CONTEXT:Various markers have been proposed to evaluate endometrial receptivity, such as molecular markers and sonographic markers. Commonly used sonographic markers include endometrial thickness and pattern. A good endometrial blood flow is considered necessary for improved pregnancy outcome.AIM:The aim of the present study is to evaluate the role of subendometrial endometrial blood flow with two-dimensional-power Doppler (2D-PD) in predicting pregnancy outcome in hormone replacement frozen-thawed embryo transfer (FET) cycles.SETTING AND DESIGN:Prospective, non-randomized observational study. A total of 165 patients undergoing their first FET cycle were evaluated for subendometrial-endometrial blood flow by 2D-PD once the endometrium was ≥7 mm thick. Group A consisted of 127 women showing the presence of subendometrial-endometrial blood flow. Group B comprised of 38 women in whom subendometrial blood flow was absent. Progesterone supplement was added and transfer of 2-3 cleavage stage good quality embryos was done after 3 days.STATISTICAL ANALYSIS:Independent two-tailed t-test and Chi-square test.RESULTS:There was no significant difference in body mass index, endometrial thickness, follicle stimulating hormone, luteinizing hormone levels, number of mature oocytes, semen parameters and the number of good quality embryos in the two groups (P > 0.05). The mean age in Group A was 32.05 years and 33.73 years in Group B, and the difference was statistically significant (P = 0.04). Overall pregnancy rate (PR) was 30.90%. PRs were significantly higher in the presence of subendometrial-endometrial blood flow than in its absence (35.43% vs. 15.78%, P = 0.02). Furthermore, clinical pregnancy rate and implantation rate were significantly higher in Group A when compared to Group B (31.49% and 14.79% vs. 13.15% and 6.52%, P = 0.02 and 0.03, respectively).CONCLUSION:The presence of endometrial blood flow significantly improves cycle outcome in hormone replacement therapy-FET cycles.
We present a case of sonographic demonstration of quadruplet heterotopic pregnancy consisting of twin intrauterine (IU) pregnancy and a twin adnexal pregnancy after ovulation induction (OI) with clomiphene citrate (CC) and timed intercourse (TI). Both heterotopic pregnancy and spontaneous twinning are frequent after OI, this combination although extremely rare must be kept in mind. The role of early transvaginal sonography and serum beta human chorionic gonadotrophin after missed periods helps in early diagnosis. It gives us an opportunity for medical management, saving the patient the agony of surgery along with loss of pregnancy. The management of heterotopic pregnancy is controversial. This patient did not have a viable IU pregnancy and both the sacs in the adnexa were small. Thus, we treated her successfully by medical management with systemic methotrexate, with regular follow-up. This patient successfully conceived after 6 months with OI and TI, with ovulation occurring from the same side of the previous ectopic. She had a viable IU gestation corresponding to 12 weeks.
To re-examine the value of amniotic fluid index at admission in labour (aAFI) as a predictor of intrapartum fetal status, in 326 term pregnancies at their admission in labour, labour admission test (LAT) and antepartum risk status were recorded. The different categories were correlated with fetal/neonatal outcome. There were 68.7% women at low risk on the Minnesota scale for antepartum status. The proportion of women with low aAFI (≤5 cm) was higher in the high-risk group (8 of 12, 64%, p = 0.0001) and occurrence of significantly higher non-reassuring fetal status (NRFS; 10 of 12 with low AFI, 83%, p = 0.0001). Number recording LAT as non-reactive trace (41 cases) was similar irrespective of the pregnancy status (24 and 17 in low- and high-risk cases, respectively) and fetal status through labour (21 and 20 in fetuses with NRFS and otherwise, respectively). Negative predictive value was similar between the groups (88% for aAFI and 89% for LAT), and LAT was found to be more specific (91%) than 64% for aAFI. Sensitivity and positive predictive values were poor in both. It is concluded that aAFI is not a reliable screening test to predict intrapartum fetal compromise.
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