Outcome of vitrified-warmed blastocyst transfer performed on days 5-7 after urine LH detection.

RESEARCH QUESTION: What is the clinical importance of vitrified-warmed blastocyst transfer timing if performed on days 5, 6 and 7 after detecting the LH surge using urine tests? DESIGN: Between 2013 and 2019, 2080 vitrified-warmed blastocyst transfers in a true natural cycle were performed and later analysed at the Department of Reproductive Medicine, University Medical Centre Maribor, Slovenia. Urine LH tests were performed twice daily to monitor the onset of the LH surge. Vitrified-warmed blastocyst transfer (frozen embryo transfer [FET]) was performed on day 5 (group 1), 6 (group 2) or 7 (group 3) after the LH surge in 18%, 77% and 4% of cycles, respectively. The patient and cycle characteristics among the groups were compared using the Cochran-Mantel-Haenszel test and respective generalized linear mixed models. Propensity score matching was used to adjust for potential differences among the groups. RESULTS: There were no statistically significant differences between groups 1, 2 and 3 in the cycle and patient characteristics, clinical pregnancy rate (38% versus 39% versus 31%), implantation rate (34% versus 36% versus 31%), miscarriage rate (7% versus 9% versus 7%) and delivery rate (31% versus 31% versus 24%). The day of FET after the LH surge detected using a urine test was not significantly associated with live births. CONCLUSIONS: The results of the current study suggested that the vitrified-warmed blastocyst transfer could be scheduled on day 5, 6 or 7 after a positive LH urine test without having a significant impact on the clinical outcome.

A Case of Stevens-Johnson Syndrome in Recurrent Late-Stage Ovarian Cancer Patient after Management of Chronic Pain with Elastomeric Pump.

(1) Background. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe mucocutaneous reactions, characterized by extensive necrosis and detachment of the epidermis. (2) Case presentation. We present a case of a 46-year-old patient with late-stage high-grade serous ovarian cancer who was primarily treated with neoadjuvant chemotherapy and interval debulking, which was followed by adjuvant chemotherapy. At first recurrence, she was again treated with chemotherapy, and due to severe abdominal pain, an elastomeric pump containing analgesics, anti-inflammatories, and ondansetron was administered. In the same month, she was admitted to the hospital due to severe dysphagia, and in the following days she developed haemorrhagic vesiculobullous lesions on the facial skin and trunk. Stevens-Johnson syndrome was confirmed and ondansetron as a plausible leading cause was discontinued. Despite multimodal treatment, her condition deteriorated, and she died. (3) Discussion and conclusion. Although gynaecologists rarely encounter Stevens-Johnson syndrome, high mortality of the disease should ensure a low threshold for diagnosing and treating this disease.

Diagnosis and management of rudimentary horn pregnancy rupture, misinterpreted as bicornuate uterus in the 14th week of pregnancy.

We present a 26-year-old primigravida with rudimentary horn pregnancy rupture at 14 weeks of pregnancy. Uterine anomaly was first diagnosed at the time of nuchal translucency scan and was presumed to be a bicornuate uterus with normal intrauterine pregnancy in the right horn. One day later, she was admitted to our department with abdominal pain, shortly leading to massive hemoperitoneum and hypovolemic shock. Uterine rupture was confirmed ultrasonically, followed by immediate laparotomy. Ruptured rudimentary horn with already expulsed pregnancy was encountered during surgery. Despite significant advances in ultrasonography, diagnosis of prerupture stage remains controversial. However, high mortality of the condition should ensure low threshold for surgical exploration.

Retained surgical needle and gauze after cesarean section and adnexectomy: a case report and literature review.

Although the incidence of retained surgical items (RSIs) is low, it is nevertheless an important preventable cause of patient injury that can ultimately lead to the patient's death and to subsequent high medical and legal costs. Unintentional RSI is the cause of 70% of re-interventions, with a morbidity of 80% and mortality of 35%. The most common RSIs are sponges or gauze (gossypiboma or textiloma), while retained surgical instruments and needles are rare. Perioperative counting of equipment and materials is the most common method of screening for RSIs, while a diagnosis can later be confirmed by the clinical appearance and by imaging studies. We present a rare case of a 43-year-old patient who was admitted to our hospital because of two retained needles following a cesarean section, despite several subsequent laparotomies. One needle had been removed previously, but in addition to the remaining needle, we also removed a retained gauze. The diagnosis of RSIs is extremely important, and safe surgical practices including the addition of new imaging technologies should be encouraged to detect RSIs.

Clinical outcome of day 2 versus day 5 transfer in cycles with one or two developed embryos.

OBJECTIVE: To determine whether extended culture of embryos to blastocysts has any benefit in cycles with only one or two created embryos. DESIGN: Retrospective analysis of cycles comparing outcomes of day 2 and day 5 transfers. Our day 2 group was from the year 1999 and our day 5 group, from the year 2000. SETTING: Assisted reproductive technology program of a teaching hospital. PATIENT(S): All patients, irrespective of age, who had developed one or two embryos. INTERVENTION(S): Stimulated IVF, intracytoplasmic sperm injection, or testicular sperm extraction and intracytoplasmic sperm injection cycles with 2-day culture in universal IVF medium (n = 133) or 5-day culture in BlastAssist media (MediCult, Jyllinge, Denmark; n = 132). MAIN OUTCOME MEASURE(S): Pregnancy, implantation, and take-home baby rates. RESULT(S): In the groups of 2-day and 5-day culture, embryo transfer was performed in 98% and in 57% of cycles, respectively. However, the total implantation rate per created embryo (18% vs. 18%), the pregnancy rate per cycle (23% vs. 21%), and the take-home baby rate (69.4% vs. 71.4%) did not differ between the day 2 and day 5 groups. CONCLUSION(S): Extended culture of embryos does not improve or decrease their capacity for implantation but only allows for better selection and is therefore not necessary in cycles with fewer than three embryos.