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To investigate the association between endometrial compaction and pregnancy rates in unstimulated natural cycle frozen embryo transfers.A single-center prospective cohort study. Endometrial thickness by transvaginal ultrasound and blood progesterone levels on the day of ovulation and the day of embryo transfer were evaluated in patients undergoing natural cycle frozen embryo transfer. Compaction was defined as 5% decrease in endometrial thickness between ovulation day and day of transfer. Clinical and ongoing pregnancy rates in cycles with and without compaction were compared.Seventy-one women were included, of which 44% had endometrial compaction, with similar rates when subdividing the patients by day of transfer (day 3 or day 5). Clinical and ongoing pregnancy rates were higher in the compaction group compared to the non-compaction group (0.58 vs. 0.16, P 0.001; 0.52 vs. 0.13, P 0.001 respectively). Subdividing by degree of compaction 10% and 15% revealed similar pregnancy rates as 5%, with no added benefit to higher degrees of compaction.About half the patients in our study undergoing unstimulated natural cycle frozen embryo transfer experienced compaction of the endometrium, occurring as early as day 3 post-ovulation. This was significantly correlated with increased clinical and ongoing pregnancy rates.

Background Second-trimester and early third-trimester uterine rupture in a nonlaboring woman is a very rare and life-threatening condition for both mothers and newborns. We aimed to present clinical characteristics, prenatal findings, and maternal and neonatal outcomes following second-trimester and early third-trimester spontaneous antepartum uterine rupture in our institute. Method The medical records of all women with full-thickness second-trimester and early third-trimester uterine rupture treated in our department from 1988 to 2019 were retrieved from the institutional database and reviewed. Small uterine defects, incomplete ruptures, and silent uterine incision dehiscence were excluded. Results From 1988 to 2019, 213 665 deliveries were recorded in our institute. Of these, 12 patients experienced second-trimester or early third-trimester spontaneous uterine rupture. Obstetric history revealed that 50% of the women in each period had undergone previous classical uterine incisions and 50% had a short interpregnancy (IP) interval. The mean age at diagnosis of uterine rupture was 26.3 ± 5.1 weeks. The ruptures were associated with abnormal placentation in 10 cases (83.3%): placenta previa (n = 7); and placenta previa and percreta (n = 3). No maternal mortality occurred. Seven of the 10 (70%) viable newborns survived. Conclusions The increasing rates of cesarean births (CB) may lead to iatrogenic complications including midgestational prelabor spontaneous uterine rupture, an obstetric emergency, which is hard to diagnose. Maternal and neonatal outcomes can be optimized by a greater awareness of the risk factors, recognition of clinical signs and symptoms, and the availability of ultrasound to assist in establishing a diagnosis to enable prompt surgical intervention.

Intrahepatic cholestasis of pregnancy and preeclampsia are two major pregnancy complications. We aimed to investigate the association between intrahepatic cholestasis of pregnancy (ICP) and preeclampsia. Single-center retrospective study. Study group included 180 women (162 singletons and 18 twin gestations) who were diagnosed with ICP based on clinical presentation, elevated liver enzymes and bile acids. The reference group included 1618 women (1507 singletons and 111 twin gestations) who delivered during the study period, and were matched according to age, gravidity, parity and singleton or twin gestation. The incidence of ICP was 0.36%. The incidence of preeclampsia was higher in women with ICP compared to reference group (7.78% vs 2.41%, aOR, 3.74 95% CI 12.0–7.02, p

Purpose Recurrence of adnexal torsion involving otherwise normal adnexa is not rare. Various oophoropexy (ovarian fixation) procedures have been suggested to prevent recurrence, however, long-term information of their efficacy is lacking. The aim of this study was to investigate the recurrence rate of adnexal torsion following oophoropexy. Methods Retrospective cohort study, including all consecutive patients who underwent an oophoropexy procedure for the prevention of recurrent torsion of “normal adnexa” in our department from 2008 to 2021. Oophoropexy techniques included shortening of the utero-ovarian ligament (between 2008 to 2019) or combined utero-ovarian and round ligament fixation (from 2020). Results Twenty-one patients (age range 7-35 years) with a mean follow-up of 82.7 ± 60.6 months were identified. Fifteen of them (71.4%) were re-operated for recurrent torsion following an oophoropexy procedure, while six (28.6%) did not experience recurrence. Twelve (57.1%) torsion recurrences following an oophoropexy occurred within the first 2 postoperative years. There were no differences in mean age and menarchal status )pre- or post-menarchal) at the time of the first torsion event, age at the time of oophoropexy, oophoropexy side, number of adnexal torsion events before oophoropexy, and follow-up duration between those with and those without post-oophoropexy recurrences. Conclusion Oophoropexy procedures may not prevent recurrent torsion of otherwise normal adnexa. Further studies to determine whether combined fixation (utero-ovarian plication and round ligament) is more efficacious than isolated utero-ovarian plication for the prevention of recurrent torsion are warranted.

To evaluate the new ultrasound-based signs for the diagnosis of post-cesarean section uterine niche in nonpregnant women.We investigated prospectively a cohort of 160 consecutive women with one previous term cesarean delivery (CD) between December 2019 and 2020. All women were separated into two subgroups according to different stages of labor at the time of their CD: subgroup A (n = 109; 68.1%) for elective CD and CD performed in latent labor at a cervical dilatation (≤4 cm) and subgroup B (n = 51; 31.9%); for CD performed during the active stage of labor (4 cm).Overall, the incidence of a uterine niche was significantly (P .001) higher in women who had an elective (20/45; 44.4%) compared with those who had an emergent (21/115; 18.3%) CD. Compared with subgroup B, subgroup A presented with a significantly (P = .012) higher incidence of uterine niche located above the vesicovaginal fold and with a significantly (P = .0002) lower proportion of cesarean scar positioned below the vesicovaginal fold. There was a significantly (P .001) higher proportion of women with a residual myometrial thickness (RMT) 3 mm in subgroup A than in subgroup B and a significant negative relationship was found between the RMT and the cervical dilatation at CD (r = -0.22; P = .008).Sonographic cesarean section scar assessment indicates that the type of CD and the stage of labor at which the hysterotomy is performed have an impact on the location of the scar and the scarification process including the niche formation and RMT.

OBJECTIVE Removal of retained products of conception (RPOC) by suction curettage or hysteroscopy may be required in the postpartum period, possibly causing intrauterine adhesions. We investigated whether rates of suction curettage, hysteroscopy, and postoperative intrauterine adhesions have changed over time. METHODS Parturients considered at risk for RPOC were followed in a specialized postpartum clinic with sequential ultrasound scans. We compared the rates of women requiring surgical procedures for RPOC removal and rates of postoperative intrauterine adhesions between two 2-years periods: 2011-2012 ("early period") and 2016-2017 ("late period"). RESULTS The overall rates of women requiring a surgical procedure for removal of RPOC did not differ between the early and late periods (38/762 [5.0%] vs 41/732 [5.6%], respectively, P = 0.595). However, removal of RPOC by suction curettage decreased significantly over time whereas removal by hysteroscopy increased (P = 0.022). Intrauterine adhesions were diagnosed in 7 of 38 women (18.4%) who underwent a surgical procedure for RPOC removal in the early period, but none of the patients operated on in the late period developed intrauterine adhesions (P = 0.004). CONCLUSION Removal of RPOC in postpartum women may be completed by hysteroscopy in most cases, significantly reducing the need for postpartum curettage and the rates of postoperative intrauterine adhesions.

Objective The 2020 COVID-19 pandemic has been associated with excess mortality and morbidity in adults and teenagers over 14 years of age, but there is still limited evidence on the direct and indirect impact of the pandemic on pregnancy. We aimed to evaluate the effect of the first wave of the COVID-19 pandemic on obstetrical emergency attendance in a low-risk population and the corresponding perinatal outcomes.Study Design This is a single center retrospective cohort study of all singleton births between February 21 and April 30. Prenatal emergency labor ward admission numbers and obstetric outcomes during the peak of the first COVID-19 pandemic of 2020 in Israel were compared with the combined corresponding periods for the years 2017 to 2019.Results During the 2020 COVID-19 pandemic, the mean number of prenatal emergency labor ward admissions was lower, both by daily count and per woman, in comparison to the combined matching periods in 2017, 2018, and 2019 (48.6 ± 12.2 vs. 57.8 ± 14.4, p 40 and 41 weeks, mode of delivery, and numbers of emergency cesarean deliveries were similar in both groups. There was no difference in the intrapartum fetal death rate between the groups.Conclusion The COVID-19 pandemic stay-at-home policy combined with patient fear of contracting the disease in hospital could explain the associated higher rate of stillbirth. This collateral perinatal damage follows a decreased in prenatal emergency labor ward admissions during the first wave of COVID-19 in Israel.Key Points

Since many tourists share the photos they take on social media channels, large collections of tourist attraction photos are easily accessible online. Recent research has dealt with identifying popular places from these photos, as well as computing city tourism routes based on these photo collections. Although current approaches show great potential, many tourism attractions suffer from being overrun by tourists, not least because many tourists are aware of only a few tourism hot spots that are trending. In the worst case, automatic city route recommendations based on social media photos will intensify this issue and disappoint tourists who seek individual experiences. In the best case, however, if individual preferences are appropriately incorporated into the route planning algorithm, more personalized route recommendations will be achieved. In this paper, we suggest distinguishing two different types of photo contributors, namely: first-time visitors who are usually tourists who "follow the crowd" (e.g., to visit the top tourist attractions), and repeated visitors who are usually locals who "don’t follow the crowd" (e.g., to visit photogenic yet less well-known places). This categorization allows the user to decide how to trade the one objective off against the other. We present a novel method based on a classification of photographers into locals and tourists, and show how to incorporate this information into an algorithmic routing framework based on the Orienteering Problem approach. In detailed experiments we analyze how choosing the parameter that models the trade-off between both objectives influences the optimal route found by the algorithm, designed to serve the user’s travel objective and preferences in terms of visited attraction types.