Lifting the veil of secrecy: maternal and neonatal outcome of oocyte donation pregnancies in Germany

Background In Germany, performing fertility procedures involving oocyte donation is illegal, as stated by the Embryo Protection Law. Nonetheless, in our clinical routine we attend to a steadily rising number of pregnant women, who have sought oocyte donation abroad. Due to the legal circumstances many women opt to keep the origin of their pregnancy a secret. However, studies have shown, that oocyte donation is an independent risk factor for the development of pregnancy complications, such as preeclampsia. Objective The aim of this study is to evaluate maternal and neonatal outcomes of oocyte donation pregnancies in three large obstetric care units in Berlin, Germany. Methods We retrospectively analyzed all available medical data on oocyte donation pregnancies at Charité University hospital, Vivantes Hospital Friedrichshain, and Neukoelln in the German capital. Results We included 115 oocyte donation (OD) pregnancies in the present study. Our data are based on 62 singleton, 44 twin, 7 triplet, and 2 quadruplet oocyte donation pregnancies. According to our data, oocyte donation pregnancies are associated with a high risk of adverse maternal and fetal outcome, i.e., hypertension in pregnancy, preterm delivery, Cesarean section as mode of delivery, and increased peripartum hemorrhage. Conclusion Although oocyte donation is prohibited by German law, many couples go abroad to seek reproductive measures using oocyte donation after former treatment options have failed. OD pregnancies are associated with a high risk of preeclampsia, C-section as mode of delivery, and peripartum hemorrhage. Detailed knowledge of the associated risks is of utmost importance to both the patient and the treating physician and midwife.

Frequency and Types of Red Cell Alloantibodies in Pregnant Females

Introduction: Maternal isoimmunization, also called alloimmunization, occurs when immune system of a pregnant female is sensitized to foreign RBC surface antigen producing immune process. This maternal blood when goes to fetal circulation, causes immune reaction and disease in case of maternal and fetal blood group differences. Aims & Objectives: To find out the frequency and types of red cell alloantibodies among females presenting to antenatal care and recognize risk factors for alloimmunization. Place and duration of study: This cross-sectional descriptive study was carried out at Antenatal Clinic of Shaikh Zayed Hospital, Lahore from 1st January 2013 to 31st August 2013. Material & Methods: Pregnant females with at least one previous pregnancy were typed for ABO and Rh antigens. They were screened and typed for red cell alloantibodies. Detailed history was taken to explore for the risk factors. SPSS version 20.0 was used for data analysis, frequencies of different alloantibodies, blood groups and risk factors reported as percentages, age and gravidity in mean±s.d. Results: Out of 200 enrolled cases, 6(3%) had alloantibodies. Of the positive cases, anti-D was found in 3(50%), anti-C in 2(33.33%) and anti-Kell in 1(16.67%). Commonest risk factors were history of peripartum hemorrhage and gynecological procedures. In Rh-negative cases, disparity of spouse Rh group was also main factor. Conclusion: The most common culprit antibody for alloimmunization was anti-D followed by anti-Kell and anti-C. Commonest risk factor for alloimmunization was pregnancy related bleeding and gynecological procedures. Large population-based studies are required to assess true magnitude of the problem.

Emergency peripartum hysterectomy: a 7-year review at tertiary hospital

Emergency peripartum hysterectomy (EPH) is a major obstetric procedure, usually performed as a life-saving measure in cases of intractable obstetric hemorrhage. The aim of this study was to determine the incidence, indications and the risk factors and complications of emergency peripartum hysterectomy (EPH). The medical records of 13 patients who had undergone EPH, between January 2012 and December 2018, were reviewed retrospectively. All necessary data was obtained by record review. The mean age of pregnant women was 30 year. There were 13 EPHs out of 15768 deliveries, a rate of 0.82 per 1,000 deliveries. Out of 13 women who underwent EPHs, 8 hysterectomies were performed after cesarean delivery and 5 after vaginal delivery. The most common indication for hysterectomy was abnormal placentation (7/13), followed by atony (4/13), rupture of scared uterus (1/13) and rupture of unscared uterus (1/13). There were two cases of intra-operative bladder injury, we had 1/13 maternal death because of EPH. There were no cases of neonatal mortality. In our series, abnormal placentation was the most common of indication for EPH. The risk factors for EPH were previous CS for abnormal placentation and placental abruption for uterine atony and peripartum hemorrhage. Limiting the number of CS deliveries would bring a significant impact on decreasing the risk of EPH.

The Obstetric Patient for Cardiac Surgery

Cardiac disease is the second leading cause of morbidity and mortality in pregnancy behind peripartum hemorrhage. In developed countries, a majority of cardiac disease in pregnancy is secondary to congenital heart defects, whereas in developing countries, mitral stenosis secondary to rheumatic fever prevails as the leading cause of cardiac disease during pregnancy. There is added workload on the heart during pregnancy due to the increased blood volume and cardiac output of the parturient. In patients with preexisting cardiac disease, this added workload may lead to decompensated congestive heart failure. Alternatively, such physiologic changes may unmask an unknown cardiac lesion in an unsuspecting patient. Medical management is always the first-line treatment of the pregnant patient with decompensated heart failure. However, if medical management has failed, cardiac surgery with cardiopulmonary bypass may be necessary. Due to the unique maternal physiology and the presence of not only one but also two patients, anesthesia, cardiac surgery, and cardiopulmonary bypass come with specific challenges, hemodynamic goals, and ethical dilemmas.

Progressive Devascularization: A Novel Surgical Approach for Placenta Previa

Background The gold standard for antenatal diagnosis of placenta previa is the transvaginal ultrasonography. In placenta previa cases, separation of placental and uterine tissues is challenging even for the most experienced surgeons. Life-threatening obstetrical complications from cesarean deliveries with placenta previa include peripartum hemorrhage, coagulopathy, blood transfusion, peripartum hysterectomy, and multiple organ failure. Cases We detailed the 3 cases of placenta previa that underwent bilateral uterine artery ligation; if hemostasis was not achieved, horizontal mattress sutures were placed in the lower uterine segment. All patients were discharged with minimal morbidity. Conclusion For patients with placenta previa and low risk for placenta creta, counseling should include the risk for maternal morbidity and criteria for pursuing peripartum hysterectomy. Our devascularization, a stepwise surgical approach, shows promising outcomes in placenta previa cases. Précis We propose a novel surgical approach, using a progressive devascularization surgical technique, for management of women with placenta previa, undergoing cesarean delivery.

Safety of pregnancy in uterine fibroids

Uterine fibroid is one of the most common intrauterine masses among females at the reproductive age. Pregnancy and uterine fibroids are highly correlated. Pregnancy-related hormones influence the size of uterine fibroids, and fibroids have many impacts on pregnancy. Although most if the uterine fibroids are asymptomatic during pregnancy, serious complications may occur. The main complications include abortion, premature rupture of membranes, premature labor, abruptio placentae, peripartum hemorrhage, fetal malpresentation, fetal intrauterine growth retardation, small for gestational age infants, and fetal anomalies. The main risk factors for complications are related to the fibroid number, size, volume, location, and type. Large, multiple, retroplacental, submucosal, subserosal, pedunculated, or low-lying fibroids carries the highest risk for complications during pregnancy. This review will address the prevalence of uterine fibroids during pregnancy, its effects, and complications.