Velamentous Cord Insertion: Interest of Antenatal Diagnosis and Review of the Literature

Velamentous insertion of the umbilical cord corresponds to the insertion of the cord directly on amniotic membranes. It is a rare situation whose frequency varies from 0.5% to 1.69% of single pregnancies. It must be diagnosed during the morphological ultrasound of the 2nd trimester, actively looking for the association with a vasa previa, due to the risk of fetal haemorrhagic threat. We report an antenatal diagnosis of velamentous cord insertion and its management with literature review.

Ectopic Cornual Pregnancy: Case Report

This article showcases a clinical case of ectopic pregnancy lodged in the cornual. A pregnancy implanted in this location is a rarity, making it difficult to diagnose. By describing this case and screening of the literature, we explain the various diagnostic and therapeutic methods, both medical and surgical. Highlighting the importance of conservative treatment flush with the uterine horn, and conclude with some practical recommendations.

Dual Trigger in <i>in Vitro</i>Fertilization: A Case-Control Study

Objective: To evaluate the benefit of dual trigger (hCG + GnRH agonist) in patients underwent controlled ovarian stimulation for IVF in an antagonist protocol. Methods: A retrospective case control study was performed (January 2017 to March 2019) in a single IVF center. The dual trigger group (n = 17), ovulation trigger was achieved with both hCG and GnRH agonist while in the single trigger group (n = 34), it was achieved by hCG alone. The first endpoint was the number of mature oocytes retrieved;the secondary endpoints were total number of oocytes retrieved, the number of cleaved embryos obtained (day 3) and blastocysts (day 5/day 6), the number of embryos transferred, the ongoing-pregnancy/miscarriage rate. Results: The dual vs. the single group showed the followings. The number of retrieved oocytes of 7.1 vs. 6.4 (p = 0.68);mature oocytes of 4.6 vs. 4.1 (p = 0.62), day-3-embryos of 2.9 vs. 2.0 (p = 0.2), day-5/6-embryos of 0.3 vs. 0.03 (p = 0.13), transferred embryos of 2.1 vs. 1.8 (p = 0.48);ongoing pregnancy of 1 vs. 9 (p = 0.14);miscarriage of 0 vs. 2 (p = 1). Conclusion: A dual trigger showed no additional clinical benefits. Future large studies are needed to demonstrate a real clinical advantage.

Conservative Management of Placenta Accreta of Seven Cases

Introduction: Placenta accreta is a potentially life threatening obstetrical condition. The incidence has increased. Diagnosis before delivery allows multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality. Prenatal ultrasonography is used to support the diagnosis and guide clinical management leading probably to favorable outcomes. Actually a conservative option which includes leaving all or part of the placenta in situ when fertility preservation is desired is recommended. Methods: We retrospectively reviewed the medical records of all patients diagnosed with placenta accreta in gynecology-obstetrics department of the university hospital Mohammed the VI of Marrakesh;Morocco;from January the first 2014 to January the second 2016. Results: We found seven cases. We described: The epidemiological characteristics, risk factors, management of placenta accreta, outcomes and prognosis. The incidence of placenta accreta was 1/3847 deliveries. The mean term of delivery was 35 weeks. We have adopted a successful conservative treatment in six cases (71.4%). The radical treatment was adopted in one patient initially admitted for severe post-partum hemorrhage;the prognosis was good in 85.7% cases. Conclusion: Conservative management of placenta accreta is a safe and efficient and is an interesting alternative for hysterectomy.