ABSTRACT
To assess the efficacy of performing transvaginal cervico-isthmic cerclage [CIC] using synthetic tape in prevention of preterm labor in high-risk women. A retro and prospective analysis of 23 transvaginal cerclages using polypropylene tape performed in women presenting with high risk of preterm delivery: prior histories of two or more losses in the second trimester and/or prior failure of Hervet or Mac Donald's cerciage. Cerclage was at 14 weeks of gestation. A polypropylene tape was placed at the cervicoisthmic junction by vaginal route. The median age of the patients in this series was 33.2 years [range 25-41 years]. No intra-operative complication occurred. The median operating time was 36.9 minutes [ +/- 4.1] [range 30-45 min]. Cesarean delivery was systematically performed in all patients since the Cerclage was considered to be definitive. Term birth rate was 57.5% [3% before CIC; p<0.0001]. Pregnancy loss in the second trimester was 7.8% [66% before CIC; p<0.0001]. Preterm birth rate was 23.1% [[31% before CIC]. Birth at less than 28 weeks occurred in only 1 patients [3.7%] [10.7% before CIC]. In one case, the tape has been removed later because of secondary displacement. Amniotic fluid infection occurred in 4 cases [5%]. Living birth rate was 80.7% [21% before CIC] and no neonatal death occurred [13% before CIC]. Transvaginal cerclage using polypropylene tape may be considered as an effective and minimally invasive alternative to transabdominal cervico-isthmic cerclage in women presenting with high risk of preterm delivery
ABSTRACT
Compare among poor responders: stimulation results, laboratory parameters and the final IVF results by assessing 2 different stimulation protocols: the long agonist protocol and the short agonist protocol. An analytical retrospective study carried out over of period of 2 years: January 2006 and December 2007. During this period, a total of 1192 IVF cycles of ICSI type were performed in 892 patients. Inclusion criteria: short agonist or antagonist stimulated patients protocols and presenting two of the three following criteria: 1- Patients aged more than 38 years with an FSH plasmatic rate on the 3rd day of the cycle 9.5 UI/ml. 2- Antral follicle count [AFC] 5 for both ovaries. 3- Failure of anterior ovary stimulation: abandonment of cycle or 3 oocytes at data collection in a previous cycle. Exclusion criteria: PCOS or single ovary. 65 patients, undergoing 92 attempts of ICSI cycles have been included in this study. Long agonist protocol was performed in 48 cases and Short agonist protocol was performed in 44 cycles. Both groups were comparable as to age [40,09 +/- 6, 59 vs 41, 04 +/- 1,71 years; NS], BMI [25,2 +/- 3,92 vs 25,35 +/- 4,09 Kgm-2 ; NS], infertility type [primary 41% vs 59%;NS ; ou secondary 58% vs 40,9% ; NS], FSH [9,98 +/- 2,42 vs 10,01 +/- 2,75 ; NS] and antral follicle count on day 3 [4,13 +/- 1,12 vs 3,8 +/- 1,16 FA ; NS]. The estradiol rate, dosed on the onset day was significantly higher in the short protocol group [1534,27 +/- 1034,34 vs 1133,31 +/- 1053,58 pg/ml; p=0.034]. However, the consumed quantity of gonadotrophins was lower in the short protocol group [1550 +/- 235,45 vs 1725,55 +/- 450,35 UI, p=0.01]. A total of 13 cycles was stopped: 9 times for the long protocol [18.75 %] and 4 times for the short protocol [9.09 %] with statistically significant difference. The number of collected oocytes was significantly higher in the short protocol [7,64 +/- 3,70 vs 4,55 +/- 2,01, P<0.001]. We significantly obtained more embryos in the short protocol [4,31 +/- 2,9 vs 2,16 +/- 2,2 embryos ; p<0,001]. With higher number of grade 1 embryos [2,61 vs 1,14 embryons; p<0.001].The results in terms of pregnancy and living births show no significant difference between the 2 groups. The short protocol is more suited to the profile of ovarian poor responders. The long protocol standard has no place in poor responders. However, the long micro dose protocol and the long degressed micro dose protocol yield results at least equivalent to the short protocol
ABSTRACT
Uterine rupture during a pregnancy may occur followin hysteroscopic metropasty. We report the case of a patient with a history of hysteroscopic resection complicated by of uterine rupture during pregnancy