Pregnancy Test Results Research Articles

Might retrigger with human chorionic gonadotropin be a solution for empty follicle syndrome after gonadotropin releasing hormone agonist trigger?

This study aimed to determine whether the use of human chorionic gonadotropin (hCG) as a trigger could offer a potential solution for addressing empty follicle syndrome following the administration of a trigger for gonadotropin-releasing hormone agonist. A retrospective cohort analysis was conducted using data extracted from the hospital database pertaining to 415 patients who underwent in vitro fertilization (IVF) with an antagonist protocol triggered by a gonadotropin-releasing hormone (GnRH) agonist between December 2019 and January 2023 at the Acıbadem Maslak Hospital Assisted Reproductive Technologies Unit. All cases that failed to obtain oocytes and required rescue were analyzed. This study analyzed 415 women who underwent IVF using GnRH agonist-triggered antagonist protocols. Among them, 6 (1.4%) had empty folicle syndrome (EFS). Patients with EFS had lower luteinizing hormone levels and fewer oocytes, embryos, and blastocysts, resulting in lower oocyte utilization rate. However, pregnancy rates were similar, with no biochemical or ectopic pregnancies observed in the EFS group. Use of an hCG retrigger in hyperresponders with no oocytes after GnRHa trigger may prevent cycle cancelation. Although the rates of egg utilization may decrease, oocyte maturity remains comparable. Frozen embryo transfer following hCG retrigger administration yields similar positive pregnancy test results and live birth rates.

The effect of youth-friendly health services on risk of pregnancy among adolescent girls and young women in Lilongwe, Malawi: a secondary analysis of the girl power-Malawi study.

In sub-Saharan Africa, adolescent girls and young women aged 15-24 (AGYW) experience high risk of early and unintended pregnancy. We assessed the impact of youth-friendly health services (YFHS) on pregnancy risk among AGYW who participated in the Girl Power study. In 2016, Girl Power randomly assigned four government-run health centers in Lilongwe, Malawi, to provide a standard (n=1) or youth-friendly (n=3) model of service delivery. At six and 12 months, study participants (n=250 at each health center) self-reported their current pregnancy status and received a urine pregnancy test. Because of missing pregnancy test results, we used multiple imputation to correct for outcome misclassification in self-reported pregnancy status, and applied the parametric g-formula on the corrected data to estimate the effect of YFHS on the 12-month risk of pregnancy. After correcting for outcome misclassification, the risk of pregnancy under the scenario where all health centers offered YFHS was 15.8% compared to 23.2% under the scenario where all health centers offered standard of care (risk difference: -7.3%, 95% CI: -15.5%, 0.8%). Access to a model of YFHS that integrates provider training with youth-friendly clinic modifications and community outreach activities may decrease risk of pregnancy among AGYW relative to standard of care.

Evaluation of telemedicine medical abortion using a no-test protocol in the Eastern Europe and Central Asian region: Evidence from Ukraine, Uzbekistan, and Azerbaijan.

To evaluate safety, feasibility, and acceptability of a telemedicine medical abortion service without pre-treatment in-person tests in Ukraine, Uzbekistan, and Azerbaijan. We conducted an open-label, prospective, observational clinical study at five clinics in the three countries. Interested and eligible participants scheduled a telemedicine consultation with a study provider by phone or video. Medical abortion pills could be obtained by mail or courier or picked up at the study clinic or a pharmacy. Study providers contacted participants 1 week after mifepristone ingestion to assess abortion outcomes based on symptoms, and 3 weeks later to review the result of an at-home, high-sensitivity, urine pregnancy test. Participants were referred to in-person visit based on symptoms, urine pregnancy test results, or initiative by the participant. In all, 300 women participated in the study. Almost all participants received medical abortion medications the same day as their first contact with the study clinic, and the majority (n = 297, 99.0%) did not experience any problems receiving them. All except two women (0.67%) followed provider instructions on administration of medications. The majority of participants had a complete abortion without a procedure (Ukraine: n = 115, 95.8%; Uzbekistan: n = 127, 97.7%; Azerbaijan: n = 49, 98.0%), few had in-person visits (Ukraine: n = 30, 25.0%; Uzbekistan: n = 3, 2.3%; Azerbaijan: n = 4, 8.0%), and most were very satisfied or satisfied with the service (Ukraine: n = 116, 96%; Uzbekistan: n = 128, 98%; Azerbaijan: n = 45, 90%). No serious adverse events occurred. Telemedicine medical abortion using the no-test protocol is safe, feasible and acceptable for women in Ukraine, Uzbekistan, and Azerbaijan.

Predictors of Pregnancy Outcome for Libyan Infertile Women Underwent Intracytoplasmic Sperm Injection Cycle at Tripoli Infertility Center

Intracytoplasmic Sperm Injection (ICSI) is a crucial treatment approach in assisted reproduction technology (ART) for infertility clinics. However, low pregnancy rates in ICSI cycles are a problem. Despite its potential, ICSI can be expensive, time-consuming, and cause concerns about gametes and newborn health. The study aims to identify factors predicting pregnancy rates among infertile couples undergoing Intracytoplasmic Sperm Injection cycle at Tripoli Infertility Center in Libya. This retrospective study reviewed all infertile couples' medical files at the Infertility Tripoli Centre from January to December 2023. A structured case sheet was used to collect data on female patients' age, causes of infertility, duration of infertility, previous pregnancy, antral follicles count, endometrial thickness, number of embryos transferred, and pregnancy outcomes. The study was divided into two groups based on pregnancy test results. Statistical analysis involved simple descriptive statistics, Chi square, and independent sample t-test. This study involved 90 women, with 35.6% having a positive pregnancy test. The pregnancy rate was 59.4% in women under 35, and decreased to 9.4% in those 40 or older. No significant differences were found in infertility duration or previous pregnancy (all P > 0.05). Partner analysis revealed that 64.2% had asthenospermia, while endocrinopathies were reported by 41.8% of women. No significant differences were found in antral follicle count, endometrial thickness, oocyte number, or quality between pregnant and non-pregnant women (all P > 0.05). Our findings suggest that Maternal age has a significant impact on the success of ICSI, with advanced age in women negatively affecting ICSI outcomes.

Performance of an Electronic Medical Record-Based "Syphilis Flag" in Identifying At-Risk Patients in an Emergency Department.

The United States has seen a > 40% increase in syphilis cases since 2017. Early disease identification and treatment are crucial. This review sought to identify emergency department (ED) patients at risk for syphilis. A 30-day retrospective review was conducted of visits to a single ED. Patient visits were assessed for predetermined syphilis "flags" to include a history of sexually transmitted infection (STI), current chief complaint or reason for visit (RFV) keyword(s) suggestive of potential STI or a positive pregnancy test result. Flagged charts were assessed for STI testing results within 6 months of ED visit. Data were analyzed using χ2 . There were 5537 total patient encounters, resulting in 455 flagged visits from 408 (8.4%) unique individuals, majority of whom were female (282, 69.1%; P < 0.001), Black (251, 61.5%; P < 0.001), aged 15 to 44 years (308, 75.5%; P < 0.001). Chief complaint was the most frequent flag (65.3%), followed by RFV (37.4%), prior STI (31.0%), and pregnancy (12.3%). Syphilis testing data were available for 120 flagged patients; 29 (24.2%) screened positive, including 11 (2.7% of total flagged cohort) with evidence for active infection. Among those, most were Black (90.9%), male (72.7%), aged 25 to 34 years (63.6%), and 9 (81.8%) had concomitant HIV. In active infection, prior STI flag was most common (72.7%), followed by chief complaint (54.5%) and RFV (45.5%). This review demonstrates the performance of an electronic medical record-based "syphilis risk flag" screener applied to ED patients. Sex- and race-based discrepancies exist in flag rates, which may be reflective of sex- and race-based epidemiologic discrepancies in STI incidence.

113 Investigation of differences in pregnancy associated glycoproteins due to different fetal parameters (sex and number) using commercial tests in multiparous ewes

Abstract Pregnancy detection is an extremely valuable practice in animal production systems as it allows for identification of pregnant or nonpregnant females and thus contributes to informed management decisions. Unfortunately, blood pregnancy tests simply provide a yes or no answer to pregnancy status. Multiparous ewes (n = 20) at the Arkansas State University Teaching and Research Center were enrolled in a study to evaluate whether lamb number or sex would impact commercial blood pregnancy test results. Weekly blood samples were collected, for a total of 5 blood samples during the breeding season (11/14/22, 11/21/22, 11/28/22, 12/5/22, and 12/12/22) ewes were followed through lambing to determine lamb number and sex. Whole blood samples were centrifuged at 2,000 x g and plasma harvested and stored at -20 C until analysis for pregnancy associated glycoproteins was completed. Plasma samples were analyzed using two commercially available blood pregnancy tests, Rapid Visual Pregnancy Test (RV plate) and OnFarm Pregnancy Test (SNAP). The RV Plate is a 96-well ELISA test that is designed to be interpreted visually by comparison with the positive (PC) and negative (NC) control wells. The RV Plate and SNAP tests were completed, and results interpreted by two technicians blind to pregnancy status using a scoring system (0 = same or less color than NC; 1 = slightly more color than NC; 2 = slightly less color than PC; 3 = same or more color than PC; 0 and 1 = not pregnant, 2 and 3 = pregnant) or by manufacturer’s instructions (SNAP). Lambing revealed a total of 18 female lambs and 13 male lambs born to the 20 ewes, furthermore, there were 6 singleton, 11 twins, and 1 set of triplets. Total score count results from the RV Plate indicate that as gestational age increased the number of 3 scores increased (11/14/22 = zero scores of ‘3’; 12/12/22 = 55 scores of ‘3’), however, overall, there were no statistical differences in pregnancy status across ewes (P = 0.78). All SNAP test results were immediate and positive for pregnancy for all collections apart from one ewe, 9113, with a conception date of 10/19/22. Ewe 9113 SNAP test result for the first collection was “not pregnant”, and for the second collection date, a positive result did not appear until 5 min and 43 sec. Lambing revealed that 9113 had a singleton female lamb. Based on the present study, sex and number of lamb offspring could not be determined by commercial blood pregnancy tests. In the present study, the earliest confirmed pregnancy determined retrospectively by subtracting average ewe gestation length (152 d) from the lambing date was determined to be September 28th but blood sampling and testing for PAGs did not begin until November 14th, therefore, further studies are needed that initiate blood sampling sooner.

Initial β-hCG levels and 2-day-later increase rates effectively predict pregnancy outcomes in single blastocyst transfer in frozen-thawed or fresh cycles: A retrospective cohort study.

To investigate whether the initial beta-human chorionic gonadotropin (β-hCG) levels and their rate of increase differ after single fresh and frozen blastocyst transfers, and whether these values effectively predict pregnancy outcomes. This retrospective cohort study was conducted at the Sisli Memorial Hospital, assisted reproductive technology, and Reproductive Genetics Center in Istanbul, Turkey, between January 2016 and January 2022. Three thousand two hundred thirty-eight single blastocyst transfers with positive pregnancy test results were evaluated. Of these, 738 were fresh transfer cycles and 2500 were frozen-thawed embryo transfer (FET) cycles. β-hCG test results from 9 days after fresh and FET cycles were compared between the groups with biochemical pregnancy, early pregnancy loss, and live birth outcomes. The threshold values were determined for each pregnancy outcome. The rate of increase between the first and second β-hCG tests performed 2 days apart was determined for each pregnancy outcome. Finally, the listed values were compared between the FET and fresh cycle. Mean baseline β-hCG levels were significantly higher in FET cycles than in fresh cycles, regardless of pregnancy outcomes (P < .005). Baseline β-hCG levels were higher in fresh cycles with live births (171.76 ± 109.64 IU/L) compared to biochemical and clinical pregnancy losses (50.37 ± 24.31 and 114.86 ± 72.42, respectively) (P < .001). Live births in FET cycles resulted in higher baseline β-hCG levels (193.57 ± 100.38 IU/L) compared to biochemical and clinical pregnancy loss groups (68.41 ± 51.85 and 149.29 ± 96.99 IU/L, respectively) (P < .001). The β-hCG threshold for live birth for fresh cycles was 116.5 IU/L (sensitivity 80%, specificity 70%, positive predictive value 90%, negative predictive value 54%) and 131.5 IU/L for FET cycles (sensitivity 71%, specificity 68%, positive predictive value 87%, negative predictive value 50%). The percentage of the area under the curve for single fresh blastocyst transfers was 0.81 and 0.76 for frozen transfers. The rate of increase in β-hCG was similar in fresh and FET cycles. Initial β-hCG levels and 2-day increases are effective parameters for diagnosing pregnancy in fresh and FET cycles. The initial β-hCG level was significantly higher in the FET cycles than in the fresh cycles. Predicting outcomes earlier helps clinicians to manage and follow high-risk pregnancies.

Improving Surgical Delays Related to Pediatric Preoperative Pregnancy Testing

Abstract Introduction Preoperative pregnancy status is a vital measure necessary for patient safety. At our institution, missing or delayed pregnancy test results, measured by human chorionic gonadotropin (HCG) levels, were identified as a contributing factor to surgical delays. Methods A quality improvement project was initiated in 2020 at a free-standing children’s hospital after missing or delayed HCG results were identified as a cause of surgical delays. A team was created to specifically evaluate this problem and devise an intervention. As a result, an automatically generated HCG test order was established to address surgical delays associated with missing or delayed HCG test results. The automatic order is triggered when the patient’s initial admission order is activated. For female patients 9 through 11 years of age, an order is automatically generated only if the admitting physician answers “No” to the question “Is the patient premenses?” when prompted. The system automatically generates an order for all female patients greater than 12 years of age regardless of menstruation. Results Pre-intervention data revealed approximately 6% of surgical cases were delayed because of pregnancy test results; post-intervention data revealed approximately 2.6% of surgical cases were delayed because of pregnancy test results. Conclusion Initiation of an automatically generated HCG test order helped achieve the overall goal of reducing surgical delays linked to missing or delayed HCG results. Continued education and collective efforts are underway to help ensure the automatic order’s continued success.

Changes in Vaginal Bacteria and Inflammatory Mediators From Periconception Through the Early Postpartum Period in a Cohort of Kenyan Women Without HIV.

Women's increased risk of HIV acquisition during pregnancy and postpartum may be mediated by changes in vaginal microbiota and/or cytokines. A cohort of 80 Kenyan women who were HIV-1 seronegative contributed 409 vaginal samples at 6 pregnancy time points: periconception, positive pregnancy test result, first trimester, second trimester, third trimester, and postpartum. Concentrations of vaginal bacteria linked with HIV risk and Lactobacillus spp were measured using quantitative polymerase chain reaction. Cytokines were measured by immunoassay. Based on Tobit regression, later pregnancy time points were associated with lower concentrations of Sneathia spp (P = .01), Eggerthella sp type 1 (P = .002), and Parvimonas sp type 2 (P = .02) and higher concentrations of Lactobacillus iners (P < .001), Lactobacillus crispatus (P < .001), Lactobacillus vaginalis (P < .001), interleukin 6 (P < .001), TNF (P = .004), C-X-C motif chemokine ligand 10 (CXCL10; P < .001), C-C motif ligand 3 (P = .009), C-C motif ligand 4 (P < .001), C-C motif ligand 5 (P = .002), interleukin 1β (P = .02), and interleukin 8 (P = .002). Most cervicovaginal cytokines and vaginal bacteria clustered separately in principal component analysis, except for CXCL10, which did not group with either cytokines or bacteria. The shift toward a Lactobacillus-dominated microbiota during pregnancy mediated the relationship between pregnancy time point and CXCL10. Increases in proinflammatory cytokines, but not vaginal bacterial taxa linked with higher HIV risk, could provide an explanation for increased HIV susceptibility during pregnancy and postpartum.

Validating the female fertility estimated breeding value in Australian commercial dairy herds

We conducted a retrospective cohort study to validate the efficacy of the Australian multitrait fertility estimated breeding value (EBV). We did this by determining its associations with phenotypic measures of reproductive performance (i.e., submission rate, first service conception rate, and early calving). Our secondary aim was to report the associations between these reproductive outcomes and management and climate-related factors hypothesized to affect fertility. Our study population included 38 pasture-based dairy herds from the northern Victorian irrigation region in Australia. We collected records for 86,974 cows with 219,156 lactations and 438,578 mating events from the date on which managers started herd recording until December 2016, comprising both fertility-related data such as insemination records, calving dates, and pregnancy test results, and systems-related data such as production, herd size, and calving pattern. We also collected hourly data from 2004 to 2017 from the closest available weather station to account for climate-related factors (i.e., temperature humidity index; THI). Multilevel Cox proportional hazard models were used to analyze time-to-event outcomes (days to first service, days to cow calving following the planned herd calving start date), and multilevel logistic regression models for binomial outcomes (conception to first service) in the Holstein-Friesian and Jersey breeds. A 1-unit increase in daughter fertility EBV was associated with a 5.4 and 8.2% increase in the daily hazard of calving in the Holstein-Friesian and Jersey breeds respectively. These are relative increases (i.e., a Holstein-Friesian herd with a 60% 6-wk in-calf rate would see an improvement to 63.2% with a 1-unit increase in herd fertility EBV). Similar results were obtained for submission and conception rate. Associations between 120-d milk yield and reproductive outcome were complicated by interactions with 120-d protein percentage and calving age, depending on the breed and outcome. In general, we found that the reproductive performance of high milk-yielding animals deteriorated faster with age than low milk-yielding animals, and high protein percentage exacerbated the differences between low and high milk-yielding animals. Climate-related factors were also associated with fertility, with a 1-unit increase in maximum THI decreasing first service conception rate by 1.2% for Holstein-Friesians but having no statistically significant association in the Jersey breed. However, THI had a negative association in both breeds on the daily hazard of calving. Our study validates the efficacy of the daughter fertility EBV for improving herd reproductive performance and identifies significant associations between 120-d milk and protein yields and THI on the fertility of Australian dairy cows.

A One-Year Epidemiological Perspective of Molar Pregnancies at Orotta Maternity Referral Hospital: Asmara, Eritrea

Gestational trophoblastic diseases (GTD) are a group of diseases originating from the placenta, with significant morbidity and mortality, especially in developing countries. A one-year prospective study on GTD was done to determine the incidence of GTD identify the risk factors; explain the clinical presentation; describe the management; and record the outcomes at Orotta Maternity Referral Hospital (OMRH) Asmara, Eritrea; A protocol for the prospective study of GTD was prepared with involvement of colleagues. All collected data was reviewed and finalized by the author. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS). During the study period a total of 6845 deliveries and 45 cases of GTD were recorded at OMRH. This gives an incidence of 6.6 per 1000 deliveries. Primgravid mothers were more affected. The majority of cases were complete molar pregnancy (87%) and vaginal bleeding was the main presentation. Pregnancy test result was read as negative in 7% of cases. Of the cases followed, 77.7% recovered while 11.1% required chemotherapy because of persistent disease and 8.9% were lost to follow up. The study confirms higher incidence, of GTD in Eritrea as compared to results of some African countries. The need to strengthen histological services and quantitative serum tests were identified as crucial in the effective management of GTD at OMRH. A standard and systematic approach of diagnosis, treatment and strict fellow-up of cases is required for better outcome.

Selectively targeted blastocyst embryo transfer: optimizing ivf pregnancy results while minimizing risks and side effects

Research Question: Is single embryo transfer a reasonable option. Design: Material and methods: This is a retrospective cohort study conducted in a single IVF center. These patients consisted of 96 patients using egg donors and 92 patients using their own eggs for a total of 188 patients undergoing IVF-ICSI. Results: Among 96 patients who received donor eggs, 59 women (61%) were positive for pregnancy tests, resulting in 40 live births (68% per Pregnancy). On the other hand, of 92 patients who received their own egg, 34 patients (37%) were positive in terms of pregnancy tests, resulting in 15 live births (44% per pregnancy). Overall, of all 55 live births, 24 were multiple pregnancies. Interestingly, all multiple pregnancies occured in patients &lt;35 years of age. All of these multiples resulted from the transfer of two blastocysts of grade A. Conclusion: These results corroborate and enhance the various reproductive society recommendations that a selective single embryo transfer at the blastocyst stage and above would be a feasible option in patients less than 38 years of age, especially in patients using egg donors younger than 33 years of age, while resulting in a reasonably high successful singleton live birth rate. This is based on the predicted calculation of a 42.5% singleton live birth per egg donor pregnancy, and a 28% singleton live birth per pregnancy for patients using their own eggs. Summary: Patients who had Blastocyst or above grade A had a 63.7% biochemical or clinical positive pregnancy test result and a 40.7% Live birth. Whilst, patients with blastocysts of other grades or lower stages of development, resulted in 30.7% positive biochemical or clinical pregnancy with 10.7% live birth.

False positive pregnancy tests in pediatric patients with augmentation enterocystoplasty

Our primary aim was to determine the prevalence of positive over-the-counter (OTC) pregnancy tests among pediatric female and male patients who had undergone augmentation enterocystoplasty. A secondary aim was to determine whether patient factors or urinalysis (UA) results were associated with false positive OTC pregnancy test results in patients with a history of augmentation enterocystoplasty. Patients at a tertiary pediatric hospital who had previously undergone augmentation enterocystoplasty, Mitrofanoff appendicovesicostomy only, and age- and sex-matched controls were prospectively recruited. Urine samples were obtained, and two OTC pregnancy tests were conducted - OTC Test A reported the ability to detect pregnancy at hCG levels as low as 9.6 mIU/mL, while OTC Test B reported positive pregnancy test results at hCG levels ≥25 mIU/mL. A point of care (POC) pregnancy test and UA were also completed. Mann-Whitney U tests and Fisher's exact tests were used to assess whether patient factors or UA results were associated with false positive pregnancy test results. Fifty pediatric patients were enrolled, including 20 with augmentation enterocystoplasty, 20 age- and sex-matched controls, and 10 with Mitrofanoff appendicovesicostomy only. Among the 20 patients who had undergone augmentation cystoplasty, 15 (75.0%) had positive pregnancy test results on OTC Test A, including 11/13 (84.6%) females and 4/7 (57.1%) males. No control patients or patients with Mitrofanoff appendicovesicostomy only had a positive test. No patients had positive pregnancy test results on OTC Test B or the POC test. While patients with augmentation enterocystoplasty were significantly more likely to test positive for blood (p=0.01), nitrate (p=0.03), and leukocytes (p<0.0001), these factors were not significantly associated with false positive pregnancy results. No patient factors or UA results were associated with increased likelihood of false positive OTC pregnancy test results. These findings indicate that sensitive OTC pregnancy tests that detect low quantities of hCG in urine may result in false positive results among patients who have undergone augmentation enterocystoplasty. Female patients of reproductive age with bladder augmentations should be counseled regarding appropriate pregnancy testing options. Additional research is needed to determine the mechanism responsible for false positive pregnancy tests in this patient population.

Serum Chemokines and Quality of Life among Patients with Endometriomas and Teratomas

Background: Endometriosis is a chronic inflammatory condition characterized by the presence of endometrial tissue outside the uterus, which can cause pelvic pain, infertility, and other symptoms. The disease may manifest as superficial peritoneal or deep-infiltrating endometriosis or as ovarian endometriomas. Although the mechanisms associated with the regulation and production of inflammatory mediators in endometriosis have been widely investigated, the precise mechanism responsible for inflammation-induced pain remains unclear, and the findings related to the cytokine expression profile and the location of cytokines in cells are contradictory. The intensity of pain experienced by endometriosis patients is not proportional to the degree and severity of their disease. Pain has a significant impact on women suffering from endometriosis. Methods: The following inclusion criteria to the study were: presence of endometriomas vs teratomas, negative pregnancy test result, no prior obstetric and infertility treatment, and good health condition with no diseases or coagulation disorders. Blood samples were collected from all patients. The serum levels of chemokines were determined by ELISA. The Nottingham Health Profile (NHP) questionnaire was made. Results: The median serum levels of chemokines: Monocyte Chemoattractant Protein 1 (MCP-1) and Monocyte Chemoattractant Protein 3 (MCP-3) were statistically higher in the endometriomas group compared to the other two groups. In the NHP questionnaire the comparison of the subjective health dimensions in individual groups showed that the patients in the endometriomas group experienced a significantly higher intensity of “PAIN” compared to other groups. Correlation analysis between NHP dimensions and serum chemokine levels: spearman’s rank correlation analysis indicated a statistically significant relationship between the “VITAL ENERGY” dimension and the level of MCP-2 (r = –0.295; p = 0.022), MCP-3 (r = 0.254; p = 0.050), and RANTES (r = –0.353; p = 0.006); between the “EMOTIONS” dimension and the level of MCP-3 (r = 0.262; p = 0.043); and between the “INCONVENIENCE IN DAILY LIFE” dimension and the level of Eotaxin-1 (r = –0.283; p = 0.028) and CCL13 (r = –0.287; p = 0.026). Conclusions: The chemokines serum levels (i.e., MCP-1 and MCP-3) and intensity of “PAIN” were statistically higher in the endometriomas compared to the teratomas group of women. Therefore, understanding their role in endometriosis-related pain could help in the development of novel, multidisciplinary treatments.

Adolescent Female with Lower Abdominal Pain and Rebound Tenderness

A healthy 16-year-old girl presented with a 2-day history of nontraumatic abdominal pain but no fever, vomiting, or diarrhea. Her blood pressure was 109/70 mm Hg, and her pulse rate was 125 beats/min. She had severe tenderness and rebound in the left lower quadrant. Her hemoglobin level was 10.4 g/dL, and her pregnancy test result was negative. The emergency physician performed bedside ultrasound (Figure), and the patient underwent emergency laparotomy.

MP11-03 FALSE POSITIVE PREGNANCY TESTS AMONG PEDIATRIC PATIENTS WITH AUGMENTATION ENTEROCYSTOPLASTIES

You have accessJournal of UrologyCME1 May 2022MP11-03 FALSE POSITIVE PREGNANCY TESTS AMONG PEDIATRIC PATIENTS WITH AUGMENTATION ENTEROCYSTOPLASTIES Zoë Baker, Arthi Hannallah, Hannah Dillon, Yuding Wang, and Evalynn Vasquez Zoë BakerZoë Baker More articles by this author , Arthi HannallahArthi Hannallah More articles by this author , Hannah DillonHannah Dillon More articles by this author , Yuding WangYuding Wang More articles by this author , and Evalynn VasquezEvalynn Vasquez More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002533.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A high number of false positive pregnancy test results have been self-reported among patients with augmentation enterocystoplasties using over-the-counter (OTC) urine pregnancy tests. We sought to determine the accuracy of OTC pregnancy tests among pediatric patients who had previously undergone augmentation enterocystoplasties. METHODS: Patients at a tertiary care pediatric hospital who had previously undergone augmentation enterocystoplasties or Mitrofanoff appendicovesicostomies only were prospectively recruited. Urine samples were obtained and two OTC pregnancy tests, one point of care testing (POCT) urine pregnancy test, and urinalysis (UA) were completed. All pregnancy tests qualitatively assessed human chorionic gonadotropin (hCG). OTC Test A was a sandwich immunoassay employing monoclonal anti-β-hCG, goat anti-rabbit, anti-α-hCG, and rabbit Immunoglobulin G (IgG) antibodies and using chromatography to separate bound and free colored label. OTC Test B was a lateral flow immunoassay dipstick containing mouse monoclonal anti-β-hCG antibody colloidal gold conjugate pre-dried on a pad, mouse monocolonal anti-α-hCG antibodies, and goat anti-mouse IgG. The POCT test employed mouse monoclonal anti-hCG antibodies and goat polyclonal anti-hCG antibodies. RESULTS: Among 14 pediatric patients who had undergone augmentation cystoplasty, 12 (85.7%) had positive pregnancy test results on OTC Test A, including all 9 females and 60% of males (n = 3/5; Table 1). No patients had positive pregnancy test results on OTC Test B or the POCT pregnancy test (Table 1). No false positive OTC pregnancy test results occurred among 4 patients with Mitrofanoff appendicovesicostomies only. Among patients with enterocystoplasties, UA results indicated that the majority had at least trace levels of protein, blood, and leukocytes, most tested positive for nitrite, and mean urine pH was 6.7 (±0.5; Table 1). CONCLUSIONS: Preliminary findings indicate that certain OTC pregnancy tests qualitatively assessing hCG in urine may be inaccurate among patients who have previously undergone augmentation enterocystoplasties. Female patients of reproductive age should be counseled regarding appropriate pregnancy testing options to avoid unplanned pregnancy scares or concerns about ectopic pregnancies. Source of Funding: The Long Road Foundation © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e157 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zoë Baker More articles by this author Arthi Hannallah More articles by this author Hannah Dillon More articles by this author Yuding Wang More articles by this author Evalynn Vasquez More articles by this author Expand All Advertisement PDF DownloadLoading ...

Pregnancy rate in intrauterine insemination, is uterine biophysical profile of predictive value? A prospective study.

This study aimed at evaluating the value of uterine biophysical profile (UBP) scoring to predict the pregnancy rate after IUI. This prospective study was carried out on 85 women who were referred to our tertiary teaching center with infertility of male factor or unknown etiology infertility in 2018. To measure the uterine biophysical criteria, transvaginal ultrasonography (TVS) was performed on the day of beta-human chorionic gonadotropin (B-hCG) injection, and the results were evaluated based on positive B-hCG. 85 patients were included with a mean age of 30years; of those 12 (14.1%) were able to conceive. UBP (p = 0.151) and it's parameters (including endometrial thickness, number of endometrial layers, myometrial echogenicity, uterine artery pulsatility index, myometrial blood flow internal to arcuate vessels, endometrial blood flow in the third zone of endometrium, myometrial contraction frequency, and ovarian follicle (OF) size [p = 0.05, 0.89, 0.59, 0.79, 1, 1, 0.59, and 0.77, respectively]) were not significantly associated with pregnancy rate. 91.7% of the cases with positive pregnancy test results, had a UBP score of > 13; however, UBP score was not meaningfully associated with IUI treatment success rate (p = 0.15). UBP scoring system seems to need more data for external validation, or it might require modifications before implementation, as it may cause false reassurance.

The impact of declining dairy fertility on calving patterns and farm systems: A case study from northern Victoria, Australia

CONTEXTFertility is crucial for pasture-based seasonal calving dairy herds, where cows are expected to calve in a single cohort at a time when peak milk production coincides with maximum pasture availability. However, dairy fertility has declined globally, and many Australian herds now use a split calving system, where non-pregnant cows are given additional opportunities to conceive by having two mating periods per year. Other factors prompting a move to split calving may include financial incentives for producing out-of-season milk, increasing levels of concentrate feeding, and pressure due to extreme seasonal conditions – all of which are particularly apparent in the northern Victorian irrigation region. OBJECTIVEThe aim of our study was to describe the fertility and herd characteristics of the study population and to examine changes in reproductive performance and calving systems that have occurred over the same period. METHODSOur study population included 38 herds from the northern Victorian irrigation region in Australia. We collected individual cow records from each herd from the date on which they started herd recording (with a median start year of 2000 for mating event data) up until December 2016, comprising both fertility-related data such as insemination records, calving dates, and pregnancy test results, and systems-related data such as production, herd size and calving pattern. RESULTS AND CONCLUSIONSFrom a relatively small number of herds, we were able to obtain a dataset comprising 438,578 mating and pregnancy test records for 86,974 cows. From 2003 to 2016, 6-week in-calf rate and first service conception rate declined in the study population for both Holstein-Friesians and Jerseys, while 3-week submission rate remained unchanged. At the same time, the proportion of split calving herds in our cohort markedly increased, with a significant expansion in herd size compared to their seasonal counterparts. The proportion of first parity heifers in herds also increased, which may be a function of increasing herd size, or involuntary culling due to poor fertility. SIGNIFICANCESplit calving represents a significant system change for herd managers, with concomitant effects on labour management, input costs, and the lifestyle they experience. However, if this change has been implemented due to poor fertility without considering whether the increased income outweighs increased input costs, then a suboptimal decision may have been made. Finally, high quality data remains underutilised on individual farms, with significant benefits to the Australian dairy industry if we can overcome the numerous challenges to access it.

Factors affecting success in intrauterine insemination cycles; 2-year single center experience

Abstract&#x0D; Objective: The aim of this study is to evaluate the success rates of intrauterine insemination cycles due to ovulation induction with clomiphene citrate and gonadotropins, and to identify factors associated with successful outcomes in women with unexplained infertility and ovulatory dysfunction.&#x0D; Material and Methods: Between June 2017 and October 2019, 223 intrauterine insemination cycle records were scanned retrospectively in 152 infertile couples diagnosed with ovulatory dysfunction or unexplained infertility. &#x0D; Result: A total of 33 positive pregnancy test results were obtained, which had shown a pregnancy success rate of 14.8%. Pregnancy success rate in Gonadotropin IUI (Intrauterine Insemination) cycles was found as 16.6% and pregnancy success rate in CC (Clomiphene Citrate) IUI cycles was found as 9.3%. While it has been detected that smoking has had a negative effect on IUI success rate for the infertile population with ovulatory dysfunction and unexplained infertility (p=0.012); factors such as female age, BMI (Body mass index), infertility span, basal FSH (Follicle Stimulating Hormone), basal LH (Luteinizing Hormone), basal estradiol levels and trigger-day endometrial thickness were found to have no correlation with IUI success rate at all.

#36: A Review of Maternal and Neonatal Characteristics and Outcomes in Pregnant Women with Serious Infectious Complications from Injection Drug Use

Abstract Background Pregnant people who inject drugs (PWID) and their infants are unique populations that have emerged from the opioid epidemic. Numerous studies have evaluated vertical transmission of HIV, HCV, sequelae of neonatal abstinence syndrome, and maternal and fetal mortality in these mother-infant dyads; however there still remains a large knowledge gap regarding how serious infections in pregnant PWID affect more proximal outcomes such as fetal and maternal distress leading to preterm delivery, risk of neonatal sepsis, need for invasive diagnostic procedures to rule-out neonatal sepsis such as lumbar puncture, neonatal intensive care unit (NICU) admission, and potential consequences of prolonged intrauterine antibiotic exposure. Methods We identified pregnant PWID ≥18 years old with serious infectious complications (defined as (sepsis, endocarditis, osteomyelitis, epidural abscesses, septic arthritis/bursitis, thrombophlebitis, and skin and soft tissue infections requiring IV antibiotics) admitted between 2017–2018 to the University of Kentucky Medical Center and their neonates treated at Kentucky Children’s Hospital. Patients were identified using positive urine or serum pregnancy test results, IVDU-associated ICD9/10 codes, infectious disease, neonatology, and obstetrics notes. Results 261 women with infectious complications from IVDU were identified, 25 were pregnant and 16 dyads were able to be matched with identification of 14 viable neonates born at the University of Kentucky. Mean maternal age was 31 years and median 30 years. Mean gestational age (GA) at time of admission was 25 weeks with median 29 weeks. Sepsis was the most common complication reported 18 (72%) followed by endocarditis 11 (44%). Staphylococcus aureus was the most isolated organism (16) 64% with 12 (48%) of isolates identified as MRSA and MSSA comprising 4 (16%). 96% were screened for HCV, with 72% HCV antibody positive and 32% with detectable viral load. There was 1 reported maternal death, 1 spontaneous abortion and 2 intrauterine fetal demises (IUFD) in the 3rd trimester and no neonatal deaths. Average GA at time of delivery was 33 weeks with median 36 weeks. 6 (42%) were routine deliveries with 3 (22%) deliveries for emergent maternal indications and 5 emergent deliveries for fetal indications (36%). 12 neonates (86%) required NICU admission with average length of stay 17 days and median 10 days. 10 (71%) underwent limited sepsis screen with 9 (64%) receiving at least 48 hours of antibiotics and 3 (22%) receiving an extended course. However none of the blood cultures yielded any organisms. All passed their hearing screening and had no evidence of renal dysfunction or cytopenias. Conclusions Pregnant PWID dyads may be at increased risk for morbidity and mortality secondary to infectious complications of IVDU. The majority of neonates were delivered early for either fetal distress or maternal distress. 2 mothers suffered IUFD in the 3rd trimester and the majority of the neonates required NICU admission (86%) due to prematurity-related factors, concern for neonatal abstinence syndrome or concern for infectious complications. Over half received 48+ hours of antibiotics in the NICU however none of the neonatal blood cultures yielded an organism. Larger cohort studies are needed to better ascertain risk in these expanding populations.