scholarly journals Subarachnoid haemorrhage in pregnancy after in vitro fertilisation with egg donation: a case report and review of the literature

2021 ◽  
Vol 15 ◽  
pp. 263349412110235
Author(s):  
Noemi J. Hughes ◽  
Saeed M.S.R. Choudhury ◽  
Sidath H. Liyanage ◽  
Munawar Hussain
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Rare Case ◽  
Egg Donation ◽  
In Vitro Fertilisation ◽  
Arterial Aneurysm ◽  
Matrix Metalloprotease ◽  
Review Of The Literature ◽  
Cerebrovascular Accidents ◽  
Increase Risk

We report a rare case of in vitro fertilisation (IVF) with egg donation complicated by a subarachnoid haemorrhage (SAH). Haemostatic changes related to IVF are known to increase risk of venous thrombosis; however, less is known regarding the risk of arterial events such as cerebrovascular accidents (CVA). Matrix metalloprotease-9 (MMP-9) upregulated in IVF patients may have a role in arterial aneurysm formation, which is the most common cause of SAH. Further research is required to assess the benefit of screening for risk of CVA and the best way to manage this in the IVF population. This may have implications for the ethics of offering certain procedures such as egg donation to women with pre-existing risk factors.

Rare case of obstetric cholestasis presenting in the first trimester following in vitro fertilisation

2021 ◽  
Vol 14 (7) ◽  
pp. e244254
Author(s):  
Krystal Koh ◽  
Rajeswari Kathirvel ◽  
Manisha Mathur
Keyword(s):  
Rare Case ◽  
First Trimester ◽  
In Vitro Fertilisation ◽  
High Dose ◽  
Third Trimester ◽  
Asian Ethnicity ◽  
The Third ◽  
South Asian Ethnicity ◽  
History Of

Intrahepatic cholestasis of pregnancy (ICP) generally presents in the third trimester with pruritus without a rash, characterised by elevated bile acids, with or without transaminitis and hyperbilirubinaemia. Risk factors include a family history of cholestasis, South Asian ethnicity, multifetal gestation, in vitro fertilisation (IVF) and history of hepatitis or biliary disorders.IVF involves the use of high dose gonadotropin stimulation and human chorionic gonadotropin trigger. High doses of progesterone supplementation are additionally given after embryo transfer. The increase in oestrogen and progesterone levels early on in the pregnancy is a possible explanation for the development of ICP in IVF pregnancies at earlier gestations.We present a rare case of iatrogenic ICP presenting in the first trimester in a pregnancy conceived by IVF. Unlike other cases reported, our patient did not have recurrence of ICP in the third trimester, and also had no history of ICP in her first pregnancy.

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