Stage IV endometriosis: to treat or not to treat before in-vitro fertilization? Further considerations besides the pregnancy rate: a case of near-miss for spontaneous hemoperitoneum.

Endometriosis represents a well-known cause of infertility. Recently, its association with spontaneous hemoperitoneum in pregnancy (SHIP) was reported. Its occurrence seems to be increased in patients with endometriosis who underwent IVF techniques. We present a case of near miss at 15 weeks of pregnancy associated with SHIP in a nulliparous patient of 39 years old with chronic endometriosis. Previously, she underwent several IVF cycles and controlled ovarian hyperstimulation plus embryo transfer (COH-ET). An explorative laparoscopy was performed, then converted in laparotomy. The bleeding endometriotic tissue was removed and an ureteral stent was placed. The patient lost a total of 4 liters of blood and fully recovered. Unfortunately, miscarriage occurred. The potential link between COH-ET, the number of cycles of ovarian stimulation and SHIP in severe endometriosis must take a part in the balanced decision between preventive surgery of direct hormonal stimulation.

Use of high-frequency ultrasound to study the prenatal development of cranial neural tube defects and hydrocephalus in Gldc-deficient mice.

OBJECTIVE: We used non-invasive high-frequency ultrasound (HFUS) imaging to investigate embryonic brain development in a mouse model for neural tube defects (NTDs) and non-ketotic hyperglycinemia (NKH). METHOD: Using HFUS, we imaged embryos carrying loss of function alleles of Gldc encoding glycine decarboxylase, a component of the glycine cleavage system in mitochondrial folate metabolism, which is known to be associated with cranial NTDs and NKH in humans. We serially examined the same litter during the second half of embryonic development and quantified cerebral structures. Genotype was confirmed using PCR. Histology was used to confirm ultrasound findings. RESULTS: High-frequency ultrasound allowed in utero detection of two major brain abnormalities in Gldc-deficient mouse embryos, cranial NTDs (exencephaly) and ventriculomegaly (corresponding with the previous finding of post-natal hydrocephalus). Serial ultrasound allowed individual embryos to be analysed at successive gestational time points. From embryonic day 16.5 to 18.5, the lateral ventricle volume reduced in wild-type and heterozygous embryos but increased in homozygous Gldc-deficient embryos. CONCLUSION: Exencephaly and ventriculomegaly were detectable by HFUS in homozygous Gldc-deficient mouse embryos indicating this to be an effective tool to study CNS development. Longitudinal analysis of the same embryo allowed the prenatal onset and progression of ventricle enlargement in Gldc-deficient mice to be determined. © 2017 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd.