Exploring uterine contractility frequency in infertile population: A comparative study among different control groups with and without a C-section defect.

OBJECTIVE: Women undergoing IVF who have had a previous c-section (CS) have a lower live birth rate than those with a previous vaginal delivery. However, the precise underlying mechanisms need clarification. Does a previous CS affect the pattern of uterine contractility?. METHODS: Prospective evaluation in patients undergoing frozen blastocyst embryo transfer in medicated endometrial preparation cycles. Twenty patients were included in groups: A/nulliparous. B/previous vaginal delivery. C/ previous CS without a niche, whereas fifteen patients were recruited in group D (CS and a niche). Patients employed estradiol compounds and 800 mg vaginal progesterone. A 3D-scan was performed the transfer-day where uterine contractility/minute was recorded. RESULTS: Baseline characteristics (age, BMI, smoking, endometrial thickness) were similar. Mean frequency of uterine contractions/minute was similar between groups (1.15, 1.01, 0.92, and 1.21 for groups A, B, C, and D, respectively). There was a slight increase in the number of contractions in patients with a sonographic niche versus controls, not reaching statistical significance (p=0.48). No differences were observed when comparing patients with a previous C-section (regardless of the presence of a niche) to those without a C-section, either nulliparous (p=0.78) or with a previous vaginal delivery (p=0.80). The frequency of uterine contractions was similar between patients who achieved a clinical pregnancy and those who did not (1.19 vs. 1.02 UC/min, p=0.219, respectively). CONCLUSIONS: Our study found no significant difference in the frequency of uterine contractility between patients with or without a previous C-section or sonographic diagnosed niche. Further investigation is necessary to understand the physiological mechanisms affecting implantation in patients with isthmocele.

Long-lasting effect of belantamab mafodotin in heavily pretreated multiple myeloma.

Belantamab mafodotin (BLMF) is an interesting therapeutic alternative for multiple myeloma (MM) patients pretreated with immunomodulatory drugs, proteasome inhibitors, and anti-CD38 monoclonal antibodies. Scientific evidence on BLMF provides immature data about progression-free survival and overall survival by short follow-up of patients with poor prognoses. Cases with long follow-ups could provide additional information about BLMF. This case reports a patient with MM treated with BLMF who had received nine previous lines of therapy with a follow-up of 11 months. No complete response was obtained. However, no disease progression was observed and the patient was still alive at the end of this work. BLMF showed manageable adverse effects. Our patient presented advanced disease, good functional status at the beginning of BLMF treatment, and elevated levels of lactate dehydrogenase during BLMF therapy. The influence of these last two factors was not evaluated in clinical trials. This relationship should be assessed more deeply in future studies.

Gonadotropin-releasing hormone agonist for ovulation trigger - OHSS prevention and use of modified luteal phase support for fresh embryo transfer.

The introduction of gonadotrophin-releasing hormone agonist (GnRHa) trigger greatly impacted modern IVF treatment. Patients at low risk of ovarian hyperstimulation syndrome (OHSS) development, undergoing fresh embryo transfer and GnRHa trigger can be offered a virtually OHSS-free treatment with non-inferior reproductive outcomes by using a modified luteal phase support in terms of small boluses of human chorionic gonadotrophin (hCG), daily recombinant luteinizing hormone LH (rLH) or GnRHa. In the OHSS risk patient, GnRHa trigger can safely be performed, followed by a 'freeze-all' policy with a minimal risk of OHSS development and high live birth rates in the subsequent frozen embryo transfer cycle. Importantly, GnRHa trigger opened the 'black box' of the luteal phase, promoting research in the most optimal steroid levels during the luteal phase. GnRHa trigger allows high-dose gonadotropin stimulation to achieve the optimal number of oocytes and embryos needed to ensure the highest chance of live birth. This review thoroughly discusses how the GnRHa trigger concept adds safety and efficacy to modern IVF in terms of OHSS prevention. Furthermore, the optimal luteal phase management after GnRHa trigger in fresh embryo transfer cycles is discussed.

Gonadotropin-releasing hormone agonist ovulation trigger-beyond OHSS prevention.

In this review the advantages of the gonadotropin-releasing hormone agonist (GnRHa) trigger are discussed beyond those immediately associated with ovarian hyperstimulation syndrome (OHSS) prevention. The GnRHa trigger concept has sparked the development of novel protocols, enriching the assisted reproductive technology (ART) armamentarium for the benefit of present and future patients. Thus, GnRHa trigger already has a pivotal role, not only for the standard in vitro fertilisation (IVF) patient, but also for patient groups like oocyte donors, cancer patients, patients with poor ovarian reserve, and patients with immature oocyte syndrome and empty follicle syndrome. Herein, we discuss the importance of the GnRHa-elicited midcycle FSH surge and the potential improvement in oocyte yield and embryo competence.

Desprendimiento prematuro de placenta normoinsertada por mutación heterocigota en el gen de la protrombina / Placental abruption associated with heterozygous prothrombin gene mutation

El desprendimiento prematuro de placenta se define como la separación parcial o completa de una placenta normalmente insertada antes del inicio del parto. Esto se produce en un 0,4-1% de las gestaciones. Esta patología se asocia a una elevada morbimortalidad materno-fetal. Existen distintos factores de riesgo asociados con el desprendimiento prematuro de placenta. Entre estos factores se encuentran: trastornos hipertensivos del embarazo, antecedentes de desprendimiento placentario o cesárea, diabetes, multiparidad, sobredistensión uterina (gestación múltiple o polihidramnios), rotura prematura de membranas, traumatismos abdominales, consumo de tóxicos y trombofilias. En un elevado número de casos la causa del desprendimiento es desconocida. El diagnóstico se basa fundamentalmente en las manifestaciones clínicas. El empleo de la ecografía tiene una utilidad muy limitada para el diagnóstico debido a su baja sensibilidad. La actitud va a estar condicionada por el estado materno y fetal, el grado de desprendimiento placentario y la edad gestacional en el momento del diagnóstico. Se presenta un caso clínico de un desprendimiento prematuro de placenta normoinsertada asociado a coagulación intravascular diseminada, útero de Couvelaire y atonía uterina debido a la mutación 620210 A heterocigota en el gen de la protrombina

Placental abruption defined as the complete or partial separation of a normally implanted placenta before delivery, occurs in 0.4-1%. It is one of the most significant causes of maternal and perinatal morbidity and mortality. The risk factor of abruption placentae are hypertension, prior caesarean delivery, previous abruption placentae, pregestational diabetes, high parity, polyhydramnion, multiple gestation, premature rupture of membranes, abdominal trauma, drug abuse and thrombophilia. The cause of placental abruption often remains unexplained. The diagnosis of placental abruption is clinical, based on characteristic signs and symptoms. Sonography is not sensitive for the detection of placental abruption. Prenatal and perinatal management depend on maternal and foetal condition, severity and gestational age. We report the case of placental abruption associated with disseminated intravascular coagulation, Couvelaire uterus and uterine atony. The patient was diagnosed with heterozygous prothrombin gene mutation 620210 A

Clinical results after the implementation of cell-free fetal DNA detection in maternal plasma.

AIM: Detection of cell-free fetal DNA in maternal blood is a type of noninvasive prenatal diagnosis test (NIPT), which has already been known for some time but has not yet been introduced in most of public hospitals in Spain. How the implementation of cell-free fetal DNA (cffDNA) in a contingent protocol has influenced the aneuploidy screening in our hospital is described. METHODS: Two cohorts of patients with positive combined screening were compared: the first one (years 2012-2013, 5747 patients) from a period of time in which the protocol valid until March 2016 - that included the use of invasive procedures - was applied; and the second one in which the current protocol - that included NIPT versus invasive procedures - was applied (first 7 months after protocol implementation, 898 patients). RESULTS: Comparison of both periods resulted in a 60.5% reduction of invasive procedures (P < 0,001) preserving the same chromosomopathy detection rate. The ratio of positive invasive procedures-indicated invasive procedures was improved by 15% in the first period to 50% in the second period (P = 0.01). CONCLUSION: NIPT introduction has caused a significant reduction of 60.5% of IP in high chromosomopathy risk patients after combined screening without modifying detection rate.

3D Hysterosalpingo-contrast sonography: description of the technique and results / Histerosonosalpingografía con contraste 3D: descripción de la técnica y resultados

Objective: To describe the 3-dimensional hysterosalpingo-contrast sonography (3D-HyCoSy) technique and analyze our results with 2 contrast agents: SonoVue® and ExEm Foam®. Material and methods: Cross-sectional study of 160 infertility patients with unknown tubal patency. Results: Bilateral tubal patency was diagnosed in 102/153 (66.7%) patients. A similar proportion of bilateral occlusion was observed with both SonoVue® 5/87 (5.7%) and ExEm foam® 4/66 (6.1%) (p = 0.52). Intrauterine disease was suspected in 33/155 (21.3%) patients: 20% (18/90) with SonoVue® and 23.1% (15/65) with ExEm Foam® (p = 0.644). The visual analog scale (VAS) revealed mild pain (VAS ≤ 4: 86.4% [70/81] with SonoVue® vs. 86.8% [59/68]) with ExEm Foam® (p = 0.951). A pediatric nasogastric probe was easily used to cannulate the cervical os in 128/159 (80.5%) cases. The volume of ExEm foam® used was lower than that of SonoVue® (median: 3 cc vs.20 cc, p < 0.001). Conclusion: 3D-HyCoSy is a reliable, well-tolerated, and effortless tool for the sonographic assessment of sterility. The results were similar with both contrast agents (AU)

Objetivo: describir la técnica y analizar nuestros resultados con histerosonosalpingografía con contraste 3D (HyCoSy-3D) utilizando SonoVue® y Exem Foam®. Material y métodos: estudio retrospectivo de corte transversal en 160 pacientes estériles con permeabilidad tubárica desconocida. Resultados: l 66,7% (102/153) de las pacientes tuvo permeabilidad tubárica bilateral. El diagnóstico de obstrucción tubárica bilateral fue similar utilizando SonoVue® 5/87 (5,7%) y Exem Foam® 4/66 (6,1%), p = 0,52. Diagnosticamos patología intrauterina en 33/155 (21,3%) de las pacientes, 20% (18/90) con SonoVue® vs. 23,1% (15/65) p = 0,644. El dolor percibido resultó leve en la mayoría de los casos (escala visual analógica ≤ 4; 86,4% (70/81) SonoVue® vs. 86,8% (59/68), p = 0,951). La canalización cervical fue sencilla con sonda nasogástrica pediátrica en 128/159 (80,5%). Exem Foam® precisó un menor volumen instilado (mediana: 3 cc vs. 20 cc, p < 0,001). Conclusiones: la HyCoSy-3D es una prueba tolerable, sencilla y rentable para el estudio ecográfico en esterilidad. Ambos contrastes mostraron similares resultados (AU)

Asociación entre horas de televisión, actividad física, horas de sueño y exceso de peso en población adulta joven / Association between hours of television watched, physical activity, sleep and excess weight among young adults

Objetivo Analizar la asociación de las horas de televisión, la actividad física autorreferida y las horas de sueño con el exceso de peso corporal o el índice de masa corporal (IMC) en población universitaria. Métodos Se han analizado de forma transversal los datos basales de 1135 participantes de 17 a 35 años de edad del proyecto «Dieta, antropometría y salud en población universitaria». Se recogió información sobre las horas de televisión y de sueño, la actividad física, el peso y la talla autorreferidos, y otras variables de interés. Se calculó el IMC (kg/m2) y se definió el exceso de peso (IMC ≥25). Se usó regresión logística múltiple para analizar la asociación entre las variables de interés y el exceso de peso (no/sí), y regresión lineal múltiple para el IMC. Resultados La prevalencia de exceso de peso fue de 13,7% (11,2% sobrepeso y 2,5% obesidad). Se encontró una asociación significativa entre el exceso de peso y más horas de televisión. Tomando como referencia a los que veían televisión ≤1h al día, los que la veían >2h al día (categoría superior) presentaron una odds ratio de 2,13 (intervalo de confianza del 95%: 1,37-3,36; p tendencia: 0,002). Una menor actividad física autorreferida se asoció a un mayor riesgo de exceso de peso, aunque la asociación sólo resultó significativa en el análisis de regresión lineal múltiple (p=0,037). No se encontró asociación entre el exceso de peso y las horas de sueño. Conclusiones Más horas de televisión y una menor actividad física se asociaron significativamente con un aumento del IMC en la población universitaria estudiada. Ambos factores pueden modificarse con estrategias preventivas (AU)

Objective To explore the association between excess weight or body mass index (BMI) and the time spent watching television, self-reported physical activity and sleep duration in a young adult population. Methods We analyzed cross-sectional baseline data of 1,135 participants (17-35 years old) from the project Dieta, salud y antropometría en población universitaria (Diet, Health and Anthrompmetric Variables in Univeristy Students). Information about time spent watching television, sleep duration, self-reported physical activity and self-reported height and weight was provided by a baseline questionnaire. BMI was calculated as kg/m2 and excess of weight was defined as ≥25. We used multiple logistic regression to explore the association between excess weight (no/yes) and independent variables, and multiple linear regression for BMI. Results The prevalence of excess weight was 13.7% (11.2% were overweight and 2.5% were obese). A significant positive association was found between excess weight and a greater amount of time spent watching television. Participants who reported watching television >2h a day had a higher risk of excess weight than those who watched television ≤1h a day (OR=2.13; 95%CI: 1.37-3.36; p-trend: 0.002). A lower level of physical activity was associated with an increased risk of excess weight, although the association was statistically significant only in multiple linear regression (p=0.037). No association was observed with sleep duration. Conclusion A greater number of hours spent watching television and lower physical activity were significantly associated with a higher BMI in young adults. Both factors are potentially modifiable with preventive strategies (AU)

[Association between hours of television watched, physical activity, sleep and excess weight among young adults]. / Asociación entre horas de televisión, actividad física, horas de sueño y exceso de peso en población adulta joven.

OBJECTIVE: To explore the association between excess weight or body mass index (BMI) and the time spent watching television, self-reported physical activity and sleep duration in a young adult population. METHODS: We analyzed cross-sectional baseline data of 1,135 participants (17-35 years old) from the project Dieta, salud y antropometría en población universitaria (Diet, Health and Anthrompmetric Variables in Univeristy Students). Information about time spent watching television, sleep duration, self-reported physical activity and self-reported height and weight was provided by a baseline questionnaire. BMI was calculated as kg/m(2) and excess of weight was defined as ≥25. We used multiple logistic regression to explore the association between excess weight (no/yes) and independent variables, and multiple linear regression for BMI. RESULTS: The prevalence of excess weight was 13.7% (11.2% were overweight and 2.5% were obese). A significant positive association was found between excess weight and a greater amount of time spent watching television. Participants who reported watching television >2h a day had a higher risk of excess weight than those who watched television ≤1h a day (OR=2.13; 95%CI: 1.37-3.36; p-trend: 0.002). A lower level of physical activity was associated with an increased risk of excess weight, although the association was statistically significant only in multiple linear regression (p=0.037). No association was observed with sleep duration. CONCLUSION: A greater number of hours spent watching television and lower physical activity were significantly associated with a higher BMI in young adults. Both factors are potentially modifiable with preventive strategies.