Obesity in Relation to Ovarian Response in IVF Treatment

Introduction: The effect of Body Mass Index (BMI), which reflects the woman’s obesity, in IVF treatment cycle, remains unclear. In 1997, the World Health Organization (WHO) provided authoritative refinements to the over-weight terminology and BMI cutoffs [1]. Objective: To verify the relationship between BMI and ovarian response in IVF treatment cycle. Design: Retrospective study. Materials & Methods: The study includes 2625 IVF treatment cycles performed in our IVF center in the period of 4 years. Patients were divided into five groups using the WHO criteria according to their BMI [2]. Cancellation rate, mean last E2 before hCG administration, mean endometrial thickness, mean duration of stimulation, number of eggs retrieved, fertilization rate, pregnancy and abortion rates were analyzed. The unpaired t-test was used in statistical analysis. Results: There was statistically significant less mean oestradiol level prior to hCG, less endometrial thickness and less number of simulation days as BMI gets higher. In contrast, there was a positive relationship between cancellation rate and higher BMI except with BMI >39 which was not, possibly due to lower number of patients available. But if we look at the cause of cancellation, it was 100% due to insufficient number of follicles obtained for this group (BMI >39). Also, days of stimulation are significantly lower for the same group of patients in comparison with the other groups. Retrieval, fertilization and pregnancy rates were not significant between all groups. Abortion rate gets significantly higher as BMI increased. Conclusion: Overweight affects ovulation, if we consider the cause of cancellation being insufficient number of follicles reflects the poor response. The fertilization and pregnancy rate were not affected once oocytes retrieved. The reduction of weight is an important part of infertility treatment in obese women with regards to the ovarian response and abortion rate in IVF cycle.

Vaginal Birth after a Cesarean Section at Good Shepherd Mission Hospital at Tshikaji in Democratic Republic of the Congo (DRC)

Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1st to December 31st, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.

应用高剂量和低剂量催产素加强产力的效果比较

Objective: To compare the efficacy and safety of high dose oxytocin in the augmentation of labor. Method: Two hundred pregnant women requiring augmentation of labor were randomly assigned to receive oxytocin by either a low dose protocol (1.5 μ M/min initially, increased by 1.5 μ M/min every 30 min) or a high dose protocol (4.5 μ M/min initially, increased by 4.5 μ m/min every 30 min) Results: High dose of oxytocin was associated with a significant shortening of labor 4 (1.10- 10) vs. 6 (1- 10) h, p< 0.0001 without a significant difference in cesarean delivery rate, neonatal and maternal outcome. Conclusion: The use of high dose oxytocin is associated with significantly shorter labor without any adverse fetal and maternal effects.