Delayed fenestration of Blake's pouch with or without vermian hypoplasia: fetal MRI at 3 tesla versus 1.5 tesla.

BACKGROUND: Fetal magnetic resonance imaging (MRI), mainly performed at standard field strength, plays a role in the classification of posterior fossa malformations. In the context of early second-trimester screening, upward rotation of the cerebellar vermis per se is usually compatible with a more favorable outcome than Dandy-Walker malformation and profound vermian hypoplasia. Delayed fenestration of Blake's pouch may either mimic vermian hypoplasia by compression or be associated with it in individual cases. To increase specificity, there is a growing interest in the use of high-field MRI which is believed to be safe as long as the specific absorption rate is kept within accepted limits. We aim to illustrate its added value during the second and third trimester. CASE PRESENTATION: In the first case, fetal MRI at 1.5 Tesla was performed at 21 and 27 weeks' gestation with sonographic follow up postnataly. In the second case, 3 Tesla MR images were acquired at 21 and 34 weeks' gestation as well as in the neonatal period. CONCLUSIONS: This pictorial case vignette supports the suggestion that mid-gestational MRI at 3 Tesla has the potential to exclude pronounced vermian hypoplasia with higher confidence than at 1.5 Tesla. However, the discrimination of mild hypoplasia from slight deformation of the cerebellar vermis will likely remain challenging.

Management of Intrauterine Arteriovenous Malformation (AVM) in 14 Patients by Sonographically Guided Tisseel Application.

PURPOSE: AVMs are rare tumorous vascular lesions derived from placental tissue that may present with massive post-partum hemorrhage (PPH) causing potentially life-threatening anemic shock. Current treatment options include the embolization of uterine arteries and emergency postpartum hysterectomy. We present a new form of minimally invasive, highly specific sonographically guided treatment in the form of the application of a human fibrin sealant leading to the instant cease of blood loss. MATERIALS AND METHODS: A management protocol was established and a case series of 14 patients is presented. Diagnosis by endovaginal color Doppler sonography is followed by the sonographically guided application of biological glue (TISSEEL®), thus allowing for super-selective occlusion of the feeding vessels. RESULTS: The procedure was technically successful in all 14 patients, 3 of whom (21 %) had a repeated procedure after 4 - 7 days. The mean age (yrs.) of the patients was 31 (25 - 40), the gravity was median 2 (1 - 5) and the parity was median 1 (0 - 4), the lowest Hb value was on average 9.35 ±â€Š2.25 (5.2 - 14.2) g/dl, the lowest Ht was on average 30.82 ±â€Š6.02 (18 - 41 %). Spectral Doppler analysis revealed an average of 80.71 ±â€Š11.2 (66 - 115) cm/sec for the maximal detectable PSV. In the period of 4 - 55 months after treatment, 7 patients (50 %) had 8 successful pregnancies and 2 miscarriages. CONCLUSION: In PPH there is vital interest in timely diagnosis of the underlying cause, thus allowing fertility-sparing, minimally invasive and super-selective emergency treatment. In AVMs causing PPH, a positive impact on perinatal morbidity and mortality may be achieved by sonographically guided application of this biological glue.

Pregnancy outcome after blastocyst transfer as compared to early cleavage stage embryo transfer.

BACKGROUND: Retrospective cohort study to evaluate differences in outcome when embryo transfer was performed either on day 2-3 (cleavage stage, CS-group) or on day 4-5 (blastocyst stage, BS-group). METHODS: A total of 1259 consecutive cycles yielding 500 live born babies performed at a single centre in Bregenz, Austria, were included. Main outcome measures were implantation and (multiple) pregnancy rates and neonatal outcome including birth defects. RESULTS: Total Pregnancy rate was 44% vs 28% (P < 0.001) and the total 'take home baby rate' was 37% vs 22% in the BS-group and the CS-group, respectively. Rate of multiple gestations (34% vs 17%, P = 0.001) was significantly higher among the BS-group, resulting in a higher rate of preterm deliveries < 36 weeks (26% vs 17%, P = 0.045). Female factor causing infertility (40% vs 21%, P < 0.001) was significantly higher among the BS-group. For the CS-group, rate of singleton pregnancies (83% vs 66%, P = 0.001) and idiopathic cause of infertility (34% vs 22%, P = 0.012) were significantly higher. No statistically significant differences were found in sex, Caesarean section rate, Apgar score and umbilical artery pH-values, total mean birth weight, admission rate to intensive care unit, days of hospitalization and number of minor and major birth defects. CONCLUSIONS: Our data suggest that blastocyst transfer may lead to a higher pregnancy rate with an overall better take-home baby rate (THBR) at the cost of higher rates of multiples and preterm deliveries.

Prevention of severe ovarian hyperstimulation syndrome (OHSS) in IVF patients by steroidal ovarian suppression--a prospective randomized study.

Ovarian hyperstimulation syndrome (OHSS) is the major complication associated with artificial reproductive technologies. The aim of this study was to assess the potential of exogenous steroids to prevent OHSS without adversely affecting pregnancy rate. A prospective and randomized study including 945 consecutive cycles in 603 women (mean age 28.6 years) was carried out to evaluate the efficiency of high-dose progesterone and oestradiol administration during the luteal phase to prevent OHSS. After ovulation induction, patients were allocated by a series of computer-generated random numbers to receive either 5000 iu human chorionic gonadotrophin (hCG) 4 and 8 days after embryo transfer (group 1, n = 534) or 500 mg hydroxy-progesterone caproate and 10 mg oestradiol valerate on days 2, 6, 10 and 14 after embryo transfer (group 2, n = 411), by i.m. injection. Total pregnancy rate was 24% (97 of 411) and 23% (121 of 534), and median serum progesterone concentrations on day 15 after embryo transfer were 5.8 ng ml(-1) (range 0.1-298) and 0.1 ng ml(-1) (range 0.1-372) in groups 1 and 2, respectively (P = 0.001). One hundred and sixty-three (30.5%) women in group 1 and 22 (5.4%) women in group 2 developed signs of OHSS (P < 0.0001). These results indicate that steroidal ovarian suppression during the luteal phase is a promising tool to reduce the incidence and severity of OHSS in a high-risk population without compromising the pregnancy rate.