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AVMs are rare tumorous vascular lesions derived from placental tissue that may present with massive post-partum hemorrhage (PPH) causing potentially life-threatening anemic shock. Current treatment options include the embolization of uterine arteries and emergency postpartum hysterectomy. We present a new form of minimally invasive, highly specific sonographically guided treatment in the form of the application of a human fibrin sealant leading to the instant cease of blood loss.A management protocol was established and a case series of 14 patients is presented. Diagnosis by endovaginal color Doppler sonography is followed by the sonographically guided application of biological glue (TISSEELThe procedure was technically successful in all 14 patients, 3 of whom (21 %) had a repeated procedure after 4 - 7 days. The mean age (yrs.) of the patients was 31 (25 - 40), the gravity was median 2 (1 - 5) and the parity was median 1 (0 - 4), the lowest Hb value was on average 9.35 ± 2.25 (5.2 - 14.2) g/dl, the lowest Ht was on average 30.82 ± 6.02 (18 - 41 %). Spectral Doppler analysis revealed an average of 80.71 ± 11.2 (66 - 115) cm/sec for the maximal detectable PSV. In the period of 4 - 55 months after treatment, 7 patients (50 %) had 8 successful pregnancies and 2 miscarriages.In PPH there is vital interest in timely diagnosis of the underlying cause, thus allowing fertility-sparing, minimally invasive and super-selective emergency treatment. In AVMs causing PPH, a positive impact on perinatal morbidity and mortality may be achieved by sonographically guided application of this biological glue.Arterio-venöse Malformationen (AVM) sind seltene Gefäßfehlbildungen ausgehend von Resten plazentaren Gewebes, die zu lebensbedrohlichen Blutungen in Form von massiven postpartalen Hämorrhagien (PPH), führen können. Embolisation der uterinen Gefäße oder aber einer notfallmäßigen Hysterektomie sind derzeit therapeutische Optionen. Wir präsentieren eine innovative, minimal-invasive Therapie mittels ultraschallgesteuerter, superselektiver Injektion eines Fibrinklebers, die zu einer unmittelbaren Blutstillung führt.Ein Standart zum Management von intrauterinen AVM wurde erstellt und eine Fallserie von 14 Patienten wird präsentiert. Nach Diagnostik durch vaginale Farb-Doppler Sonografie erfolgt die Applikation eines biologischen zwei-Komponenten Gewebekleber unter Ultraschallkontrolle. Der Gewebekleber, gewonnen aus tiefgefrorenem, gepooltem, humanem Frischplasma, beinhaltet eine Mischung aus konzentriertem Fibrinogen, Fibronectin und Albumin. Die verwendete Thrombin-Lösung enthält Calciumchlorid. Durch diese beiden Komponenten wird eine superselektive Okklusion der zuführenden Gefäße zur AVM erreicht und das Restgewebe kann durch Abrasio und/oder Hysteroskopie entfernt werden.Die Behandlung konnte in allen 14 Patienten erfolgreich durchgeführt werden, in 3 (21 %) Patienten musste der Eingriff innerhalb von 4 – 7 Tagen wiederholt werden. Das mittlere Alter der Patienten war 31 (25 – 40) Jahre, die Gravidität war median 2 (1 – 5) und die Parität median 1 (0 – 4). Der niedrigste Hb-Wert war im Mittel 9,35 ± 2,25, (5,2 – 14,2) g/dl, der niedrigste Hk-Wert war im Mittel 30,82 ± 6,02 (18 – 41)%. Spektral Doppler Analyse eine maximal nachweisbare PSV von 80,71 ± 11,2 (66 – 115) cm/sec. Im Abstand von 4 – 55 Monaten nach der Behandlung hatten 7 Patienten (50 %) eine erfolgreiche Schwangerschaft, wovon eine eine monochoriale Zwillingsschwangerschaft war. Zwei Patienten hatte eine frühe Fehlgeburt im ersten Trimenon.Beim Auftreten einer PPH besteht die lebenswichtige Notwendigkeit einer zeitnahen Diagnostik, so dass noch rechtzeitig minimal invasive und superselektive Therapiemaßnahmen ergriffen werden können, um somit die perinatale Morbidität und Mortalität zu senken. Die Applikation eines biologischen zwei-Komponenten Gewebekleber unter Ultraschallkontrolle könnte die Rate an anämisierenden Metrorrhagien senken.

BACKGROUND: Retrospective cohort study to evaluate differences in outcome when embryo transfer was performed either on day 2– 3 (cleavage stage, CS-group) or on day 4– 5 (blastocyst stage, BS-group). METHODS: A total of 1259 consecutive cycles yielding 500 live born babies performed at a single centre in Bregenz, Austria, were included. Main outcome measures were implantation and (multiple) pregnancy rates and neonatal outcome including birth defects. RESULTS: Total Pregnancy rate was 44% vs 28% ( P< 0.001) and the total ‘take home baby rate’ was 37% vs 22% in the BS-group and the CS-group, respectively. Rate of multiple gestations (34% vs 17%, P 5 0.001) was significantly higher among the BS-group, resulting in a higher rate of preterm deliveries

Ovarian hyperstimulation syndrome (OHSS) is the major complication associated with artificial reproductive technologies. The aim of this study was to assess the potential of exogenous steroids to prevent OHSS without adversely affecting pregnancy rate. A prospective and randomized study including 945 consecutive cycles in 603 women (mean age 28.6 years) was carried out to evaluate the efficiency of high-dose progesterone and oestradiol administration during the luteal phase to prevent OHSS. After ovulation induction, patients were allocated by a series of computer-generated random numbers to receive either 5000 iu human chorionic gonadotrophin (hCG) 4 and 8 days after embryo transfer (group 1, n = 534) or 500 mg hydroxy-progesterone caproate and 10 mg oestradiol valerate on days 2, 6, 10 and 14 after embryo transfer (group 2, n = 411), by i.m. injection. Total pregnancy rate was 24% (97 of 411) and 23% (121 of 534), and median serum progesterone concentrations on day 15 after embryo transfer were 5.8 ng ml(-1) (range 0.1-298) and 0.1 ng ml(-1) (range 0.1-372) in groups 1 and 2, respectively (P = 0.001). One hundred and sixty-three (30.5%) women in group 1 and 22 (5.4%) women in group 2 developed signs of OHSS (P0.0001). These results indicate that steroidal ovarian suppression during the luteal phase is a promising tool to reduce the incidence and severity of OHSS in a high-risk population without compromising the pregnancy rate.

The purpose of the study was to evaluate the efficiency of administration of high dose progesterone in combination with oestradiol during the luteal phase for the prevention of ovarian hyperstimulation syndrome in a high-risk population of patients undergoing in vitro fertilization. An observational study was carried out involving 21 women (mean age 28.6 years) undergoing controlled ovarian stimulation for in vitro fertilization. The women were identified as at risk of ovarian hyperstimulation syndrome as they had suffered from the condition when hCG was used for luteal phase support in previous cycles. Steroidal suppression of the stimulated ovary on days 2, 6, 10 and 14 after embryo transfer was achieved by intramuscular injections of 500 mg hydroxyprogesterone caproate and 10 mg oestradiol valerate. The incidence of moderate and severe ovarian hyperstimulation syndrome under steroidal ovarian suppression, serum progesterone concentration and pregnancy rates were compared with those in cycles in which human chorionic gonadotrophin was used for luteal phase support. No cases of moderate or severe ovarian hyperstimulation syndrome occurred under steroidal ovarian suppression. Despite low progesterone concentrations (mean 10.7 nmol l(-1), range 2.6-24.5), indicating almost complete ovarian suppression, the pregnancy rate was not impaired. These preliminary results indicate that steroidal ovarian suppression during the luteal phase is a promising tool for reducing the incidence and severity of ovarian hyperstimulation syndrome in a high-risk population, without compromising the pregnancy rate.