Intracytoplasmic sperm injection outcome using ejaculated sperm and retrieved sperm in azoospermic men

We aimed to determine pregnancy and miscarriage rates following intracytoplasmic sperm injection [ICSI] cycles using retrieved epididymal and testicular sperm in azoospermic men and ejaculated sperm in oliogospermic and normospermic men. This retrospective study was carried out on 517 couples who underwent ICSI. They included 96 couples with azoospermia and 421 with oligospermia or normal sperm count in the male partner. Of the men with azoospermia, 69 underwent percutaneous epididymal aspiration [PESA] and 47 underwent testicular sperm extraction [TESE]. In the 421 men with oligospermia or normal sperm count, ejaculated sperm was used for ICSI. The differences in the outcomes of ICSI using PESA or TESE and ejaculated sperm were evaluated. The main outcome measures were pregnancy and miscarriage rates. No significant differences were seen in pregnancy and miscarriage rates with surgically retrieved and ejaculated sperm. The pregnancy rates [including frozen embryo transfer] were 43.5%, 36.2%, and 41.4% in couples with PESA, TESE, and ejaculated sperm, respectively [P=.93]. The miscarriage rates were 16.7%, 23.5%, and 12.1, respectively [P=.37]. Intracytoplasmic sperm injection in combination with PESA and TESE is an effective method and can successfully be performed to treat men with azoospermia. The outcomes with these procedures are comparable to ICSI using ejaculated sperm

Massive primary postpartum haemorrhage: setting up standards of care

To review practice of massive primary postpartum haemorrhage management and develop a protocol. Cross-sectional study conducted at the Department of Obstetrics and Gynaecology at Aga Khan University Hospital, Karachi between January 1, 2003 and July 31, 2004. Women with primary postpartum haemorrhage and had blood loss >1000ml were included in the study. Medical record files of these women were reviewed for maternal mortality and morbidities which included mode of delivery, possible cause of postpartum haemorrhage, supportive, medical and surgical interventions. Approximately 3% [140/4881] of women had primary postpartum haemorrhage. 'Near miss' cases with blood loss >1500ml was encountered in 14.37% [20/140] of these cases. Fifty-six percent [18/32] of the women who had massive postpartum haemorrhage delivered vaginally. Uterine-atony was found to be the most common cause, while care in High Dependency Unit [HDU] was required in 87.5% [28/32] of women. In very few cases balloon tamponade [2-cases] and compression sutures [2-cases] were used. Hysterectomy was performed in 4-cases and all of them encountered complications. Blood transfusions were required in 56% of women who had massive postpartum haemorrhage. This study highlights the existence variable practices for the management of postpartum haemorrhage. Interventions to evaluate and control bleeding were relatively aggressive; newer and less invasive options were underutilized. Introduction of an evidence-based management model can potentially reduce the practice variability and improve the quality of care