We report a prospective study on the use of sublingual glyceryl trinitrate at Caesarean section to induce uterine relaxation; 23 women were entered into the study with both emergency and elective cases considered. A metered dose spray was used to deliver a dose of 400 or 800 microgrammes of glyceryl trinitrate to the women. There were no major side-effects of hypotension or postpartum haemorrhage. The mean maximal systolic blood pressure drop in the patients following drug administration was 18% of the systolic pressure prior to drug administration. Subjective assessment of uterine tone showed the uterus to contract well postdelivery in response to standard oxytocic regimens. Minimal maternal side-effects were reported. We conclude that glyceryl trinitrate is a safe form of uterine relaxation at Caesarean section which may be used in emergency situations and may also be given prophylactically in cases such as breech presentation and in delivery of the preterm infant where fetal trauma is possible. The use of a metered-dose sublingual spray is ideally suited to obstetric practice, being both easy to use and also rapidly administered.
Background: Ovarian torsion accounts for 2.7% of the surgical emergencies in women 1 yet remains a morbid and frequently misdiagnosed condition 2 . Aim: Here we describe a case of ovarian torsion prior to administration of the trigger in a 35-year-old multigravida undergoing controlled ovarian stimulation on a background of bilateral salpingectomy, along with the outcome of post detorsion oocyte pick up. Result: An antagonist protocol was used with a follicular count on day 12 confirming eight follicles in each of the right and left ovaries. The day prior to the planned GnRH agonist trigger, she developed a sudden onset of severe abdominal pain associated with vomiting. Urgent laparoscopy demonstrated a 720-degree torsion of the right ovary, which was detorted without complication. The patient was discharged home on the same day, a trigger was administered, and oocyte retrieval completed as per schedule. Post torsion 11 oocytes were collected, four from the left and seven from the right, a final embryo cryopreservation rate of 57% from the affected right ovary compared with 50% from the left ovary was achieved. Conclusion: In vitro fertilisation is a recognised risk factor for ovarian torsion 2 . Here we report the first case of a torsion in a woman prior to the administration of a trigger, who successfully underwent detorsion with salvage of oocytes collection and embryo cryopreservation.
Background: Platelet rich plasma (PRP) is well researched and utilized in many medical fields to increase angiogenesis, tissue healing and regeneration a . Recent studies have reported that intra-uterine PRP infusions when used during frozen embryo transfer (FET) cycles, can similarly affect endometrial proliferation, resulting in decreased cycle cancellation rates and improved endometrial thickness and pregnancy outcomes in women with thin linings b , c Aim: To establish if intra-uterine PRP infusions can increase endometrial thickness and improve pregnancy rates in women with a history of thin endometrial lining. Method: An analysis of all PRP infusions and their FET cycles undertaken at Ballarat IVF between November 2020 and May 2021 was performed. Patients with a history of thin endometrial lining were offered a PRP infusion from day 6 of their cycle, followed by a second infusion 2-3 days later. Endometrial thickness was measured by ultrasound prior to PRP infusion, post infusion #1/prior to PRP infusion #2, and post PRP infusions, and pregnancy outcomes collected. Results: Thirty patients were offered PRP infusions prior to their FET cycle and all 30 patients received one infusion of PRP. Twenty-six patients went on to receive a 2nd PRP infusion. Twenty-five patients had an FET, only one cycle was cancelled due to poor endometrial thickness. Average Endometrial thickness increased by 0.8mm after each PRP infusion; from 6.2mm prior to PRP infusion, to 7.0mm prior to PRP infusion #2, to 7.8mm post PRP infusions. Clinical pregnancy rates and ongoing pregnancy rates were 48%* and 24%* respectively (*two scans pending: anticipated rates 48% and 28% respectively). Conclusion: Intra-uterine Platelet Rich Plasma infusions prior to a FET appear to offer a safe method to increase endometrial lining in women with a history of thin endometrium, allowing these cycles to proceed to an embryo transfer. Clinical pregnancy rates are increased compared to women who have no history of thin endometrial lining. Despite increased implantation, ongoing pregnancy rates (defined by a fetal heart) are decreased compared to women with no history of a thin lining. A longer-term study on a larger number of patients is required to confirm the effectiveness of this technique on live birth rates.
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