Obstetric and neonatal outcomes of pregnancies conceived after preimplantation genetic diagnosis: cohort study and meta-analysis.

Preimplantation genetic diagnosis (PGD) may pose risks to pregnancy outcome owing to the invasiveness of the biopsy procedure. This study compares outcome of singleton and twin clinical pregnancies conceived after fresh embryo transfers of PGD (n = 89) and matched intracytoplasmic sperm injection (ICSI) pregnancies (n = 166). The study was carried out in a single university affiliated centre. Because of the paucity of available data, a literature-based meta-analysis of studies comparing neonatal outcome of PGD and ICSI pregnancies was also conducted. In the retrospective cohort study, obstetric and neonatal outcome were available in 67 PGD and 118 ICSI pregnancies. Perinatal outcomes were comparable between PGD and ICSI pregnancies. Meta-analysis revealed similar outcomes, except for higher rate of low birth weight (<2500 g) neonates in ICSI twin pregnancies (RR 0.86, 95% CI 0.74 to 1.0). Mean birth weight, gestational age at birth, pre-term deliveries (<37 weeks) and malformations were all comparable. In this cohort study and subsequent meta-analysis, no association was found between PGD conceived pregnancies and risks of adverse neonatal or obstetrical outcomes compared with ICSI pregnancies. Hence, blastomere biopsy for PGD does not seem to increase the risk for adverse perinatal outcome compared with ICSI pregnancies.

Outcome of induced deliveries in growth-restricted fetuses: second thoughts about the vaginal option.

OBJECTIVE: To assess the outcome of induced deliveries with IUGR. STUDY DESIGN: We reviewed the computerized files of parturients who underwent inducted labor because of IUGR (<5th percentile). Outcome assessment included mode of delivery, indication for CS, NICU admissions and 5 min Apgar score. We compared these parameters to a control group of women whose deliveries were induced for other indications. RESULTS: A total of 836 women with IUGR were included. Mean gestational age and birth weight were 38.2 weeks and 2,114 g, respectively. Overall, 43% of women delivered by non-elective C/S. The rate of non-elective CS for other indications was 12.3% (P < 0.0001) for all deliveries and 23.6% (P < 0.001) for induced deliveries. CS was performed due to non-reassuring FHR in 63% of IUGR fetuses, compared with 27% of all induced deliveries. There were 160 women with IUGR who preferred elective CS. Their newborns' NICU admission and 5 min Apgar score <7 rates were lower than those for induced deliveries (NICU 43.1 and 29.4%, P < 0.05, 5 min Apgar <7 5 and 1%, P < 0.05). CONCLUSION: Growth-restricted neonates born after labor induction had higher rates of low Apgar scores and NICU admissions compared to growth restricted neonates delivered by elective C/S. Inductions of labor for IUGR were associated with higher rates of non-elective C/S due to non-reassuring fetal heart rate compared with inductions performed for other indications.

Pilot study of prevalence of high-risk human papillomavirus genotypes in Israeli Jewish women referred for colposcopic examination.

The objective of the present study was to determine the prevalence of high-risk (HR) human papillomavirus (HPV) genotypes in a group of Israeli Jewish women referred for colposcopic examination. Scrape specimens were prospectively collected from 84 women referred for colposcopic examination. All the women underwent Papanicolaou (Pap) smears and colposcopies, and some also underwent cervical or loop electrosurgical excision procedure biopsy. HR HPV was detected in scrape specimens (Amplicor HPV test; Roche Molecular Systems), and the individual genotypes in these specimens were identified (HPV GenoArray test kit; Hybribio Ltd., Hong Kong). Forty-one (49%) specimens were positive by the Amplicor HPV test. Sixty-four samples (41 positive and 23 negative by the Amplicor HPV test) were also assayed by use of the HPV GenoArray kit. The overall level of agreement between the two assays was 93.8% (Cohen's kappa = 0.98). HR genotypes were found in 37/41 (90%) HPV-positive samples. The prevalences of the HR HPV genotypes in the 37 HPV-positive samples were 41% of patients for HPV type 16 (HPV-16), 22% for HPV-39, 19% for HPV-52, and 14% for HPV-18. Forty-one percent of these patients were infected with a single HR genotype, whereas 59% were infected with mixtures of HR genotypes. The presence of a relatively high percentage of HPV types 39 and 52 and the relatively high incidence of infections with mixtures of genotypes may be one of the reasons for the low rate of conversion from high-grade squamous intraepithelial lesions to invasive carcinoma in Israeli women. Larger and more comprehensive studies are warranted to investigate this issue in greater detail.

The clinical significance of postpartum transperineal ultrasound of the anal sphincter.

BACKGROUND AND OBJECTIVE: To evaluate the clinical significance of postpartum anal sphincter damage by transperineal ultrasonography (TPUS) performed on the day of delivery. METHODS: Continence questionnaires were handed out and TPUS was performed on 154 consecutive primiparous women 6-24h after vaginal delivery. At 2 and 6 months later, complaints and sphincteric sonographic appearance were reassessed. The puerperal women's clinical status and sonographic findings in the immediate and late postpartum period were evaluated. RESULTS: Thirty-five (23%) women complained of anal incontinence on the first postpartum day and anal sphincter damage was demonstrated by TPUS in 31 (89%) of them. Four women with anorectal complaints had an intact anal sphincter by TPUS. Follow-up questionnaires, 2 months later, revealed 30 symptomatic women: all of them had sonographically recognized tears on the initial TPUS and 27 of them had positive findings on the TPUS performed 2 months after birth. Six months after delivery, 27 women reported symptoms and all of them had sphincteric disruption evidenced on TPUS performed on the day of delivery. All the women with intact sphincter on the initial TPUS were asymptomatic 6 months later. CONCLUSION: TPUS findings on the day of delivery are related to long-term anorectal complaints, supporting a potential role for TPUS as a screening aid for anal sphincter tears.

Effects of ovarian endometrioma on embryo quality.

The proportions of good, fair, and poor embryos in 13 women with bilateral endometriomas were compared with those of 39 women without endometriomas and were found to be similar (47.2% vs. 41.1%, 28.3% vs. 32.8%, and 24.3% vs. 26.0%, respectively). Therefore, it appears that the presence of bilateral endometriomas during IVF treatment is not associated with reduced embryo quality.

Promoting implantation by local injury to the endometrium.

OBJECTIVE: To evaluate the association between endometrial injury, implantation and pregnancy rate. DESIGN: We performed a literature search using the keywords endometrial injury, local endometrial injury, endometrial biopsy, endometrial receptivity, implantation, in vitro fertilization, and implantation failure and conducted the search in Medline, EMBASE, and Cochrane Database of systematic reviews. SETTING: None. PATIENT(S): None. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): None. RESULT(S): Clinical and basic science data regarding the association between endometrial injury and improved implantation rate are limited. However, current evidence suggests that endometrial injury before IVF among women with previous repeated IVF failure is associated with increased rates of implantation, clinical pregnancy, and live birth. CONCLUSION(S): Endometrial injury may have a beneficial role in implantation and improve the pregnancy rate. However, there are still many unanswered question including patients selection, timing, technique and number of endometrial biopsies needed.

Accuracy of diagnosis of retained products of conception after dilation and evacuation.

OBJECTIVE: Uterine re-evacuation samples taken in cases of suspected residua after curettage are occasionally negative for gestational tissue. We aimed at evaluating the occurrence of such postcurettage re-evacuation-negative samples and at exploring factors that may influence their occurrence. METHODS: This was a cross-sectional comparative retrospective study of 69 consecutive women who underwent uterine re-evacuation for suspected postcurettage gestational remnants. Pathologic reports of samples drawn during re-evacuations were reviewed to determine whether the extracted tissue contained gestational tissue. The presence of factors that may influence the rate of a positive or negative sample (eg, sonographic findings, gestational age at initial procedure, and presenting symptom) was noted and compared between women with and without histologically verified remnants. RESULTS: Twenty-eight (41%) of the re-evacuation samples were histopathologically positive for gestational remnants. Residual tissue was more commonly found when the initial evacuation was performed at a more advanced gestational age (> 15 weeks). Women referred by emergency department attendants had significantly fewer positive samples. Normal expert sonographic examination practically excluded yielding samples. Conversely, no negative samples were preceded by sonographic reports mentioning residua. CONCLUSIONS: Most re-evacuation samples taken during a re-evacuation procedure for suspected residua are negative for gestational tissue. Parameters that are likely related to histologically confirmed gestational residual tissue are advanced gestational age at initial evacuation, level of the sonographer's skill, persistent bleeding as the presenting symptom, and a sonographic report specifically mentioning retained gestational tissue.