1,720,981 research outputs found
Dealing with equipment failure during oocyte retrieval
No full textThis chapter includes clinical cases, background, evidence-based practical management options, preventive measures, key-point summaries of equipment failure during oocyte retrieval and answers to questions patients ask. It is important any equipment failure is clearly documented, reported on the institution's reporting system and reviewed for learning and actions to mitigate future risk. If the issues cannot be adequately resolved, no oocytes may be retrieved in the window of time available after ovulation trigger. In such cases, the patient will require a full explanation and discussion as per the duty of candor. The question about any equipment failure is not if but rather when it will happen. A good preventive strategy will reduce the chance of failure, allow its prompt recognition and have a plan B for what to do when it occurs.</p
Surgical treatment of fibroids for subfertility
Full text linkBACKGROUND: Fibroids are the most common benign tumours of the female genital tract and are associated with numerous clinical problems including a possible negative impact on fertility. In women requesting preservation of fertility, fibroids can be surgically removed (myomectomy) by laparotomy, laparoscopically or hysteroscopically depending on the size, site and type of fibroid. Myomectomy is however a procedure that is not without risk and can result in serious complications. It is therefore essential to determine whether such a procedure can result in an improvement in fertility and, if so, to then determine the ideal surgical approach.OBJECTIVES: To examine the effect of myomectomy on fertility outcomes and to compare different surgical approaches.SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility Group (CGFG) Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, Epistemonikos database, World Health Organization (WHO) International Clinical Trials Registry Platform search portal, Database of Abstracts of Reviews of Effects (DARE), LILACS, conference abstracts on the ISI Web of Knowledge, OpenSigle for grey literature from Europe, and reference list of relevant papers. The final search was in February 2019.SELECTION CRITERIA: Randomised controlled trials (RCTs) examining the effect of myomectomy compared to no intervention or where different surgical approaches are compared regarding the effect on fertility outcomes in a group of infertile women suffering from uterine fibroids.DATA COLLECTION AND ANALYSIS: Data collection and analysis were conducted in accordance with the procedure suggested in the Cochrane Handbook for Systematic Reviews of Interventions.MAIN RESULTS: This review included four RCTs with 442 participants. The evidence was very low-quality with the main limitations being due to serious imprecision, inconsistency and indirectness. Myomectomy versus no intervention One study examined the effect of myomectomy compared to no intervention on reproductive outcomes. We are uncertain whether myomectomy improves clinical pregnancy rate for intramural (odds ratio (OR) 1.88, 95% confidence interval (CI) 0.57 to 6.14; 45 participants; one study; very low-quality evidence), submucous (OR 2.04, 95% CI 0.62 to 6.66; 52 participants; one study; very low-quality evidence), intramural/subserous (OR 2.00, 95% CI 0.40 to 10.09; 31 participants; one study; very low-quality evidence) or intramural/submucous fibroids (OR 3.24, 95% CI 0.72 to 14.57; 42 participants; one study; very low-quality evidence). Similarly, we are uncertain whether myomectomy reduces miscarriage rate for intramural fibroids (OR 1.33, 95% CI 0.26 to 6.78; 45 participants; one study; very low-quality evidence), submucous fibroids (OR 1.27, 95% CI 0.27 to 5.97; 52 participants; one study; very low-quality evidence), intramural/subserous fibroids (OR 0.80, 95% CI 0.10 to 6.54; 31 participants; one study; very low-quality evidence) or intramural/submucous fibroids (OR 2.00, 95% CI 0.32 to 12.33; 42 participants; one study; very low-quality evidence). This study did not report on live birth, preterm delivery, ongoing pregnancy or caesarean section rate. Laparoscopic myomectomy versus myomectomy by laparotomy or mini-laparotomy Two studies compared laparoscopic myomectomy to myomectomy at laparotomy or mini-laparotomy. We are uncertain whether laparoscopic myomectomy compared to laparotomy or mini-laparotomy improves live birth rate (OR 0.80, 95% CI 0.42 to 1.50; 177 participants; two studies; I2 = 0%; very low-quality evidence), preterm delivery rate (OR 0.70, 95% CI 0.11 to 4.29; participants = 177; two studies; I2 = 0%, very low-quality evidence), clinical pregnancy rate (OR 0.96, 95% CI 0.52 to 1.78; 177 participants; two studies; I2 = 0%, very low-quality evidence), ongoing pregnancy rate (OR 1.61, 95% CI 0.26 to 10.04; 115 participants; one study; very low-quality evidence), miscarriage rate (OR 1.25, 95% CI 0.40 to 3.89; participants = 177; two studies; I2 = 0%, very low-quality evidence), or caesarean section rate (OR 0.69, 95% CI 0.34 to 1.39; participants = 177; two studies; I2 = 21%, very low-quality evidence). Monopolar resectoscope versus bipolar resectoscope One study evaluated the use of two electrosurgical systems during hysteroscopic myomectomy. We are uncertain whether bipolar resectoscope use compared to monopolar resectoscope use improves live birth/ongoing pregnancy rate (OR 0.86, 95% CI 0.30 to 2.50; 68 participants; one study, very low-quality evidence), clinical pregnancy rate (OR 0.88, 95% CI 0.33 to 2.36; 68 participants; one study; very low-quality evidence), or miscarriage rate (OR 1.00, 95% CI 0.19 to 5.34; participants = 68; one study; very low-quality evidence). This study did not report on preterm delivery or caesarean section rate. AUTHORS' CONCLUSIONS: There is limited evidence to determine the role of myomectomy for infertility in women with fibroids as only one trial compared myomectomy with no myomectomy. If the decision is made to have a myomectomy, the current evidence does not indicate a superior method (laparoscopy, laparotomy or different electrosurgical systems) to improve rates of live birth, preterm delivery, clinical pregnancy, ongoing pregnancy, miscarriage, or caesarean section. Furthermore, the existing evidence needs to be viewed with caution due to the small number of events, minimal number of studies and very low-quality evidence.</p
The patient with thrombophilia
No full textThis chapter includes clinical cases, background, evidence-based practical management options, preventive measures, key-point summaries of thrombophilia and answers to questions patients ask. Thromboembolism is a rare complication of ovarian stimulation for IVF. Venous thrombosis is a potentially serious disorder which may often lead to post-thrombotic syndrome causing chronic morbidity. Because women undergoing IVF are generally young and active, this may afflict their lives for many years. screening for thrombophilia should be considered in women with a history of recurrent miscarriage, or personal or family history of venous thromboembolism (VTE). The management of the woman with a single previous VTE has been controversial, but data from studies of pregnancy may guide therapy in the context of IVF. Clinical reports of deep venous thrombosis occurring following IVF treatment indicate that it most frequently presents in early pregnancy between 5 and 10 weeks after human chorionic gonadotropin administration.</p
Pre and post operative medical therapy for endometriosis surgery
No full textBackground: Endometriosis is a common gynaecological condition affecting approximately 10% of women of reproductive age (Ozkan 2008). Common symptoms are dysmenorrhoea, pelvic pain, infertility or a pelvic mass. Diagnosis by laparoscopy or laparotomy enables identification of the location, extent and severity of the disease. Surgery may include removal (excision) or destruction (ablation) of endometriotic tissue, division of adhesions and removal of endometriotic cysts. Laparoscopic excision or ablation of endometriosis has been shown to be effective in the management of pain in mild to moderate endometriosis. Adjunctive medical treatment pre or post-operatively may prolong the symptom-free interval.Objectives: To determine the effectiveness of medical therapies for hormonal suppression before or after surgery for endometriosis for improving painful symptoms, reducing disease recurrence and increasing pregnancy rates.Search strategy: We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (searched Sept 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Sept 2010), MEDLINE (January 1966 to September 2010), EMBASE (January 1985 to September 2010) and reference lists of articles.Selection criteria: Trials were included if they were randomised controlled trials comparing medical therapies for hormonal suppression before or after or before and after, surgery for endometriosis.Data collection and analysis: Data extraction and assessment of risk of bias were performed independently by two authors. Where possible, data were combined using relative risk (RR), standardised mean difference or mean difference and 95% confidence intervals (CI).Main results: Sixteen trials were included. Two trials of pre-surgical medical therapy showed no evidence of benefit compared to surgery alone. There was no evidence of benefit for post-surgical hormonal suppression of endometriosis compared to surgery alone for the outcomes of pain, disease recurrence or pregnancy rates (RR 0.84, 95% CI 0.59 to 1.18). There were no trials identified in the search that compared hormonal suppression of endometriosis before and after surgery with surgery alone. One trial found no evidence that pre-surgical hormonal suppression was different from post-surgical hormonal suppression for the outcome of pain. Another single trial comparing post-surgical medical therapy with both pre and post-surgery found no difference in the outcomes of American Fertility Society (AFS) scores and pregnancy rate.Authors' conclusions: There is no evidence of benefit associated with post surgical medical therapy and insufficient evidence to determine whether there is a benefit from pre-surgical medical therapy with regard to the outcomes evaluated.<br/
Are skin scar characteristics associated with the degree of pelvic adhesions at laparoscopy?
No full textObjectiveTo investigate whether individual or a combination of abdominal surgical scar characteristics can predict the severity and extent of intra-abdominal adhesions.DesignA prospective cohort study.SettingA tertiary referral center in the United Kingdom.Patient(s)One hundred women who had previously undergone abdominopelvic surgery and were undergoing an elective laparoscopic gynecologic operations.Intervention(s)Abdominal scars were evaluated preoperatively using the modified Manchester Scar Questionnaire Adhesions were assessed intraoperatively and compared with the cutaneous findings.Main Outcome Measure(s)Presence and severity of intra-abdominal adhesions.Result(s)Of 100 women recruited into this study, 71 (71%) women were found to have intra-abdominal Aadhesions, and 29 (29%) had no adhesions. Women who had more than one abdominal scar, a palpable scar, and/or a longer scar were most likely to have pelvic adhesions during the current surgery. Women with the highest mean scar scores also had a greater total adhesion score.Conclusion(s)Adhesions are a common postoperative consequence of open or laparoscopic surgery. Skin scar characteristics are associated with the presence and degree of pelvic adhesions. Future studies should examine whether these characteristics can be used as a preoperative predictive tool to facilitate surgical decision-making and elective operating room organization
Management of anti-Rhesus-D antibodies in pregnancy: a review from 1994 to 1998
No full textIntravascular as opposed to intraperitoneal transfusions were found to be the main method of transfusion in the later years in this study, a finding which was expected with improved sonographic equipment. Apart from this, management and prognosis of anti-D red cell isoimmunisation in pregnancy have remained relatively stable since the 1980s. Amniocentesis was useful in the management of such pregnancies, especially as an initial procedure in the cases with a lower initial anti-D level. In this series 90% of the fetuses requiring blood transfusion, but were without hydrops, survived, whereas this was about 70%, if they had become hydropic (this latter figure was reduced by 2 hydropic deaths before 20 weeks' gestation in the same very severely affected woman)
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