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PREVALENCE OF UTERINE ANOMALIES AND THEIR IMPACT ON EARLY PREGNANCY IN WOMEN CONCEIVING AFTER ASSISTED REPRODUCTION TREATMENT

To estimate the prevalence of congenital uterine anomalies in subfertile women and to evaluate their influence on early pregnancy following assisted reproduction treatment (ART).

Ultrasound assessment of the peri‐implantation uterus: a review

Emerging evidence suggests that early embryo implantation is a more active maternal process than hitherto appreciated, involving active encapsulation of the implanting blastocyst by maternal decidual cells and coordinated changes in the underlying inner myometrium, known as the junctional zone. These concepts raise the possibility that early ultrasound markers predictive of adverse pregnancy outcome could be identified. In this review we assess the role of ultrasound in predicting the likelihood of different pregnancy outcomes and highlight potential novel markers that could be tested. Copyright

Embryo volume measurement: an intraobserver, intermethod comparative study of semiautomated and manual three-dimensional ultrasound techniques.

To compare the reliability of our recently introduced technique for first‐trimester embryo volume measurement, the ‘semiautomated technique’ using both Virtual Organ Computer‐aided AnaLysis (VOCAL™) and Sonography‐based Automated Volume Count (SonoAVC) with a manual technique using VOCAL alone.

A Novel Technique for the Semi-Automated Measurement of Embryo Volume: An Intraobserver Reliability Study

The aim was to assess intraobserver reliability of a new semi-automated technique of embryo volumetry. Power calculations suggested 46 subjects with viable, singleton pregnancies were required for reliability analysis. Crown rump length (CRL) of each embryo was analyzed using 2-D and a 3-D dataset acquired using transvaginal ultrasound. Virtual organ computer-aided analysis (VOCAL) was used to calculate volume of gestation sac (GSV) and yolk sac (YSV) and SonoAVC (sonography-based automated volume count) was used to quantify fluid volume (FV). Embryo volume was calculated by subtracting FV and YSV from GSV. Each dataset was measured twice. Reliability was assessed using Bland-Altman plots and intraclass correlation coefficients (ICCs). Fifty-two datasets were analyzed. Median embryo volume was 1.8 cm(3) (0.1 to 8.1 cm(3)); median gestational age 7 + 4 weeks; median CRL 13 mm (2 to 29 mm). Mean difference of embryo volume measurements was 0.1cm(3) (limits of agreement [LOA] -0.3 to 0.4 cm(3)); multiples of mean (MoM) 0.38; mean difference of CRL measurements 0.3 mm (LOA -1.4 to 2.0 mm), MoM = 0.26. ICC for embryo volume was 0.999 (95%CI 0.998 to 0.999), confirming excellent intraobserver agreement. ICC for CRL was 0.996 (95%CI 0.991 to 0.998). Regression analysis showed good correlation between embryo volume and CRL (R(2) = 0.60). The new semi-automated 3-D technique provides reliable measures of embryo volume. Further work is required to assess the validity of this technique.

The management of miscarriage

Women diagnosed with incomplete and delayed miscarriage are faced with three options for their subsequent management: expectant, medical or surgical. Health-care practitioners must empower patients to make educated decisions about their own management by providing them with sufficient information in a readily understandable format. This can be difficult both for the patient and the staff in what is often an understandably, highly emotional situation. Detailed counselling is an essential part of the process as psychological outcomes have been shown to be improved when women feel in control of the decision-making process. In this article, we discuss each of the treatment options in detail, and explore how the type of miscarriage influences their relative success rates. We also consider the comparative risks of bleeding, infection, side effects of drugs, pain scores and quality-of-life scores associated with each method through evidence derived from systematic reviews, meta-analyses and randomised controlled trials.

Heparin for assisted reproduction: summary of a Cochrane review

It is suggested that heparin given in the peri-implantation period may improve clinical outcomes in women undergoing assisted reproduction techniques (ART). This systematic review evaluates the use of heparin in subfertile women undergoing ART.

Pregnancy of unknown viability or location: less is more in the majority of cases

Ultrasound has become an essential part of any early pregnancy assessment. This is particularly true during the first trimester when an ultrasound examination can confirm the number of fetuses, their viability, size and therefore gestational age. Ultrasound was primarily introduced to accurately date a pregnancy and thereby reduce perinatal mortality by decreasing the prevalence of postmaturity and identify multiple pregnancies. This is still relevant today but ultrasound now offers a great deal more information, which can be used to counsel patients and ensure they are appropriately managed throughout their pregnancy. One of the most important developments has been the identification of an ectopic pregnancy, an important cause of maternal morbidity and mortality and one that is often subject to substandard care. When an ultrasound examination is performed in early pregnancy there are three eventualities in terms of the location of the gestation sac: the pregnancy can be correctly located within the endometrial cavity (an intrauterine pregnancy), the pregnancy can be ectopically located (an ectopic pregnancy), or the pregnancy cannot be identified [a pregnancy of unknown location (PUL)].1 Intrauterine pregnancies may be viable, non-viable or of uncertain viability. The latter has been a subject of great debate in the media of late and national guidelines have recently been modified to extend the period during which non-viability can be confidently diagnosed to avoid inadvertent termination of a potentially viable pregnancy.2,–,4 These papers highlight the risks that may be associated with developing protocols in early pregnancy on the basis of insufficient data or ‘expert opinion’ alone.5 Ectopic pregnancies can exist outside of the uterus (a tubal or much less commonly an ovarian or abdominal pregnancy) or ectopically within the uterus (interstitial, cervical and Caesarean scar ectopics). Ultrasound can be used to positively identify the location of …

Dharmasena case illustrates what is wrong with complaints procedures.

A junior doctor who acted in the best interests of his patient as he saw it has found himself before a criminal court, suspended, and subjected to a trust inquiry and a future General Medical Council hearing.1 Such multiple jeopardy is unreasonable. Obstetricians condemned these actions,2 and the patient was quoted as saying, “I am concerned about being labelled as the first woman in …

P11.02: How does IVF treatment affect uterine artery pulsed wave Doppler indices

Objectives: In severe anomalies requiring early intervention in utero, ultrasound diagnosis may be beneficial facilitating neonatal care. The aim of this study is to determine the correlation of ultrasound findings in congenital fetal heart disease and neonatal diagnosis. Methods: A retrospective study of all patients with singleton pregnancy between 2010–2011 was performed. The data collected included patient age, gestational age, cardiac diagnosis, extracardiac anomalies, prenatal and postnatal management and outcome. Results: Out of 4749 patients admitted in our hospital 23 were CHDs (congenital heart defects), 18 living newborns, 3 stillbirths and 2 misscariages. Mean age was 24 (range 16–40) and mean gestational age 31 weeks (range 24–40). Ultrasound was the most relevant diagnosis tool in all CHDs cases for both in utero and postpartum diagnosis. We recorded VSD (ventricular septal defect) in 10 cases, ASD (atrial septal defect) in 8 cases, TGA (transposition of great arteries) 4 cases, common arterial trunk 1 case, coarctation of aortic artery 1 case, TOF (tetralogy of Fallot) 1 case and HLHS (hypoplastic left heart syndrome) 1 case. In utero ultrasound findings were VSD (10 cases), ASD (8 cases), TGA (4 cases), common arterial trunk 1 case, coarctation of aortic artery 1 case, TOF 1 case and HLHS 1 case. We recorded 8 cases of extracardiac anomalies (hydrocephalia, keiloskisis, esophagus athresia, abdominal situs inversus and encephalocele). We had 3 stillbirth cases with mean gestational age 35 weeks and 2 misscariages at 24 and 22 weeks with complex CHDs associated with extracardiac anomalies. Conclusions: In our study the most common CHDs was VSD. The correlation rate between prenatal and postnatal ultrasound findings was more than 90%. Although the sensitivity of routine ultrasound remains low there is no doubt that an increasing number of fetal diagnosis are being made and sonografic diagnosis of CHDs is feasible from early gestation.

P11.01: How does IVF affect the endometrium and is this predictive of conception?

Objectives: In severe anomalies requiring early intervention in utero, ultrasound diagnosis may be beneficial facilitating neonatal care. The aim of this study is to determine the correlation of ultrasound findings in congenital fetal heart disease and neonatal diagnosis. Methods: A retrospective study of all patients with singleton pregnancy between 2010–2011 was performed. The data collected included patient age, gestational age, cardiac diagnosis, extracardiac anomalies, prenatal and postnatal management and outcome. Results: Out of 4749 patients admitted in our hospital 23 were CHDs (congenital heart defects), 18 living newborns, 3 stillbirths and 2 misscariages. Mean age was 24 (range 16–40) and mean gestational age 31 weeks (range 24–40). Ultrasound was the most relevant diagnosis tool in all CHDs cases for both in utero and postpartum diagnosis. We recorded VSD (ventricular septal defect) in 10 cases, ASD (atrial septal defect) in 8 cases, TGA (transposition of great arteries) 4 cases, common arterial trunk 1 case, coarctation of aortic artery 1 case, TOF (tetralogy of Fallot) 1 case and HLHS (hypoplastic left heart syndrome) 1 case. In utero ultrasound findings were VSD (10 cases), ASD (8 cases), TGA (4 cases), common arterial trunk 1 case, coarctation of aortic artery 1 case, TOF 1 case and HLHS 1 case. We recorded 8 cases of extracardiac anomalies (hydrocephalia, keiloskisis, esophagus athresia, abdominal situs inversus and encephalocele). We had 3 stillbirth cases with mean gestational age 35 weeks and 2 misscariages at 24 and 22 weeks with complex CHDs associated with extracardiac anomalies. Conclusions: In our study the most common CHDs was VSD. The correlation rate between prenatal and postnatal ultrasound findings was more than 90%. Although the sensitivity of routine ultrasound remains low there is no doubt that an increasing number of fetal diagnosis are being made and sonografic diagnosis of CHDs is feasible from early gestation.