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Background In in vitro fertilization (IVF), transferring frozen–thawed blastocysts is a widely adopted practice. This meta‐analysis aims to evaluate the reproductive outcomes of transferring blastocysts derived from frozen–thawed cleavage embryos (FT‐CDB group) compared to direct frozen–thawed blastocyst (DFB group) transfers. Methods We searched the following electronic databases for relevant studies: PubMed/MEDLINE, EMBASE, Scopus, and Web of Science. Studies were included if they compared the clinical and neonatal outcomes of IVF patients receiving either FT‐CDB or DFB transfer with vitrification method. The protocol for this review has been registered in PROSPERO. Results A total of seven studies (2057 patients) were included in the analysis. Participants in the FT‐CDB group demonstrated significantly higher odds of achieving clinical pregnancy (OR 1.24, 95% CI 1.03–1.49, p = 0.022, I2 = 27%), and live birth (OR 1.31, 95% CI 1.08–1.60, p = 0.007, I2 = 0%) compared to the DFB group. No significant differences were observed in the birth weights of infants between the groups (MD −87.05 g, 95% CI −293.77 to 119.67, p = 0.41, I2 = 83%). Conclusion Transferring blastocysts derived from frozen–thawed cleavage embryos is associated with higher odds of clinical pregnancy and live birth compared to frozen–thawed blastocyst transfers. Trial Registration PROSPERO number: CRD42024591620

Limited data exist regarding the outcomes of frozen-thawed cleavage-stage embryos that undergo extended culture to reach the blastocyst stage. This study aimed to compare the pregnancy outcomes between two approaches: transferring blastocysts derived from frozen-thawed cleavage embryos (D3-5 group) and frozen-thawed blastocysts (D5 group). This retrospective observational cohort analysis was conducted at Hung Vuong Hospital (CS/HV/24/23) from January 2022 to December 2023. The D3-5 group comprised 167 patients who underwent embryo transfer with frozen-thawed cleavage embryos, which were subsequently cultured for 2 days before being transferred as blastocysts. The D5 group included 342 patients who received frozen-thawed blastocysts. Positive human chorionic gonadotropin (hCG) rate, clinical pregnancy rate, ongoing pregnancy rate, live birth rate, pregnancy failure rate and cancellation rate were compared between the two groups. In the D3-5 group, a significant proportion of cycles (65.3%) were cancelled, primarily due to the absence of developed blastocysts for transfer (85.3%), while the remaining 14.7% of cancellations were attributed to other reasons. Patients in the D3-5 group demonstrated comparable pregnancy outcomes to those in the D5 group: positive hCG rate (52 vs. 53%, P=0.898), clinical pregnancy rate (45 vs. 48%, P=0.785), ongoing pregnancy rate (34 vs. 33%, P=0.873), live birth rate (31 vs. 29%, P=0.839), and pregnancy failure rate (21 vs. 24%, P=0.656). The strategy of culturing frozen-thawed cleavage embryos for two days and transferring them as blastocysts is not inferior to the transfer of frozen-thawed blastocysts. It increases workload for embryologists and poses a risk of cycle cancellation. We propose that the use of frozen-thawed blastocysts may be a more efficient and patient-friendly option.

Key clinical message In in vitro fertilization (IVF), laser offers several advantages. In this study, we employed laser to eliminate the zona pellucida of a contaminated embryo. This approach helps to rescue embryo with bacterial contamination, and improve embryo‐endometrium interaction. To present a case report on the removal of a contaminated zona pellucida from an embryo of patient with a history of recurrent implantation failure (RIF), which was followed by a successful live birth. We present the case of a 34‐year‐old patient with a history of 3 years of infertility who underwent in vitro fertilization. During the culture process, the embryos became contaminated, leading to three failed implantations. Despite the aneuploidy of the embryo and the implementation of a washing technique, the contamination persisted. In the final attempt, the contaminated zona pellucida was successfully removed using laser, followed by embryo transfer, resulting in a live birth. We provided detailed clinical information, including patient demographics, infertility history, ovarian response, evidence of bacterial contamination, embryo development, treatment protocols, and outcomes. Laser excision of the zona pellucida is a safe and effective method for addressing bacterial infection in embryos.

ObjectiveThere are no globally agreed on strategies on early detection and first response management of postpartum haemorrhage (PPH) during and after caesarean birth. Our study aimed to develop an international expert’s consensus on evidence-based approaches for early detection and obstetric first response management of PPH intraoperatively and postoperatively in caesarean birth.DesignSystematic review and three-stage modified Delphi expert consensus.SettingInternational.PopulationPanel of 22 global experts in PPH with diverse backgrounds, and gender, professional and geographic balance.Outcome measuresAgreement or disagreement on strategies for early detection and first response management of PPH at caesarean birth.ResultsExperts agreed that the same PPH definition should apply to both vaginal and caesarean birth. For the intraoperative phase, the experts agreed that early detection should be accomplished via quantitative blood loss measurement, complemented by monitoring the woman’s haemodynamic status; and that first response should be triggered once the woman loses at least 500 mL of blood with continued bleeding or when she exhibits clinical signs of haemodynamic instability, whichever occurs first. For the first response, experts agreed on immediate administration of uterotonics and tranexamic acid, examination to determine aetiology and rapid initiation of cause-specific responses. In the postoperative phase, the experts agreed that caesarean birth-related PPH should be detected primarily via frequently monitoring the woman’s haemodynamic status and clinical signs and symptoms of internal bleeding, supplemented by cumulative blood loss assessment performed quantitatively or by visual estimation. Postoperative first response was determined to require an individualised approach.ConclusionThese agreed on proposed approaches could help improve the detection of PPH in the intraoperative and postoperative phases of caesarean birth and the first response management of intraoperative PPH. Determining how best to implement these strategies is a critical next step.

Endometrial preparation significantly influences the success of embryo transfer procedures. Although both oral and transdermal estradiol are common methods for endometrial priming, their efficacy and potential side effects remain uncertain. This randomized controlled trial aims to compare the effectiveness of oral and transdermal estradiol in endometrial preparation, while also evaluating their respective side effects in patients undergoing assisted reproduction treatments. This randomized clinical trial (ISRCTN15301227) was conducted at Hung Vuong Hospital between July 2020 and March 2022. Among 550 eligible patients undergoing frozen embryo transfer cycles, we included 380 patients for the study. The study protocol and all materials received approval from the Ethics Committee of Hung Vuong Hospital (1315/CN-HDDD). Participants were randomly assigned to one of two groups: Group A (n =190) received oral estradiol at an initial dose of 4 mg per day for 7 days, with the dose increased according to clinical response. Group B (n =190) received transdermal estradiol at an initial dose of 2 measures of 2.5 g estradiol gel per day for 7 days, with the dose similarly increased according to clinical response. Treatment in both groups began on days 2-3 of the menstrual cycle, with the maximum duration of estradiol administration being 27 days. We compared estradiol levels on the day of progesterone administration, duration of treatment, total estradiol dose, endometrial thickness, pregnancy outcomes, and any observed side effects between the two groups. Group A exhibited significantly higher estradiol levels on the day of progesterone administration compared to Group B (270.5 pg/ml versus 186.5 pg/ml, p < 0.001). However, the comparison revealed no significant difference in endometrial thickness between the two groups (10.5 mm versus 10.6 mm, p = 0.85). Furthermore, pregnancy rates including positive human chorionic gonadotropin, clinical pregnancy, ongoing pregnancy, live birth, and pregnancy failure were also found to be similar between the two groups. Notably, a greater proportion of patients in Group A experienced mild side effects compared to those in Group B (20.3% versus 10.1%, respectively; n =37 versus n =18), and this discrepancy was found to be statistically significant (p = 0.007). Transdermal estradiol offers comparable endometrial thickness and pregnancy outcomes, along with improved patient compliance and fewer side effects compared to oral estradiol.

Purpose: The primary aim of this research is to enhance the utilization of advanced deep learning (DL) techniques in the domain of in vitro fertilization (IVF) by presenting a more refined approach to the segmentation and organization of microscopic embryos. This study also seeks to establish a comprehensive embryo database that can be employed for future research and educational purposes.Methods: This study introduces an advanced methodology for embryo segmentation and organization using DL. The approach comprises three primary steps: Embryo Segmentation Model, Segmented Embryo Image Organization, and Clear and Blur Image Classification. The proposed approach was rigorously evaluated on a sample of 5182 embryos extracted from 362 microscopic embryo videos.Results: The study’s results show that the proposed method is highly effective in accurately segmenting and organizing embryo images. This is evidenced by the high mean average precision values of 1.0 at an intersection over union threshold of 0.5 and across the range of 0.5 to 0.95, indicating a robust object detection capability that is vital in the IVF process. Segmentation of images based on various factors such as the day of development, patient, growth medium, and embryo facilitates easy comparison and identification of potential issues. Finally, appropriate threshold values for clear and blur image classification are proposed.Conclusion: The suggested technique represents an indispensable stage of data preparation for IVF training and education. Furthermore, this study provides a solid foundation for future research and adoption of DL in IVF, which is expected to have a significant positive impact on IVF outcomes.

Background There is a paucity of data regarding risk factors associated with suboptimal breastfeeding practices in urbanized areas of low-middle income countries (LMICs). Methods Through a large prospective birth cohort, which enrolled 6706 infants in Vietnam between 2009 and 2013, we investigated the practice of exclusive breastfeeding during hospital stay in urban and semi-rural populations and aimed to identify factors associated with suboptimal breastfeeding practices. Univariate and multivariable logistic regression were performed to determine factors associated with not exclusive breastfeeding during hospital stay. Results Of 6076 mothers, 33% (2187) breastfed their infant exclusively before hospital discharge; 9% (364/4248) in urban and 74% (1823/2458) in semi-rural areas. Exclusive breastfeeding up to 4 months was recorded in 15% (959/6210) of participants; this declined to < 1% (56/6093) at 6 months. Delivery by Caesarean section (Odds Ratio [OR] 0.07; 95% Confidence Interval [CI] 0.04, 0.11 and OR 0.05; 95% CI 0.03, 0.08) and neonatal complications (OR 0.2; 95% CI 0.07, 0.47 and OR 0.25; 95% CI 0.14, 0.46) were common and highly significant risk factors associated with a lack of exclusive breastfeeding during hospital stay in urban and semi-rural settings, respectively. Conclusions To our knowledge, this is the first large-scale investigation aimed at identifying factors associated with exclusive breastfeeding during hospital stay in Vietnam. Breastfeeding promotion strategies should prioritize common risk factors in hospital, such as Caesarean section and neonatal complications, and other location specific factors associated with socioeconomics.

Background Several inherited metabolic diseases are underreported in Vietnam, namely glucose‐6‐phosphate dehydrogenase deficiency (G6PDd), phenylketonuria (PKU) and galactosemia (GAL). Whilst massively parallel sequencing (MPS) allows researchers to screen several loci simultaneously for pathogenic variants, no screening programme uses MPS to uncover the variant spectra of these diseases in the Vietnamese population. Methods Pregnant women (mean age of 32) from across Vietnam attending routine prenatal health checks agreed to participate and had their blood drawn. MPS was used to detect variants in their G6PD, PAH and GALT genes. Results Of 3259 women screened across Vietnam, 450 (13.8%) carried disease‐associated variants for G6PD, PAH and GALT. The prevalence of carriers was 8.9% (291 of 3259) in G6PD and 4.6% (152 of 3259) in PKU, whilst GAL was low at 0.2% (7 of 3259). Two GALT variants, c.593 T > C and c.1034C > A, have rarely been reported. Conclusion This study highlights the need for routine carrier screening, where women give blood whilst receiving routine prenatal care, in Vietnam. The use of MPS is suitable for screening multiple variants, allowing for identifying rare pathogenic variants. The data from our study will inform policymakers in constructing cost‐effective genetic metabolic carrier screening programmes. This study highlights the need for routine carrier screening, where women give blood while receiving routine prenatal care, in Vietnam. The use of massively parallel sequencing is suitable for screening multiple allele variants, allowing for identifying rare disease‐associated variants.NonBreakingSpace; #10;

IntroductionImplementation of low-intensity, evidence-based psychological interventions can help meet the mental health and psychosocial needs of people with cancer, especially in low-resource settings where there is a dearth of mental health specialists. In this study, we will conduct a feasibility randomised controlled trial (RCT) of the stress management intervention Self-Help Plus, which has been translated and adapted to Vietnamese, vSH+, among people newly diagnosed with breast or gynaecological cancer in Viet Nam.Methods and analysisAt six participating hospitals, individuals diagnosed with breast or gynaecologic cancer within the past year will be recruited, consented and randomised into either enhanced usual care (EUC) or EUC plus the vSH+ intervention, which consists of four sessions each lasting approximately 75 min. Quantitative surveys will be administered at three time points: enrolment/baseline (T0), after 6 weeks (T1) and after 4 months (T2). A qualitative evaluation component, which will include in-depth interviews with patients, implementers and healthcare staff and managers, as well as focus group discussions with caregivers, will assess the acceptability and feasibility of the vSH+ intervention.Ethics and disseminationEthical reviews for the study were obtained from Boston University, Hanoi University of Public Health (HUPH) and all the participating hospital sites. On completion of data collection and analyses, the research team will prepare and submit abstracts to scientific conferences as well as manuscripts to peer-reviewed journals. We will also conduct dissemination events to report the trial results to relevant stakeholders.Trial registration numberNCT06398067.

Shigella sonnei is a pathogen of growing global importance as a cause of diarrhoeal illness in childhood, particularly in transitional low-middle income countries (LMICs). Here, we sought to determine the incidence of childhood exposure to S. sonnei infection in a contemporary transitional LMIC population, where it represents the dominant Shigella species. Participants were enrolled between the age of 12-36 months between June and December 2014. Baseline characteristics were obtained through standardized electronic questionnaires, and serum samples were collected at 6-month intervals over two years of follow-up. IgG antibody against S. sonnei O-antigen (anti-O) was measured using an enzyme-linked immunosorbent assay (ELISA). A four-fold increase in ELISA units (EU) with convalescent IgG titre >10.3 EU was taken as evidence of seroconversion between timepoints. A total of 3,498 serum samples were collected from 748 participants; 3,170 from the 634 participants that completed follow-up. Measures of anti-O IgG varied significantly by calendar month (p = 0.03). Estimated S. sonnei seroincidence was 21,451 infections per 100,000 population per year (95% CI 19,307-23,834), with peak incidence occurring at 12-18 months of age. Three baseline factors were independently associated with the likelihood of seroconversion; ever having breastfed (aOR 2.54, CI 1.22-5.26), history of prior hospital admission (aOR 0.57, CI 0.34-0.95), and use of a toilet spray-wash in the household (aOR 0.42, CI 0.20-0.89). Incidence of S. sonnei exposure in Ho Chi Minh City is substantial, with significant reduction in the likelihood of exposure as age increases beyond 2 years.