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  • PublicationMetadata only
    Total colpocleisis technique in huge neglected ulcerated uterovaginal prolapse
    Introduction and hypothesis We present a video describing the technical considerations for performing a total colpocleisis in the management of significant, neglected, ulcerated, and symptomatic complete uterovaginal prolapse. Methods A 79-year-old debilitated woman presented with a large, ulcerated pelvic bulge. A previous attempt at pessary treatment failed because of a disproportion of the pessary with the prolapse size. She had a history of liver insufficiency and hypertension. Obliterative colpocleisis surgery was selected because the healing of a large ulcerated vagina was not likely within a short timeframe. Sharp dissection with scissors and de-epithelialisation of the remaining non-eroded vaginal mucosa with the friction of a sharp-edged surgical knife were performed. Closely located purse strings were used to obliterate potential spaces. Two mirror image triangles in the anterior and posterior vaginal walls were removed. After the formation of a new perineal body, the diamond-shaped vaginal incision was closed vertically to narrow introitus. Results The patient was discharged on the first postoperative day and an uncomplicated postoperative course ensued. At the 4-week follow-up, there was no evidence of infection, recurrent prolapse, de novo stress incontinence, or voiding with difficulty. Conclusions Total colpocleisis is an excellent surgical option in women with multiple, large cervicovaginal ulcers and multiple comorbidities with no desire for penetrative vaginal function.
  • PublicationMetadata only
    The importance of serum progesterone concentration at embryo transfer day and effect of rescue additional progesterone during programmed artificial frozen embryo transfer cycles
    (2022-01-01T00:00:00Z) ÖZCAN, PINAR; ÇETİN, ÇAĞLAR; Okten, Berkem; TANOĞLU, FATMA BAŞAK; Taha, Havva Sevde; Pasin, Ozge; Ficicioglu, Cem; ÖZCAN, PINAR; ÇETİN, ÇAĞLAR; TANOĞLU, FATMA BAŞAK; PASİN, ÖZGE
    © 2022 Reproductive Healthcare Ltd.Research question: What is the efficacy and possible positive effect of additional rescue subcutaneous (s.c.) progesterone therapy for restoration of progesterone concentration on embryo transfer day and pregnancy rates during programmed artificial frozen embryo transfer (FET) cycles with vaginal progesterone tablet plus i.m. progesterone? Design: Multicentre prospective cohort study (NCT04769401) including a total of 238 programmed artificial FET between February 2021 and September 2021. Patients were divided into ≥10 ng/ml and <10 ng/ml according to serum progesterone concentrations on embryo transfer day; 25 mg of s.c. progesterone was added to patients with <10 ng/ml; blood samples were taken 2 days later. The primary outcome was the ongoing pregnancy rate. Results: The proportion of patients having ≥10 ng/ml serum progesterone concentrations on embryo transfer day was 70.7%. There was no statistically significant difference with regard to cumulative pregnancy rate, ongoing pregnancy rate and miscarriage between the groups (55.4% versus 61.5%, P = 0.4; 78.2% versus 72.5% per pregnancy, P = 0.5; 21.8% versus 27.5%, P = 0.5, respectively, ≥10 ng/ml and <10 ng/ml). Eighty-three per cent of patients with low serum progesterone concentrations on embryo transfer day reached an adequate progesterone concentration with rescue s.c. progesterone treatment; 90% of pregnancy rates in patients with serum progesterone concentrations <10 ng/ml on embryo transfer day were in patients who reached adequate serum progesterone concentrations with daily rescue s.c. progesterone treatment. Conclusions: The measurement of serum progesterone concentrations on embryo transfer day may create the opportunity for rescue progesterone administration on that day for patients who fail to reach adequate serum progesterone concentrations, achieving similar pregnancy rates without cancellation of the cycle.