Perceptions in Reproductive Medicine

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EISSN : 2640-9666
Current Publisher: Crimson Publishers (10.31031)
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Perceptions in Reproductive Medicine; doi:10.31031/prm

Firas M Al Rshoud, Khamaiseh K, Emad Al Sharu, Ziad Awwad, Nagham Younis, Ban Tell, Abdel Hamid Malhas
Perceptions in Reproductive Medicine, Volume 4, pp 1-2; doi:10.31031/prm.2020.04.000582

Abstract:
Firas M Al Rshoud1*, Khamaiseh K2, Emad Al Sharu3, Ziad Awwad4, Nagham Younis5, Ban Tell6 and Abdel Hamid Malhas7 1Professor of Reproductive Medicine and Infertility, JSFG CME head, Jordan 2JSFG President, MRCOG, Jordan 3Senior Consultant of REI, Jordan 4JFSG Vice president, senior consultant of urology and andrology, Jordan 5MSc in embryology, General Secretary of JSFG, Biological science department, Jordan 6MSc clinical embryology, CME JSFG, Jordan 7Consultant of OB & Gyn, Financial committee of JSFG, Jordan *Corresponding author: Firas Al Rshoud, Assistant professor of REI, JSFG CME head, Faculty of Medicine, The Hashemite university , Zarqa, Jordan Submission: October 01, 2020;Published: October 07, 2020 DOI: 10.31031/PRM.2020.04.000582 ISSN: 2640-9666Volume4 Issue2 Objective: This JSFG guidance comes in response to the coronavirus (COVID-19) global pandemic crisis and to the need of a clear information for provision of ART and Infertility treatments in Jordan aiming to protect both the patients and the health care workers [1]. By the end of September 2020, the risk of COVID-19 infection is increasing dramatically in Jordan (we are close from 2000 case/day), the normal daily Work should be modified to adapting a new life taking in consideration the following: Conclusion: We hope after the release of the JSFG guidance on Recommencing ART and Infertility Treatments our colleagues in the ART field will have a clear information that makes the work safer for both the staff and the patients during the pandemic of COVID-19. Keywords: COVID-19; ART and Safety The society board members and the Advisory committee identified pillars of good medical practice proposed for the restart of activity in the ART clinic and labs. Information and consent to the start of treatment All our Patients must be fully informed, clearly understand the risks related to COVID-19 disease, this can be achieved by providing a written information. Priority of ART treatment We should give priority of treatment to certain patients such as: Staff and patient triage Treatment cycle protocol The Ovarian stimulation: Oocyte retrieval: Embryo transfer: Laboratory guidelines: Staff safety Laboratory contingency plan (sudden shutdown): The Jordanian Society for Fertility and Genetics(JSFG) hope that all ART health worker in Jordan follow the above guidelines as these guidelines will make it safer for both the staff and patients. JSGF don’t recommend routine testing for asymptomatic patients either by PCR or antibodies at the present situation. 1. This guidance is inspired by the ESHRE 2020 Guidelines. 2. We want to thank the advisory board of the society(Mazen Zebdah, Faheem Zayed, Khaldoun Sharif, Suleiman Dabit and Aref Al Khaledi) for their participation in making these guidelines. © 2020 Firas M Al Rshoud. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.
Hani Raoul Khouzam
Perceptions in Reproductive Medicine, Volume 4, pp 1-3; doi:10.31031/prm.2020.04.000580

Abstract:
Hani Raoul Khouzam1,2* 1Staff Psychiatrist, Mental Health and psychiatry services, PTSD treatment program and General Mental Health Clinic, USA 2Clinical Professor of Psychiatry and Medicine, USA *Corresponding author: Ajit Kumar Saxena, Department of Pathology/ Laboratory Medicine, India Submission: September 15, 2020;Published: October 06, 2020 DOI: 10.31031/PRM.2020.04.000580 ISSN: 2640-9666Volume4 Issue1 The Severe Acute Respiratory Syndrome Coronavirus 1 (SARS-CoV-1) which precipitated the COVID-19 pandemic, could adversely affect human reproductive health. This review summarizes the potential risks of COVID-19 on pregnancy, neonatal health and fertility as reported through clinical observation and recently published studies. Keywords: COVID-19, pregnancy, neonates, fertility, coronavirus Coronavirus disease 2019 (COVID-19) is a novel type of highly contagious infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).It has several medical complications that keep being observed and addressed on a daily basis as this global pandemic continues to progress worldwide. Some of the recently observed clinical findings have documented SARS-CoV-2 ability of affecting reproductive health and neonate’s health. This review summarizes some of the recently described effects of COVID-19 infection on pregnant women, neonates and fertility. According to World Health Organization (WHO), pregnant women do not appear to be at higher risk of severe disease. Furthermore, WHO reports that currently there is no known difference between the clinical manifestations of COVID-19 in pregnant and non-pregnant women of reproductive age. Nevertheless, the available data on the exact effects of COVID-19 on fertility and pregnancy is scarce. Despite the increasing number of published studies on COVID-19 in pregnancy, there are insufficient rigorous and systematically collected data with regard to the severity of the disease or specific complications of COVID-19 in pregnant women, as well as vertical transmission, perinatal and neonatal complications and the capture of critical data is needed to better understand the effects of this infection on pregnant women and neonates [1]. The main presenting symptoms of SARS-CoV-2 infection include fever, cough, fatigue, shortness of breath, sputum production, headache, and myalgias with some patients presenting with gastrointestinal symptoms [2]. Other patients may manifest anosmia which is an absence or decreased sense of smell or ageusia which is the loss or impairment of the sense of taste [3]. The severity of infection ranges from asymptomatic carriers, to mild flulike disease, to critical illness and death. Critically ill patients may experience respiratory failure, shock, or multiple organs failure [4]. Approximately 80% of infections are mild with flu-like symptoms, 15%-20% are severe, requiring hospitalization and supplemental oxygen, and 5% are critical and require mechanical ventilation [5]. The risk factors for severe illness include older age and the presence of co-occurring underlying medical conditions such as cardiovascular disease, diabetes, chronic respiratory disease, hypertension, and cancer [6]. Up to 3% of SARS-CoV-2 infections have been associated with increase mortality in individuals older than 60 years of age or in those with underlying medical conditions ,however it is important to recognize that death to COVID-19 can occur at any age including younger patients , and women of reproductive age who could be initially asymptomatic carriers of the virus [3]. Based on limited reports and the available data from other respiratory pathogens, it is unknown whether pregnant women with COVID-19 will experience more severe illness than nonpregnant adults. COVID-19 infection during pregnancy is not generally associated with an increased risk of spontaneous abortion and spontaneous preterm birth [7]. In some reports, SARSCoV- 2 was found to increase the risk for pregnancy complications especially in the third trimester including acute respiratory distress syndrome, disseminated intravascular coagulopathy, renal failure, secondary bacterial pneumonia, and sepsis [8]. To prevent these possible complications, the delivery should optimally be performed in health care facilities with close maternal and fetal monitoring. The timely delivery in women with COVID-19 critical status is not usually associated with increased risk of premature birth or asphyxia of the newborn and could improve the treatment and rehabilitation of maternal pneumonia [9]. Pregnant women with comorbidities such as obesity are likely at increased risk for severe illness consistent with the general population with similar comorbidities. However, given that pregnancy itself is now identified as a risk factor for certain outcomes, the magnitude of further increase from such comorbidities will need to be further delineated. Clinicians are urged to provide educational instructions to pregnant women and those contemplating pregnancy about the potential risk for severe illness from COVID-19, and measures to prevent infection with SARS-CoV-2 should be emphasized for pregnant women and their families. Pregnant individuals are encouraged to take all available precautions to optimize health and avoid exposure to COVID-19. These educational efforts could be provided via phone or telehealth sessions before scheduled appointments to allow clinics to appropriately prepare and optimize care coordination needs. There seem to be a low frequency of spontaneous preterm birth and general favorable immediate neonatal outcome in pregnant women with COVID-19 and the rate of vertical or peripartum transmission of SARS-CoV-2 is considered to be very low and not yet detected for cesarean delivery [10]. Although vertical transmission of SARS-CoV-2 was not detected, the proportion of neonatal bacterial pneumonia was higher than other neonatal diseases in newborns [11]. Although...
Hani Raoul Khouzam
Perceptions in Reproductive Medicine, Volume 4, pp 1-2; doi:10.31031/prm.2020.04.000581

Abstract:
Hani Raoul Khouzam1,2* 1Staff Psychiatrist, Mental Health and psychiatry services, PTSD treatment program and General Mental Health Clinic, USA 2Clinical Professor of Psychiatry and Medicine, USA *Corresponding author: Ajit Kumar Saxena, Department of Pathology/ Laboratory Medicine, India Submission: September 15, 2020;Published: October 06, 2020 DOI: 10.31031/PRM.2020.04.000581 ISSN: 2640-9666Volume4 Issue1 Aging is emerging in 20th and 21st centuries more than any time before. Development in science, technology, medicine, food, clean water, and hygiene have widely helped in more human longevity. Through such series of development, people are experiencing longer life as compared with their ancestors. Many countries in developing countries do not yet have such experience as how to interact with the growing aging people [1]. East, or broadly speaking, the developing world is unexpectedly facing new generations of the elderly people on the one hand, and the lowering of their youth below the age of 15 on the other hand. Despite the East, the Western countries have more experience in how to handle their aging people. Those countries have appropriately invested on research and practice in the field of biology, nursing, medicine, social work, public health, housing and anthropology for such people [2]. The nature of gerontology means that there are a number of sub-fields which overlap with gerontology. The developed countries entered the study of population aging quite earlier. Due to their declining fertility rates and rising life expectancy, mostly the developed countries are facing more aging population. Aging population is an indicator of industrial countries. Social work plays a very prominent role to identify the status of aging people with special reference to those who are usually 65 and older. It functions quite better in the developed world countries, whereas in developing countries social work is not as developed, and because of that, many aging people are facing hazards of various kinds. Many aging people are afflicted with dementia and Alzheimer's disease disorders [3]. Not only the Western scientists have written on aging and gerontology, Avicenna the Islamic scientist and researcher (1025) indicated the care of the aging people, including remedies, diet and constipation problems. The increasing number of the aged and life expectancy have started rising since the 14th century, but with higher acceleration in recent centuries. The phenomenon has resulted in increasing many family issues. The term "gerontology" was first coined by [4]. However, since 1940s National Institute on Aging started its activities at the University of Southern California [5]. People over 60 years old are predicted to be about 22 percent of the total population by the year 2050. Because of the age-related diseases the term the issues of aging people have been of priority with reference to treatment. As a demographic rule, baby-boomers of a time turn to aging population at another time. It is currently happening in Japan with 29 percent of aging people, Western Europe with 21 percent and the United States with 16 percent of aging 65 and over [6]. Due to change and transition in science and technology, most parts of the world will face more elderly people in the next three decades. So, geoscience needs to be used more to solve the issues emerging. Sex ratio is an indicator used in demography and gerontology. It indicates the number of males per 100 females. In industrial countries females outnumber males in in old ages. © 2020 Mohammad Taghi Sheykhi. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.
Ajit Kumar Saxena, Ramanuj K, Aniket K, Singh Ck, Agarwal M
Perceptions in Reproductive Medicine, Volume 4, pp 1-6; doi:10.31031/prm.2020.04.000579

Abstract:
Ajit Kumar Saxena1*, Agarwal M2, Ramanuj K1, Aniket K1 and Singh CK1 1Department of Pathology/Laboratory Medicine, India 2Department of Obstetrics/Gynecology, India *Corresponding author: Ajit Kumar Saxena, Department of Pathology/ Laboratory Medicine, India Submission: September 07, 2020;Published: September 28, 2020 DOI: 10.31031/PRM.2020.04.000579 ISSN: 2640-9666Volume4 Issue1 Introduction: CUL4B gene is ubiquitin ligase belongs to the Cullinring ubiquitin ligase family. In recent study we have identified a series of MTNR1B, SENP3, AKAP3 and PLOD3 genes and their functional interaction to the ligand binding capacity after prediction of 3D structure to the drug like methotrexate, which plays a significant role during spermatogenesis. Although, the role of Cul4B gene mutation and its impact to the ligand binding during development and differentiation of male gonad (testis) remains unexplored in fertility. Objective: The present study has been designed to characterize the mutation of CUL4B gene sequence and correlate with functional aspect to the ligand binding site to understand the translational event of non-frame shift mutated (deleted) nucleotide sequence GGAGGA of DNA. The findings of mutations try to correlate with anatomical feature (testicular size) of the gonad and fertility. Material and methods: Blood samples were collected from the cases of clinically diagnosed non obstructive azoospermia (NOA) with respective age matched controls. Study was carried out using whole genome sequencing (NGS) from Illumina (USA) to characterize the nature of mutation. The study was further extended to develop 3D structural analysis of the candidate gene CUL4B and protein (ligand) binding activity with drug like methotrexate using molecular docking (iTASSER) techniques for gene coded functional changes in testis. Results: Findings of NGS DNA sequencing confirm the non - frame shift mutation in homozygous condition of CLU4B gene involving deletion at position 1761-1746 of GGAGGA nucleotide sequences. After decoding of mutation region (gene) confirm loss of non-essential amino acid glycine glycine resulting changes in physiological function during spermatogenesis in testis. The predicted 3D helical structure of CLU4B gene showing binding of amino acid residue to ligand (methotrexate) as model to evaluate the functional activity of the gene by using bioinformatics tools. Conclusion: DNA sequencing analysis confirms the non-frame shift mutation of CUL4B gene in non-obstructive azoospermia male in homozygous condition. After mutation of GGAGGA sequence confirm either loss or deletion of non-essential amino acid residue (glycine-glycine) failed to bind to the ligand respective ligand (protein) resulting interference to the development of testis and infertility. Keywords: CUL4B gene; Infertility; DNA sequencing; 3D protein structure Human infertility is a highly complex phenomenon and etiological factors are poorly understood [1]. CUL4B gene is a member of the family of Cullin scaffold proteins which makes a series of ubiquitin-protein ligase complexes that regulate the degradation of cellular proteins [2]. The CUL4B gene is mapped on Xq24, is and consist of 22 exons which encodes a protein of 913 amino acids (https://www.ncbi.nlm.nih.gov/gene/?term=cul4b). The cullin domain is located between amino acid residues 14 and 354 and is characterized by a C-terminal globular domain (cullin homology domain). Earlier study of CUL4B gene point mutation assigned on X- chromosome in homozygous condition of has been associated to male infertility [3]. CUL4B gene hypothesized to play an important role in maintaining structural and functional role during spermatogenesis. CUL4 gene family have two members, CUL4A and CUL4B play a crucial role for the survival of both male and female germ cells. CUL4B is expressed in testis during spermatogenesis and mostly in post-meiotic spermatids stage and hardly expressed in spermatocytes [4,5]. CUL4B gene expression has distinct functions during development of gonad, but still to date, the crucial function(s) of CUL4B gene has not been clear in association with infertility. The rationale behind this study to recognize the impact of non-frame shift gene mutation of CUL4B and their interaction to ligand (protein) binding after prediction of 3D structure using known MTX drug as a model of infertility using molecular docking techniques. The present study might be helpful to explore the mechanism of abnormal differentiation of male gonad (testis) after gene protein drug interaction if mother exposed antenatally with anticancer molecules which might have interfare to the spectrum of cellular events of spermatogenesis and fertility. In the present study, clinically diagnosed cases of male infertility referred from OPD of AIIMS, Patna (Bihar, India) for Genetic investigations. The study was approved by Institutional Ethical Committee (IEC) and blood samples were collected by written informed consent from guardian. These cases of infertility are mainly categorized in three different groups i.e. non-obstructive azoospermia, obstructive azoospermia and oligozoospermia on the basis semen analysis by WHO [6] where the sperm count >20×106/ml, progressive motility>50% and normal morphology >30% and established fertility (with one or more children) were included as controls. All patients were initially evaluated by clinician and conventional medical diagnostic including patient’s background and physical examination analyses were performed. None of them had any history of childhood disease, environmental exposure, radiation exposure or prescription drug usage that could account for their infertility. The median age of patients included in the study was 35.4 years. Isolation and characterization of mutation using whole exome sequencing (WGS) Genomic DNA was isolated from clinically diagnosed cases of non-obstructive azoospermia and blood sample (1.0 ml) were collected after written...
Gyawali M, Bhandari P, Saud B, Shrestha Rk, Thapa Hs, Dangi Nb
Perceptions in Reproductive Medicine, Volume 4, pp 1-5; doi:10.31031/prm.2020.04.000578

Abstract:
Gyawali M1*, Thapa HS2, Bhandari P1, Dangi NB3, Saud B1 and Shrestha RK1 1Janamaitri Foundation Institute of Health Sciences (JFIHS), Nepal 2School of Health Science, CTEVT, Nepal 3School of Health and Allied Sciences, Nepal *Corresponding author: Gyawali M, Janamaitri Foundation Institute of Health Sciences (JFIHS), Nepal Submission: August 10, 2020;Published: September 04, 2020 DOI: 10.31031/PRM.2020.04.000578 ISSN: 2640-9666Volume4 Issue1 The risk of unsafe abortion lies mainly in the developing countries like Nepal. Medical abortion is use of medicines to terminate pregnancy. Mostly invalid pregnant women are ready to afford high cost without proper counseling due to social stigma and fear of family and society which is in scene among various community pharmacies in Nepal. Thus, this study was conducted in Kathmandu valley of Nepal to evaluate medical abortion kit dispensing practices of community pharmacies (CPs). Semi-structured types questionnaire was used as the instrument for data collection. Data collection was done through simulated patient via simple random sampling technique in 102 pharmacies. Out of six brand of medical abortion kit available in Nepalese market, 32% is unregistered product. It is found that 78% of the CPs used to sell in higher price than labeled price. Most of the CPs did not ask the general (screening) questions and also most of them counseled only about drug dosing and common side effects and price but neither of CPs referred (suggest to visit) to trained abortion service provider. The study discloses that CPs has been practicing the dispensing of medical abortion kit illegally and no proper screening and counseling was done. CPs are providing only profit oriented services which may be due to lack of skilled human resources in CPs. Keywords: Evaluation, Medical abortion kit, Community pharmacy, Counseling, Screening Abbreviations: CPs: Community pharmacies; SP: Simulated patients; MTP: Mifepristone and Misoprostol combination kit; Rs: Nepalese rupees An abortion is a process to cease pregnancy with the aid of either drug or surgical procedure to remove the embryo or fetus and placenta. According to World Health Organization (WHO), abortion is the cessation of pregnancy before the fetus has attained viability, i.e. become capable of independent extra-uterine life. Medical abortion (MA) is use of medicine to terminate pregnancy. It is also known as “non-surgical abortion” and “medical abortion” [1]. The hazard of unsafe abortion is found more in the developing countries. The rate of unsafe abortion is found highly in African, Latin American and the Caribbean, followed by South and South-East Asian people. Worldwide, it has been expected that some 68,000 women die each year as a result of unsafe abortion, and 5.3 million women suffer with temporary or permanent disability. The public health risk is found highest in the developing countries [1]. In a developing nation like Nepal, where policy and law regarding abortion is liberal but the implementation part is poor that results in the practice of unsafe abortion. Another major problem regarding unsafe abortion is due to lack of technical human resource, poor socio-economic condition as well as difficult geographic condition of the country. The main causes of practicing unsafe abortion in Nepal even after the legalization are- lack of awareness about current new abortion law and difficulty of access of safe abortion services, high cost procedure of abortion, limited number of abortion service centers, poor decision making ability of pregnant women and social fear. Abortion is even now considered as wrong deeds in Nepalese community and women usually are in search for clandestine street abortions to ensure confidentiality [2]. Abortion has been legalized, but in order to make abortion services available throughout the countries there is a need for skilled service providers, adequate equipment, and essential drugs. Abortion was legalized in Nepal under the 11th amendment to the Country Code (Muluki Ain) in March 2002 and approved by government of Nepal in September 2002. It empowers women’s rights to control over and decide on their unplanned pregnancies [3]. According to the health point of view, abortion is the cessation of pregnancy and is "legal under certain conditions in almost all countries, ninety six percentages of countries recognizing a risk to a mother's life as legal basis for abortion"[4]. Medical abortion or abortion by orally administered regimens of mifepristone and misoprostol has recently been accepted worldwide as an effective and safe option for early abortion [5]. It is proven fact that there is still a need of expanding safe abortion clinics to provide medical abortion services to venerable group of people without doing surgical abortion procedures [6]. Medical abortion has become an alternative process of terminating pregnancy in first trimester by prostaglandins and anti- progesterone. Safe Abortion guidelines states that use of medical abortion drug (mifepristone and misoprostol) up to nine weeks, nine to twelve weeks, and after twelve weeks of gestation. In all three conditions mifepristone 200mg is followed by misoprostol l800μg (microgram) is needed to administer either through vaginal or sub sublingual route. Initially mifepristone is taken then after twenty-four to forty-hour misoprostol must be give through above mentioned route. There may be need of misoprostol 400μg dose on the basis of patient conditions. Medical abortion shows ninety five percent success rates [7]. The percentage of pregnant women attending unqualified practitioner for unsafe abortion is also in higher number. Nepalese society still do not accept single mother concept, therefore due to social fear and fear of violation of abortion law, pre-marital pregnancies, illegal pregnancies are subjected to more unsafe abortion. Mostly invalid pregnant women are ready to afford...
Malagón Reyes R, Soria Soriano El, Garcia Gonzalez Bn
Perceptions in Reproductive Medicine, Volume 4, pp 1-3; doi:10.31031/prm.2020.04.000577

Abstract:
Malagón Reyes R1*, Soria Soriano EL2 and Garcia Gonzalez BN3 1Surgeon General, Mexico 2Resident Gynecology Doctor, Mexico 3Gynecology Resident Physician, Mexico *Corresponding author: Malagón Reyes R, Surgeon General, Mexico Submission: July 17, 2020;Published: September 04, 2020 DOI: 10.31031/PRM.2020.04.000577 ISSN: 2640-9666Volume4 Issue1 Monica Pretelini Saenz Maternal Perinatal Hospital, Toluca, Mexico. We present a clinical case of a pregnant patient diagnosed with a percrete placenta at the Monica Pertelini Sáenz Maternal Perinatal Hospital. Antenatal diagnosis is described, as well as intraoperative management and technique. They make themselves known the immediate and mediate complications presented by the patient, in addition to the post-discharge follow-up. Finally, a review of the literature is carried out and recommendations for better multidisciplinary management are suggested. Abstract We presented a clinical case of a pregnant patient diagnosed with a percrete placenta at the Monica Pretelini Saenz Maternal Perinatal Hospital. Prenatal diagnosis is described, as well as intraoperative management and technique. The immediate and mediate complications presented by the patient are disclosed, as well as the follow-up after her progress. Finally, a review of the literature is carried out and recommendations are sought for better multidisciplinary management. Placental accretion is associated with maternal morbidity and mortality. Accreted Placenta Spectrum (AP) is the general term applied to abnormal adherence of the placental trophoblast to the uterine myometrium, also known as morbidly attached placenta. Placental accreta includes placenta accreta (fixation of the placenta to the myometrium without intervening (deci-dua), placenta increta (invasion of the trophoblast to the myometrium), and placenta percreta (PP) (invasion through the myometrium, serous, and surrounding structures) [1]; Figure 1. The first PA case reports were published in the literature in 1920, the first series in 1937 by obstetrician Frederick C. Irving and pathologist Arthur TH of the Boston Lying-In Hospital [2]. Risk factors are any procedure or manipulation that damages the endometrium, including uterine curettage, myomectomy, endometrial ablation, uterine artery embolization, or manual removal of the placenta [1]. The fetus and maternal complications are mainly the result of massive bleeding. In turn, this leads to disseminated intravascular coagulation, multiorgan failure, the need for additional surgery that includes hysterectomy, thromboembolism, and even death. The median estimated blood loss in cohorts of acrets ranges from 2,000 to 7,800mL [3]. Ultrasound is recommended as a first-line imaging study and represents the gold standard for the diagnosis of placental accretion. The sensitivity and specificity of ultrasound in the 2nd and 3rd trimester is 80%-90% [4]. Doppler findings associated with PA include blood flow turbulent neo saccular, increased subplantar vascularization (Figure 2), vessels connecting the placenta to the margin. Magnetic resonance imaging has a sensitivity and specificity of 80%-90%, it is recommended to be performed only when the a priori risk is high due to its high cost and it has been found to be useful in cases of posterior placenta previa, obesity morbid or in cases of potential invasion to bladder [1]; Figure 3. There is an apparent invasion of the rectus abdominis muscles. The hyperintense line that separates the muscles of the uterus is lost. One of the most frequent complications in this pathology is massive hemorrhage and massive transfusion with its consequent complications and a third presents incidental injury to the bladder. Ureteral injury, vesicovaginal fistula, and surgical reoperation are complications that occur less frequently. count. (1) Finally, maternal death has been reported in up to 7% of cases [3]. Figure 1: Placenta accreta, Increta and percreta. Figure 2: Turbulent flow in the gaps and increased vascularity between the placenta and bladder in a case of percrete placenta, using doppler color. Figure 3: A Sagittal image, weighted at T2. It is noted irregularity of the bladder bed with loss of the interface separating the myometrium and the placenta. B. T1- weighted sagittal image. 38-year-old female, 6 deliveries 2 caesarean sections 3 without other important pathological history, who went to the emergency department at 33.1 weeks of gestation for presenting little transvaginal bleeding. On physical examination without active bleeding, ultrasound with fetometry according to gestational age, total occlusive placenta previa, loss of the uteroplacental interphase with penetrating vessels towards myometrium and presence of multiple gaps suggesting that bladder percretism be ruled out. Lung maturity scheme is started and graduated due to improvement. Patient cited 2 weeks later to resolve the pregnancy via the abdomen, undergoing a subarachnoid block, with a mid-infraumbilical incision and dissection through planes until reaching the abdominal cavity, once the uterus was located, bladder-penetrating vessels were identified, and a hysterotomy was decided. Transplacental transverse body type (Figure 4). A live male newborn with a weight of 2470 grams, Apgar 7/8 and Capurro of 36 weeks was extracted. It proceeds. Figure 4: A. Uterine transplacental incision site. B. Uterovesical neoformation vessels. Hysterorrhaphy in a plane with chromic catgut 1 and total intrafacial abdominal hysterectomy, dissecting the bladder gently and ligating neoformation vessels of greater caliber (Figure 4). The surgical piece is removed, and the cupola is left semi-open. Ligation of the hypogastric arteries is performed using the Gala technique. Before layer bleeding, packing is performed with placement of 2 penrose towards parietocolic slides. Mala bag is placed and the abdominal wall is closed with points of confrontation, total bleeding of 4000cc...
Víctor Manuel Vh, Jesús Estuardo Li, José Juan Gv, Alejandro Kb, Felipe De Jesús Ap, Daniela Ar, Carlos Dm
Perceptions in Reproductive Medicine, Volume 4, pp 1-5; doi:10.31031/prm.2020.04.000576

Abstract:
Jesús Estuardo LI, José Juan GV, Alejandro KB, Felipe de Jesús AP, Daniela AR, Carlos DM and Víctor Manuel VH* *Department of Women’s Health Clinic, Mexico *Corresponding author: Víctor Manuel VH, Women’s Health Clinic, Mexico Submission: June 18, 2020;Published: July 21, 2020 DOI: 10.31031/PRM.2020.04.000576 ISSN: 2640-9666Volume4 Issue1 Background: In Mexico there are 17% of women of reproductive age with infertility problems, equivalent to 1.4 million couples who need assisted reproductive techniques; 9 to 24% of these patients present low ovarian response, mainly in women older than 38 years, due to ovarian aging. Objective: To design a human method to administer autologous adipose tissue mesenchymal stem cells directly into the ovaries to elucidate the underlying mechanisms of ovarian rejuvenation and point the way for the development of future therapies. Method and Result: We present a case of a 39-year-old woman, classified as low or suboptimal ovarian response. included in group 2, subgroup 2a, of the Poseidon criteria; to which a human method was designed to administer autologous adipose tissue mesenchymal stem cells (AD-MSCs) directly into the ovaries prior to ovarian stimulation; under written informed consent to the patient; It was carried out in a procedure where 14 oocytes were obtained, which were fertilized with donor semen (normozoospermic) and a biopsy was performed of three blastocysts obtained, to carry out a preimplantation genetic study that reported an euploid embryo; This is placed in the mother's uterus in order to achieve pregnancy and a healthy newborn. Once transferred to the mother, the euploid blastocyst, the human gonadotropin hormone beta subunit test was positive 6572mUI/mL and it was completed, obtaining a male newborn obtained by caesarean section at 39.2 weeks of healthy gestation with adequate evolution. Conclusion: Stem cell therapy obtained from bone marrow is an alternative for women with low ovarian response to achieve pregnancy, by improving the quality of oocytes; it is the first report in Mexico, in women with low idiopathic ovarian response. Keywords: Low ovarian response; Infertility; Ovarian aging; Adipose tissue mesenchymal stem cells In Mexico there are 17% of women of reproductive age with infertility problems, which is equivalent to 1.4 million couples need assisted reproduction techniques; from 9 to 24% of these patients present a low ovarian response, which is defined as the poor obtaining of mature eggs after ovarian stimulation of follicular puncture during in vitro fertilization, which occurs with a higher incidence in women older than 38 years, mainly due to ovarian aging and decreased ovarian reserve. In particular, low responders are not a homogeneous population of patients and their prognosis varies greatly depending on parameters such as age and number of oocytes retrieved [1-5]. Scientific and technological advances in the management and treatment of patients with a low ovarian response continue to be controversial and the criteria for diagnosing it have changed and since 2011 the Bologna criteria and later those of Poseidon [1-5] have been implemented. The Poseidon criteria are divided into 4 categories, based on quantitative parameters, quality, age, number of antral follicles or antimullerian hormone levels, and ovarian response (after standard reference stimulation). Within these criteria, specifically group 1 (those
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