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1/5. Pelvic abscess in the second half of pregnancy after oocyte retrieval for in-vitro fertilization: case report.

    We describe a very late manifestation of pelvic abscesses after oocyte retrieval for in-vitro fertilization (IVF). In a twin pregnancy achieved after intracytoplasmic sperm injection, rupture of bilateral ovarian abscesses occurred at the end of the second trimester. An emergency laparotomy was necessary because of an acute abdomen. This complication led to severe maternal and neonatal morbidity, preterm birth and neonatal death. The rare occurrence of acute abdomen in pregnancy due to pelvic infection and the non-specific symptoms of a pelvic abscess after oocyte retrieval for IVF are discussed.
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2/5. Three-week delayed delivery in a triplet pregnancy at full dilatation with aggressive tocolysis.

    We describe our aggressive management of a woman with a triplet pregnancy resulting from in vitro fertilization who presented at 22 weeks' gestation in labor with full cervical dilation. Successful multiagent tocolysis and delayed delivery of the two remaining fetuses after delivery of the presenting fetus led to an improved outcome for all three babies.
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keywords = fertilization
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3/5. Unilateral pleural effusion as the main presentation of "early onset" severe ovarian hyperstimulation syndrome.

    OBJECTIVE: To report a case of severe early onset ovarian hyperstimulation syndrome with unilateral pleural effusion and little ascites as the main presenting clinical signs. DESIGN: Case report. SETTING: University affiliated teaching hospital and in vitro fertilization (IVF) clinic. PATIENT(S): A 33-year-old woman known to have bilateral polycystic ovaries underwent IVF and became pregnant. INTERVENTION(S): Pleuracentesis. MAIN OUTCOME MEASURE(S): Resolution of symptoms, pregnancy outcome. RESULT(S): A total of 4,200 mL of pleural fluid was drained from the right hemithorax. Complete resolution of symptoms did not occur until 16 weeks' gestation. The pregnancy progressed normally until 27 weeks when spontaneous preterm labor resulted in a vaginal delivery of a live female infant weighing 880 grams. CONCLUSION(S): This case described is unusual in that the patient presented with significant right-sided pleural effusions on day 2 after embryo transfer and continued to be symptomatic until 16 weeks' gestation. This is much earlier than any previously described case report of isolated unilateral pleural effusion associated with ovarian hyperstimulation syndrome.
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keywords = fertilization
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4/5. Fetal outcome of triplets in a Turner mosaic.

    Pregnancies are now being reported resulting from fertilization of donor oocytes in women with ovarian failure. A case of triplets in a Turner mosaic is reported herein following transfers of embryos resulting from donor oocytes. She had previously demonstrated a normal sized uterine cavity by hysterosalpingography. The opinion from our group was that she should consider selective reduction but a perinatology consult thought she should have a favorable outcome. Her pregnancy was complicated by polyhydramnios, pre-term labor, and eventual fetal demise at 25 and 27 weeks of all three fetuses. Natural pregnancies in patients with gonadal dysgenesis have been reported in at least 138 patients. Many aborted or had stillbirths and this high rate of fetal mortality has been ascribed to chromosomal abnormalities. The continued use of donor oocytes will provide data to evaluate whether there will continue to be a higher spontaneous abortion rate and complications in second and third trimesters in Turner's pregnancies even in single pregnancies. The outcome of this case can at least be provided to future gonadal dysgenesis patients with triplets to help them in their decision as to whether or not to have selective reduction.
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keywords = fertilization
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5/5. candida glabrata chorioamnionitis following in vitro fertilization and embryo transfer.

    candida glabrata is a yeast which is considered to be a commensal of the vagina with limited pathogenicity in the immunocompetent host. We report 2 cases of severe chorioamnionitis occurring in pregnancies achieved by in vitro fertilization techniques which resulted in preterm delivery and pregnancy loss. candida glabrata as the causative agent was probably introduced into the uterus by the cannula at the time of embryo transfer. It is recommended that appropriate investigation of the microbial flora of the cervix be undertaken and treatment instituted prior to embryo transfer in order to prevent this complication.
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