The administration of human serum albumin has been reported to prevent severe ovarian hyperstimulation syndrome (OHSS) while undergoing ovarian stimulation protocols for in-vitro fertilization (IVF). This prospective, randomized study investigated the effectiveness of a single dose of human serum albumin (20 g) administered i.v. immediately after oocyte retrieval. Women enrolled in the IVF programme were treated with long gonadotrophin-releasing hormone agonist, triptorelin, and an individually-adjusted human menopausal gonadotrophin protocol. The criteria for inclusion in the study were young age, non-obesity, oestradiol concentration > 9200 pmol/l on the day of human chorionic gonadotrophin administration and > 20 follicles > 14 mm diameter as observed by transvaginal sonography. The treatment group (n = 22) received albumin while the control group (n = 18) did not. Patients were followed-up using ultrasound every 3 days. There was a significantly higher number of severe OHSS cases in the control group (n = 4) than in the treatment group (n = 0) (P = 0.035). Where the data base was restricted to patients with an oestradiol concentration > 15,000 pmol/l, the difference between control and treatment groups was highly significant (P = 0.008). These findings support the use of i.v. albumin in preventing severe OHSS during IVF treatment.
Fifty-five patients with non-vertex presentation at 37 to 40 weeks' gestation were evaluated to determine which factors were associated with a successful external cephalic version (ECV). Maternal parity, obesity, amniotic fluid volume, placental location, type of breech and position of fetal spine were analyzed. Only amniotic fluid volume and fetal weight were significantly associated with a successful version (p < 0.05), 40/55 (73%) were successfully converted, 36/55 (65%) were vertex at delivery, and 32/55 (58%) delivered vaginally. Version attempts were successful in six out of eight patients who had undergone a previous cesarean section. Two out of six of the successful version patients went on to have vaginal birth after cesarean section. We conclude that although ECV is a reasonable alternative in the management of pathological presentation near term it should be performed only when there is sufficient amniotic fluid volume.
In this survey, different aspects of treatment and PDPH management were examined. EBP is considered the gold standard in treating PDPH, although prophylactic blood patch is ineffective. We observed a tendency of very low performance of both prophylactic EBP and epidural normal saline administration after delivery in most centers. Most hospitals perform EBP after 24-48 hours of conservative treatment, along with published recommendations that show increased EBP efficiency with this timeframe. In light of the survey information, we aim to reach a uniform literature-based management strategy across Israeli hospitals.
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