Live birth of monochorionic triamniotic triplets after in vitro fertilization and blastocyst transfer: case report and review of the literature.

UNLABELLED: Monozygotic triplet pregnancies are very rare, even after in vitro fertilization (IVF). We present a case of a live birth of triplets from a monochorionic triamniotic pregnancy after blastocyst transfer. A 29-year-old woman underwent intracytoplasmic sperm injection (IVF-ICSI). Her medical history included a 4-year infertility treatment with ovarian stimulation, three cycles of intrauterine insemination, hysteroscopy and an unsuccessful attempt at IVF. During the second IVF attempt, the patient underwent ovulation simulation according to the long GnRH agonist protocol. Eleven metaphase II (MII) oocytes were injected with spermatozoa, resulting in four expanded blastocysts. In the end, two blastocysts (4AA) were transferred into the uterine cavity. Ultrasound examination performed at 7 weeks of gestation showed an ongoing triamniotic triplet pregnancy. Regular uterine contractions began at 33 weeks of gestation and a cesarean section was performed, resulting in a birth of three healthy girls, weighing 2060g (Apgar 7), 1860g (Apgar 6), 2000g (Apgar 6). After 13 days of hospitalization the infants and the mother were discharged home. CONCLUSION: The causes of monozygotic multiple gestations in spontaneous and ART pregnancies are poorly understood. They seem to occur more often after IVF. Any definitive relationship between particular stages of the IVF procedure and monozygotic multiple pregnancies remains controversial.

[Prognostic value of chosen parameters of mechanical and bioelectrical uterine activity in prediction of threatening preterm labour]. / Wartosc wybranych parametrów mechanicznej i bioelektrycznej aktywnosci miesnia macicy w przewidywaniu zagrozenia porodem przedwczesnym.

OBJECTIVES: To record and analyse bioelectrical activity of the uterine muscle in the course of physiological pregnancy, labour and threatening premature labour; to define which parameters from the analysis of both electrohysterogram and mechanical activity signal allow us to predict threatening premature labour. MATERIAL AND METHODS: Material comprised 62 pregnant women: Group I--27 patients in their first physiological pregnancy, Group II--21 patients in their first pregnancy with symptoms of threatening premature labour, and Group III--14 patients in the first labour period. The on-line analysis of the mechanical (TOCO) and electrical (EHG) contraction activity relied on determination of quantitative parameters of detected uterine contractions. RESULTS: The obtained statistical results demonstrated a possibility to differentiate between Group I and II through the amplitude and contraction area for EHG signal, and only the contraction amplitude for TOCO signal. Additionally, significant differentiating parameters for electrohysterogram are: contraction power and its median frequency. Analyzing Group I and III, significant differences were noted for contraction amplitude and area obtained both from EHG and TOCO signals. Similarly, the contraction power (from EHG) enables us to assign the contractions either to records from Group I or to labour type. There was no significant difference noted between Group II and III. CONCLUSIONS: Identification of pregnant women at risk of premature labour should lead to their inclusion in rigorous perinatal surveillance. This requires novel, more sensitive methods that are able to detect early symptoms of the uterine contraction activity increase. Electrohysterography provides complete information on principles of bioelectrical uterine activity. Quantitative parameters of EHG analysis enable the detection of records (contractions) with the symptoms of premature uterine contraction activity.

[Mechanical and electrical uterine activity. Part I. Contractions monitoring]. / Aktywnosc mechaniczna i elektryczna macicy. Czesc I. Monitorowanie skurczów.

Correct uterine contraction activity during labour determines physiological fetal delivery and ensures its satisfactory outcome. Contraction activity monitoring may be accomplished by either recording of the mechanical properties of the uterine muscle and/or by measurement of the action potentials produced by the uterus during contraction. In the following paper, the current state of knowledge concerning the methods for assessment and monitoring of the uterine contraction activity was evaluated. The electrophysiological properties of the uterus were given. The mechanical methods of uterine activity monitoring: internal and external tocography were described. The development of the electrohysterography as the method providing the signal comprising complete information on bioelectrical properties of the uterine muscle was presented. The conclusion was that the analysis of the electrohysterogram enables a description of the source of the uterine contraction activity, whereas currently applied mechanical methods merely record the results of this activity.

[Mechanical and electrical uterine activity. Part II. Contractions parameters]. / Aktywnosc mechaniczna i elektryczna macicy. Czesc II. Parametry skurczów.

Frequency and strength of the uterine contractions monitoring enables to control the labour progress and also, although in a restricted way, to determine the beginning of labour, as long as it is not preterm. Mechanical approach provides only the low frequency signal, which describes the contractions more or less accurately, depending on whether an intrauterine pressure measurement is used in the former case or whether an external stress measurement is applied in the latter case. This signal does not comprise information on contractions characteristics and enables only to estimate their basic timing parameters. Description of the electrophysiological properties may be obtained only by means of the uterine electrical signals measurement. In the following paper, the classical interpretation of the uterine contraction activity which relies upon its mechanical and electrical activity was presented. Additionally, the frequency parameters provided exclusively by the electrical signal were proposed. The possibility of the electrohysterogram analysis may provide more complete information on uterine muscle functioning. Results of the research studies show that further development of electrohysterography will enable its wider application in pregnancy and labour diagnostics.

Homocysteine, folic acid and vitamin B12 concentration in patients with recurrent miscarriages.

OBJECTIVES: The aim of the project was the assessment of clinical usefulness of the determination of blood serum homocysteine concentration, folic acid and vitamin B12 in recurrent miscarriages. METHODS: 30 non-pregnant women with recurrent miscarriages (examined group-I) and for 20 non-pregnant women without obstetric failures in medical history (control group-II) were examined. RESULTS: In the examined group (group I), the average concentration of homocysteine (9,45 micromol/l) was not statistically higher in comparison to the control group (group II) (8,47 micromol/l) (p>0,05). In group I the average vitamin B12 concentration in blood serum was 178,3 pg/ml and it was statistically lower (p<0,001) in comparison with the control group (II) (268,6 pg/ml). Such a relation was not observed for the vitamin B12, where the average concentration of this parameter was not dependent on the miscarriage number. A high negative correlation (R= -0,5397, p<0,01) was observed between the level of folic acid and homocysteine concentration in the group of women with recurrent miscarriages and a very high negative correlation (r = -0,9586 p<0,001) in the control group. No relation (R=0,0992 p>0,05) between the average concentration of vitamin B12 in blood serum and the average homocysteine in the nullipara group with recurrent miscarriages CONCLUSIONS: Together with the increasing number of abortions, the average homocysteine concentrations grew and the average folic acid concentrations lowered.

Homocysteine serum concentration and uterine artery color Doppler examination in cases of recurrent miscarriages with unexplained etiology.

OBJECTIVES: To study the assessment of diagnostic value and clinical usefulness of the determination of homocysteine concentration in blood serum in cases of recurrent miscarriages and the relation between the concentration of homocysteine in blood serum and parameter values determining the Doppler blood flow in the uterine arteries. METHODS: Homocysteine concentration in blood serum was determined in a group of 30 women with at least two subsequent miscarriages with no clear reason and in the control group consisted of 20 non-pregnant women without a medical history of obstetric failures, having at least one healthy child. In all cases Color Doppler sonography was performed to determine flow velocity waveforms of the uterine arteries in luteal phase of the menstrual cycle. RESULTS: Both pulsatility (PI) and resistance indices (RI) were considerably higher (p<0.01, p<0.05) for the group of women with recurrent abortions. In the group of women with obstetrical failures high positive correlation (R=0.6903, p<0.001) and in the control group very high positive correlation (r=0.8163, p<0.001) was found, between average values of PI and average HC concentration. High positive correlation (R=0.6260, p<0.001) in the examined group and very high positive correlation (r=0.9201, p<0.001) in the control group was obtained between average values of RI, and average HC concentrations in blood serum . CONCLUSIONS: The recurring miscarriages occur in connection with the elevated homocysteine concentration, in consequence they can point out the pathology within the uterine-fetal blood vessels.