Pregnancy outcome after laparoscopy or laparotomy in pregnancy.

STUDY OBJECTIVE: To assess obstetric performance and fetal outcomes after laparoscopy or laparotomy performed during pregnancy. DESIGN: Nationwide, multicenter, retrospective chart review (Canadian Task Force classification II-2). SETTING: Seventeen hospitals throughout Israel: 12 university or university-affiliated hospitals and 5 general hospitals. PATIENTS: Three hundred eighty-nine pregnant women. INTERVENTION: Laparoscopy or laparotomy for various indications. MEASUREMENTS AND MAIN RESULTS: Of 192 laparoscopies performed, 141 were during the first, 46 during the second, and 5 during the third trimester; respective figures for 197 laparotomies were 63, 110, and 24. No intraoperative complications were reported for either procedure. Six and 25 women had complications after laparoscopy and laparotomy, respectively. There was no significant difference in abortion rates between groups. Mean gestational age at delivery and mean birthweight were comparable between groups. No significant difference was found in frequency of fetal anomalies between groups or when compared with the Israel register of anomalies. CONCLUSION: Operative laparoscopy seems to be as safe as laparotomy in pregnancy.

Cumulative pregnancy rate following IVF and intracytoplasmatic sperm injection with ejaculated and testicular spermatozoa.

The purpose of this study was to calculate the cumulative pregnancy rates of IVF cycles with ICSI using ejaculated or testicular spermatozoa. A computerized database for the IVF cycles with ICSI performed between January 1996 and December 1998 was utilized. Cycles with spermatozoa obtained after electro-ejaculation were excluded. A multifactorial analysis was performed to define the impact of different factors on the success rate of IVF and ICSI. During a 36-month period, 229 pregnancies were achieved by 643 couples using ejaculated spermatozoa, and 83 pregnancies by 167 couples who required testicular spermatozoa. The pregnancy rates (PR) per cycle, including all treatment cycles with ejaculated spermatozoa, remained similar during the first five consecutive cycles achieving a cumulative PR of 80.44%. The cumulative pregnancy rates for cycles with testicular spermatozoa showed a consistent rise during four consecutive treatments and reached 61.84%. The regression analysis of pregnancy rate showed that it was significantly positively correlated with oocyte fertilization rate (P = 0.02), and negatively correlated with maternal age (P = 0.03). Thus, according to the present results, couples with infertility who require IVF with ICSI should be offered at least five consecutive attempts if ejaculated spermatozoa are used, and at least four cycles whenever testicular spermatozoa are used.

Vaginal sonography of the cervix for the prediction of "time to delivery" in ART twins gestations.

The present study aimed to determine a reliable tool to estimate the interval time to delivery in assisted conception twin pregnancies. Mid-gestation cervical length was prospectively measured using transvaginal sonography (TVS) during routine antenatal care. Fifty-seven of 101 suitable women were longitudinally followed and two TVS measurements of their cervical length were obtained, first at approximately 24 weeks gestation and then at approximately 27 weeks gestation. The mean cervical length decreased from 37 +/- 12mm at first measurement to 34 +/- 11mm at the second one. A linear regression model was found between the time interval of the first (R = 0.656, p < 0.001) and the second (R = 0.435, p < 0.001) assessments and the week of delivery. The current data confirm that the length of the preserved segment of the cervix is an important indicator of its competence. A simple equation using the cervical length (mm) divided by 3 can predict mid gestation scan-to-delivery interval in twin gestation.