Uterine Pregnancy Research Articles

The application of chain management in preoperative health education for pregnant women with second scar uterus incision pregnancy

Objective To explore the application effect of chain management on preoperative health education for pregnant women with second scar uterus incision. Methods A total of 120 patients with scarred uterus incision pregnancy of surgerily treatment admitted to the department of obstetrics of this hospital and were selected as the research objects and were divided into the observation group and the control group according to the random number table method, 60 cases of each group.The patients of the control group received routine preoperative health education, the patients of the observation group received the chain management mode preoperative health education.The disease knowledge, anxiety, depression and preoperative sleep quality of the two groups were measured and compared. Results The awareness rate of disease in the observation group was significantly higher than that of the control group, and the difference was statistically significant(P<0.05). The rate of awareness of patients in the observation group was significantly higher than that of the control group.The difference was statistically significant(P<0.01). The scores of anxiety and depression of the observation group were significantly lower than those of the control group, and the differences were statistically significant(P<0.05). The total score of PSQL in the observation group was significantly higher than that of the control group, and the difference was statistically siginificant(P<0.05). Conclusions The health education in the chain management model can make the health education more systematic, continuous and flexible.It can effectively relieve preoperative anxiety and improve sleep quality of pregnant patients with second pregnancy scar uterine incision. Key words: Chain management; Second scar uterine incision pregnancy patients; Preoperative health education

EVALUATION OF RESULTS OF SIMULTANEOUS MYOMECTOMY AND CESAREAN SECTION

Introduction. Myoma of the uterus is the most common neoplasm of the female reproductive system. The frequency of combination of uterine fibroids and pregnancy varies from 1.6% to 10.7%, often fibroids occur in pregnant women of late reproductive age. Traditionally, myomectomy during caesarean section was not recommended because of the risk of bleeding and postoperative complications. To assess the safety and feasibility of a one-stage myomectomy in a caesarean section, this study was conducted.Materials and methods. From 2010 to 2015, we examined 260 pregnant women with uterine myoma, who had a cesarean section with a single-stage myomectomy. The data obtained during the survey were compared with the data of 96 women from the control group. We study assessment of intraoperative blood loss, pre- and postoperative hemoglobin levels, duration of hospitalization.Results. Statistically significant differences in intraoperative blood loss, changes in hemoglobin levels and in the duration of hospitalization between the examined groups of women were not revealed. A prognostic model has been developed to assess risk factors for intraoperative blood loss of more than 1000 ml.Conclusion. The size, localization of myomatous nodes are not risk factors for high blood loss in abdominal delivery with a one-stage myomectomy. The factor of risk of hemorrhage is multiple uterine fibroids, whereas the size of myomatous nodes less than 5 cm can be regarded as a protective factor for blood loss. The study showed that a one-stage myomectomy with a caesarean section is safe and can be performed with the surgeon’s experience.

Factors associated with increased odds of cesarean delivery in ART pregnancies

To quantify the effect of medical and obstetrical factors on the odds of cesarean delivery, comparing assisted reproductive technology (ART)-treated women and women with subfertility not treated with ART versus fertile women. Retrospective cohort. Not applicable. Singleton deliveries to primiparous women; with the source of this data being the Massachusetts vital and hospital records linked to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System data (2004-2010). None. Mode of delivery. The 173,130 deliveries included 5,768 ART-treated, 2,657 subfertile (1,627 non-ART medically assisted reproduction [MAR] and 1,030 unassisted infertile), and 164,705 fertile pregnancies and 117,743 vaginal and 55,387 cesarean deliveries. ART-treated women were older, more often white and non-Hispanic, and with more private insurance, previous uterine surgery, gestational diabetes, pregnancy hypertension, bleeding, and placental complications than fertile women. Overall rates of cesarean delivery were 45.7%, 43.3%, and 31.1% for ART-treated, subfertile, and fertile women and 41.7% and 45.9% for MAR and unassisted infertile deliveries. When adjusted for demographics, underlying medical factors, previous uterine surgery, and placental and delivery complications, adjusted odds ratios (ORs) compared with fertile women were 1.27 for ART-treated and 1.15 for subfertile women, with greater odds among unassisted infertile (OR 1.26) but not MAR (OR 1.09) women. The strongest confounders of odds of cesarean delivery were age and previous uterine surgery. ART and unassisted infertility were associated with greater odds of cesarean compared with fertile women. Underlying medical and obstetrical risks had strong confounding effects strongly attenuating the odds for cesarean delivery.

The Use of Endoscopic Biopsy to Compare Histological Finds of Stallions With and Without Seminal Vesiculitis

This study compared hormone treatments given to mares during anestrus, spring transition, and different stages of the estrous cycle, by assessing uterine features and pregnancy rates after embryo transfer (ET). Embryo recipient mares (n = 160) were equally arranged as follows: G1-spontaneous ovulation (control), G2-anestrus, G3-spring transition, G4-early estrus, G5-estrus, G6-diestrus, G7-early diestrus treated with a dose of dinoprost, and G8-early diestrus treated with two doses of dinoprost. At treatment initiation (Day-4), G2-7 were given dinoprost and estradiol-17β, thereafter, estradiol-17β was repeated on Days-3,-2, and -1. On Day0, mares received long-acting altrenogest. Then, each mare had one ET performed from Day + 3 to Day + 8 after altrenogest. Immediately before the ET, mares received a boost of altrenogest and had uterine features assessed. Pregnant mares on each of the checks (by 7, 30, 60, and 120d after ET) were maintained on weekly injections of LA-P4 until 120d. G8 received similar management, but dinoprost was repeated on Day-3. G1-G6 and G8 displayed uterine edema and satisfactory pregnancy rates ≥65%. Repeating dinoprost to G8 likely ensured proper luteolysis and response to estrogen as determined by higher uterine edema scores and pregnancy rates than G7 (p < .05). Our results were consistent with previous studies and other successful commercial ET programs (except G7), thus, demonstrating the usefulness of the hormone treatments described herein to synchronize embryo recipient mares with donor mares. Thus, we foresee that other groups may use the strategies described herein for the management of embryo recipient mares.

ПРЕГРАВІДАРНА ПІДГОТОВКА ЖІНОК, ЯКІ ПЕРЕНЕСЛИ ПОЗАМАТКОВУ ВАГІТНІСТЬ

Мета дослідження – проведення реабілітаційних заходів, які включали призначення лікувальних середників для покращення стану прохідності маткових труб та стимуляції овуляції при дисфункції яєчників після консервативного та оперативного лікування позаматкової вагітності.Матеріали та методи. Для проведення лікувальних заходів були взяті жінки із позаматковою вагітністю за типом трубного аборту (15 жінок), у яких за даними визначення β-субодиниць ХГЛ та даними УЗД були показання до призначення консервативної терапії метотрексатом за наведеною схемою. А також 15 жінок, у яких позаматкова вагітність була порушеною і лікування проводили лапароскопічним методом. Лікування прогресуючої позаматкової вагітності проводили метотрексатом 75–100 мл внутрішньом’язово при показниках β-ХГЛ більше 1500 МО/л, за даними УЗД – діаметр плідного яйця не більше 3,5 см у ділянці придатків матки. Додатково для усунення побічних явищ та впливу на печінку призначали гепатопротектори та фолати. Контроль за динамікою лікування здійснювали повторним визначенням β-ХГЛ. Якщо він знижувався більше ніж на 15 %, то повторно метотрексат не вводили, у випадку меншого зниження проводили повторне введення метотрексату. Виписку хворої із стаціонару здійснювали на 8–10 добу під контролем УЗД та показників β-ХГЛ. Хворим із ІІ групи проводили лапароскопічне видалення плідного яйця: туботомію з неосальпінгостомією.Результати дослідження та їх обговорення. Відновлення репродуктивної функції проводили за даними визначення в сироватці крові ФСГ, прогестерону та пролактину. З метою прегравідарної підготовки застосовували фітопрепарати екстракту плодів прутняку (циклодинон, мастодинон) та фолати. У післяопераційному періоді проводили призначення монофазних контрацептивів протягом 3-х менструальних циклів із подальшим визначенням прохідності маткових труб. Під час проведення консервативного лікування позаматкової вагітності та комплексу заходів для відновлення репродуктивної функції протягом трьох менструальних циклів маткова вагітність настала в 6-ти жінок протягом 6-ти місяців після прегравідарної підготовки. Ще у 6-ти жінок вагітність настала протягом одного року при включенні повторного курсу гормональної корекції після шестимісячної перерви й у 3-х жінок не вдалося досягнути позитивного результату. У ІІ групі жінок, у яких було проведено оперативне лікування позаматкової вагітності, в комплекс прегравідарної підготовки включали призначення монофазних контрацептивів протягом 3-х місяців та проведення контрольної МСГ на прохідність маткових труб. Прегравідарна підготовка включала проведення комплексу заходів, які сприяли відновленню прохідності маткових труб, та однофазні гормональні контрацептиви. У результаті проведених реабілітаційних заходів та прегравідарної підготовки вагітність настала у 33 % обстежених жінок у перші 12 місяців.Висновки. Проведення консервативного лікування ПВ із збереженням маткової труби дозволило досягти настання вагітності в більш ранні терміни проведення реабілітаційних заходів для виконання репродуктивної функції в жінок, які перебували під нашим спостереженням. Призначення фітокомплексу (циклодинон) та фолієвої кислоти для корекції гормональної дисфункції дозволяє отримати настання вагітності та її виношування у 33 % обстежених жінок.

Management of uterine ectopic pregnancy - local vs. systemic methotrexate.

The aim of this study was to compare ultrasound-guided local methotrexate (MTX) vs. systemic methotrexate in uterine ectopic pregnancy regarding the beta human chorionic gonadotropin (hCG) clearance duration. Patients with interstitial pregnancy, cervical pregnancy or cesarean scar pregnancy were included. Methotrexate was administered locally ultrasound-guided (25mg methotrexate fixed dose) or systemically (intramuscular; 50mg/m2 body weight). Beta hCG clearance duration in days formed the main outcome measure. Forty-six patients with uterine ectopic pregnancy were included. The mean estimated beta hCG clearance duration was 29.2days longer in patients with local methotrexate compared with systemic methotrexate (64.7 vs. 31.5days, respectively; p=0.026). There was no significant difference between local vs. systemic methotrexate regarding adverse events such as bleeding (p=0.376), pain (p=0.146) or secondary surgery (p=0.631). There was no association of initial beta hCG levels (p=0.746), initial progesterone levels (p=0.870) or patients' age (p=0.604) and the beta hCG clearance duration. No significant difference in beta hCG clearance duration comparing local methotrexate injection with aspiration vs. local methotrexate injection without aspiration could be found (mean 49.4 and 71.6days, respectively, p=0.225). In patients with uterine ectopic pregnancies, the mean estimated beta hCG clearance duration was 29.2days longer when applying local methotrexate compared with systemic methotrexate.

Role of osteopontin in decidualization and pregnancy success.

OPN is essential for blastocyst implantation and placentation. Previous study found that miR181a was increased while miR181b was downregulated in endometrium during decidualization. However, the information regarding their effects on decidualization in human endometrium is still limited. Here, we report a novel role of OPN and miR181b in uterine decidualization and pregnancy success in humans. The expression of OPN was high in endometrium in secretory phase and in vitro decidualized hESC, whereas miR181b expression was low in identical conditions. Further analysis confirmed that OPN expression was upregulated by cAMP and C/EBPβ signal pathway, while downregulated by miR181b. Increased OPN expression could promote the expression of decidualization-related and angiogenesis-related genes. Conversely, the processes of decidualization and angiogenesis in hESC were compromised by inhibiting OPN expression in vitro OPN expression was repressed in implantation failure group when compared with successful pregnancy group in IVF/ICSI-ET cycles. These findings add a new line of evidence supporting the fact that OPN is involved in decidualization and pregnancy success.

ВНЕМАТОЧНАЯ БЕРЕМЕННОСТЬ И ОСТРЫЙ АППЕНДИЦИТ ВО ВРЕМЯ БЕРЕМЕННОСТИ, НАСТУПИВШЕЙ ПОСЛЕ ЭКСТРАКОРПОРАЛЬНОГО ОПЛОДОТВОРЕНИЯ (клинический случай)

The paper presents a clinical case of the Patient T., 34 years old, who underwent the treatment in the Department of&#x0D; ART of the Regional Perinatal Center for tubal peritoneal infertility for seven years. In the anamnesis: one spontaneous&#x0D; uterine pregnancy, culminating in medical abortion for up to 12 weeks, treatment for chronic salpingo-oophoritis, tu-&#x0D; bectomy on the right side for a progressing ectopic pregnancy. The patient denied the presence of Chlamydia infection&#x0D; in the anamnesis. Studies on sexually transmitted infections before the IVF program were negative. During laparo-&#x0D; scopic tubectomy, no endometriotic foci were found. There were four programs of ART in anamnesis: in 2009, 2012,&#x0D; 2014, 2016. During the fourth ART program in 2016, two embryos were transferred to the uterine cavity, resulting in&#x0D; a uterine pregnancy in combination with an ectopic pregnancy diagnosed in the ultrasound study at 4 to 5 weeks of&#x0D; gestation, in the absence of clinical symptoms. The patient underwent emergency laparoscopic tubectomy on the left,&#x0D; the course of the postoperative period proceeded without complications. Later, in the period of uterine pregnancy of&#x0D; 7–8 weeks, with a clinical picture of acute appendicitis, the woman was hospitalized in the surgical department where&#x0D; she underwent laparoscopic appendectomy. Later the pregnancy proceeded without complications, at 39 weeks the&#x0D; planned cesarean section was performed, a girl weighing 3480 grams, 51 cm long with an Apgar score of 9–10 points&#x0D; was extracted on the operation. The course of the early postoperative period without complications, the patient was&#x0D; discharged with the child on the 4th day.

Pik3ca is required for mouse uterine gland development and pregnancy.

The PI3K/AKT signaling pathway plays a critical role in the maintenance of equilibrium between cell survival and apoptosis. The Pik3ca gene is mutated in a range of human cancers. It has been found to be oncogenic, and mutations lead to constitutive activation of the PI3K/AKT pathway. The expression patterns of PIK3CA proteins in the uterus of mice during early pregnancy indicate that it may play a role in the regulation of glandular epithelial cells, which is required to support uterine receptivity. To further investigate the role of Pik3ca in uterine function, Pik3ca was conditionally ablated only in the PGR-positive cells (Pgrcre/+Pik3caf/f; Pik3cad/d). A defect of uterine gland development and decidualization led to subfertility observed in Pik3cad/d mice. Pik3cad/d mice showed significantly decreased uterine weight compared to Pik3caf/f mice. Interestingly, a significant decrease of gland numbers were detected in Pik3cad/d mice compared to control mice. In addition, we found a decrease of Foxa2 expression, which is a known uterine gland marker in Pik3cad/d mice. Furthermore, the excessive proliferation of endometrial epithelial cells was observed in Pik3cad/d mice. Our studies suggest that Pik3ca has a critical role in uterine gland development and female fertility.

Total laparoscopic hysterectomy for successful treatment of uterine cervical pregnancy: a report of 2 cases

Total laparoscopic hysterectomy for successful treatment of uterine cervical pregnancy: a report of 2 cases

MRI Imaging of Focal Adenomyosis and Adenomyotic Cyst: Case Report

Adenomyosis is defined by the presence of ectopic endometrial glands and stroma within the myometrium. This happens when the normal boundary between the endometrial basal layer and the myometrium is disrupted. It proposed that it may be due to uterine trauma, pregnancy, postpartum endometritis, or caesarean delivery. Adenomyosis has been noted to occur in about 30% of the general female population and the reported prevalence of adenomyosis in hysterectomy specimens varies from 5% to 70%. We report a case of a 42 year old female, nulligravida, with a medical history of complete spontaneous miscarriage five years ago; with uncontrolled bleeding which it need to be treated with cervical cerclage. Actually she has a menstrual menometrorrhagia and dysmenorrhea treated with oral contraceptive pills but it did not stop. Transvaginal sonography showed a globular uterine enlargement with one leiomyoma and uterine wall thickening. Vascular malformation or adenomyosis were suspected. A MRI was performed which it showed findings in respect with adenomyosis.

Successful Management of Heterotropic Pregnancies with Favorable Outcomes

Introduction: Heterotrophic pregnancy, or coexistence of intrauterine and extra uterine pregnancy, is a rare entity, with a difficult pre-operative diagnosis. The incidence in the general population is estimated to be 1 in 30,000 to 1 in 40,000. Cases: We present two interesting cases of heterotrophic pregnancies with successful outcomes. The illustrated cases did not have any risk factor for the heterotypic gestation and presented in early gestation with abdominal pain. Both the patients were taken up for operative management and we were able to continue the intrauterine pregnancy further to a term delivery. Prompt diagnosis and management could save the intrauterine pregnancies and the ectopic pregnancies were treated timely. Conclusion: The two cases represent heterotypic pregnancy in patients with no risk factors. Quick operative intervention is the mainstay of management.

Bilateral Tubal Molar and Embryonic Pregnancy

Aim: To report a case of bilateral tubal molar and embryonic pregnancy diagnosed and treated at the Yalgado Ouedraogo Teaching Hospital in Ouagadougou, Burkina Faso. Observation: It was an 18-year-old patient, G2P0 with no known pathological history. She was received in obstetric emergencies for suspicion of ectopic pregnancy in a two-month amenorrhea context. At the admission, the physical examination had found a sensitivity of the hypogastric region with a cry of the umbilicus and the bleeding. At pelvic ultrasound, the uterus was empty with a medium-abundance pelvic effusion and a left extra uterine mass. The initial rate of beta HCG was 5700 ml IU per ml. A framed laparotomy was carried out. The operative exploration has revealed a right tubal pregnancy cracked and a left unbroken tubal pregnancy. The diagnosis of a bilateral ectopic pregnancy was retained. A right salpingectomy and a left tubal caesarean section were carried out. Histological analysis confirmed the diagnosis of a left embryonic ectopic pregnancy associated with a right molar ectopic pregnancy. Conclusion: The systematic use of histological analysis for any extra uterine pregnancy treatment is required to not ignore an associated molar pregnancy.

The Risks of American Single-Payer for Women’s Health

Cornual pregnancy is a rare form of ectopic pregnancy, accounting for 2–4% of all ectopic pregnancies. The terms interstitial and cornual pregnancy are often used synonymously. Cornual gestation is considered as one of the rarest types of ectopic gestation since it is associated with high maternal risks, including mortality which is doubled compared to classic tubal extra uterine pregnancy. The diagnosis is made by ultrasound and positive human chorionic gonadotropin. The diagnosis and treatment are challenging and constitute a medical emergency. A recent literature review has revealed that no gold-standard is defined in this pathology concerning the diagnosis, the treatment and prognosis. We present a case of a 38-year-old pregnant woman who was admitted at 23 weeks of pregnancy after being diagnosed with an appendicular abscess. An emergency laparotomy was performed with an operative diagnosis of a pre ruptured cornual pregnancy.

Ovarian ectopic pregnancy: a review article

Ectopic pregnancy is a major health issue in reproductive age group female. Incidence of primary ovarian ectopic pregnancy as mentioned in literature of India is variable from 0.001% to 0.014% of normal pregnancies. Only 0.15% to 3.0% of all ectopic pregnancy occurs in ovary and it is 2ndmost common site of ectopic pregnancy after fallopian tube. Annual incidence of extra uterine cavity pregnancy is rising over past 3 yrs. The aim of ourpresent study isto find out the incidence of ovarian ectopic pregnancy, role of USG in pre-operative diagnosisand risk factors, feasibility of conservative management with medical method or conservative management e.g. minimal invasive surgery in developing countries like India. We analysed the incidence, management of ovarian pregnancy &amp; reviewed the literature, risk factors and clinical presentation of ovarian ectopic pregnancies managed at NIMS Medical College and Hospital jaipur. According to Spielberg criteria, it is a diagnostic challenge to obstetrician. Diagnosis of ectopic pregnancy can be missed radio logically and intra operatively. It Should be suspected in patients presented with rupturedectopic pregnancy, ultrasound features suggestive of normal bilateralfallopian tube with hemo peritoneum with breached ovarian surface. Conservative surgical approach is preferred, now days Medical management is preferred for unruptured ectopic pregnancy. Confirmation of ovarian pregnancy done only after histopathological report. Now daysMedical management with single dose of Methotrexate is very successful for un ruptured ovarian pregnancy

SECOND TRIMESTER MEDICAL TERMINATION OF PREGNANCY. CHALLENGES OF IMPLEMENTATION

The article describes the specific features of termination of progressive uterine pregnancy in the II trimester. It was found that the efficacy of medical abortion in the II trimester of pregnancy is 94–98%. High efficacy, low incidence of side effects or early and late complications and economic feasibility demonstrate that the method is promising and safe; therefore, it can be recommended as a priority when choosing a method for medical termination of pregnancy in the II trimester.

Dydrogesterone has no effect on uterine fibroids when used to prevent miscarriage in pregnant women with uterine fibroids.

To analyse the effect of dydrogesterone use during pregnancy on uterine fibroids, pregnancy complications, and pregnancy outcome. In all, 372 pregnant women with uterine fibroids who were treated at the Affiliated Provincial Hospital of Shandong University were included in this study. Thirty-three of these women received dydrogesterone and constituted the treatment group, and the 27 women who were found to have uterine fibroids during the first trimester but did not receive intervention to prevent miscarriage composed the control group. The changes in uterine fibroids before and after pregnancy and the pregnancy complications were recorded; immunohistochemistry was used to detect the expression of progesterone receptor (PR) and proliferation- and apoptosis-related proteins in the uterine fibroid tissue. No significant difference was observed in the change in uterine fibroid volume during pregnancy between the treatment group and the control group (p > 0.05). The percentage of uterine fibroids with red degeneration was lower in the treatment group than in the control group, but the difference was not statistically significant. No significant difference was observed in newborn weight, height, Apgar score, threatened miscarriage, or premature birth, among other characteristics, between the two groups (p > 0.05). Immunohistochemistry showed no significant difference in the expression of PR, cyclinD1, insulin-like growth factor (IGF1), or B-cell lymphoma 2 (Bcl2) between the two groups. The use of dydrogesterone during pregnancy has no significant effect on uterine fibroids, pregnancy progression, or pregnancy outcomes in pregnant patients with uterine fibroids.

Synchronization of cyclic and acyclic embryo recipient mares with donor mares

This study compared hormone treatments given to mares during anestrus, spring transition, and different stages of the estrous cycle, by assessing uterine features and pregnancy rates after embryo transfer (ET). Embryo recipient mares (n = 160) were equally arranged as follows: G1-spontaneous ovulation (control), G2-anestrus, G3-spring transition, G4-early estrus, G5-estrus, G6-diestrus, G7-early diestrus treated with a dose of dinoprost, and G8-early diestrus treated with two doses of dinoprost. At treatment initiation (Day-4), G2-7 were given dinoprost and estradiol-17β, thereafter, estradiol-17β was repeated on Days-3,-2, and -1. On Day0, mares received long-acting altrenogest. Then, each mare had one ET performed from Day + 3 to Day + 8 after altrenogest. Immediately before the ET, mares received a boost of altrenogest and had uterine features assessed. Pregnant mares on each of the checks (by 7, 30, 60, and 120d after ET) were maintained on weekly injections of LA-P4 until 120d. G8 received similar management, but dinoprost was repeated on Day-3. G1-G6 and G8 displayed uterine edema and satisfactory pregnancy rates ≥65%. Repeating dinoprost to G8 likely ensured proper luteolysis and response to estrogen as determined by higher uterine edema scores and pregnancy rates than G7 (p < .05). Our results were consistent with previous studies and other successful commercial ET programs (except G7), thus, demonstrating the usefulness of the hormone treatments described herein to synchronize embryo recipient mares with donor mares. Thus, we foresee that other groups may use the strategies described herein for the management of embryo recipient mares.

Induction of ovulation with letrozole in women with polycystic ovary syndrome

The aim of the study was to evaluate the effectiveness of the use of letrozole as an inducer of ovulation in women with polycystic ovary syndrome (PCOS) and anovulatory infertility and to determine possible clinical and laboratory predictors of the effect of therapy. Materials and methods: 61 women with anovulatory infertility and PCOS (mean age 28.5 ± 3.3 years, mean body mass index - BMI 21.8 ± 2.7 kg / m2) were included in the study. In order to induce ovulation, the patient received letrozole at a dose of 2.5-5 mg / day from day 3 to 7 of the menstrual cycle under the control of folliculometry, ultrasound m / pelvis on the 20-24 day cycle and the level of progesterone in the blood. Results: the frequency of ovulation per cycle was 77.2% (146/189), 98.4% for women, 24.9% for conception (47/189), 77% for women (47/61) , in 6 (12.8%) women the pregnancy was biochemical, in 1 (2.1%) ectopic, multiple pregnancy took place in 2 (5%) women with progressive uterine pregnancy, spontaneous abortion in the period up to 12 weeks of gestation occurred in 5 (12.5%) women, there was no case of ovarian hyperstimulation syndrome or other side effects. Comparative analysis revealed higher levels of BMI, the percentage of total adipose tissue by densitometry, and the number of antral follicles in the volume of the ovaries in the group with no pregnancy. Conclusion: letrozole is an effective medication for induction of ovulation and pregnancy in the treatment of infertility in patients with PCOS, characterized by good tolerability, low risk of multiple pregnancies and the absence of cases of ovarian hyperstimulation syndrome.

A case of heterotopic pregnancy with selective reduction of the ovum cervical localization and preservation of intrauterine pregnancy

Failure of implantation with the formation of heterotopic pregnancy is, unfortunately, continues to accompany the IVF. This may be due to the inability of the impact on endometrial receptivity. Changing characteristics of endometrial receptivity in conducting IVF determines the probability of formation of this kind of complications. The lack of standards for the conduct of heterotopic uterine and cervical pregnancy include the woman to the group at high risk for bleeding, a subsequent hysterectomy and loss of fertility. Promptly detection of ectopic localization of the ovum by means of methods of ultrasonic diagnostics allows in some cases to carry out organ-sparing surgery. Currently, there is a need for improved approaches to preimplantation training. The article describes a clinical case of heterotopic pregnancy with successful selective reduction of cervical localization of one of the two fertilized eggs and preservation of intrauterine pregnancy.