Background To explore the efficacy of follitropin delta in ovarian stimulation of patients with the Rotterdam ESHRE/ASRM 2003 phenotypes of polycystic ovarian syndrome (PCOS) using a retrospective case series with an electronic file search in a reproductive medicine clinic. Case presentation Seventy-four patients with PCOS undergoing ovarian stimulation according to the individualized dosing algorithm of follitropin delta for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI)/oocyte freezing were included. Follitropin delta resulted in a high number of pre-ovulatory follicles at the end of stimulation as expected in patients with PCOS. There was a large number of oocytes retrieved with an acceptable percentage of metaphase II (MII) oocytes. There were no cases of moderate or severe OHSS across all phenotypes. Conclusion Follitropin delta, using the individualized dosing algorithm, appears to be a safe method of ovarian stimulation with a low risk of OHSS in PCOS patients without sacrificing successful stimulation outcomes.

Ovarian vein thrombophlebitis is rare and mostly occurs during the puerperal period and in higher rates after a cesarean delivery. The objective of this case report and literature review is to highlight the rare occurrence of an ovarian vein thrombosis in a 37-year-old woman postcesarean delivery in the setting of a large uterine fibroid who subsequently developed a pulmonary embolism. The patient presented with severe abdominal pain, fever, and chills. Imaging showed a right ovarian vein thrombosis. Following initiation of anticoagulation therapy, she developed dyspnea and testing showed a subsegmental pulmonary embolism. Further investigation showed that the patient had an undiagnosed thrombophilia thus meeting the classic Virchow triad. Complete clinical recovery was observed, and anticoagulation therapy was continued for 1 year. Our case highlights the importance of recognizing ovarian vein thrombosis because of the risk of fatal complications such as pulmonary embolus. The presence of large fibroids should raise our awareness for OVT in the setting of abdominal pain and fever. The absence of complications in previous pregnancies should not alter our clinical suspicion.

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Short oral presentation abstractsMethods: The study includes data from Norfolk and Norwich University Hospitals (NNUH) where a policy of routine POCUS was adopted from November 2020 following stage-wise implementation in 2016. We included two groups: a historical cohort of women who received routine care (2015) and those who had POCUS at the 36-week visit (November 2020-2021). Women with multiple pregnancies, preterm birth < 37 weeks, congenital abnormalities and those undergoing planned Caesarean section (CS) for breech presentation were excluded. Undiagnosed breech presentation was defined as: a) women who presented in labour or with ruptured membranes at term and were subsequently discovered to have a baby in a breech presentation, and b) women who attended for induction of labour at term and were found to have a breech presentation before commencing induction of labour. The primary outcome was undiagnosed breech presentation in labour. Secondary outcomes included mode of birth and neonatal adverse outcomes. Percentages were compared using chi squared test. Results: The analysis included 5013 pregnancies before and 4474 pregnancies after routine implementation of POCUS. After the implementation of routine POCUS, the rate of undiagnosed breech presentation reduced from 4.8/1000 births to 1.1/1000 births. The risk of undiagnosed breech in labour reduced by 77% with routine POCUS (Relative Risk: 0.23, 95% CI 0.09-0.61, p = 0.003). There was also a significant reduction in the incidence of emergency CS and breech delivery at term by 22.2% (p = 0.02) and 8.8% (p = 0.01), respectively. Approximately 271 POCUS would be required to prevent one undiagnosed breech presentation in labour. Conclusions: POCUS was associated with a reduction in undiagnosed breech in labour and emergency CS at term.

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