Abstract Objective The aim of this study was to report three cases of early severe ovarian hyperstimulation syndrome (OHSS) in patients undergoing a GnRH antagonist protocol triggered with GnRH agonist (GnRH-a), leading to hospitalization and the need for peritoneal drainage. Additionally, a review of the existing literature on this topic is provided. Design This is a retrospective case series and a literature review. Setting This study was conducted at obstetrics and gynecology department of tertiary academic referral hospitals, Israel. Participants This study included three patients presented with severe OHSS symptoms, including abdominal distension, ascites, and hemoconcentration. Main outcome measures The main focus of the treatment was to address the symptoms and prevent any further complications. The outcome was the complete recovery of the patients. Results The presented cases detail instances of severe OHSS following oocyte retrieval, utilizing GnRH-a for triggering. Case 1 involved a 33-year-old patient with a history of polycystic ovary syndrome (PCOS), Case 2 featured a 22-year-old patient with familial adenomatous polyposis (FAP), and Case 3 included a 41-year-old patient with a history of depressive disorder. All patients receiving supportive care, including infusions and medications, exhibited gradual improvement during hospitalization, with complete resolution observed during the 20-day post-hospitalization check-up. Conclusions These three cases highlight the occurrence of severe early OHSS following a GnRH antagonist protocol triggered with GnRH-a in the absence of human chorionic gonadotropin (hCG) administration for trigger or luteal-phase support. Clinicians must be aware that a GnRH-a trigger followed by a freeze-all approach does not guarantee the complete elimination of OHSS in all patients.

OBJECTIVES:To determine the feasibility and safety of resectoscopic treatment for uterine evacuation of first-trimester miscarriage. METHODS:A single-centre prospective study performed between April 2021 and October 2021 at a university-affiliated tertiary medical centre. Patients diagnosed with early miscarriage of up to 12 weeks from the last menstrual period were eligible for participation. Recruited patients underwent hysteroscopic uterine evacuation under general anaesthesia by a Versapoint 2 bipolar resectoscope 24Fr (Johnson and Johnson, Germany). RESULTS:A total of 15 patients were recruited for the study. The procedural characteristics as well as intra- and postoperative adverse events were recorded. The mean duration of the procedure was 14.3 ± 3.7 minutes. The achievement of complete evacuation was recorded in all cases, and no adverse events occurred during any procedure. Post-procedure follow-up 6 weeks after treatment was conducted by office hysteroscopy in 10 women and by ultrasonography in 4 women. One woman had conceived prior to her scheduled follow-up visit. In total, 2 (13.3%) cases of retained products of conception were diagnosed during office hysteroscopy and they were removed by the "see-and-treat" technique without anaesthesia. The diagnosis was confirmed pathologically. No intrauterine adhesions were detected and none of the women required a second hysteroscopy under anaesthesia due to retained products of conception. CONCLUSIONS:Hysteroscopic evacuation of first-trimester miscarriage by a standard resectoscope is a safe and feasible technique.

To determine the association of vaginal progesterone treatment and the risk of spontaneous preterm birth (sPTB) in women with a short cervix diagnosed at 24-34 weeks of gestation. A retrospective cohort study in a single university affiliated medical center with approximately 12,500 annual deliveries (2011-2022). Women with a singleton pregnancy and a newly diagnosed short cervix (≤25mm) at 24+0-33+6 weeks who were given vaginal progesterone were compared to those that were not treated. The initiation of progesterone treatment was based on physician's preference and continued until 36 weeks. Severe short cervix was defined as cervical length (CL) ≤15 mm. Exclusion criteria were: prior progesterone or tocolysis usage, cerclage and previous PTB. The primary outcome was sPTB < 37 weeks of GA. 1. Overall, 862 women were eligible for analysis, among them 471 (54.6%) women were treated with vaginal progesterone and 391 (45.4%) did not. 183 women (21.2%) were diagnosed with CL≤15mm. 2. There was no significant difference between the groups in the rate of sPTB at < 37 weeks (29.4% vs.33.5%, p=0.19), 34 weeks (8.7% vs 12.1%, p=0.11) and 32 weeks (4.9% vs 7%, p=0.19). 3. No significant differences were found in background characteristics. Women in the progesterone group were diagnosed earlier (29.5 ± 2.7 vs. 31.5 ± 2.3, weeks P< 0.001), had a shorter CL at diagnosis (17.5 ± 5.3 Vs 19.6 ± 5 mm, P< 0.001), and higher rate of CL≤15 mm (25.9% vs 15.6%, P=0.01). 4. Progesterone treatment was associated with a longer interval from diagnosis to delivery, in women with CL≤ 25mm and CL≤15mm as comparted to no treatment [Mean time of 54 ± 27 vs. 41.8 ± 23.5 days, and 52.6 ± 29.5 vs 33.2 ± 27 days, respectively. (P< 0.001)]. Hazard Ratio of 1.9, 95% CI [1.7-2.3], and 2.2, 95% CI [1.4-3.3], respectively. (Figure). Vaginal progesterone given to women with a short cervix at 24-34 weeks of GA is associated with mean prolongation of pregnancy of 12-19 days, with not significant impact on the rate of sPTB.

Objective: The increasing rate of cesarean sections (CSs) raises concerns over severe intra-abdominal adhesions, which are associated with numerous complications. We aimed to identify risk factors and predictive tools for severe adhesions. Design: A prospective study was conducted. Participants/Materials: Women with at least one prior CS were evaluated. Setting: The study was conducted at a tertiary medical center from January to July 2021. Methods: Surgeons assessed adhesions at four anatomical sites, scoring them from 0 (none) to 2 (dense), with a total possible score of 0-8. Severe adhesions were defined as a score of >= 5. Risk factors were analyzed using logistic regression to create a prediction model. Results: Overall, 341 women were included in the study. Significant predictors included the number of previous CS, maternal body mass index, maternal morbidity at the time of the previous CS, and operation time. The model predicted severe adhesions with 79.1% accuracy, a positive predictive value of 68.4%, and a negative predictive value of 79.5%. Limitations: Few risk factors, such as surgical history beyond cesarean sections, endometriosis, and pelvic inflammatory disease were not available. Additionally, the sample size of 341 women, while substantial, may limit the identification of further risk factors and the precision of the predictive model. Conclusion: The severity of most cases of post-CS adhesions can be predicted by a model which considers common risk factors. (c) 2024 The Author(s).Published by S. Karger AG, Basel

OBJECTIVE:To identify the key risk factors contributing to re-hospitalization after term cesarean delivery (CD). METHODS:This retrospective cohort study included women who underwent CD at term at a university-affiliated tertiary medical center (January 2021 to March 2023). The primary outcome was risk factors for re-hospitalization within 30 days post-discharge. Data on selected maternal demographic, pregnancy-related and delivery variables were extracted from electronic medical records. A multivariable logistic regression analysis was conducted to identify independent risk factors for re-hospitalization. Logistic regression analysis was used to determine the odds ratios (ORs) and 95% confidence intervals (CIs) for various independent risk factors. RESULTS:A total of 2878 women were included in the study, of whom 76 required re-hospitalization (2.6%). The rates of high-risk pregnancies were more prevalent among those who were re-hospitalized (41 [62.1%] vs. 1148 [49.1%], P = 0.043). Furthermore, the rates of emergency CDs (42 [56%] vs. 1040 [37.8%], P = 0.001), prolonged surgery duration (17 [22.4%] vs. 292 [10.4%], P = 0.001) and hospitalization duration (14 (18.4%) vs. 273 (9.7%), P = 0.015) were significantly higher in the re-hospitalized group. Emergency CD (OR 1.90, 95% CI 1.06-3.42, P = 0.030) and prolonged surgery duration (OR 2.44, 95% CI 1.25-4.77, P = 0.016) remained significant risk factors of re-hospitalization in the multivariate analysis. CONCLUSIONS:The need for emergency CD and prolonged surgery duration were found as independent risk factors for re-hospitalization after CD at term.

(Abstracted from Am J Obstet Gynecol 2022;227:599.e1–599.e9) There has been an increase in the use of medical treatments for the termination of pregnancy. However, no prospective trials have evaluated the efficacy of misoprostol in treating retained products of conception following induced termination of pregnancy.

To evaluate the correlation of maternal and cord blood levels of SARS‐CoV‐2 antibodies in pregnant women immunized against COVID‐19.

Objective This study aimed to compare the rates of positive specimen margins and postconization recurrent dysplasia between loop electrosurgical excision procedures (LEEPs) performed under general anesthesia (GA) and LEEP under local anesthesia (LA). Methods This retrospective cohort study included all consecutive women who underwent LEEP between 2011 and 2019. Collected data included demographics, LEEP indication, cone dimensions, and margin involvement as well as recurrence rate. Women who had undergone previous conization, cold-knife conization, or those who were lost to follow-up during the first 2 years after the procedure were excluded. Results Overall, 71 women who underwent LEEP under GA and 75 women under LA were included. Demographic characteristics were similar between the groups, as were the rates of preceding abnormal cytology and high-grade dysplasia before conization. Although cone depth and volume were higher for LEEP specimens done under GA compared with LA, the rate of positive specimen margins was comparable both for the endocervical margin (16/71 [22.5%] vs 16/75 [21.3%], respectively; p = .861) and the ectocervical margin (14/71 [19.7%] vs 11/75 [14.7%], respectively; p = .418). During the first 2 years after conization, the rates of high-grade dysplasia (cervical intraepithelial neoplasia ≥ 2) in repeat biopsy and the need for repeat conization were also not significantly different between the GA and LA groups (4.2% vs 1.3%, p = .356; 7.0% vs 9.3%, p = .614, respectively). Conclusions Anesthesia mode does not seem to affect the rate of positive LEEP margins and the need for repeat conization. Our study findings suggest that LA should be preferred instead of GA in LEEP.

Measles is a major public health concern. Recently, there has been an increase of measles infections worldwide due to low vaccination coverage in certain regions that allowed for the development of measles outbreak in susceptible populations. According to the World Health Organization (WHO), there have been significant measles outbreaks in all WHO regions, and below 10% of cases were reported [1]. It is difficult to measure the impact of measles virus infection on pregnancy outcome.