Uterus and cervix anatomical changes and cervix stiffness evolution throughout pregnancy.

The coordinated biomechanical performance, such as uterine stretch and cervical barrier function, within maternal reproductive tissues facilitates healthy human pregnancy and birth. Quantifying normal biomechanical function and detecting potentially detrimental biomechanical dysfunction (e.g., cervical insufficiency, uterine overdistention, premature rupture of membranes) is difficult, largely due to minimal data on the shape and size of maternal anatomy and material properties of tissue across gestation. This study quantitates key structural features of human pregnancy to fill this knowledge gap and facilitate three-dimensional modeling for biomechanical pregnancy simulations to deeply explore pregnancy and childbirth. These measurements include the longitudinal assessment of uterine and cervical dimensions, fetal weight, and cervical stiffness in 47 low-risk pregnancies at four time points during gestation (late first, middle second, late second, and middle third trimesters). The uterine and cervical size were measured via 2-dimensional ultrasound, and cervical stiffness was measured via cervical aspiration. Trends in uterine and cervical measurements were assessed as time-course slopes across pregnancy and between gestational time points, accounting for specific participants. Patient-specific computational solid models of the uterus and cervix, generated from the ultrasonic measurements, were used to estimate deformed uterocervical volume. Results show that for this low-risk cohort, the uterus grows fastest in the inferior-superior direction from the late first to middle second trimester and fastest in the anterior-posterior and left-right direction between the middle and late second trimester. Contemporaneously, the cervix softens and shortens. It softens fastest from the late first to the middle second trimester and shortens fastest between the late second and middle third trimester. Alongside the fetal weight estimated from ultrasonic measurements, this work presents holistic maternal and fetal patient-specific biomechanical measurements across gestation.

Antenatal Corticosteroids: Extending the Practice for Late-Preterm and Scheduled Early-Term Deliveries?

Respiratory distress in late-preterm and early term infants generally may warrant admission to a special care nursery or an intensive care unit. In particular, respiratory distress syndrome and transient tachypnea of the newborn are the two most common respiratory morbidities. Antenatal corticosteroids (ACS) facilitate surfactant production and lung fluid resorption. The use of ACS has been proven to be beneficial for preterm infants delivered at less than 34 weeks' gestation. Literature suggests that the benefits of giving antenatal corticosteroids may extend to late-preterm and early term infants as well. This review discusses the short-term benefits of ACS administration in reducing respiratory morbidities, in addition to potential long term adverse effects. An update on the current practices of ACS use in pregnancies greater than 34 weeks' gestation and considerations of possibly extending versus restricting this practice to certain settings will also be provided.

Compassionate embryo transfer: physician practices and perspectives.

OBJECTIVE: To assess reproductive endocrinology and infertility (REI) physicians' basic knowledge of compassionate embryo transfer, current practices, and perceived barriers to offering compassionate transfer. DESIGN: Cross-sectional survey study. SETTING: Not applicable. PATIENTS: Not applicable. INTERVENTION: None. MAIN OUTCOME MEASURES: Number of physicians offering and performing compassionate transfer, barriers, beliefs and demographics of physicians. RESULTS: A total of 744 members of the Society for Reproductive Endocrinology and Infertility were sent the survey, and 202 (27.1%) responded. Of the 168 (83.2%) physicians who had heard of compassionate transfer, 75 (44.6%) had offered it. In all, 130 physicians stated that they would offer compassionate transfer if there was patient demand, and 74 would offer it if there were American Society for Reproductive Medicine guidelines. Among physicians who did not offer compassionate transfer, 97 cited lack of patient interest as a barrier. In all, 55 physicians had performed compassionate transfer (range 0-8) performed within the past 2 years. The majority of physicians (76.4%) placed embryos in the endometrium, and there was no consensus on timing. Of the physicians, 27 restricted the number of embryos transferred. Three physicians reported pregnancies following compassionate transfer; none were ectopic. CONCLUSION: Data from this survey suggest that REI physicians have a wide range of knowledge and practices concerning compassionate transfer. Individual practices should be encouraged to develop written protocols regarding the use of embryos for nonreproductive purposes. American Society for Reproductive Medicine should develop recommendations to standardize the practice of compassionate transfer for those physicians who plan to offer this procedure.

Increasing access to fertility care through private foundations.

OBJECTIVE: To characterize the available support for infertility treatment and populations served by private foundations across the United States. DESIGN: Web-based cross-sectional survey. SETTING: Not applicable. PATIENT(S): Not applicable. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Geographies and populations served, dollar-amount and scope of financial assistance provided by private foundations for individuals seeking financial assistance for infertility treatment. RESULT(S): Thirty-seven private foundations were identified, 25 responded (68% response rate). More than one-half of the foundations had awarded grants to lesbian, gay, and transgender individuals, as well as single men and women. Forty percent of the foundations serve only a single state or geographic region. Foundations have provided 9,996 grants for infertility treatment, 1,740 in 2016 alone, with an average value of $8,191 per grant. The Livestrong foundation has provide more than 90% of these grants, and only to patients with a history of cancer. Twelve percent of foundations provide assistance for fertility preservation in patients with cancer, and 20% provide assistance for elective oocyte cryopreservation. CONCLUSION(S): Private foundations significantly increase access to infertility care for individuals and couples affected by cancer who could otherwise not afford treatment. Significant heterogeneity exists regarding the populations served and the services available for grant support by these foundations, and the landscape of options for patients unaffected by cancer is severely limited.