Mostafa Abuzeid

Temporary Ovarian Suspension at Laparoscopy for Prevention of Adhesions

We performed an innovative technique of temporary ovarian suspension after operative laparoscopy for stage 3 and 4 endometriosis and evaluated the results in a retrospective study. Subjects were 20 women who underwent operative laparoscopy for infertility. Temporary ovarian suspension to the anterior abdominal wall was performed as the last step in the surgical procedure. It was done in an attempt to separate adhesiogenic surfaces during the initial phase of tissue healing (5-7 days). No complications occurred. After excluding patients who had additional infertility factors and/or were of advanced reproductive age, nine women tried to conceive spontaneously. Of these, five conceived (55%): three delivered, one pregnancy continues (80%), and one woman had an ectopic pregnancy (20%). Of the remaining 15 patients who failed to conceive spontaneously, 5 had a second-look laparoscopy. In four patients (80%), we found no evidence of recurrent adhesions. The remaining 20% had minimal adhesions. Temporary ovarian suspension appears to be simple and safe, and may be effective in preventing postoperative adhesions near the ovaries after operative laparoscopy for advanced endometriosis.

Interstitial ectopic pregnancy: conservative surgical management.

Introduction: Interstitial pregnancy is a rare and life-threatening condition. Diagnosis and appropriate management are critical in preventing morbidity and death. Case Description: Four cases of interstitial pregnancy are presented. Diagnostic laparoscopy followed by laparotomy and cornuostomy with removal of products of conception was performed in 1 case. Laparoscopic cornuostomy and removal of products of conception were performed in the subsequent 3 cases with some modifications of the technique. Subsequent successful reproductive outcomes are also presented. Discussion: Progressively conservative surgical measures are being used to treat interstitial pregnancy successfully, with no negative impact on subsequent pregnancies.

Infertility and ventriculoperitoneal shunt.

Two women with a ventriculoperitoneal shunt had primary infertility. At laparoscopy they both had extensive peritoneal adhesions that made evaluation of pelvic organs impossible and increased the risk of bowel injury. History of ventriculoperitoneal shunt should be considered a contraindication of laparoscopy.

Pediatric Foley Catheter Placement After Operative Hysteroscopy Does Not Cause Ascending Infection

STUDY OBJECTIVE To determine the incidence of postoperative ascending infection without antibiotics with the use of a pediatric Foley catheter (PFC) after operative hysteroscopy for intrauterine pathology. DESIGN Retrospective case series (Canadian Task Force classification III). SETTING University-affiliated outpatient medical center. PATIENTS Patients who underwent operative hysteroscopy for uterine septum, arcuate uterine anomaly, or multiple submucosal myomas between 1992 and 2015. INTERVENTIONS In all patients, a PFC was placed in the endometrial cavity at the conclusion of operative hysteroscopy and left in place for 7 days to reduce intrauterine adhesion formation. MEASUREMENTS AND MAIN RESULTS A total of 1010 patients who underwent operative hysteroscopy for uterine septum (n = 479), arcuate uterine anomaly (n = 483), or multiple submucosal myomas (n = 48) were studied. All patients presented with infertility, recurrent pregnancy loss, or excessive uterine bleeding (in patients with submucous myomas). In all patients, a PFC was placed at the conclusion of the procedure and left in place for 7 days. An 8Fr PFC was used after hysteroscopic division of uterine septum or arcuate uterine anomaly, and a 10Fr PFC was used after hysteroscopic myomectomy. Patients with a history of pelvic inflammatory disease were excluded. Following PFC placement, patients were prescribed estrogen for 6 weeks and progestogen for the last 10 days of the estrogen course. No prophylactic antibiotic therapy was provided. All patients were discharged to home on the same day. Postoperative pain was well controlled with oral pain medication in 98.5% of the patients. There were no reported postoperative infections, and all patients had an uneventful recovery. CONCLUSION In 1010 consecutive operative hysteroscopies followed by temporary (7-day) PFC placement, no clinically significant uterine infection was observed.

Obstetric Outcome in Dichorionic Versus Trichorionic Triplet Pregnancies After IVF-ET [22H]

INTRODUCTION: To compare the obstetric outcome of dichorionic triplet and trichorionic triplet pregnancies following in vitro fertilization and embryo transfer (IVF-ET). METHODS: This is a retrospective cohort study that included 64 triplet pregnancies that occurred following IVF-ET in the period between 2007–2014 at our IVF unit. Patients were divided into 2 groups. Group 1 consisted of 27 patients who had 2 embryos transferred resulting in dichorionic triplet, while group 2 included 37 patients that had trichorionic triplet as a result of transferring 3 embryos. RESULTS: There were no significant differences in underlying etiology of infertility, maternal age (33.4±4.5 vs 33.2±3.7 years), BMI (25.7±7.0 vs 26.3±7.2 kg/m2), preterm birth rates (81.4% vs 90.6%), gestational age at birth (30±9 vs 33±4 weeks) and average birth weight (1890.9±823.7 vs 2054.8±741.5 grams) between group 1 and 2 respectively. The live birth rate after viability (completed 24 week gestation) was significantly lower in dichorionic triplet pregnancies compared to trichorionic triplet pregnancies (77.8% vs 97.3% P<.05). CONCLUSION: Our data suggests that dichorionic triplet pregnancy has lower chance to have live birth compared to trichorionic triplet pregnancy.

Selective Fetal Reduction Versus Expectant Management in Triplet Pregnancies After IVF-ET [20G]

INTRODUCTION: To compare the effect of selective fetal reduction procedure on obstetric outcome of triplets conceived after in vitro fertilization and embryo transfer. METHODS: This is a retrospective cohort study that included 64 triplet pregnancies that occurred in the period between 1/1/2007 to 12/31/2014 at our IVF unit. Patients were divided into 2 groups. Group 1 consisted of 15 patients who underwent a selective fetal reduction procedure, while group 2 included 49 patients who did not go for a fetal reduction procedure. The primary outcomes were: gestational age at delivery and average birth weight. RESULTS: There were no significant differences in underlying etiology of infertility, maternal BMI (26.1±6.3 vs 26.0±7.3 kg/m2), gestational age at birth (30.7±9.6 vs 32.1±5.9 weeks), incidence of preterm birth rate (83.3% vs 75.6%) and live birth rate after viability (80.0% vs 91.8%) between group 1 and 2 respectively. However, there were significant differences in maternal age (35.7±3.7 vs 32.6±3.9 years P<.01) and average birth weight (2671.3±887.4 vs 1813.9±631.4 grams P<.01) between group 1 and 2, respectively. CONCLUSION: Our data suggests that selective fetal reduction procedures can improve triplet pregnancy outcome by increase the average birth weight by 857.4 grams or 47%. Further studies with larger sample size are needed to guide patient counseling and decision regarding selective fetal reduction in triplet pregnancies.

Preterm Birth Rate Following Surgical Correction of Uterine Septum/Arcuate Uterus in Singleton Gestations [30E]

INTRODUCTION: This study compared preterm birth rate, gestational age at delivery and neonatal birth weights in singleton gestations, in a cohort of women with primary infertility and a surgically corrected uterine anomaly to those with normal uterine cavity. METHODS: This retrospective cohort study included 265 patients between 1992–2011. The study group (106 patients) had primary infertility patients with hysteroscopically corrected incomplete uterine septum or arcuate uterus. The control group (159 patients) had primary infertility with normal uterine cavity by hysteroscopic evaluation. All patients conceived a singleton gestation via spontaneous conception (SC), or intrauterine insemination after controlled ovarian stimulation (IUI+COS), or in vitro fertilization and embryo transfer (IVF-ET). RESULTS: There was no significant difference in patient age, BMI, day 3 FSH levels, the incidence of male factor infertility or ovulatory disorders between the two groups. There was significantly lower duration of infertility (P<.01), incidence of tubal factors (P<.001) and endometriosis (P<.001) in the study group compared to the control group. There was no statistically significant differences in the incidence of preterm birth (17.9% vs 22.6%), mean gestational age at delivery in weeks (37.6±5.3 vs 37.9±3.8) and birth weight in kg (3.2+0.6 vs 3.3±0.6) between the study group and the control group respectively. CONCLUSION: Our data suggest that in patients with primary infertility and hysteroscopically corrected incomplete uterine septum or arcuate uterus, the incidence of preterm birth, gestational age, and birth weight appear to be similar to those patients with normal uterine cavities.

Preterm Birth Rate in Twin Gestation After Hysteroscopic Septoplasty of Incomplete Uterine Septum/Arcuate Uterus [27G]

INTRODUCTION: The purpose of this study was to evaluate the risk of PTD in primary infertility patients who underwent hysteroscopic septoplasty and had a subsequent twin gestation. METHODS: This retrospective cohort study included 265 patients between 1992–2011. The study group (36 patients) were primary infertility patients who underwent hysteroscopic septoplasty for either an incomplete uterine septum or an arcuate uterine anomaly. The control group (50 patients) had primary infertility and a normal uterine cavity by hysteroscopic evaluation. All patients conceived twin gestations via spontaneous conception (SC), or intrauterine insemination after controlled ovarian stimulation (IUI+COS) or in vitro fertilization and embryo transfer (IVF-ET). RESULTS: There was no significant difference in age, duration of infertility, day 3 FSH levels, or incidence of male factor infertility between the two groups. There was a significantly higher BMI kg/m2 (30.1+6.9 vs 24.7+5.0; P<.03) and incidence of ovulatory disorders (P<.05). There was significantly lower incidence of tubal factors (P<.001) and endometriosis (P<.01) in the study group compared to the control group. The incidence of PTD in the study group (77.8%) was significantly higher compared to the control group (52.0%), P<.05. There were no differences in gestational ages or neonatal birth weights. CONCLUSION: This study suggests that the risk of PTD in patients with hysteroscopic correction of uterine anomalies may be compounded in twin gestations. Therefore, every effort should be made to achieve a singleton pregnancy in these patients. These patients may require increased surveillance, while future studies regarding possible interventions to reduce the incidence of PTD may be warranted.

Preterm Birth and IVF-ET in Singleton Pregnancy After Hysteroscopic Correction of Uterine Septum [27H]

INTRODUCTION: The purpose of this study is to compare preterm birth rate in a cohort of women with primary infertility, and hysteroscopically corrected incomplete uterine septum or arcuate uterine anomaly, who subsequently conceived singleton gestation via spontaneous conception (SC), or intrauterine insemination after controlled ovarian stimulation (IUI+COS) or IVF-ET. METHODS: This retrospective study included women with primary infertility and incomplete uterine septum or arcuate uterine anomaly. All patients underwent successful hysteroscopic septoplasty that resulted in a normal uterine cavity postoperatively between 1992–2011. Subsequently all patients conceived singleton gestation by SC, IUI+COS, or IVF-ET. The study included 106 patients, 45 conceived spontaneously, 11 with IUI+COS, and 50 with IVF-ET. The primary outcome was the preterm birth rate. Secondary outcomes were gestational age at delivery and neonatal birth weight. RESULTS: There was a significant difference in age, but no significant differences in duration of infertility, BMI, day 3 FSH levels or underlying etiology among the three groups. There was no statistical difference in preterm birth rates (17.8% vs 27.3% vs 16%), mean gestational age at delivery in weeks (38.6±2.5 vs 37.6±3.6 vs 36.6±7.0), and birth weight in Kg (3.3±0.6 vs 3.1±0.8 vs 3.2±0.7) between SC, IUI+COS, and IVF-ET groups respectively. CONCLUSION: Our data suggest that in patients with incomplete uterine septum or arcuate uterine anomaly, who underwent successful hysteroscopic correction, IVF-ET treatment per se is not associated with increased risk of preterm birth and/or low birth weight.

Placental Location and Reproductive Outcome in Patients With Uterine Septum or Arcuate Uterus [19G]

INTRODUCTION: The aim of this study is to determine placental location in pregnancy that ended in a live birth in patients with known uterine septum or arcuate uterine anomaly. METHODS: This retrospective study included sixty-seven patients who had a live birth and a diagnosis of uterine septum or arcuate uterine anomaly based on trans-vaginal 3D ultrasound scan (TV 3D US) with or without saline infusion sonohysterogram (SIH) between 2005 and 2015. Thirty patients (44.8%) presented with secondary infertility, 6 patients (9%) presented with recurrent pregnancy loss (RPL), 3 patients (4.5%) presented with history of miscarriage, and 28 (41.8%) presented with secondary infertility and miscarriage or RPL. RESULTS: Mean age was 32.4±4.3 years. Mean gestational age was 37.1±3.9 weeks. Placental location was not on the septum in 57 patients (85.1%); placental location was anterior in 29 patients (43.3%), posterior in 25 patients (37.3%), and lateral in 3 patients (4.5%). Eight patients (11.9%) had partial fundal location (fundal anterior in 6 patients [75%], and fundal posterior in 2 patients [25%]). Placental location was fundal in 2 patients (3%). In one of these patients the septum was found to be very vascular during hysteroscopy; the patient experienced vaginal bleeding through the pregnancy and delivered at 28 weeks. CONCLUSION: Our data support the long held theory that placental location in relation to uterine septum or arcuate uterine anomaly influence reproductive outcomes. Also, our data may explain the variable reproductive outcome of patients with such anomalies in the literature.