Case series on mullerian anomalies incidence during caesarean section over one year period

Congenital uterine anomalies occur due to abnormal fusion of Mullerian duct during embryonic life. It is associated with high incidences of reproductive failures and adverse obstetrical outcomes. It may be associated with malpresentation, preterm labour or recurrent pregnancy losses. The association of congenital anomalies and early pregnancy loss has been well established but its adverse effect on late pregnancy in form of malpresentation, preterm deliveries has not yet been elaborated. Hence, this case series aimed to summarize the incidence and perinatal outcome of pregnancy in women with congenital uterine anomalies undergoing cesarean section. This was a case series which was conducted on women who underwent cesarean section at P. C. Sethi hospital, Indore between time period of October 2020 to September 2021. Out of total 1835 cesarean undergoing patients, 12 patients were found to have uterine anomalies. Out of 12 patients, 9 (75%) patients were associated with malpresentation, 4 (33.3%) patients had preterm delivery and 6 (50%) patients had low birth weight babies. Hence it can be said that women with congenital uterine anomalies were at higher incidence of malpresentation and preterm deliveries. Presence of congenital uterine anomalies were associated with adverse obstetrical outcome. This knowledge warrants the need for a larger case control study to extrapolate these findings to the general population and also to recommend the need for universal prenatal screening for uterine anomalies to improve the obstetrical and perinatal outcome in patients with uterine anomalies.

Evaluation of materno-fetal antibody transfer in patients with antiphospholipid syndrome

Introduction: Antiphospholipid syndrome (APS) is characterized by thrombotic events and recurrent pregnancy losses and is considered the most common acquired thrombophilia.Objective: To carry out a narrative review of the transplacental passage and antibodies in patients with APS.Methods: A narrative literature review.Results: When it is not associated with any connective tissue disease, it is said to be primary, and when in association with systemic lupus erythematosus, it is said to be secondary. Gestational morbidity is frequent, and it is crucial to evaluate the passage of these antibodies transplacentally since there are animal models of the syndrome with passive transfer of these antibodies. The transplacental passage of specific antibodies has already been determined in studies, which demonstrated low levels of these antibodies in the maternal serum, but an efficient transplacental passage for the newborn.Conclusions: There are few studies on this maternal-infant passage in patients with APS reviewed here.

Immunotherapy for Recurrent Pregnancy Loss: A Review

Modern medicine has made extraordinary progress in the last few decades. But little success has been achieved in the management of recurrent pregnancy losses and implantation failures post in vitro fertilization. It results in extreme duress and financial burden on the couples seeking treatment. To prevent such pregnancy losses a lot of new therapies are offered to them. Immunotherapies like Allogenic Lymphocyte Immunization, Corticosteroid therapy, Intravenous Immunoglobulin, etc., are being researched and tried. We searched current literature for evidence pertaining to all the different immunotherapies for treatment. We studied trials, meta-analyses and review articles on it. This review has summarized the current status of research and evidence on all these therapies. We concluded that the causation and mechanism of alteration of immune system has been well documented in most of the therapies. Clinical evidence indicating definite benefit is conflicting and at times lacking. More research and studies need to be done to validate these therapies for routine clinical use. Keywords: Recurrent pregnancy loss, Recurrent implantation failure, Immunotherapy, Abortions.

O-236 The clinical and morphokinetic factors indicating a risk of pregnancy loss after a euploid embryo transfer

Study question Are there any clinical and morphokinetic factors which may affect the pregnancy outcome after a euploid embryo transfer? Summary answer Body mass index (BMI), endometriosis, the history of recurrent pregnancy losses and the number of previous frozen-thawed unsuccessful embryo transfer (FET) cycles impact pregnancy outcomes. What is known already Preimplantation genetic testing for aneuploidy (PGT-A) is largely used for various indications to detect chromosomal abnormalities in assisted reproductive technologies (ART). The most common reason for the first trimester pregnancy losses is chromosomal abnormalities. However, the factors that cause pregnancy loss after a euploid embryo transfer are not fully understood. Study design, size, duration The pregnancy results of all single euploid embryos tested with next generation sequencing (NGS) in Istanbul Memorial Hospital between January 2017 and March 2020 were evaluated in this single center retrospective cohort study. The cases that resulted in pregnancy below the age of 43 were analyzed according to outcomes; biochemical pregnancy loss (Group 1), clinical pregnancy loss (Group 2) and live birth (Group 3). Participants/materials, setting, methods The transfer of 2041 single euploid embryos resulted in 1492 pregnancies. The clinical and morphokinetic parameters observed using time lapse imaging (TLI) were compared among the three groups. Main results and the role of chance The overall pregnancy rate was 73.1%, the rates of biochemical pregnancy losses and clinical losses were 9.7% and 11.4% respectively. The live birth rate was 58.5%. The indications for PGT-A were as follows; recurrent pregnancy losses (RPL) (14.9%), recurrent implantation failure (RIF) (11.7%), advanced maternal age (AMA) (28.6%), a history of abnormal fetal karyotype or single gene defects (12.1%). In 32.6% cases PGT-A was performed to reduce time to pregnancy. There were no differences in terms of female age, AMH, the diagnosis or the duration of infertility, the mean numbers of oocytes retrieved, mature and fertilized oocytes. However, BMI values, the presence of severe endometriosis, including adenomyosis, the history of recurrent pregnancy losses and the number of previous unsuccessful FET cycles were significantly higher in Groups 1 and 2. When pregnancy losses were evaluated according to PGT indications, patients with a history of RPL had a significantly higher pregnancy loss rate (27.8%) compared to the other groups: AMA (19.6%), RIF (19.4%), genetic factors (21.6%) and cases where PGT was performed to reduce time to pregnancy (16.4%) (p < 0.05). When morphokinetic parameters were evaluated, they were found to be not significantly different in the three groups (p > 0.05). Limitations, reasons for caution The retrospective nature of the data is the major limitation of the study. On the other hand, the strength of the study is the large number of PGT-A tested embryos from a single center which used the same laboratory conditions. Wider implications of the findings PGT-A is widely used to avoid pregnancy losses. However, BMI values, the presence of severe endometriosis, including adenomyosis, the history of recurrent pregnancy losses and the number of previous unsuccessful FET cycles should be taken into consideration during counselling and/or treatment. Trial registration number not applicable