Management of Twin Pregnancy Complications Amid COVID-19: Posterior Colpotomy Approach for Abdominal Cerclage Removal at 18 Weeks Gestation - A Case Report.

BACKGROUND Cervical incompetence and deformities contribute significantly to mid-trimester pregnancy losses and preterm births. Abdominal cerclages prevent these complications, particularly in patients with a history of failed vaginal cerclage or severe cervical deformities. However, pregnancy complications such as chorioamnionitis and fetal demise may necessitate cerclage removal. The removal methods vary, with the least invasive being the colpotomy approach, associated with lower morbidity rates than the transabdominal approach or laparoscopy. CASE REPORT We detail a case involving a 31-year-old woman with a twin pregnancy at 18 weeks gestation, complicated by COVID-19 and chorioamnionitis. This clinical scenario necessitated the removal of an abdominal cerclage. Given the patient's risk profile, a posterior colpotomy approach was deemed most suitable. CONCLUSIONS The posterior colpotomy approach provided an effective and less risky method for abdominal cerclage removal in a high-risk patient. It successfully mitigated the potential complications of general anesthesia and operative risks associated with laparoscopy/laparotomy, offering optimal operative conditions.

Ovarian Vein Thrombosis Complicated by Pulmonary Embolism after Cesarean Delivery in the Presence of a Large Fibroid: Case Report and Literature Review of Contributing Factors.

Ovarian vein thrombophlebitis is rare and mostly occurs during the puerperal period and in higher rates after a cesarean delivery. The objective of this case report and literature review is to highlight the rare occurrence of an ovarian vein thrombosis in a 37-year-old woman postcesarean delivery in the setting of a large uterine fibroid who subsequently developed a pulmonary embolism. The patient presented with severe abdominal pain, fever, and chills. Imaging showed a right ovarian vein thrombosis. Following initiation of anticoagulation therapy, she developed dyspnea and testing showed a subsegmental pulmonary embolism. Further investigation showed that the patient had an undiagnosed thrombophilia thus meeting the classic Virchow triad. Complete clinical recovery was observed, and anticoagulation therapy was continued for 1 year. Our case highlights the importance of recognizing ovarian vein thrombosis because of the risk of fatal complications such as pulmonary embolus. The presence of large fibroids should raise our awareness for OVT in the setting of abdominal pain and fever. The absence of complications in previous pregnancies should not alter our clinical suspicion.

Low risk of OHSS with follitropin delta use in women with different polycystic ovary syndrome phenotypes: a retrospective case series.

BACKGROUND: To explore the efficacy of follitropin delta in ovarian stimulation of patients with the Rotterdam ESHRE/ASRM 2003 phenotypes of polycystic ovarian syndrome (PCOS) using a retrospective case series with an electronic file search in a reproductive medicine clinic. CASE PRESENTATION: Seventy-four patients with PCOS undergoing ovarian stimulation according to the individualized dosing algorithm of follitropin delta for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI)/oocyte freezing were included. Follitropin delta resulted in a high number of pre-ovulatory follicles at the end of stimulation as expected in patients with PCOS. There was a large number of oocytes retrieved with an acceptable percentage of metaphase II (MII) oocytes. There were no cases of moderate or severe OHSS across all phenotypes. CONCLUSION: Follitropin delta, using the individualized dosing algorithm, appears to be a safe method of ovarian stimulation with a low risk of OHSS in PCOS patients without sacrificing successful stimulation outcomes.