The aim of this review is to analyze the relationship between the preovulatory progesterone (P) rise and the in vitro fertilization (IVF) pregnancy outcome. It also investigates the sources and effects of P level increase, including the underlying mechanisms and potential strategies in preventing its elevation during ovarian stimulation. The origin of production of P in the early follicular phase is adrenal which shifts toward the ovaries prior to the ovulation. Several factors contribute to the etiology of P level increase including the number of multiple follicles, the overdose of gonadotropins and poor ovarian response. Nowadays, the influence of the preovulatory P rise on IVF outcome remains controversial. Several authors have failed to demonstrate any negative impact, while others reported a detrimental effect associated with the rise of P. It seems that P rise (≤ 1.5 ng/ml or 4.77 nmol/l) may have deleterious effects on endometrial receptivity, namely, accelerating the endometrial maturation process that subsequently narrows the time-frame for implantation and thus decreases pregnancy rates. To prevent a P rise, it might be preferable to use milder stimulation protocols, earlier trigger of ovulation, cryopreservation of all embryos and transfer in the natural cycle.
After the administration of hCG there was a visible increase in perifollicular capillary network volume, relative volume of blood, and balancing of blood inflow of each feeding vessel of the perifollicular circulation.
Poster abstractsan almost linear way with gestational age, whereas little variability is observed for PI and RI in the renal arteries. The Vmax in the renal veins increases with gestational age, whereas little variation in PI is observed. These data are consistent with those in literature. Conclusions: Reference curves for renal Dopplers flow measurements in normal pregnancies are provided. These will serve as potential predictors for renal function in fetuses with renal and urinary tract pathology.P01.14 Bilateral accessory renal arteries: a prenatal observation
of the initial scan the forms were filled in. The subjective assessment of the contribution of 2D and 3/4D techniques regarding the information obtained was noted, on a scale from 1 to 10, by both the operator and the patient. Results: We included 100 normal cases and 23 cases of fetal anomalies. In normal cases, the level of the operator's confidence raised statistically significant (p < 0.05, Wilcoxon Signed Ranks Test) by 3D for facial and spine in the FT, and for the fetal profile in the ST. 2D proved to be superior for increasing operator confidence in normality for calvaria, extremities, abdominal wall and brain in the FT and the ST. Patients were more confident in normal anatomy by 3D vs 2D for spine and brain in the FT and for spine, calvaria and abdomen in the ST. 2D statistically increased the patient confidence level in normality for extremities and fetal profile in the FT, and for the fetal face and profile in the ST. There were no significant differences between 2D and volumetric US in the demonstration of normality of the heart and in skeleton, facial and brain anomalies during both trimesters, for both subjects. Conclusions: Volumetric ultrasound has helped in demonstrating the fetal surfaces. On a daily basis there is no evidence of benefits in anomaly detection. The gestational age has a critical importance in the amount of information contained in the volumes, similar to 2D scan. We need to understand what systems will benefit from volumetric US application. For the moment, these techniques serve for scientific purposes only.
OP28.10Routine third trimester ultrasound screening detection rate of congenital anomalies
Hospital Clinico Zaragoza, Zaragoza, SpainObjectives: To evaluate the detection rate of congenital anomalies at the routine third trimester ultrasound screening. Methods: We conducted a prospective study of 17063 consecutive pregnancies between 2009 and 2013. In all cases ultrasound screening of congenital defects was carried out at each trimester of the gestation (11-14 weeks; 18-22 weeks; 31-35 weeks). We only included in the study those pregnancies delivered in our hospitals. Results: The overall incidence of fetal malformations was 1.9% (n = 326), of which 31.9% (n = 104) were diagnosed at 11-14 weeks. The following 2nd trimester scan revealed 120 (36.8%) new fetal malformations. An additional 102 (31.3%) structural abnormalities were found in the routine third trimester ultrasound screening. These were mainly abnormalities of the urogenital system (n = 39), followed by congenital heart diseases (n = 28) and central nervous system (n = 12). Third trimester ultrasound presented the best rate for urogenital anomalies, and similar detection rate of the second trimester scan for congenital heart diseases and gastrointestinal system. The 4.1% (n = 5) of congenital anomalies that requested TOP according to our legal framework were diagnosed at third trimester.
Conclusions:The ultrasound routine scan in the third trimester increased the detection rate of previously unknown structural ab...
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