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Endocrine Disorders, Contraception, and Hormone Therapy during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
The absolute risk [for birth defects] remains low at 0.15% in IVF-ICSI conceptions and 0.02% in spontaneous conception … Because the balance of evidence suggests an association with pooled birth defects, it is reasonable to inform patients of potential increased risk keeping in mind the low absolute risk and limited alternatives to conception.
Maternal obesity
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
D. Yvette LaCoursiere, Thomas R. Moore
Even if a woman has a history of infertility, she should be counseled that spontaneous conception is possible after bariatric surgery. It is important that women acknowledge this and delay contraception for the first 12 to 18 months to avoid pregnancy in the rapid weight loss phase to protect the fetus from growth restriction. When pregnancy does occur, women should be screened for vitamin and mineral insufficiency each trimester and supplemented as needed using rapid release or oral solutions in lieu of extended release medications. Some women may not tolerate a 1-hour glucose tolerance test and may require fasting and 1 to 2 hours postprandial glucose levels for 1 week at 25 to 28 weeks. Clinicians should have a high index of suspicion for band or bypass complications when women present with abdominal pain, nausea/vomiting, and anorexia. Consultation with bariatric or general surgeons should be sought readily and early (Table 9) (40,41).
Implantation and In Utero Growth
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
Kugajeevan Vigneswaran, Ippokratis Sarris
Data demonstrate a decreased pregnancy rate in spontaneous conception as well as in intrauterine insemination cycles [31]. However, in the absence of hyperplasia or malignancy, there is no randomized trial data available to guide treatment of asymptomatic polyps. In the case of symptomatic polyps, resolution of symptoms, which was predominantly intermenstrual bleeding, can be observed in up to 75% of patients who underwent polypectomy [32]. Hysteroscopically guided polypectomy, using microscissors or a resectoscope, has been shown to be superior to blind curettage.
Triplet pregnancy with complete mole
Published in Journal of Obstetrics and Gynaecology, 2021
Sujata Siwatch, Minakshi Rohilla, Vanita Jain, Radhika Srinivasan, Shalini Gainder, G. R. V. Prasad
Triplet pregnancy is rare; with a prevalence of 5/100,000 live births as reported from United States in 2015. It is higher with ovulation induction than spontaneous conception. Multiple gestations with complete hydatidiform mole are a rare condition reported in 1:20,000–1:100,000 and poses a risk of various complications to the mother such as haemorrhage, preeclampsia, thyrotoxicosis and gestational trophoblastic neoplasia (Rohilla et al. 2015). Though foetal survival is reported, there is risk of abortion, prematurity, chromosomal abnormalities and intrauterine foetal demise. Twin gestation with molar pregnancy has been christened as ‘sad foetus syndrome’ (Malinowski et al. 1995). However, we report here on a triplet pregnancy with a complete mole. We propose to name it the ‘sad twins syndrome’! Only about 20 women with triplet/quadruplet pregnancies with one complete mole have been reported, most after ovulation indication (Chao et al. 1999; Tariq et al. 2016). We report a case of a triplet pregnancy with one complete mole after a spontaneous conception.
Does multifollicular development and number of intermediate follicles contribute to the effect of luteal phase support with vaginal progesterone gel in intrauterine insemination cycles?
Published in Gynecological Endocrinology, 2020
Vehbi Yavuz Tokgoz, Mehmet Sipahi, Yunus Aydin, Ahmet Basar Tekin
IUI (intrauterine insemination) is a widespread fertility treatment that combined with ovarian stimulation by gonadotropin or clomiphene citrate and effective for especially unexplained infertility, mild male factor infertility and minimal-mild endometriosis [1–3]. Embryonic implantation is very important for both spontaneous conception and fertility treatment like IUI and IVF (in vitro fertilization). Progesterone has an important role in this process and it is secreted from corpus luteum in the luteal phase and early pregnancy, provides secretory transformation of the endometrium and thus improves endometrial receptivity [4]. In a result of superovulation that aimed multiple follicle development in especially IVF cycles, supraphysiological progesterone and estradiol levels secreted by follicles and corpus luteum. Negative feedback of this high steroid levels causes inhibition of LH release and luteal phase deficiency [5,6]. The benefit of progesterone administration has been proven in IVF cycles to exceed luteal phase deficiency [7,8]. However, the efficacy of luteal phase support (LPS) during IUI cycles which are performed with lower dose of gonadotropins and follicle development is controversial. In some studies, there was some benefit of progesterone administration in IUI cycles as well as some of them did not establish any improvement [9–13].
Pregnancy outcome after emergency uterine artery embolisation for management of intractable haemorrhage associated with laparoscopic-assisted myomectomy
Published in Journal of Obstetrics and Gynaecology, 2020
Akihiro Takeda, Wataru Koike, Shiori Tsuge, Mayu Shibata, Sanae Shinone, Hiromi Nakamura
The use of UAE for the management of intractable haemorrhage associated with abdominal (Wan et al. 2014) and LAM (Takeda et al. 2008) are limited; however, the present results were obtained from such a case series after appropriate selection in a single centre. Thus, the major strength of the current examination is precise description of the combined measures composed of LAM (Takeda et al. 2007, 2012) and UAE (Takeda et al. 2008), which were performed by the same gynaecologic surgeons and interventional radiologist with sufficient experience in minimally invasive procedures. Furthermore, concerning pregnancy outcomes in women with fertility wish, the obtained results appeared to be favourable because of high spontaneous conception rate.