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To compare the prevalence of placental abnormalities in pregnancy following different modes of operative myomectomy.A retrospective cohort study, including all women after myomectomy that gave birth in a single tertiary care center from February 2011 to January 2019. Data was collected from the patients' medical files and completed by telephone questionnaire. Patients were stratified to 3 groups, according to the mode of operative myomectomy (laparotomy, laparoscopy, hysteroscopy). Groups were compared for women demographics, fibroid's characteristics, operative management, post-operative placental evaluation and delivery characteristics. Primary outcome was defined as the need for any intervention for placental separation during the third phase of the delivery.Two hundred forty one women met inclusion criteria. Complete follow-up was achieved in 199 (82.57%) women, of whom 82, 89, and 28 underwent laparoscopic, laparotomy and hysteroscopic myomectomy, respectively. There were no in-between groups differences in women's age, BMI, and gravidity. Disruption of the endometrial cavity during laparoscopy and laparotomy was reported in 3 (3.6%) and 7 (7.8%) cases, respectively (Subsequent pregnancy following surgical myomectomy was not found to be associated with higher prevalence placental abnormality. Furthermore, other than manual lysis, the different modes of myomectomy did not necessitate any further intervention for complications associated with abnormal placentation requiring intervention.Subsequent pregnancy following surgical myomectomy is not associated with higher prevalence of placental abnormality.

A pseudoaneurysm of the uterine artery or its branches is usually a result of vascular trauma during invasive procedures such as a cesarean section, vaginal delivery, myomectomy, hysterotomy, or dilatation and curettage. A uterine artery pseudoaneurysm rupture is a rare, yet life-threatening event. Deep infiltrating endometriosis usually involves a decrease in symptoms and imaging findings throughout pregnancy, with the notable exception of the phenomenon of decidualization. We present the case of a pregnant woman with a recent diagnosis of endometriosis, who conceived spontaneously and presented with disabling pain at 13 weeks' gestation. She was diagnosed with a left, huge (and rapidly growing) retrocervical endometriosis nodule encompassing a uterine artery pseudoaneurysm. Selective transarterial embolization was performed at 22 weeks' gestation owing to enlargement of the pseudoaneurysm sac, and the pseudoaneurysm was obliterated successfully. The patient was followed intensively throughout the pregnancy and the baby was delivered at term by cesarean section. After delivery, the nodule returned to the pregestational size.

OBJECTIVE: To develop a standardized sonographic evaluation and reporting system for Cesarean scar pregnancy (CSP) in the first trimester, for use by both general gynecology and expert clinics. METHODS: A modified Delphi procedure was carried out, in which 28 international experts in obstetric and gynecological ultrasonography were invited to participate. Extensive experience in the use of ultrasound to evaluate Cesarean section (CS) scars in early pregnancy and/or publications concerning CSP or niche evaluation was required to participate. Relevant items for the detection and evaluation of CSP were determined based on the results of a literature search. Consensus was predefined as a level of agreement of at least 70% for each item, and a minimum of three Delphi rounds were planned (two online questionnaires and one group meeting). RESULTS: Sixteen experts participated in the Delphi study and four Delphi rounds were performed. In total, 58 items were determined to be relevant. We differentiated between basic measurements to be performed in general practice and advanced measurements for expert centers or for research purposes. The panel also formulated advice on indications for referral to an expert clinic. Consensus was reached for all 58 items on the definition, terminology, relevant items for evaluation and reporting of CSP. It was recommended that the first CS scar evaluation to determine the location of the pregnancy should be performed at 6-7 weeks' gestation using transvaginal ultrasound. The use of magnetic resonance imaging was not considered to add value in the diagnosis of CSP. A CSP was defined as a pregnancy with implantation in, or in close contact with, the niche. The experts agreed that a CSP can occur only when a niche is present and not in relation to a healed CS scar. Relevant sonographic items to record included gestational sac (GS) size, vascularity, location in relation to the uterine vessels, thickness of the residual myometrium and location of the pregnancy in relation to the uterine cavity and serosa. According to its location, a CSP can be classified as: (1) CSP in which the largest part of the GS protrudes towards the uterine cavity; (2) CSP in which the largest part of the GS is embedded in the myometrium but does not cross the serosal contour; and (3) CSP in which the GS is partially located beyond the outer contour of the cervix or uterus. The type of CSP may change with advancing gestation. Future studies are needed to validate this reporting system and the value of the different CSP types. CONCLUSION: Consensus was achieved among experts regarding the sonographic evaluation and reporting of CSP in the first trimester. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. ispartof: ULTRASOUND IN OBSTETRICS & GYNECOLOGY vol:59 issue:4 pages:437-449 ispartof: location:England status: published

Aim To investigate the clinical and the sonographic characteristics of adnexal torsion (AT) during pregnancy and to underline differences in AT manifestation between pregnancy trimesters. Methods This is a retrospective cohort study in a tertiary medical center. The study included all pregnant women with surgically confirmed AT between March 2011 and April 2020. The patients were divided into three groups according to pregnancy trimesters, and the clinical and sonographic characteristics were compared between the groups. Results The study cohort included 140 cases of AT. Ninety-nine (70.7%) of the cases occurred during the 1st trimester, and 31 (22.1%) and 10 (7.1%) occurred during the 2nd and the 3rd trimesters, respectively. Conception by assisted-reproductive technologies (ART), nausea, and finding of enlarged ovary on ultrasound scan were all more common among patients in the 1st trimester group as compared to the 3rd trimester group (p = 0.001, 0.015, and 0.024, respectively). The mean time from admission to surgery was significantly shorter in the 1st trimester group as compared to late pregnancy (p = 0.001). The majority of cases were right-sided. There was a significant difference in the organs involved in every trimester of pregnancy-ovary only, ovary and fallopian tube, and fallopian tube only (p = 0.023). Conclusions Most AT cases during pregnancy occurred during the 1st trimester. Conception by ART and enlarged ovary on ultrasound scan were also more common in AT cases during early pregnancy. Time from admission to surgery was longer as pregnancy progressed and organs involved differed between trimesters. Understanding the difference in manifestation of AT in every trimester might improve the preoperative evaluation of AT in pregnancy.

The incidence of caesarean scar pregnancy (CSP) increases in recent years. Yet, the best mode of treatment and its effects on successive pregnancies is not well established. The aim of this study was to investigate the success rate of single-dose methotrexate (MTX) in the management of CSP, and the outcomes of subsequent pregnancies in a retrospective cohort study. All women who were treated for CSPs between the years 2011 and 2019 were included. Treatment included systemic MTX and ultrasound-guided needle aspiration (UGNA) in cases with active foetal heartbeat. Overall, 34 women were diagnosed with CSP, of whom 31 were treated with systemic MTX. Twelve patients (38.7%) needed additional curettage or hysteroscopy. The only identified risk factor for failure of MTX-based treatment was time interval between the previous caesarean delivery and CSP (22 vs 34 months, p = 0.04). Twelve women had a subsequent pregnancy. Five pregnancies ended in term delivery, three in preterm delivery, three in abortion and one woman had a recurrent CSP. The study conclusion is that a single dose MTX with UGNA in cases of active heartbeat is an effective mode of treatment in cases of CSP with good sequential pregnancy outcomes. Longer time interval from the previous caesarean delivery was identified as a risk factor for failure of conservative management.

To evaluate pregnancy outcomes of women with surgically confirmed adnexal torsion (AT) as compared to those in whom AT was ruled out.A retrospective cohort study in a tertiary medical center. All pregnant women who underwent diagnostic laparoscopy due to suspected AT between 3/2011 and 4/2020 were included. We compared maternal, delivery and neonatal outcomes of both groups. We further compared women with confirmed AT to a control group of women who did not undergo laparoscopy during pregnancy.During the study period, 112 women met the inclusion criteria. AT was confirmed in 93 cases (83.0%). Baseline characteristics did not differ between groups, excluding the rate of previous AT [5.4% in the torsion vs. 26.3% in the no-torsion group, odds ratio (OR) 0.15, 95% confidence interval (CI) 0.04-0.62,Pregnancy outcomes among women who underwent laparoscopy for a suspected AT during pregnancy were reassuring, irrespective of the surgical findings and gestational week. Outcomes did not differ when compared to pregnant women who did not undergo laparoscopy.Maternal, fetal and neonatal outcomes among women who underwent laparoscopy for suspected adnexal torsion during pregnancy are reassuring, irrespective of the surgical findings and gestational week.

The study aimed to perform external validation of the International Ovarian Tumor Analysis (IOTA) classification of adnexal masses as benign or malignant in women with suspected endometrioma. A retrospective study including women referred to an endometriosis tertiary referral center for dedicated transvaginal ultrasound (TVUS). Adnexal masses were evaluated using the IOTA classification simple descriptors, simple rules and expert opinion. The reference standard was definitive histology after mass removal at laparoscopy. In total, 621 women were evaluated and divided into four groups: endometrioma on TVUS and confirmed on surgery (Group 1 = 181), endometrioma on TVUS but other benign cysts on surgery (Group 2 = 9), other cysts on TVUS but endometrioma on surgery (Group 3 = 2), masses classified as other findings or suspicious for malignancy on TVUS and confirmed on surgery (Group 4 = 5 potentially malignant, 11 benign). This gave a sensitivity 98.9%, specificity 64%, positive 95.3% and negative 88.9% predictive values, positive 2.74 and negative 0.02 likelihood ratios and 94.7% overall accuracy. The surgical diagnosis for the five masses suspected to be malignant was: borderline serous tumor (2), borderline mucinous tumor (2), and endometrioid lesion with complex hyperplasia without atypia (1). The conclusions were that the IOTA classification simple descriptors, simple rules and expert opinion performs well for classifying adnexal masses suspected to be endometrioma. The most common potentially malignant masses in these women were borderline ovarian tumors.

Study Objective To compare expectant versus interventional management of Heterotopic pregnancies. Design A retrospective cohort study, from January 2011 to December 2020. Setting Single tertiary care center. Patients or Participants All women diagnosed with heterotopic pregnancy on ultrasound examination during the study period. Interventions Data were collected from women's' medical files including demographic, laboratory and ultrasound findings, management of heterotopic pregnancy, intrauterine pregnancy, follow up and delivery characteristics. Expectant and interventional management outcomes were compared. Data are presented as median and interquartile range. Measurements and Main Results Forty-one women were diagnosed with heterotopic pregnancy during the study period, of them 73.2% (n=30) following IVF treatment. Abdominal pain was the most frequent presenting symptom (n=25.6%). Ectopic pregnancy was diagnosed in the fallopian tubes in 36 (87.8%) of the women. Management was expectant in 10 (24.4%) and interventional in 31(75.6%) of the women. Expectant management was considered when patient was stable, and ectopic pregnancy did not continue to develop. Interventions included laparoscopic salpingectomy (n=26), laparoscopic cornual resection (n=2), laparotomic cornual resection (n=1) and gestational sac aspiration (n=2). Ongoing intra-uterine pregnancy was achieved in 6 (60%) and 77%(n=17) of the women in the expectant and interventional groups, respectively. All of the women managed expectantly reached term delivery, as opposed to 22 (71.0%) in the intervention management group (p=0.60). Multivariate analysis including: Age, vaginal bleeding, BHCG and management treatment, found BHCG as the only independent parameter associated with ongoing pregnancy rate (p=0.04). Conclusion Both expectant and interventional management were found to be acceptable when heterotopic pregnancy is diagnosed with high ongoing intra-uterine pregnancy rate and term deliveries. BHCG was found as the only independent parameter associated with the ongoing rate.

Objective Cesarean-induced niche can cause symptoms such as abnormal postmenstrual bleeding, pain and associated infertility. Hysteroscopic niche resection is usually a successful treatment, but can result in a failure to improve symptoms or symptoms can recur. In the present study we aim to evaluate the feasibility, effectiveness, and safety of a second hysteroscopic niche resection for patients in whom an initial hysteroscopic resection failed to improve symptoms. Study design This retrospective cohort study (Canadian Task Force classification II-2) hospital tell hashomer (tertiary center) included all patients who underwent a second hysteroscopic niche resection between 2011 and 2015. Measurements:Fertility,obstetric outcomes, clinical outcome and complications were compared between the first surgery and the second Results Eight patients underwent a second hysteroscopy after failure of the first hysteroscopy to resolve symptoms or after recurrence of symptoms. Abnormal uterine bleeding (AUB) was the most common symptom, occurring in all patients. The average number of days of bleeding per cycle were significantly reduced following the second surgery [14.50 (range 8-21 days) vs 11.75 (range 8-20 days), respectivelyp = 0.009]. The second surgery improved symptoms in 6 out of the 8 patients with AUB and 1 of 2 patients with pain. There were no significant differences in fertility and obstetric outcomes between the first and the second surgery and no complications were reported during any of the surgeries. Conclusion Reintervention with a second hysteroscopic niche resection is both feasible and effective treatment option following a failed first attempt or recurrence of symptoms. The second surgery improved symptoms, especially AUB, with no consequent detrimental effect on obstetric outcomes on our series.

Study Objective To develop a risk score for surgically proven recurrent adnexal torsion (rAT), among women with a previous adnexal torsion proven surgically. Design A retrospective cohort study between 2011 and 2020. Setting A tertiary, university affiliated medical center. Patients or Participants All women with a history of surgically confirmed adnexal torsion, who underwent surgical diagnostic procedure due to a suspected rAT. Overall, 115 women were included. Interventions Operative laparoscopy. Measurements and Main Results We collected demographic and clinical characteristics, sonographic findings and laboratory results of all suspected rAT cases that subsequently underwent surgery. We compared cases with adnexal torsion to cases without, as confirmed by operative laparoscopy. Adnexal torsion was identified in 86 (74.8%) of the surgical procedures. Age and pregnancy rates were similar in both groups. Women with adnexal torsion had less prior pelvic surgeries (excluding prior adnexal torsion) [OR(95%CI) 0.24(0.09-0.59), p=0.001], prior oophoropexy [OR(95%CI) 0.36(0.13-0.97), p=0.04] or right adnexal tenderness [OR(95%CI) 0.21 (0.08-0.52), p After multivariate analysis, four risk factors remained significantly independently associated with adnexal torsion. Previous pelvic surgery [aOR(95%CI) 0.06(0.007-0.54), p=0.01] and right side pain [aOR(95%CI) 0.05(0.008-0.33), p=0.002] were negatively associated with adnexal torsion. A larger maximal diameter of the affected ovary [aOR(95%CI) 1.78(1.08-2.93), p=0.02] and enlarged ovary [aOR(95%CI) 7.40(1.28-42.59), p=0.02] were positively associated with adnexal torsion. Conclusion Our risk score enables to predict a true positive rAT that may assist clinicians in decision management in cases of suspected rAT.

Study Objective To develop a risk score calculator for the prediction of adnexal torsion during pregnancy. Design A retrospective cohort study between 3.2011-4.2020. Setting Tertiary medical center. Patients or Participants All women who underwent surgical diagnostic procedure due to suspected adnexal torsion in pregnancy. Overall, 156 women were included. Interventions Operative laparoscopy. Measurements and Main Results We collected demographic and clinical characteristics. The presence or absence of adnexal torsion during the surgical procedure was recorded. Adnexal torsion was identified in 131 (83.9%) of the surgical procedures. The rate of previous ovarian torsion was lower in the torsion group [OR(95%CI) 0.29(0.11-0.79), p=0.01]. Pregnancy following assisted reproductive technology (ART) was more common in the torsion group [OR(95%CI) 7.0(1.99-24.54), p

Ovarian endometriomas are cysts on or within the ovarian parenchyma that contain chocolate-like fluid. Ovarian endometriomas are a typical manifestation of the disease, and their prevalence is between 17% and 44% of patients with endometriosis (Jenkins et al., Obstet Gynecol 67(3):335–338, 1986; Redwine, Fertil Steril 72(2):310–315, 1999; Busacca and Vignali, Curr Opin Obstet Gynecol 15:321–326, 2003).

Study Objectives To describe the management of interstitial pregnancies in a tertiary medical center, identify factors associated with treatment failure, and report subsequent pregnancy outcome. Design Retrospective cohort study. Setting Department of Gynecology in a tertiary medical center. Patients All women who were admitted to and treated for interstitial pregnancy at our center between 2011 and 2019. Interventions The women were originally assigned to undergo expectant, medical, or surgical treatment. The women's background and clinical data were compared according to initial treatment modality. Nonsurgical (expectant and medical) management outcomes were analyzed to identify risk factors for treatment failure. Subsequent pregnancy outcomes were described separately. Measurement and Main Results Thirty-seven cases of interstitial pregnancy were identified. There were high rates of pregnancy achieved by in vitro fertilization (45.9%) and a history of ipsilateral salpingectomy (43.2%) among these patients. At presentation, the mean age of the study cohort was 34.76 years, and the median β-human chorionic gonadotropin level was 3853.0, and median gestational age was 7.0, respectively. The nonsurgical management success rate was 70.0%. Uterine rupture occurred during treatment in 5 cases (16.6%). Gestational sac diameter significantly affected treatment failure (p = .03), and a diameter >20 mm was observed in all cases of failed non-surgical treatment. Data on future fertility was available for 21 (58.3%) women: 13 (61.9%) had a subsequent pregnancy, 1 of which was a recurrent interstitial pregnancy. The median interpregnancy interval was 8.1 months, and all but 3 pregnancies reached third trimester and resulted in a live birth, with an overall cesarean delivery rate of 61.5%. None of the subsequent pregnancies were complicated by uterine rupture, and no serious adverse outcomes were noted in any of the subsequent intrauterine pregnancies that reached third trimester. Conclusion Successful nonsurgical management of an interstitial pregnancy is feasible, although appropriate selection of cases is advised. A large gestational sac is a risk factor for treatment failure and should prompt surgical intervention. Subsequent pregnancies can generally be considered safe and with a favorable outcome.

Study Objective To investigate the predisposing factors for recurrent adnexal torsion (rAT) in patients who had surgical intervention for primary adnexal torsion (pAT). Design A retrospective cohort study between 2011 and 2020. Setting A tertiary, university affiliated medical center. Patients or Participants 358 women with a primary occurrence of surgically proven adnexal torsion. Interventions Adnexal detorsion, with adjuvant cystectomy, salpingectomy or salpingoophorectomy by laparoscopy. Measurements and Main Results We collected demographic and clinical characteristics, sonographic findings and laboratory results of all pAT episodes. We compared those who had experienced rAT to those who had not. The study included 358 women. Of those, 35 (9.8%) had a rAT. Women who experienced rAT were younger (mean age 26 vs. 30, p=0.01) with higher proportion of age ≤15 [Odds Ratio (OR) 95%CI 4.4(1.80-11.1)]. A history of hysterectomy was positively associated with rAT [3(8.6%) vs. 1(0.3%), p=0.003]. Pregnancy rates during pAT were comparable between study groups. However, rAT was associated with lower gestational age at pAT (mean 9 weeks vs. 12 weeks, p=0.01) and conception by assisted reproductive technologies [OR 95%CI 6.0(1.21-29.65), p=0.02]. Clinical characteristics did not differ between groups except smaller ovarian cyst diameter in those with rAT (mean 42 vs. 59 mm. p Conclusion Recurrent adnexal torsion is more common than previously thought. Younger age and smaller ovarian cyst at pAT are independently associated with the risk for future recurrence of adnexal torsion. These factors should be considered when contemplating oophoropexy at pAT.

Study Objective To report pregnancy success rate and pregnancy outcome in women following cesarean scar defect (niche) repair. Design A retrospective cohort study from July 2014 to March 2019. Setting Single medical care center. Patients or Participants All women after laparoscopic niche repair done by a single high skilled surgeon, during the study period. Interventions Data was collected from women's medical records and a telephone interview was performed to assess further symptoms and attempts to conceive, including pregnancy outcomes. Measurements and Main Results During the study period 48 women underwent laparoscopic niche repair, of them complete follow-up was achieved for 37 (78.7%) women. Median age was 35 years (IQR 32-39) with median of one cesarean delivery in the past (IQR 1-1). The median residual myometrial thickness measured by ultrasound before the repair was 2.0 mm (IQR 1.4-2.5). Attempts to conceive were reported by 81% (n=30) of the women, while 18 (60%) achieved pregnancy in median time of 6 month (IQR 5-12) post niche repair. 14 (78%) of the women conceived spontaneously. No placental abnormalities were reported in any of the women. All gave birth by cesarean delivery at a median of 38.4 gestation week (IQR 37.0-39.5). No uterine dehiscence or rupture were reported. Conclusion Pregnancy following cesarean scar defect repair can be achieved with low pregnancy complication rate and good pregnancy outcomes. Further studies need to be done in order to strengthen our findings.

Study Objective The relationship between various niche features and symptoms has not fully been elucidated. The aim of this study is to evaluate the association between the presence of niche to the presence of symptoms. Design A prospective cohort study conducted between December 2018 to March 2020. Setting Single tertiary medical center. Patients or Participants Women that underwent cesarean delivery during January 2011 to December 2018. Interventions All women were requested to arrive at the gynecological clinics. During their visit they completed questionnaire regarding symptoms related to the presence of niche (menorrhagia, spotting, pelvic pain and infertility) . A trans-vaginal 2-D ultrasound examination targeted to assess the uterine scar characteristics was performed. Primary outcome was defined as the presence of uterine niche evaluated by length, depth, residual myomtrial thickness (RMT) and the proportion between residual to adjacent myometrial thickness (RMT/AMT). Data are presented as median and Interquartile range. Measurements and Main Results Two hundred twenty-five women were included in the study. 128 (56.88%) and 97 (43.11%) were symptomatic and asymptomatic, respectively. Median time from delivery to follow-up was 16 months for both of the groups. RMT was the only measurement associated with symptoms. RMT Conclusion Residual myometrial thickness was found associated with infertility. All other niche measurements were comparable between symptomatic and asymptomatic women. Further investigation is required to strengthen this finding.

Study Objective To compare the clinical characteristics and sonographic findings of adnexal torsion between pregnancy trimesters. Design A retrospective cohort study between 2011 and 2020. Setting A tertiary, university affiliated medical center. Patients or Participants Overall, 122 pregnant women with 131 separate episodes of surgically proven adnexal torsion. Interventions Laparoscopy for confirmation and treatment of adnexal torsion. Measurements and Main Results We collected demographic and clinical characteristics as well as sonographic findings and laboratory results of all adnexal torsion episodes. We compared the three trimesters of pregnancy. Overall, 92 of the episodes occurred during 1st trimester, 29 and 10 occurred during 2nd and 3rd trimester, respectively. The majority of cases were right sided (61%). Pregnancy achieved following assisted reproductive technology (ART) was more common in the 1st trimester group (p 6 was more common in 1st and 3rd trimester, compared to 2nd trimester (p=0.02). Gastrointestinal symptoms were also more common among patients in the 1st trimester (p The mean diameter of affected adnexa was similar in all trimesters, while the non-affected adnexa was marginally significantly smaller in the 2nd and 3rd trimesters. In approximately one third of all cases ultrasound findings included at least one specific feature: edematous ovary, absent doppler flow or presence of whirlpool sign. Absent doppler flow was more common in the 2nd and 3rd trimester compared to the 1st trimester (p Duration from admission to surgery was significantly longer in the 2nd and 3rd trimesters (p=0.002). Conclusion We found differences in the clinical, sonographic and laboratory manifestations of adnexal torsion in each trimester of pregnancy. When assessing pregnant patients with suspected adnexal torsion, these differences may assist in ameliorating an accurate diagnosis.

Study Objective Laparoscopic management of nonobstetric acute abdominal pain in the third trimester of pregnancy remains controversial with limited data regarding procedure safety and feasibility. This study aimed to investigate the feasibility, immediate complications, and short-term outcomes of laparoscopic surgery at an advanced gestational age. Design Case-series. Setting Sheba Medical Center, a tertiary referral center. Patients Pregnant women who underwent urgent laparoscopic surgery at 27 weeks of gestation and above. Intervention Emergent laparoscopic surgery. Measurements and Main Results Clinical data were retrospectively collected and analyzed. A telephone questionnaire was administered in cases of missing data. Clinical information obtained included detailed medical and obstetric history; preoperative, intraoperative, and postoperative data; complications; and pregnancy outcomes. Between January 2010 and July 2017, 12 patients underwent emergent laparoscopic surgeries during the third trimester of pregnancy. The gestational age at the time of the surgery ranged between 27 and 38 weeks. All women had singleton pregnancies. Laparoscopic surgeries included 7 appendectomies, 4 adnexal surgeries, and 1 diagnostic laparoscopy. No complications related to the access route for any of the 12 laparoscopic surgeries occurred. The laparoscopic surgical procedure was successfully completed in 11 patients; only 1 laparoscopic appendectomy for perforated acute appendicitis with purulent peritonitis at 30 weeks of gestation was converted to laparotomy because of a limited operative field. Two patients had preterm labor at 35 and 36 weeks of gestation, respectively. None of the women was complicated with intrauterine fetal demise or low Apgar scores. Conclusion Our results demonstrate that urgent laparoscopic surgeries in the third trimester of pregnancy are feasible and can be safely performed with minimal risk for the patient and fetus. Larger prospective studies are required to validate these recommendations.

Cesarean scar defect (CSD) is often associated with postmenstrual bleeding, infertility, and pain. Hysteroscopic CSD repair was described in the past, mainly as excision of the proximal edge of the defect to allow continuous blood flow during menstruation. In this study we aimed to evaluate the efficacy of extensive hysteroscopic cesarean scar niche excision in symptomatic patients.A retrospective cohort study.Symptomatic patients treated with hysteroscopic CSD excision who were considered eligible for the procedure when myometrial thickness of 2 mm or more was observed on sonohysterography.Tertiary referral center.Extensive CSD excision was performed using a cutting loop and pure cutting current. The proximal and distal edges of the defect were resected. This was followed by resection of tissue at the base of the niche, until underling muscular tissue was evident. Tissue sampled from the base of the CSD was collected for histologic examination. Patients were followed for a minimum of 1 year after hysteroscopic CSD excision. Clinical information obtained included detailed obstetric history and preoperative and postoperative menstruation pattern.Between 2011 and 2016, 95 patients underwent extensive hysteroscopic niche excision; 67 were included in the study, whereas the remaining were lost to follow-up. Patient mean age at the time of the procedure was 38 ± 5.5 years. Twenty-nine patients (43%) had a history of high-order repeat cesarean surgeries. Sixty-six patients (98.5%) presented with postmenstrual bleeding, 26 with secondary infertility (38.8%), and 2 with pelvic pain (2.9%). After hysteroscopic niche excision, 63.4% of patients reported significant improvement or resolution of postmenstrual bleeding. A statistically significant reduction in number of bleeding days per cycle (15.5 ± 4.8 vs 9.8 ± 4.7, p.001) was also noted. Histologic evidence for myometrial tissue within the obtained samples was associated with better outcomes. A histologic specimen from patients who experienced significant improvement or resolution of postmenstrual bleeding was more likely to reveal myometrial tissue (p = .04). Of the 26 patients who suffered from infertility, 19 attempted to conceive spontaneously after CSD excision. Of those, 10 patients (52.6%) conceived and 9 delivered at least once (47.36%).Extensive hysteroscopic surgical excision of cesarean scar niche should be considered in symptomatic patients suffering from irregular menstrual bleeding. The quality of the excision at the apex of the niche could be associated with a higher success rate. The role of niche excision to overcome secondary infertility should be further evaluated.

Objective To determine the association between early increase in the serum hCG levels (days 0–4) and treatment success rates following methotrexate therapy in ectopic pregnancy patients. Study design A level II-2 case-control study of involving 140 patients treated with methotrexate for ectopic pregnancy at the gynecology department in a tertiary care hospital. Results A logistic regression model for the "failure of treatment" was fitted with serum hCG levels change between day 0 and day 4, patient age, pregnancy age at day-0, and day-0 β-hCG level as predictors. The logistic regression analysis indicated that having more than 50% increase in the β-hCG levels between days 0 and 4 significantly (P = 0.011) increases the risk of MTX treatment failure. Conclusion The results of this study indicate that >50% increase in β-hCG levels between days 0 and 4 significantly increases the risk of methotrexate treatment failure. This novel information could assist patients and physicians in making decisions regarding ectopic pregnancy treatment.

Study Objective To compare the incidence of placental abnormalities in subsequent pregnancy after myomectomy performed by laparoscopy, laparotomy and hysteroscopy. Design A retrospective cohort study, conducted from February 2011 to November 2018. Setting A single tertiary care center. Patients or Participants All women after myomectomy that gave birth. Interventions Data was collected from patients' medical files. Groups were compared for women demographics, fibroids characteristics, operative management, post-operative placental evaluation and delivery characteristics. Primary outcome was defined as the need for any intervention for placental separation during the third phase of the delivery. Non-parametric statistics were used for analysis. Measurements and Main Results 241 women met inclusion criteria. Complete follow-up was achieved in 199 (82.57%) women, of them 82, 89 and 28 underwent laparoscopic, laparotomy and hysteroscopic myomectomy, respectively. There were no significant differences between the groups in women's age, BMI, gravidity and history of cesarean deliveries. Endometrial damage during laparoscopy and laparotomy was reported in 3 (3.6%) and 7 (7.8%) of the women, respectively (p=0.21), and in all women undergoing hysteroscopic myomectomy (p=0.001). During subsequent pregnancy, morbidly adherent placenta was suspected in only one woman in each of the groups (p=0.63), a rate that is considered lower than the reported rate after one cesarean delivery. Placenta previa was not seen in any of the women included in the study. Normal vaginal delivery was significantly higher in the hysteroscopy group compared to laparoscopy and laparotomy groups [11 (36.3%) vs. 5 (6.1%) vs. 4 (4.5%); p=0.001], with significantly lower need for manual lysis of the placenta [11(39.0%) vs. 51 (62.1%) vs. 62 (69.7%); p=0.01] and no need for any further interventions to control blood loss. Conclusion Subsequent pregnancy after myomectomy was not found to be associated with high placental abnormality rate. Furthermore, other than manual lysis, no difference in abnormal placentation requiring intervention was seen between the different techniques.

Objective Intracavitary uterine fibroids and fibroids that distort the uterine cavity are associated with excessive vaginal bleeding and infertility. While intracavitary fibroids smaller than 4 cm are usually treated safely by operative hysteroscopy, larger fibroids may require multiple surgeries or more extensive surgery with possible damage to the integrity of the uterine wall. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a noninvasive approach for treating uterine fibroids, mainly the intramural type. We present the outcome of MRgFUS treatment for intracavitary fibroids (FIGO class 1) in cases that could not be treated by hysteroscopy due to either fibroid size or patient refusal. (Canadian Task Force II-1). Study design A retrospective cohort study from a single tertiary referral center. A total of 68 patients were treated by MRgFUS for symptomatic uterine fibroids from January 2013 to December 2016. Six of them had FIGO class 1 fibroids. Adverse effects and short- and long-term outcomes (quality of life issues and need for additional surgical intervention) were assessed during ambulatory clinic visits and by phone interviews. Results The mean ± SD fibroid volume on MRI screening was 86.3 ± 60.9 cm3. Six of those patients underwent the procedure (mean age 40.5 ± 5.6 years, range 33–48). The follow-up duration was 24.1 ± 12.0 months. Four patients were not interested in future fertility and did not undergo additional treatment, while the two who planned to conceive underwent another surgical intervention (one underwent operative hysteroscopy after reduction of fibroid size and the other underwent laparoscopic myomectomy). Conclusion This preliminary study shows that MRgFUS can be a feasible treatment option for FIGO class 1 uterine fibroids. Shrinkage of fibroids by MRgFUS can obviate or facilitate subsequent surgical intervention in selected cases.

Study Objective To compare the long-term outcome of laparoscopic myomectomy with MR-guided focused ultrasound (MRgFUS) for symptomatic uterine fibroids. Design A cohort study, from January 2012 to January 2017. Setting Single tertiary care center. Patients or Participants All patients with symptomatic uterine fibroids treated operatively with laparoscopic myomectomy or treated conservatively with MR-guided focused ultrasound. Interventions A telephone interview was performed to assess further interventions and sustained fibroid associated symptoms using the Uterine Fibroid Symptom and Quality of Life symptom severity score (UFS-QOL-SSS). Measurements and Main Results One-hundred fifty-four women met the inclusion criteria. Complete follow-up was achieved for 64 women underwent laparoscopic myomectomy and 68 were treated by MRgFUS. Follow up time was similar for both groups (median, IQR: 31 month, (17-51) vs 36 month (24 - 41); P=0.95, respectively). The rate of additional interventions was 5 (7.8%) and 9 (13.2%), respectively (p=0.312). Similarly, the uterine fibroid symptom-quality of life-symptom severity score (QOL-SSS) questionnaire at follow up interview revealed comparable score 17(12-21) vs 17 (13-22) for laparoscopic myomectomy and MRgFUS, respectively (p=0.439). Analyzing each of the symptoms separately (bleeding, changes in menstruation, abdominal pain, bladder activity, nocturia, fatigue), did not change these findings. Conclusion Long term outcome and surgical intervention following MRgFUS treatment for uterine fibroids seems comparable with that laparoscopic myomectomy. Further larger randomized trials are needed to confirm these findings.

Study Objective To determine an effective method of intrauterine device (IUD) retrieval from pregnant women who had previous unsuccessful ultrasound-guided IUD extraction failure. Design A retrospective cohort study (Canadian task force classification II-1). Setting A gynecology department of an outpatient clinic. Patients Pregnant patients in their first trimester with IUD in situ who underwent prior unsuccessful ultrasound-guided IUD extraction. Interventions Hysteroscopic IUD extraction guided by transabdominal ultrasound. Measurements and Main Results Between 2011 and 2014, 7 of 8 pregnant patients who had undergone previous failed attempts at IUD retrieval via ultrasound guidance underwent successful removal via ultrasound-guided hysteroscopy performed without anesthesia. The sole patient with extraction failure was in her 12th week of pregnancy, and the procedure was concluded to avoid risk to the fetus. Minimal vaginal bleeding was experienced by 2 patients after the procedure. Seven of 8 patients delivered at term without any obstetric complications. One patient had a miscarriage in her 8th week of pregnancy, 2 weeks after successful IUD removal. Conclusion A novel, easy outpatient hysteroscopic technique without anesthesia is presented in case of failure of previous ultrasound-guided IUD removal in early pregnancy. Results are encouraging in this difficult context.

Aims: To determine the clinical yield of abdominal ultrasound in the evaluation of elevated liver enzymes (ELEs) in the second and the third trimester of pregnancy. Methods: A retrospective cohort study including all pregnant women admitted to a single tertiary care center was conducted between April 2011 and January 2015 with ELE. Inclusion criteria included gestational age above 24 weeks and ELEs, abdominal ultrasound report, and live fetus. Exclusion criteria included known maternal liver disease, structural or chromosomal fetal anomalies, and positive serology for viral hepatitis. All patients underwent abdominal ultrasound. A significant finding of this study led to a change in treatment. Results: One hundred and twenty patients (41.8%) met inclusion criteria: 93 (77.5%) had a normal scan and 27 (22.5%) had abnormal findings. Significant ultrasound findings were found only in 2 (1.6%) patients: gallstones in the common bile duct and suspected autoimmune hepatitis. There were no significant differences between patients with and without ultrasound findings in the rate of cholestasis of pregnancy, preeclampsia, chronic hypertension, and gestation diabetes. Conclusion: Abdominal ultrasound examination in this population has a low clinical yield. The decision to perform an abdominal ultrasound must be individualized based on the obstetric history, clinical findings, and the level of liver enzymes.

Study Objective To determine the long-term outcome of intrauterine pregnancies after treatment of heterotopic pregnancies. Design Retrospective cohort study (Canadian Task Force classification II-3). Setting Tertiary center university hospital. Patients All women who underwent surgery because of heterotopic pregnancy over 12 years. Intervention Laparoscopic surgery. Measurements and Main Results Infant development and future pregnancy. Extrauterine pregnancies were located in the tube (n = 13), uterine cornua (n = 3), ovary (n = 1), and tubal stump (n = 2). During laparoscopy, a ruptured tube was found in 6 tubal pregnancies (46%), blood transfusion was needed in 7 heterotopic pregnancies (37%), and salpingectomy was performed in 12 women with tubal pregnancies (91.7%). The pregnancy outcome consisted of 13 babies (term and preterm) taken home and 5 miscarriages. Long-term follow up demonstrated that 10 of 13 infants (76.9%) exhibited normal development. Three infants, all from 1 triplet pregnancy, exhibited borderline to normal development. Ten of 15 women achieved additional pregnancies, with 10 deliveries and only 1 extrauterine pregnancy in the tubal stump. Conclusions Women with a heterotopic pregnancy are at high risk for late diagnosis and at risk for hypovolemic shock at diagnosis, and may require blood transfusion. The outcome of intrauterine pregnancy in association with heterotopic pregnancy requiring surgical intervention is good, and most complications were associated with multifetal pregnancy and preterm delivery.

The purpose of the study was to construct a clinical profile of a patient more likely to have ovarian torsion (OT). The study design was a retrospective chart review (Canadian Task Force Classification II-3). The study was done in a tertiary referral center setting. Patients were 78 women who underwent laparoscopy for suspected ovarian torsion. Intervention done was urgent laparoscopic surgery. The main outcome measure was a comparison of demographic data and the presenting signs and symptoms of the women with and without laparoscopically proven OT. Multivariable analysis was performed with a logistic regression model in order to determine the independent risk predictors for OT. The following factors were found to be predictive of OT: vomiting (OR = 5.67, 95% CI 1.69–19.0, p = 0.005); duration of pain less than a day (OR = 3.74, 95% CI 1.24–11.3, p = 0.02), and sudden/nocturnal onset of pain (OR = 4.13, 95% CI 1.19–14.3, p = 0.02). The model was found to be adequate, with a c value of 0.798. A patient presenting with an episode of pain lasting less than a day that started suddenly and or at night, accompanied by vomiting is more likely to have OT on urgent laparoscopy.

Objectives: To determine the levels of first-trimester free β-human chorionic gonadotrophin (free βhCG), pregnancy-associated plasma protein A (PAPP-A) and nuchal translucency (NT) in twin pregnancies. Methods: The study included 93 patients with twin pregnancy and 4,977 with singletons who underwent first-trimester testing using free βhCG, PAPP-A and NT at 10–13 weeks of gestational age. Results: In twin pregnancies, the maternal serum free βhCG level was 2.18 higher and the PAPP-A level was 2.38 higher than in singleton pregnancies. These marker levels were significantly higher than the expected 2.0 multiples of the median (MoM). In contrast, NT values did not differ between twins and singletons. Conclusion: These data may be used to establish first-trimester combined screening for twin pregnancies.

Omentin, a newly identified adipokine, enhances insulin mediated glucose uptake in human adipocytes, thus, inducing systemic insulin-sensitizing effect. The aims of this study were to determine whether circulating maternal omentin levels are associated with insulin resistance indices and to assess which compartment, maternal, fetal, or placental, is the source of omentin in maternal circulation.Fasting serum glucose, insulin, and omentin were determined in 25 healthy pregnant women at the third trimester, before and 3 days after elective cesarean section. Cord blood omentin was measured in the 25 term neonates. Homeostasis model assessment (HOMA) was used to evaluate insulin sensitivity before and after delivery.Antepartum maternal omentin levels were negatively correlated with insulin levels (r=–0.41, P=0.04) and positively correlated with insulin sensitivity (HOMA%S; r=0.4, P=0.04). Postpartum omentin levels were negatively correlated with maternal body mass index (r=–0.44, P=0.02). Median maternal omentin levels was comparable before and after delivery (57.2, inter-quartile range: 38.2–76.2 ng/mL vs. 53.4, 39.8–69.4 ng/mL, respectively, P=0.25) and highly correlated (r=0.83, PCirculating maternal omentin levels are correlated with insulin resistance indices, suggesting that this adipokine may play a role in metabolic adaptations of normal gestation. The strong correlation between anteparum and postpartum maternal omentin levels, as well as the lack of association between maternal and neonatal omentin levels, suggest that placental or fetal compartments are unlikely as the main source of circulating maternal omentin.

Of all markers evaluated for first-trimester biochemical screening for Down syndrome (DS), PAPP-A and free beta-hCG emerged as the most predictive. The combined test uses these markers in conjunction with nuchal translucency measurements, and is estimated to achieve a DS detection rate of 80% to 85% at a 5% false-positive rate. The integrated test, combining first-trimester sonographic and biochemical markers with second-trimester markers, provides a single estimate of a patients DS risk, and may yield a DS detection rate of 94% at a 5% false-positive rate. The acceptability and feasibility of this test, however, remain to be proved.

Pemphigus vulgaris (PV) is an uncommon, immune-mediated bullous dermatosis, which, during its active phase, has been associated with infertility. Pemphigus vulgaris during pregnancy is exceedingly rare-only 26 cases with immunopathological confirmation have been reported. The disease may be associated with adverse neonatal outcome, including prematurity and fetal death. Transient skin lesions may occasionally appear in the neonate. We report a patient who conceived during the active phase of PV, required high doses of corticosteroids to control the disease, and was delivered of a pre-term, appropriate-for-gestational age newborn.

OBJECTIVE: The purpose of this study was to compare clinical manifestations, treatment, and pregnancy outcome of adnexal torsion in pregnant and nonpregnant women. STUDY DESIGN: We conducted a retrospective case-control study in the Departments of Gynecology at 2 tertiary centers between 19992008. Forty-one pregnant and 77 nonpregnant women with surgically proved adnexal torsion were assessed. RESULTS: Recurrence rate of torsion was 19.5% in pregnant women and 9.1% in control subjects; 73% of pregnant women conceived through assisted reproductive technologies. Doppler blood flow was falsely normal in 61% of pregnant women and in 45% of nonpregnant women; 83.3% of pregnant women delivered at term. Laparoscopic detorsion was the main surgical procedure. CONCLUSION: Presentation of adnexal torsion is similar in pregnant and nonpregnant women. Past assisted reproductive technology is an important risk factor in pregnancy. Doppler bloodflow has a high falsenegative rate and should not outweigh clinical suspicion. Although pregnancy outcome is favorable, the high rate of recurrence raises the issue of surgicalfixation at thefirst episode.

To reevaluate the rate of correct diagnosis of ovarian torsion (OT) in our department.Retrospective computerized chart review.Tertiary referral center.Seventy-eight women who underwent laparoscopy for suspected OT.Laparoscopy.Rate of true diagnosis of torsion, correlation with Doppler studies.The preoperative diagnosis of OT was confirmed in only 36 (46.1%) of the patients. Immediate operation (10 hours) after admission (n = 48) was associated with a statistically significantly higher likelihood of operatively confirming OT (56.2% vs. 28.6%). We found that the lack of ovarian blood flow on Doppler sonography was a good predictor of OT; women with pathologic flow were statistically significantly more likely to have OT (77% vs. 29%). The sensitivity and specificity of abnormal ovarian flow for OT were 43.8% and 91.7%, respectively, with a positive and negative predictive value of 78% and 71%, respectively.Despite 20 years of research, the accuracy of the preoperative diagnosis of OT remains low. The urge to operate can be attributed to the importance of preserving ovarian function in young women as well as to the availability and the low associated complication rate of laparoscopy.

Objective To determine the outcome of laparoscopic management of cornual pregnancy. Design Retrospective cohort study (Canadian Task Force classification II-3). Setting A tertiary referral hospital in Israel. Patient(s) Twenty-seven consecutive women with cornual pregnancy who were diagnosed and treated at our institute. Intervention(s) Laparoscopy was undertaken in 20 (74%) of the patients. Resection of the cornua and/or a Vicryl loop placement was performed. In 6 cases, laparoscopy was converted to laparotomy. In addition, laparotomy was performed in 2 other cases. Five cases were managed conservatively: 3 with systemic methotrexate (MTX) and leucovorin, 1 with transvaginal sonography-guided KCl injection to the amniotic sac, and 1 with hysteroscopic-guided MTX injection to the amniotic sac. Further treatment after surgery was required in 4 cases: transvaginal sonography–guided KCl injection, MTX or KCl + MTX (1 case each) injection to the amniotic sac, and systemic MTX injection. Main Outcome Measure(s) Successful laparoscopy, determined as not needing follow-up treatment. Result(s) The mean gestational age was 56 days. The average and median serum hCG levels were 31,199 and 6,653 IU/mL, respectively. Six of the women (22%) were admitted in hypovolemic shock. Nine patients (33.3%) were asymptomatic upon admission, 14 (52%) had abdominal pain, and 8 (29.6%) were evaluated for vaginal bleeding. One woman developed hypovolemic shock after admission. Only 15 (55.6%) of the 27 pregnancies were diagnosed as a cornual pregnancy by transvaginal sonography before the therapeutic procedure. Blood transfusion was given in seven cases (26%) during surgery. The mean number of days of hospitalization was 5.7 days for patients who underwent surgery and was 7.1 days for all patients. A comparison was made between the first 11 and the last 11 cases treated surgically. Although the two groups were similar in all parameters, conversion from laparoscopy to laparotomy was higher in the first group, although not at a statistically significant level. Conclusion(s) Improved laparoscopic technique, accumulated experience, and possibly earlier diagnosis have led to fewer operative failures or need to convert to laparotomy during treatment of cornual pregnancy. Conservative treatment, when possible, should be considered. If surgery is indicated, and as more laparoscopic skill is gained, laparoscopy should be considered the preferred method of treating cornual pregnancy. In experienced hands, laparoscopy is a safe and effective treatment for cornual pregnancy.

Objective Endometriosis is known to be associated with an increased risk for early pregnancy complications, including ectopic pregnancy and miscarriage. However, little has so far been reported on complications linked to severe endometriosis occurring during the third trimester of pregnancy. Study Design A retrospective review of 800 women attending the endometriosis clinic of the Sheba Medical Center during the years 2002-2006 was performed. Cases with severe endometriosis and associated complications during late pregnancy were identified. Results Three women were found who experienced significant intraabdominal bleeding in the third trimester of pregnancy attributed to a lesion resulting from severe endometriosis. The intraabdominal bleeding occurred between 26-29 weeks of gestation. In all cases the major presenting prenatal symptom was severe lower abdominal pain. The pain was not relieved by the administration of tocolytics or mild analgesics. Explorative laparotomy, performed in all 3 cases, revealed the presence of significant intraabdominal bleeding requiring immediate transfusion of blood products stemming from endometriotic lesions. Fetal complications occurred in all 3 cases. Conclusion The symptoms of endometriosis are often relieved during pregnancy. Yet lesions caused by severe endometriosis can lead to significant intraabdominal bleeding during the third trimester of the pregnancy. Physicians must be aware that close antenatal follow-up and prompt intervention may be required in such cases.

C-reactive protein (CRP) is believed to be a sensitive marker of endothelial activation and inflammation. The association between an inflammatory state and CRP has prompted research on changes in CRP levels in assisted reproductive technique (ART) cycles. IVF success and CRP levels were not correlated previously. The aim of this prospective study was to assess CRP levels during IVF stimulation and correlate them with IVF success.Twenty-eight Women were stimulated using the 'Flare-up' protocol with down-regulation of Triprorelin. CRP levels were measured on cycle days 3, 8, ovum pick-up day and 12 days following embryo-transfer (betahCG testing day).CRP levels in women who conceived after IVF protocol (n=8) were compared to CRP levels in women who failed to conceive (n=20).The mean age for both groups was similar. CRP levels were significantly different on day 3 (p0.05), but not on day 8, of the cycle. Average CRP levels on ovum pick-up and on betahCG test days were similar, as was the number of oocytes collected or embryos replaced. Patients who failed to conceive had significantly higher levels of CRP on day 3 of the cycle, before commencement of gonadotrophin administration, and the higher levels continued throughout treatment, although not reaching statistical significance.An inflammatory state, indicated by high CRP levels during stimulation, may serve as a prognostic indicator of IVF success.

Study Objective To study the usefulness of and applications for frozen section in the laparoscopic management of adnexal masses. Design Historical prospective study (Canadian Task Force classification II-3). Setting Large tertiary care hospital with university affiliation. Patients One hundred forty-one women undergoing laparoscopy for a suspicious adnexal mass. Intervention Adnexal masses suspicious on ultrasound were managed by laparoscopy. After laparoscopic diagnosis, frozen sections were used to confirm a diagnosis of malignancy. Treatment was performed by laparoscopy whenever feasible. Measurements and Main Results The results of frozen section were compared with the results of permanent sections, and the consequences of the intraoperative diagnosis on the surgical management were evaluated. The frozen section diagnosis was correct in 125 of the 141 patients (88.7%). In one patient, the result was false negative. Specifically, frozen section diagnosis was correct in 96.8% of cases when a cyst or biopsy was sent for pathologic examination and in 86.4% when the whole adnexa was sent. It was correct in 93% of the cases involving tumors smaller than 100 mm and in 74% of larger tumors. It was correct in 92.3% of the women younger than 50 years and in 81.6% of women older than age 50. Intraoperative pathologic diagnosis was correct in 95.5% of benign tumors, 77.8% of low-malignancy tumors, and 75% of cancer cases. Conclusion Frozen section is a useful examination for surgical management decision making; however, the limitations and the difficulties should be taken into account.

Background Ovarian hyperstimulation syndrome (OHSS), is characterized by marked ovarian enlargement and acute third space fluid sequestration that almost always develops after hCG administration or in early pregnancy. OHSS is similar to vascular leak syndrome (VLS), which may be attributable to the massive increase in systemic inflammatory cytokines. In the present pilot exploratory case series, we sought to evaluate interleukin (IL)-2 and suppressor of cytokine signaling (SOCS)-1 expressions in the peripheral blood mononuclear cells (PBMCs) of patients suffering from severe ovarian hypertimulation syndrome (OHSS), and to examine whether their expressions differ when compared to PBMCs originated from normal early pregnant women (without OHSS). Methods Interleukin-2 and SOCS-1 mRNA expressions were examined in PBMCs of 5 women who were hospitalized due to severe OHSS (OHSS group) and 5 women with early IVF pregnancies and without OHSS (control group). Results Interleukin-2 mRNA levels in PBMCs were significantly higher in the OHSS as compared to the control groups. Moreover, while SOCS-1 mRNA levels were non-significantly lower, the ratio between IL-2 and SOCS-1 mRNA levels was significantly higher in the OHSS, as compared to the control group. Conclusions The inflammatory response to hCG, leading to dysregulation of Il-2 expression and SOCS activation, might be the culprit of OHSS. Additional large prospective studies are required to elucidate the effect of hCG on patients’ inherited inflammatory cascades, which may help discriminating those at risk to develop severe OHSS from those who are not.