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year. Objective of present study was to compare the clinical outcome of laparoscopic ovarian drilling with gonadotropin ovulation induction in patients with clomiphene resistant Polycystic Ovarian Syndrome.Methods: Present study was a comparative interventional study conducted at the Institute of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, New Delhi for a period of one and a half year. We enrolled 40 clomiphene citrate resistant infertile PCOS women who were undergoing treatment for infertility, after taking written informed consent. The women were randomly divided into two equal groups: one for LOD (laparoscopic ovarian drilling) (group A) and other for gonadotropins (group B).Results: Out of 20, 16 women (80%) in group A ovulated with clomiphene citrate and 18 women (90%) ovulated in group B. Pregnancy was the second major outcome and 4 women (20%) in group A with clomiphene citrate got pregnant and 9 women (45%) got pregnant in group B.Conclusions: Out of 20, 16 women (80%) in group A ovulated with clomiphene citrate and 18 women (90%) ovulated in group B. Pregnancy was the second major outcome and 4 women (20%) in group A with clomiphene citrate got pregnant and 9 women (45%) got pregnant in group B. The treatment option can be selected and tailored according to the individual needs and desires of the patient

Successful management of post-in-vitro fertilization cervical heterotropic pregnancy

A case of post-in-vitro fertilization (IVF) cervical and intrauterine heterotropic pregnancy with cardiac activity in both embryos is presented. It was diagnosed in the 7th week of gestation by ultrasonography and cervical pregnancy was treated conservatively with intrathoracic administration of potassium chloride under transvaginal ultrasound guidance with regression of trophoblastic tissue. The intrauterine pregnancy continued and cesarean section was performed in the 31st week due to absent end diastolic umbilical artery fetal blood flow. A live male baby was delivered

Comparison of clinical outcomes in clomiphene citrate resistant infertile polycystic ovarian syndrome women after treatment with laparoscopic ovarian drilling (LOD) versus gonadotropins

Background: Infertility is the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year. Objective of present study was to compare the clinical outcome of laparoscopic ovarian drilling with gonadotropin ovulation induction in patients with clomiphene resistant Polycystic Ovarian Syndrome.Methods: Present study was a comparative interventional study conducted at the Institute of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, New Delhi for a period of one and a half year. We enrolled 40 clomiphene citrate resistant infertile PCOS women who were undergoing treatment for infertility, after taking written informed consent. The women were randomly divided into two equal groups: one for LOD (laparoscopic ovarian drilling) (group A) and other for gonadotropins (group B).Results: Out of 20, 16 women (80%) in group A ovulated with clomiphene citrate and 18 women (90%) ovulated in group B. Pregnancy was the second major outcome and 4 women (20%) in group A with clomiphene citrate got pregnant and 9 women (45%) got pregnant in group B.Conclusions: Out of 20, 16 women (80%) in group A ovulated with clomiphene citrate and 18 women (90%) ovulated in group B. Pregnancy was the second major outcome and 4 women (20%) in group A with clomiphene citrate got pregnant and 9 women (45%) got pregnant in group B. The treatment option can be selected and tailored according to the individual needs and desires of the patient

Association Between Progesterone Elevation on the Day of Human Chronic Gonadotropin Trigger and Pregnancy Outcomes After Fresh Embryo Transfer in In Vitro Fertilization/Intracytoplasmic Sperm Injection Cycles

Progesterone elevation (PE) during the late follicular phase of controlled ovarian stimulation in fresh embryo transfer in vitro fertilization (IVF)/intracytoplasmic sperm injection cycles has been claimed to be associated with decreased pregnancy rates. However, the evidence is not unequivocal, and clinicians still have questions about the clinical validity of measuring P levels during the follicular phase of stimulated cycles. We reviewed the existing literature aimed at answering four relevant clinical questions, namely (i) Is gonadotropin type associated with PE during the follicular phase of stimulated cycles? (ii) Is PE on the day of human chorionic gonadotropin (hCG) associated with negative fresh embryo transfer IVF/intracytoplasmic sperm injection (ICSI) cycles outcomes in all patient subgroups? (iii) Which P thresholds are best to identify patients at risk of implantation failure due to PE in a fresh embryo transfer? and (iv) Should a freeze all policy be adopted in all the cycles with PE on the day of hCG? The existing evidence indicates that late follicular phase progesterone rise in gonadotropin releasing analog cycles is mainly caused by the supraphysiological stimulation of granulosa cells with exogenous follicle-stimulating hormone. Yet, the type of gonadotropin used for stimulation seems to play no significant role on progesterone levels at the end of stimulation. Furthermore, PE is not a universal phenomenon with evidence indicating that its detrimental consequences on pregnancy outcomes do not affect all patient populations equally. Patients with high ovarian response to control ovarian stimulation are more prone to exhibit PE at the late follicular phase. However, in studies showing an overall detrimental effect of PE on pregnancy rates, the adverse effect of PE on endometrial receptivity seems to be offset, at least in part, by the availability of good quality embryo for transfer in women with a high ovarian response. Given the limitations of the currently available assays to measure progesterone at low ranges, caution should be applied to adopt specific cutoff values above which the effect of progesterone rise could be considered detrimental and to recommend “freeze-all” based solely on pre-defined cutoff points

data_sheet_1_Association Between Progesterone Elevation on the Day of Human Chronic Gonadotropin Trigger and Pregnancy Outcomes After Fresh Embryo Transfer in In Vitro Fertilization/Intracytoplasmic Sperm Injection Cycles.DOCX

<p>Progesterone elevation (PE) during the late follicular phase of controlled ovarian stimulation in fresh embryo transfer in vitro fertilization (IVF)/intracytoplasmic sperm injection cycles has been claimed to be associated with decreased pregnancy rates. However, the evidence is not unequivocal, and clinicians still have questions about the clinical validity of measuring P levels during the follicular phase of stimulated cycles. We reviewed the existing literature aimed at answering four relevant clinical questions, namely (i) Is gonadotropin type associated with PE during the follicular phase of stimulated cycles? (ii) Is PE on the day of human chorionic gonadotropin (hCG) associated with negative fresh embryo transfer IVF/intracytoplasmic sperm injection (ICSI) cycles outcomes in all patient subgroups? (iii) Which P thresholds are best to identify patients at risk of implantation failure due to PE in a fresh embryo transfer? and (iv) Should a freeze all policy be adopted in all the cycles with PE on the day of hCG? The existing evidence indicates that late follicular phase progesterone rise in gonadotropin releasing analog cycles is mainly caused by the supraphysiological stimulation of granulosa cells with exogenous follicle-stimulating hormone. Yet, the type of gonadotropin used for stimulation seems to play no significant role on progesterone levels at the end of stimulation. Furthermore, PE is not a universal phenomenon with evidence indicating that its detrimental consequences on pregnancy outcomes do not affect all patient populations equally. Patients with high ovarian response to control ovarian stimulation are more prone to exhibit PE at the late follicular phase. However, in studies showing an overall detrimental effect of PE on pregnancy rates, the adverse effect of PE on endometrial receptivity seems to be offset, at least in part, by the availability of good quality embryo for transfer in women with a high ovarian response. Given the limitations of the currently available assays to measure progesterone at low ranges, caution should be applied to adopt specific cutoff values above which the effect of progesterone rise could be considered detrimental and to recommend “freeze-all” based solely on pre-defined cutoff points.</p

Book of Abstracts of the 2nd International Conference on Applied Mathematics and Computational Sciences (ICAMCS-2022)

It is a great privilege for us to present the abstract book of ICAMCS-2022 to the authors and the delegates of the event. We hope that you will find it useful, valuable, aspiring, and inspiring. This book is a record of abstracts of the keynote talks, invited talks, and papers presented by the participants, which indicates the progress and state of development in research at the time of writing the research article. It is an invaluable asset to all researchers. The book provides a permanent record of this asset. Conference Title: 2nd International Conference on Applied Mathematics and Computational SciencesConference Acronym: ICAMCS-2022Conference Date: 12-14 October 2022Conference Organizers: DIT University, Dehradun, IndiaConference Mode: Online (Virtual