Introduction:
Several independent risk factors of Ectopic Pregnancy (EP) have been described to date. Nevertheless, estradiol and progesterone have not been related to ectopic pregnancy, although there is biological rationale to think about them as possible candidates. Our aim was to correlate the incidence of EP with levels of estradiol (E2) and progesterone (P4), measured on two days (hCG day, and seven days later (hCG+7)), including the differences and ratios of these concentrations, between the two time-points.

Material and methods:
Retrospective cohort study of 578 patients undergoing fresh embryo transfer after IVF (100 cycles), ICSI (508 cycles) and IVF/ICSI (64 cycles) without risk of EP, between January 2005 and December 2015. We evaluated EP incidence (10 ectopic pregnancies) in fresh embryo transfers according to estradiol and progesterone levels on hCG day (hCGd) and seven days later (hCG+7) and their variation between both. The proportions were compared using the chi-square test or Fisher’s exact test and the means were compared using T-test or ANOVA. To determine the accuracy of each studied variable receiver-operating curves were built.

Results:
We identified a trend towards an increased risk of EP as progesterone levels rose on hCGd (p=0.020) and an association of progesterone values >1.89ng/ml on hCGd with EP (OR 6.8). An increased risk of EP when the difference of estradiol between hCGd and hCG+7 was either <39pg/mL, or >745pg/mL (p=0.001) was also found. ROC analysis only resulted significant for a moderate/good predictive ability for progesterone values on hCGd (AUC: 0.694).

Discussion:
We conclude that these measurements are sufficient to identify patients at a high risk of EP. These hormone levels on specific days, leading us to define proper strategies to prevent EP risks in IVF. Further studies should design to prove this hypothesis.

Permanent sterilization is a very common form of family planning. Hysteroscopic sterilization has been an ongoing target for litigation, complaints and adverse publicity. To establish a positive correlation between Essure® insertion and any given side effect, it must be demonstrated that the incidence of the specific symptom is higher in patients who underwent Essure® insertion than in the general population. There are many confounders that must be taken into consideration before concluding that a given symptom is related to an intervention. A review of different clinical conditions regarding Essure® is presented.

Conclusion: Evidence based support linking the use of Essure® to adverse events is lacking when placed in appropriate selected candidates. Adequate patient selection and thorough inform consent is strongly encouraged before inserting Essure®.

The Genitourinary Syndrome of Menopause (GSM) is the last terminology accepted that describes various menopausal symptoms and signs. It includes genital (burning, dryness or pain), sexual (lack of lubrication, discomfort), but also urinary symptoms (urgency, dysuria, and recurrent urinary tract infections).

In this review we explain this terminology and discuss the importance of this syndrome. Moreover, we comment the necessity of active treatment in postmenopausal women.

Objective:
To analyze the clinical effect of traditional Chinese herbs on acupoint shenque to manage postpartum urinary retention after vaginal delivery.

Methods:
47 women with postpartum urinary retentions following vaginal delivery from Haidian Maternal and Child Health Hospital (April 2011 to August 2011) were randomly divided into two sub-groups: Shenque acupoint group and intramuscular injection of neostigmine group, and then observed the effects of Shenque acupoint and neostigmine on urinary retention in the two groups.

Results:
61.89% patients in the neostigmine group had an immediate clinical response, while 100% response rate was observed in Shenque acupoint group (p<0.01). Patients in the Shenque acupoint group had a significantly shorter mean voiding time when compared to patients in the neostigmine group (p<0.01).

Conclusion:
Shenque application is an effective option for women with postpartum urinary following vaginal delivery.

Women with pre-existing medical conditions are at increased risk of complications during pregnancy that can affect the immediate and long-term health of themselves and their offspring. Evidence suggests that preparation in the peri-conception period, before and during very early pregnancy, is effective but not all women are aware of, or able to undertake, the advised condition-specific behaviour change prior to pregnancy. Improving outcomes for these women requires a greater understanding of what approaches work, for whom they work, in what context and how. This protocol outlines how realist review methods can be used to synthesize evidence on peri-conception care for women with pre-existing medical conditions. The review will be conducted in two phases using electronic database and supplementary searching to find relevant evidence to develop and test program theories about how peri-conception care works. Phase 1 will focus on initial theory development, specifically the context and mechanisms that may explain how it works. Phase 2 will then be undertaken to test and refine these program theories. Experts and women with relevant lived experience will be consulted at each phase of the review to ensure it is grounded in real-life. The findings will be disseminated locally, nationally and internationally to peri-conception care networks. This realist review will explore how and for whom peri-conception care works, in order to support decisions regarding how to implement effective peri-conception care for women with pre existing medical conditions and thus improve the lives of affected families. The findings will also inform a realist evaluation of peri-conception care, with the aim to further refine program theory and explore different methods of implementation of peri-conception care.

Objective:
To demonstrate effective strapping emergency in therapeutic management of threat with open cervix.

Methodology:
We conducted a descriptive cohort study at Yopougon Abidjan (Côte d’Ivoire) University Hospital. Over a period of two years (February 2015 to January 2017), the study concerned 11gestantes who presented a severe threat of late miscarriage with the opened cervix, protrusion and intact membranes in the second trimester of Pregnancy. For all pregnant, a strapping of the cervix has been performed according to Mac Donald’s procedure.

Results:
Mean’s age of patients was 30 years, 27.30% primigravida and 36.40% nulliparous. More than half (55%) had a history of abortion. Symptomatology was dominated by pelvic pain (63.60%). The average gestational age at the time of strapping was 20 weeks. Average duration of the interventions was 12, 27min and hospitalization of pregnant after cerclage was 3 days. Following up was marked by a new hospitalization in 3 patients, because of membrane’s rupture at 31 weeks of pregnancy. Average gestational age for childbirth was 36 weeks, 82% of births by caesarean section. 64% of children were born with a score of APGAR greater than 7 at the first minute. No cases of newborn death have been noted. Average time between strapping and childbirth was 115 days or 15 weeks.

Conclusion:
Emergency cervical strapping is used to prolong the duration of pregnancy and to reduce risk of high prematurity, thereby improving fetus viability and prognosis.

Introduction:
Over the past few decades, the incidence of placenta accreta, increta and percreta have increased due to the increasing cesarean delivery rate. The American College of Obstetricians and Gynecologists estimated that placenta accreta complicates 1 in 2500 deliveries. It is a leading cause of intractable postpartum hemorrhage requiring emergency peripartum hysterectomy and maternal deaths.

Aims and Objectives:
The purpose of this study was to evaluate the demographic profile, high risk factors, fetal and maternal outcome and management options in women presenting with morbidly adherent placenta to our hospital which is a tertiary care referral centre.

Materials and Methods:
This was a retrospective study conducted in the department of Obstetrics and Gynecology, mamata medical college, khammam from January 2005 to December 2014 for a period of ten years. All the pregnant women who were diagnosed with morbidly adherent placenta were included in the study. Patients were identified from the admission and labour room registers.

Results:
Forty women were having Morbidly Adherent Placenta in the study period. 50% placenta accreta, 30% placenta increta and 20% placenta percreta. The mean age was 25.5 ± 3.8 years with 10% >35 years of age. The mean parity was 2.5 ± 0.9. Only 10% of them were booked patients. 70% had previous caesarean section and 5% had prior curettage. Placenta previa was present in 70% women. 10% women had no known risk factors. 80% presented antenatally, 20 % presented postdelivery with retained placenta. 70% presented with antepartum hemorrhage, 10% had asymptomatic placenta previa at term. 5 % presented with shock between 28 and 30 weeks. 85 % underwent hysterectomy. Massive blood loss was present in all the women with a mean blood loss of 2.8l. An average of 8 units of whole blood and six units of fresh frozen plasma were transfused. Bladder was injured during dissection in 15% and partial cystectomy was done in 5% due to bladder involvement by percreta. 60% of the women had to be shifted to ICU. The maternal mortality in our study was 25%. All of them died due to DIC. The average gestational age in our study was 34.2 weeks. 70% of the newborns were preterm with an average birth weight of 2.1 kg. The perinatal mortality was 45%.

Conclusion:
To conclude, incidence of placenta accreta is increasing and previous caesarean section and placenta previa are important risk factors, so there is a need to keep the primary caesarean section rates at a low level. Early preoperative diagnosis in the suspected women is the key to save the women’s life. Adherent placenta should be suspected even in the second trimester in women with known high risk factors who are undergoing MTP or suction evacuation.

Policies and guidelines exist at the local, state, national and international levels for the identification of pregnant women with mental health issues for their care and management needs throughout the perinatal period. It is known that there is an increased rate of adverse birth outcomes in this population and this case series highlights the lack of clarity in these guidelines, particularly regarding which clinicians are required for multidisciplinary team management. This leads to a system design that allows gaps in service provision to occur for some more vulnerable women. Recommendations for future research and clinical approaches are discussed.