Predictive Factors for Successful Vaginal Delivery after a Trial of External Cephalic Version: A Retrospective Cohort Study of 946 Women.

OBJECTIVE: Our aim was to find the factors which predict a vertex presentation of vaginal delivery (VD) in women who are admitted for a trial of external cephalic version (ECV). STUDY DESIGN: This is a retrospective cohort study of women who underwent a trial of ECV and delivered between November 2011 and December 2018 in a single tertiary center. The main outcome measure was successful VD of a fetus in the vertex presentation. Women who achieved VD in the vertex presentation or underwent cesarean delivery were compared on the basis of variety of predictive factors. Adverse neonatal and maternal outcomes were reported. Logistic regression was used for the multivariate analysis. RESULTS: A total of 946 women were included; 717 (75.8%) women had a successful ECV and 663 (70.1%) women had a VD in the vertex presentation. Parous women had 79.3% VD rate (570/719) and nulliparous women had 41.0% VD rate (93/227). Women with an amniotic fluid index (AFI) of 50 to 79, 80 to 200, and >200 mm had 34.8, 71.0, and 83.1% VD rate, respectively. Parous versus nulliparous women had an adjusted odds ratio (aOR) of 5.42 (95% confidence interval [CI]: 3.90-7.52, p < 0.001), women with AFI 50 to 79 mm compared with AFI 80 to 200 mm had an aOR of 0.21 (95% CI 0.12-0.37, p < 0.001), and women with an AFI >200 mm compared with AFI 80 to 200 mm had an aOR of 1.74 (95% CI: 1.03-2.92, p = 0.037) to achieve VD. The final prediction model for the chances of a VD based on data on admission for ECV was reported. The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model (p = 0.836). CONCLUSION: Being parous and having an AFI >200 mm are positive independent predictive factors for achieving VD of a vertex presenting fetus after ECV. Whereas AFI 50 to 79 mm is a negative independent predictive factor. KEY POINTS: · The goal of ECV is to achieve a vertex VD.. · Predictors for ECV success might not predict a VD.. · Parity & AFI independently predict a VD after ECV..

Twin TOLAC is an independent risk factor for adverse maternal and neonatal outcome.

PURPOSE: To determine factors associated with a successful twin trial of labor after Cesarean delivery (TOLAC). METHODS: A retrospective cohort study was conducted at a single medical center in a population highly motivated for TOLAC (> 80%). The effect of maternal demographic and obstetric characteristics on the likelihood of twin TOLAC success was analyzed. Maternal complications and combined adverse outcome (uterine rupture, Apgar < 7 at 5 min, and umbilical cord pH < 7.1) were compared between singleton and twin TOLAC groups. RESULTS: Ninety-five women with a twin gestation and one previous Cesarean delivery comprised the study group. Five thousand seven hundred and three women with a singleton gestation and one previous Cesarean delivery comprised the control group. 30.5% and 83% of women with twin and singleton gestation, respectively, underwent a trial of labor. Women in the twin TOLAC group were significantly less likely to succeed and less likely to have a spontaneous unassisted vaginal delivery compared to women in the singleton TOLAC group. Maternal age less than 35 years, parity greater than two, and at least one previous VBAC increased the likelihood of TOLAC success. Statistically significant differences were found between the twin TOLAC and the singleton TOLAC group for uterine rupture, maternal complications, and for combined adverse outcome. CONCLUSIONS: Twin TOLAC is not common, even in parturients highly motivated for TOLAC. Our results demonstrate that even in a selected population, women undergoing twin TOLAC are less likely to have a successful spontaneous vaginal delivery and have a higher risk for uterine rupture, maternal complications, and combined adverse perinatal outcome than women undergoing TOLAC with a singleton gestation. Demographic and obstetric risk factors were identified which can aid the attending obstetrician in the counseling of these challenging cases.

Severe intrahepatic cholestasis of pregnancy is a risk factor for preeclampsia in singleton and twin pregnancies.

OBJECTIVE: Intrahepatic cholestasis of pregnancy (ICP) is known to be associated with fetal complications. It recently was suggested to be associated possibly with preeclampsia (PET) as well. The objective of this study was to investigate that possibility. STUDY DESIGN: The study group included 78 women (54 singleton and 24 twin pregnancies) who had been diagnosed with ICP based on clinical presentation, elevated liver enzymes, and elevated total bile acids (>10 µmol/L). Disease severity was based on total bile acids levels as being severe (>40 µmol/L), moderate (20-40 µmol/L), or mild (10-20 µmol/L). The course of disease was reviewed carefully in each case. The control groups were comprised of apparently healthy women with singleton (n = 200) and twin (n = 100) pregnancies that were drawn randomly from a computerized registry of all the deliveries in our institution during the study period. RESULTS: The total incidence of PET was significantly higher for the patients with ICP who had singleton and twin pregnancies compared with the control groups (singletons: 7.4% vs 1.5%; P < .05; twins: 33.3% vs 6.2%; P < .05, respectively). The incidence of severe PET was also significantly higher in both singleton (11-fold) and twin (8-fold) pregnancies compared with control subjects. Severe ICP, but not mild ICP, was a major risk factor for PET among women with either singleton or twin pregnancies. The timing of the initial presentation of ICP had no effect on PET incidence rates. Preeclampsia occurred usually 2-4 weeks after the diagnosis of ICP, and proteinuria preceded elevated blood pressure in all cases. Moreover, the total bile acid levels among 33 women who were diagnosed as having PET, but not ICP, were within normal range. CONCLUSION: ICP increases the incidence of PET; severe disease was a major risk factor for preeclampsia. Therefore, we strongly suggest including routine evaluation for preeclampsia in the treatment of women with moderate and severe ICP.

Risk factors, symptoms, and treatment of ovarian torsion in children: the twelve-year experience of one center.

OBJECTIVE: To assess risk factors, clinical findings and mode of diagnosis and treatment in premenarchal children with surgically verified ovarian torsion (OT). STUDY DESIGN: A retrospective case review (Canadian Task Force Classification II-2). SETTING: Teaching and research hospital, a tertiary center. PATIENTS: Premenarchal children with surgically verified OT. INTERVENTIONS: Patients underwent either laparoscopy or laparotomy. RESULTS: Twenty-two cases of OT in 20 premenarchal girls (median age 12 years) were identified. Three cases involved recurrent torsion after detorsion without cystectomy. The main presenting symptoms were sudden pain and vomiting. Six patients underwent Doppler examinations, and all demonstrated an abnormal flow. Seventeen interventions were by laparoscopy. Conservative management, mainly detorsion with additional cyst drainage or cystectomy, was performed in 19 cases (86.4%). Oophoropexy was performed in 3 cases (13.6%). Pathologic examination demonstrated 5 simple cysts and 1 dermoid cyst. CONCLUSIONS: Ovarian torsion in premenarchal girls usually presents with intermittent abdominal pain and abdominal tenderness. Other signs and symptoms are nonspecific. When performed, Doppler imaging may assist in diagnosing ovarian torsion in children. Detorsion followed by cystectomy may prevent recurrence.

Outcomes of mid-trimester emergency cerclage in twin pregnancies.

INTRODUCTION: Placement of emergency cerclage at mid-trimester is controversial. At present, clinical trials comparing outcomes of mid-trimester cerclage to bed rest in twin pregnancies are lacking. Our aim was to examine the efficacy, safety and outcomes of mid-trimester cerclage in patients carrying twin gestations. MATERIAL AND METHODS: We retrospectively studied the outcomes of 14 patients carrying twin gestations with significant cervical dynamics who underwent cerclage. Outcomes of patients with cervical effacement only and patients with bulging membranes through the external os were examined. The interval between cerclage and delivery and the complication rates were calculated. RESULTS: The average time interval between cerclage placement and delivery was 71.1 days overall. Patients with cervical shortening or effacement only (n = 10) gave birth an average of 80.2 days after the procedure, while 4 patients with bulging membranes gave birth an average of 48.5 days after cerclage placement. The overall procedure failure rate, defined as delivery before 28 completed weeks, was 14.2%. DISCUSSION: Patients carrying twin gestations with advanced cervical changes might benefit from therapeutic cerclage. Further studies are required to demonstrate whether there is a difference compared to bed rest alone.

[Anti mullerian hormone (AMH)--is it a new reliable marker of the ovarian reserve? Its role in predicting the ovarian response in assisted reproductive technology (ART)].

Anti-Müllerian hormone (AMH) is predominantly known for its important role in the differentiation of the male and female sexual system during the early embryonic period. Recently, many animal and human researches have been studying the role of the AMH in the postnatal ovarian function. In the female, AMH is produced by the granulosa cells of early developing follicles. It plays a major role in the folliculogenesis and seems to be able to inhibit the initiation of the growth of primordial follicles and FSH-induced follicles. As AMH is expressed throughout the folliculogenesis, from the primary follicular stage to the antral stage, the serum levels of AMH may represent both the quantity and the quality of ovarian follicles. Thus, the AMH levels may be useful as a new potential marker of the ovarian reserve. As compared to other ovarian reserve tests, the AMH has unique characteristics which make it a favorable marker. The measurement of AMH levels may be useful in the prediction of poor response and cycle cancellation as well as hyper-response and the ovarian hyperstimulation syndrome in assisted reproductive technology (ART). We assume that the measurement of AMH Levels may play a role in the individualization of treatment strategies among patients who are treated by ART. However, the AMH cannot predict the qualitative ovarian response in ART. In men, the AMH was not found to have satisfactory clinical utility as a single marker of spermatogenesis.

Third- and fourth-degree perineal tears: prevalence and risk factors in the third millennium.

OBJECTIVE: We sought to assess the modern prevalence and risk factors for third- and fourth-degree perineal tears. STUDY DESIGN: The study population comprised 38,252 women who delivered in one medical center, from January 2005 through December 2009, and met the following inclusion criteria: singleton pregnancy, vertex presentation, and vaginal delivery. Of these, 96 women (0.25%) sustained third- or fourth-degree perineal tears. Maternal and obstetric variables were compared between women with vs without severe perineal tears. RESULTS: Five variables were found to be statistically significant independent risk factors: Asian ethnicity (odds ratio [OR], 8.9; 95% confidence interval [CI], 4.2-18.9), primiparity (OR, 2.4; 95% CI, 1.5-3.7), persistent occipito posterior (OR, 2.1; 95% CI, 1-4.5), vacuum delivery (OR, 2.7; 95% CI, 1.6-4.6), and heavier birthweight (OR, 1.001; 95% CI, 1-1.001). CONCLUSION: Severe perineal tears are uncommon in modern obstetric practice. Significant risk factors are Asian ethnicity, primiparity, persistent occipito posterior, vacuum delivery, and heavier birthweight.

Protracted postpartum urinary retention: the importance of early diagnosis and timely intervention.

AIMS: To evaluate the prevalence and obstetric risk factors of protracted postpartum urinary retention, beyond the third postpartum day. METHODS: Thirty thousand seven hundred fifty-seven consecutive women delivered in Lis maternity hospital during June 2006 to June 2009. The term "protracted postpartum urinary retention" was defined as the absence of adequate voiding beyond the third postpartum day. Study group comprised 55 women who developed protracted postpartum urinary retention. Control group comprised 110 women, matched by age and parity, who delivered at the same day but did not develop urinary retention. RESULTS: Fifty-five (0.18%) women (41 primipara, 14 multipara) developed protracted postpartum urinary retention. On multivariate logistic regression analysis, only duration of the second stage of labor and vacuum deliveries was found to be significant independent risk factors. Thirty-six (65%) women achieved normal voiding within 4-14 days postpartum, and 19 (35%) others within 15-28 days. Higher postvoid residual urinary volume at 72 hr after delivery was associated with increased risk for late recovery. Forty-eight (87%) patients were available for 3-39 months follow-up. Of these, five (10.4%) had stress urinary incontinence, and four (8.3%) had overactive bladder symptoms. Three (6.3%) others had subjective voiding difficulties; however, urodynamic evaluation failed to reveal any voiding phase abnormalities. CONCLUSIONS: Protracted postpartum urinary retention is uncommon in modern obstetric practice. The duration of the second stage of labor and vacuum deliveries were found to be significant independent risk factors. With early diagnosis and timely intervention, complete resolution is expected within 28 days postpartum with no extraordinary long-term consequences.

The safety and efficacy of the "inside-out" trans-obturator TVT in elderly versus younger stress-incontinent women: a prospective study of 353 consecutive patients.

OBJECTIVES: To analyze the safety and efficacy of the trans-obturator tension-free vaginal tape (TVT-O) in elderly versus younger stress-incontinent women. METHODS: Ninety-seven consecutive elderly, aged 70 and older, and 256 younger women (mean age 75 and 55 years, respectively) who underwent TVT-O for urodynamically confirmed stress urinary incontinence (SUI) were prospectively enrolled. Concomitant pelvic organ prolapse (POP) repair was performed in 90% of the elderly and 70% of the younger women. The surgical procedures, as well as all pre- and postoperative clinical and urodynamic evaluation, were performed in one university-affiliated medical center. Main outcome measures were operative complications, early and late postoperative morbidity, postoperative urodynamically confirmed SUI (symptomatic, or asymptomatic), persistent, or de novo overactive bladder (OAB) and bladder outlet obstruction (BOO). RESULTS: Mean follow-up of the patients was 30 ± 17 months (range 3-58 months). Early and late postoperative morbidity was similar in both groups, except for significantly more cases of postoperative recurrent UTI's among elderly women (13.7% vs. 6.2%). The incidence of persistent urodynamically confirmed overt SUI was similar in both age groups (5%). However, asymptomatic urodynamic SUI was significantly more common among elderly patients (19% vs. 3.7%, P<0.05). The incidence of persistent OAB was similar in elderly and younger patients (68% and 62%, respectively), while de novo OAB was significantly more common in elderly patients (11.9% vs. 4.7%, P<0.05). CONCLUSIONS: TVT-O is safe and efficient for both elderly and younger stress-incontinent women. However, elderly patients are in increased risk for postoperative recurrent UTI's as well as de novo OAB.

Intrafollicular and serum levels of leptin during in vitro fertilization cycles: comparison between the effects of recombinant follicle-stimulating hormones and human menopausal gonadotrophin.

OBJECTIVES: To compare the effect of recombinant follicle-stimulating hormones (r-FSH) and human menopausal gonadotrophin (hMG) on leptin levels in serum and follicular fluid (FF) during in vitro fertilization IVF/ET treatment, and to investigate whether leptin levels in the follicular fluid and/or serum are correlated with IVF success. METHODS: Sixty-three patients undergoing IVF cycle were subdivided into two groups. r-FSH was used to for controlled ovarian hyperstimulation in 29 patients (Group A) while, hMG was used in 34 patients (Group B). Our main outcomes were serum and FF leptin on the day of oocyte collection. RESULT(S): The two groups were comparable in age, body mass index (BMI), indications for IVF/ET, E2 level on human chorionic gonadotrophin day, number of retrieved oocytes, fertilization rate, number of transferred embryos and pregnancy rate. Serum and FF leptin levels were similar between the two study groups. Additionally, no correlation was found between levels of leptin in either serum or FF and cycle results such as: number of retrieved oocytes, fertilization rate and pregnancy rate. CONCLUSIONS: r-FSH and hMG have been found to have comparable effects on leptin levels in the serum and the FF of patients undergoing IVF/ET. Additionally, leptin levels in both serum and FF on day of retrieval have no correlation to IVF/ET outcome.

Ten-year subjective outcome results of the retropubic tension-free vaginal tape for treatment of stress urinary incontinence.

STUDY OBJECTIVE: To assess the 10-year subjective outcome of use of retropubic tension-free vaginal tape (TVT). DESIGN: Structured telephone interview (Canadian Task Force classification II-3). SETTING: Universitiy-affiliated tertiary medical center. PATIENTS: Sixty consecutive women with urodynamically confirmed stress urinary incontinence (SUI) who underwent retropubic TVT surgery during 2000. At surgery, their mean (SD) age was 62.4 (9.3) years, and parity was 2.9 (1.3). INTERVENTIONS: Retropubic TVT, with 10-year subjective outcome questionaire. MEASUREMENTS AND MAIN RESULTS: Of the 60 patients, 52 (87%) were available for 10-year follow-up. Preoperatively, all patients reported substantial SUI, and 28 (54%) also had concomitant urge urinary incontinence (UUI). At 10 years postoperatively, 34 women (65%) considered their condition cured, 6 (12%) believed it was improved, and 12 (23%) thought surgery had failed. Eleven women (21%) reported SUI, 22 (42%) had UUI (de novo UUI in 9), and 8 (15%) had recurrent urinary tract infections. Two women (4%) underwent repeated TVT. Of the various perioperative variables, only postoperative impaired bladder emptying was a statistically independent risk factor for long-term failure (odds ratio, 6.4; 95% confidence interval, 1.3-30.1). CONCLUSIONS: Ten-year subjective outcome of retropubic TVT are less favorable than previously reported. Early postoperative impaired bladder emptying is the most significant risk factor for long-term failure.

Clinical estimation of fetal weight: is accuracy acquired with professional experience?

OBJECTIVE: This study was conducted in order to determine whether experience and type of obstetrical profession improves the accuracy in the clinical estimation of fetal weight among obstetricians and midwives in the delivery room. METHODS: Four groups of professionals in the delivery room clinically estimated the fetal weight in 236 parturients in active labor. Obstetric parameters such as gravidity, parity, gestational age, body mass index, amniotomy, station and cervical dilatation were recorded. Fetal weight estimations were compared with the actual birth weight after delivery. RESULTS: The mean error rate of fetal weight estimation by attending obstetricians, residents, experienced and junior midwives was 7.9 ± 8.8, 8.0 ± 8.4, 7.8 ± 6.3 and 8.5 ± 6.8%, respectively. Error rates of the 4 groups of examiners were similar, although it was increased in all subgroups when estimating birth weights <2,500 and >4,000 g. Major discrepancies of fetal weight estimation (>10% of the actual fetal birth weight) occurred in 27.2, 28.9, 31.9 and 34.7% by attending obstetricians, residents, experienced and junior midwives, respectively. CONCLUSIONS: We found no additional value for experience and type of obstetrical training in the accuracy of clinical fetal weight estimation.

[Upper extremity deep vein thrombosis following ovarian stimulation].

Upper extremity deep venous thrombosis (UEDVT) is uncommon as a spontaneous event in the general population and is associated with well-defined risk factors. Thromboembotic events are serious, but fortunately rare, complications following ovarian stimulation for IVF. A review of the Literature indicates that thromboembolic events after ovarian stimulation are usually associated with ovarian hyperstimulation syndrome (OHSS). The incidence of UEDVT is higher in women undergoing assisted reproductive technology (ART) compared to the general population. The incidence of this condition is estimated to be 0.08%-0.11% of treatment cycles. While lower extremity DVT may be considered a natural consequence of OHSS, given the diminished venous return secondary to enlarged ovaries and ascites, it is unclear why there appears to be a predilection for thrombi in the upper extremities in women undergoing ART. Early diagnosis and treatment is crucial for both maternal and fetal well-being. Since infertility treatment is becoming commonplace in today's society, women undergoing treatment and their clinicians should be better informed of the presentation and clinical course of UEDVT to enable early diagnosis and start treatment. Consideration must be given to screening patients at risk for OHSS for thrombophilias, as well as administrating prophylactic anticoagulation therapy to patients who develop OHSS.

Safety of vaginal delivery in women infected with COVID-19.

BACKGROUND: There is limited data regarding the safety of vaginal delivery in women infected with COVID-19. Our goal was to assess the safety of vaginal delivery in women infected with COVID-19 and the risk of neonatal infection. METHODS: This was a single medical center cohort study. Data were collected about the outcome of twenty-one women with laboratory-confirmed COVID-19 infection who delivered between March 23, 2020, and May 8, 2020. RESULTS: Twenty-one gravidas were diagnosed with COVID-19 infection. None required admission to the intensive care unit (ICU) and there were no fatalities. Seventeen delivered vaginally and four by caesareans. Apgar scores of all neonates were 9 at 1 min and 10 at 5 min. One neonate was diagnosed with COVID-19 infection 24 h after birth. CONCLUSIONS: Vaginal delivery in women infected with COVID-19 is not associated with a significant risk of neonatal infection.

Titers of SARS CoV-2 antibodies in cord blood of neonates whose mothers contracted SARS CoV-2 (COVID-19) during pregnancy and in those whose mothers were vaccinated with mRNA to SARS CoV-2 during pregnancy.

OBJECTIVE: We compared neonatal immunity after vaccination against SARS-CoV-2 during pregnancy to that achieved after maternal infection. STUDY DESIGN: We tested cord blood from women infected with SARS-CoV-2 during pregnancy (group 1, n = 29), women who were vaccinated during pregnancy (group 2, n = 29) and from women not infected and not vaccinated (Group 3, n = 21) for titers of antibodies to both SARS-CoV-2 spike and 'N' proteins. RESULTS: Seventy-nine women were included: Antibodies against SARS-CoV-2 spike protein were detected in all samples from Group 1 and 2. Antibodies to the 'N' protein were detected in 25/29 samples in Group 1. None of the samples from Group 3 had antibodies to either protein. Mean titers of SARS-CoV-2 antibodies were significantly higher in Group 2 than in Group 1 (p < 0.05). CONCLUSIONS: Neonates born to mothers vaccinated during pregnancy have higher antibody titers and may therefore have more prolonged protection than those born to women infected during pregnancy.

Adverse obstetric outcome for the vanishing twin syndrome.

The aim was to compare obstetric outcomes of IVF singleton pregnancies diagnosed with vanishing twin (VT) syndrome with those pregnancies originating as singleton pregnancies and with twin pregnancies. In this case control study, 57 patients diagnosed with VT syndrome were matched and compared with 171 singleton controls and 171 twin controls. Mean gestational age was 35.1+/-3.7 versus 38.2+/-2.6 weeks (P=0.001) for patients and singleton controls respectively. Birth weights were 2834.4+/-821.2 versus 3036+/-489.3g (P=0.02), proportion of low birth weight (< 2500 g) was 33.3 versus 11.7% (P=0.0001) and very low birth weight (< 1500 g) 3.5 versus 0.6% for patients and singleton controls respectively. The proportion of deliveries before 28 weeks of gestation was 7.0 versus 1.2% (P=0.01) for patients and singleton controls respectively. When comparing the study group to twin control pregnancies, a similar gestational age at delivery (35 weeks) and rate of preterm birth (23%) were found. In conclusion, pregnancies diagnosed with the VT syndrome after IVF carry a higher rate of adverse obstetric outcomes in terms of preterm deliveries and lower birth weight, compared with IVF pregnancies that were originally singleton. Additionally, significant similarities were observed in the obstetrics outcome of vanishing twin pregnancies and twin pregnancies.

Comparison of adnexal torsion between pregnant and nonpregnant women.

OBJECTIVE: The purpose of this study was to compare clinical manifestations, treatment, and pregnancy outcome of adnexal torsion in pregnant and nonpregnant women. STUDY DESIGN: We conducted a retrospective case-control study in the Departments of Gynecology at 2 tertiary centers between 1999-2008. Forty-one pregnant and 77 nonpregnant women with surgically proved adnexal torsion were assessed. RESULTS: Recurrence rate of torsion was 19.5% in pregnant women and 9.1% in control subjects; 73% of pregnant women conceived through assisted reproductive technologies. Doppler blood flow was falsely normal in 61% of pregnant women and in 45% of nonpregnant women; 83.3% of pregnant women delivered at term. Laparoscopic detorsion was the main surgical procedure. CONCLUSION: Presentation of adnexal torsion is similar in pregnant and nonpregnant women. Past assisted reproductive technology is an important risk factor in pregnancy. Doppler blood flow has a high false-negative rate and should not outweigh clinical suspicion. Although pregnancy outcome is favorable, the high rate of recurrence raises the issue of surgical fixation at the first episode.

Histologic evaluation of fresh human ovarian tissue before cryopreservation.

Transplantation of cryopreserved tissue from patients with cancer may carry the risk of reactivation or redissemination of micrometastases. This prospective study was conducted to evaluate the potential involvement of micrometastases in ovarian tissue in cancer patients. Ovarian biopsies were collected from patients who underwent ovarian tissue cryopreservation, in our IVF unit before chemotherapy between 2000 and 2008. Indications for cryopreservation included breast cancer (n=13), osteosarcoma (n=13), hematologic malignancies (n=13), uterine cervix carcinoma (n=2), endometrial carcinoma (n=1), colon cancer (n=1), and brain medulloblastoma (n=1). The samples were stained with hematoxylin and eosin, and examined histologically. Immunoperoxidase broad-spectrum cytokeratin staining was also performed on specimens from breast cancer patients. There were 44 patients (age range 5-40 yr) who yielded 40 specimens. No gross pathologic involvement was observed, and the histologic examination revealed normal histology with no evidence of metastases. Our findings showed that for the purpose of considering ovarian tissue cryopreservation in cancer patients, the likelihood of microscopic metastases within ovaries of normal appearance is apparently very low. Clarification of the actual risk of ovarian involvement and any subsequent risk of micrometastases and tumor reimplantation requires further investigation.

Complications of trans-cervical Foley catheter for labor induction among 1,083 women.

OBJECTIVE: To report complications associated with the use of trans-cervical Foley catheter with extra-amniotic saline infusion (EASI) for cervical ripening. METHODS: This is a retrospective descriptive study of 1,083 women who underwent EASI ripening. Data on perinatal outcome was retrieved from our computerized database and the medical charts. The primary study outcome was the occurrence of side effects related to the procedure. RESULTS: The study population included 1,083 women. The balloon had to be removed due to complications in 95 (8.8%). The main complications were: acute transient febrile reaction in 32 (3%), non-reassuring fetal heart rate tracing in 22 (2%), vaginal bleeding in 20 (1.8%), unbearable pain that necessitated removal of the catheter in 19 women (1.7%) and altered presentation from vertex to breech in 14 (1.3%). CONCLUSION: Complications associated with trans-cervical ripening and EASI occurred in 7.6% and included acute febrile reaction, pain, vaginal bleeding and altered fetal presentation.