Endometrial Lines Research Articles

Combining demographic data and transvaginal ultrasonography: a predictive model for endometrial carcinoma in postmenopausal patients

BackgroundAlthough clinical guidelines exist for diagnosing abnormal uterine bleeding, there is a significant lack of agreement on the best management strategies for women presenting with symptom, particularly in diagnosing endometrial cancer. This study aimed to develop a preoperative risk model that utilizes demographic factors and transvaginal ultrasonography of the endometrium to assess and predict the risk of malignancy in females with endometrial cancer.MethodsIn this retrospective study, a logistic regression model was developed to predict endometrial carcinoma using data from 356 postmenopausal women with endometrial lesions and an endometrial thickness (ET) of 5 mm or more. These patients had undergone transvaginal ultrasonography prior to surgery, with findings including 247 benign and 109 malignant cases. The model’s predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis and compared with post-surgical pathological diagnoses.ResultsOur model incorporates several predictors for endometrial carcinoma, including age, history of hypertension, history of diabetes, body mass index (BMI), duration of vaginal bleeding, endometrial thickness, completeness of the endometrial line, and endometrial vascularization. It demonstrated a strong prediction with an area under the curve (AUC) of 0.905 (95% CI, 0.865–0.945). At the optimal risk threshold of 0.33, the model achieved a sensitivity of 82.18% and a specificity of 92.80%.ConclusionsThe established model, which integrates ultrasound evaluations with demographic data, provides a specific and sensitive method for assessing and predicting endometrial carcinoma.

Predictive value of crossover sign for outcome of ultrasound-guided vacuum aspiration in women with Cesarean scar pregnancy.

To examine the value of the crossover sign (COS) in predicting treatment outcome in women with a Cesarean scar pregnancy (CSP) who were treated with ultrasound-guided vacuum aspiration. This was a retrospective cohort study of women with CSP who underwent ultrasound-guided vacuum aspiration. Based on the relationship between the gestational sac, Cesarean scar and anterior wall of the uterus, CSPs were classified by COS type. Analysis was conducted to investigate the association between COS type (COS-1, COS-2) and treatment outcome. The incidence of treatment failure, retained pregnancy tissue, secondary therapy and bleeding ≥ 200 mL were analyzed. In total, 181 eligible patients with CSP, including 90 (49.7%) women with COS-1 and 91 (50.3%) women with COS-2, were analyzed. COS-1 patients had a higher incidence of treatment failure compared with COS-2 patients (25.6% vs 8.8%; P = 0.003), as well as higher rates of retained pregnancy tissue (18.9% vs 6.6%; P = 0.013), secondary therapy (20.0% vs 6.6%; P = 0.002) and bleeding of ≥ 200 mL (13.3% vs 4.4%; P = 0.034). COS-1 and a large gestational sac (30.1-50.0 mm or >50.0 mm in diameter) were associated independently with increased risk of treatment failure (odds ratio, 4.57 (95% CI, 1.66-12.56); P = 0.003, 4.34 (95% CI, 1.35-13.94); P = 0.014 and 10.50 (95% CI, 2.54-43.46); P = 0.001, respectively). Ultrasound evaluation of the relationship between the gestational sac and the endometrial line (COS classification) in women with CSP may help to predict treatment outcome among those undergoing vacuum aspiration. Among COS-1 patients, especially those with a gestational sac diameter of >30.0 mm, vacuum aspiration may be discouraged. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

P-39 Fictitious hyperestrogenism in perimenopause: Difficulties in diagnosis by laboratory pitfalls

Abstract Introduction Laboratory errors related to interfering substances can cause significant morbidity related to unnecessary investigations and interventions and patient anxiety. Estradiol (E2) is quantified mainly with competitive immunoassays. The prevalence of analytical interference can be up to 6% and is due to the impairment of the interaction between test antibody and analyte, causing falsely elevated levels. Nevertheless, interference due to heterophile antibody is extremely rare. Clinical Case A 51-year-old woman, normal weight, nulliparous, irrelevant previous medical history, menarche at 12 years old and regular menstrual cycles, was referred to the Endocrinology Department due to elevated E2 level. She was followed 4 years before in another institution with no formal diagnosis complaining of severe vasomotor symptoms, vaginal dryness and menometrorrhagias. She was on combined oral contraceptives for 10 years as a method of contraception, which she stopped two years ago. The first two E2 random values were 2362 and 3121 pmol/L, respectively when she had 47 and 49 years old. During our evaluation in January 2021, at the age of 51 years old, in the 4th day of her menstrual cycle, the laboratory evaluation revealed: FSH 9.56 mUI/mL (2.5-10.2), LH 5.43 mUI/mL (1.9-12.5), Prolactin 18.12 ng/mL (2.8-29.2), E2 3530.51 pmol/L (71.6-529.2), 17-Hydroxiprogesterone 0.52 ng/mL (0.32-1.47), DHEA-SO4 75.9 ug/dL (35-430), 4-Androstenedione 1 ng/mL (0.3-3.3) and SHBG 137 nmol/L (18-144). Transvaginal pelvic ultrasonography performed 15 days after menstrual period revealed 2 subserous leiomyomas, a 12 mm endometrial line and a right ovary with a pre-ovulatory follicle. CT scan of adrenal glands was unremarkable and a sellar MRI revealed a 4mm area of hypocaptation in the left region of the adenohypophysis. During this period the patient was treated with escitalopram 10 mg od, with vasomotor symptoms improvement. Two years later, after a 6-month period of amenorrhea, she repeated the analytical evaluation that revealed raised gonadotropins levels (FSH 102.12 mUI/mL, LH 25.37 mUI/mL), low progesterone 0.91 mUI/mL (< 4.45) but maintained a largely elevated estradiol level (1128.01 pmol/L) with undetectable free Estriol (< 0.10 ng/mL). This pattern motivated laboratorial review of blood samples by mass spectrometry and not by chemiluminescence as before. The value was substantially lower (447 pmol/L) hypothesizing the presence of heterophilic antibodies. Conclusion Although false E2 elevation due to analytical interference is rare, it must be suspected when results are discordant with the clinical picture and there is no evidence of neoplastic disease. Here, we report a case of falsely elevated E2 that led to prolonged investigation and major impact on a female's quality of life during the challenging period of perimenopause.

Intrauterine Medical Therapies (i.e.: PRP Infusions, G-CSF)

Endometrial thickness is an important and crucial factor that contributed to success rate in IVF. A thin endometrium < 7 mm revealed inadequate endometrial blood flow which will affect the embryo implantation process. There are a number of intra uterine therapies currently being used to improve chances of implantation such as vaginal sildenafil, GCSF, PRP and stem cell therapy. However, despite these interventions many women with thin or damaged endometrial linings do not respond to these therapies. intrauterine autologous PRP in women with thin lining seems to show promise. Study in our group about regeneration of endometrial line using 3-D scaffold and self-endometrial cells was addressed particularly for unresponsive thin endometrium cases. Three-dimension acellular scaffolds, amnion bilayer womb patch enriched by autologous endometrial cell were attached into uterine cavity for 14 days. Endometrial sections indicated that initial biopsy before treatment had undefine histoarchitecture, while 14 days application of womb patch showed some areas had epithelial structure, although not obvious. After cell treatment, the epithelial had been formed, with high thoracal, rich with vacuoles, had cilia, and more complex with tubing system. The epithelial also expressed E-Cadherin, and the stroma cells had expressed ER, but not the PR. These had indicated patient phase secretion. This showed that 3d scaffold and self-endometrial cells look promising to improve regeneration of unresponsive thin endometrium.

#342 : Asherman’s Syndrome Attributed to Genital Tuberculosis: A Case Report

Background: Asherman’s syndrome is a rare pathology secondary to intrauterine adhesion formation characterized by menstrual disorders and reproductive dysfunction. Although the cause intrauterine adhesion is thought to be associated with vigorous curettage or previous uterine surgery, other causes such as tuberculosis or schistosomiasis leading to intrauterine adhesion, are particularly important in developing countries. Case Presentation: A 33-year-old, multiparous woman, has applied for care to our hospital after 6 months of secondary amenorrhea. Other than occasional untreated heavy vaginal discharge, she had no past medical history nor prior uterine surgical procedure. No one in her family was treated for tuberculosis. Previously she was given combination oral contraceptive pills for 2 months, with no desirable outcome. On June 2022, we conducted a transvaginal ultrasound, with several features suggestive of uterine synechiae i.e. interrupted endometrial line in sagittal plain, small focal cystic areas within endometrium, and hyperechoic lesion with and without posterior shadowing. We decided to perform a hysteroscopy, with findings of mottled endometrium across the fundus and corpus of the uterus. Adhesiolysis was performed. An intrauterine foley catheter was inserted to prevent the reformation of adhesions. The specimen from this procedure were collected for pathology testing, with positive result for endometrial tuberculosis with caseous necrosis. The patient was treated with anti-tuberculosis drugs for 9 months. Upon completion of her tuberculosis treatment, she received combination oral contraceptive pills for endometrial restoration. She had her first period on May 2022, but only scanty bleeding occurred. On July 2022, she had two days of period with heavier blood flow. She is still closely observed. Conclusion: Asherman’s syndrome attributed to genital tuberculosis may emerge in otherwise healthy individual especially in countries where tuberculosis is prevalent. Although the results of hysteroscopic adhesiolysis in Asherman’s syndrome are encouraging, unfortunately, women with Asherman’s syndrome due to genital tuberculosis have poorer prognosis for restoration of menstrual function as there is usually complete destruction of endometrium by the mycobacterial disease. Well-designed clinical trials are needed to determine the most appropriate diagnostic and therapeutic modalities.

P-538 The association between Clinical Pregnancy Rate in IVF-Cycles and Endometrial Receptivity based on a Novel Ultrasonographic Endometrial Receptivity Scoring System

Abstract Study question Our study was aimed towards determining whether Ultrasound based assessment of Endometrial features like blood flow, echopattern and thickness, can correlate with IVF pregnancy rates. Summary answer It was found that Clinical Pregnancy Rate in IVF cycles improved as the Ultrasound based Endometrial Receptivity Score increased. What is known already Establishing a successful pregnancy depends on the endometrium and embryo. Suboptimal endometrial receptivity account for one-third of implantation failures. Despite the in-depth understanding of the processes associated with embryo-endometrial crosstalk, little progress has been achieved for diagnosis and treatments for suboptimal endometrial receptivity. Continuously mature embryo laboratory operation technology and embryo culture technology have significantly improved the quality of embryos. In addition, because of its accuracy and non-invasiveness, transvaginal ultrasound is widely used in the field of assisted reproduction, not only for monitoring follicles, but also for evaluating endometrial receptivity and this technique can help in achieving improved pregnancy rates. Study design, size, duration This was a prospective study carried out from 2020 to 2022 in which 275 participants were recruited. Exclusion Criteria were the following: congenital uterine anomalies or acquired uterine diseases, submucosal myoma, intrauterine adhesion, uterine effusion and adenomyosis, hydrosalpinx; endometriosis; pre-implantation genetic test cycles, freeze-thaw embryo transfer cycles which all transferred embryos were non-high quality embryos. That is to say, FET cycles with the transfer of at least one high-quality embryo were included in the analysis. . Participants/materials, setting, methods 275 patients underfoing FET cycle were included in this prospective study carried out from January 2020 to December 2022. Endometrial preparation protocols included natural ovulatory cycles, ovulation induction cycles, and hormone replacement treatment cycles. Transvaginal ultrasound monitoring of endometrial thickness and the diameter of the dominant follicle began on the 10-12th day of menstrual cycle. Embryo transfer was timed accordingly and frozen embryo transfer carried out. Main results and the role of chance A total number of 275 patients of FET were analyzed. It was found that only the echo of the endometrial central line was different between the pregnant group and non-pregnant group. Other parameters, such as endometrial thickness, volume, endometrial peristalsis, or the endometrial blood flow were not statistically different between the two groups. Then, according to the relationship between the different groups and the clinical pregnancy rate, a score of 0 to 2 was respectively scored. The sum of the scores for the six items was the patient’s endometrial receptivity score. It showed that the clinical pregnancy rate increased as the endometrial receptivity score increased, and when the receptivity score reaches at least 5, the clinical pregnancy rate is significantly improved (58.2% versus 40.4%, P = 0.001). The echogenicity of the endometrial functional layer in the pregnancy group was more homogeneous, but it did not reach statistical significance. Other parameters, such as endometrial thickness, volume, the presence or absence of endometrial peristalsis, the direction of endometrial peristalsis, or the endometrial blood flow were not statistically different between the two groups. Limitations, reasons for caution In the absence of data of live birth rate, we considered clinical pregnancy rate as a proxy outcome to confirm receptive endometrium. Moreover, the sample size of the study was relatively small, and it is necessary to further expand the sample size to verify our conclusions. Wider implications of the findings We developed an endometrial receptivity scoring system and demonstrated its validity. It may aid clinicians in choosing the useful marker in clinical practice and for informing further research. As Ultrasonography is a simple and non-invasive diagnostic tool, the cost of the IVF cycle will also reduce. Trial registration number NOT REQUIRED

Establishing 3D Endometrial Organoids from the Mouse Uterus.

Endometrial tissue lines the inner cavity of the uterus and is under the cyclical control of estrogen and progesterone. It is a tissue that is composed of luminal and glandular epithelium, a stromal compartment, a vascular network, and a complex immune cell population. Mouse models have been a powerful tool to study the endometrium, revealing critical mechanisms that control implantation, placentation, and cancer. The recent development of 3D endometrial organoid cultures presents a state-of-the-art model to dissect the signaling pathways that underlie endometrial biology. Establishing endometrial organoids from genetically engineered mouse models, analyzing their transcriptomes, and visualizing their morphology at a single-cell resolution are crucial tools for the study of endometrial diseases. This paper outlines methods to establish 3D cultures of endometrial epithelium from mice and describes techniques to quantify gene expression and analyze the histology of the organoids. The goal is to provide a resource that can be used to establish, culture, and study the gene expression and morphological characteristics of endometrial epithelial organoids.

Evaluation of Endometriosis and Uterine Fibroids Leading to Infertility in Females Using Ultrasonography

The most common complaint among women who visit for an ultrasound is infertility, and ultrasound should be the first imaging technique to assess these patients. Objective: The aim of this study is to study uterine fibroids and endometriosis causing infertility in females using ultrasonography. Methods: The study was carried out in Gujranwala Pakistan at Chatha Hospital, Gondal hospital, and Al-Amin diagnostic center. The sonographic scanning of the 95 patients are included in the study. The bladder must be sufficiently filled; the lower abdomen should be lubricated with a coupling agent. Start by scanning transversely from the symphysis pubis to the umbilicus. Then, tilt the probe sharply downward until the uterus appears in the center of the screen and the endometrial line is visible. Finally, increase the image's gain and freeze the result. Results: The uterine fibroids and endometriosis are mainly affected in the age group of 30-39 has the highest frequency of (44.2%). The Ultrasound finding of the disease is such that endometriosis has the frequency of 23(24.2%) patients and the uterine fibroids have the frequency of 43(45.3%) patients. Secondary infertility has a maximum frequency of patients that is 51(53.7%) and primary infertility has a minimum frequency of patients that is 44(46.3%). Conclusions: In this study, uterine fibroids and endometriosis cause infertility in women between the age between 20 years to 60 years. More females are affected at the age of 30-39 years. More infertility is caused by uterine fibroids.

Influence of pregravid preparation on the structural reorganization of the endometrium in women with chronic endometritis in infertility

Aim. To reveal the peculiarities of structural reorganization of the endometrium in various variants of pregravid preparation in women with chronic endometritis (CE) and infertility.
 Materials and methods. We examined 90 women aged 1840 who were treated for CE. For all patients, examination with microbiological (cultural) examination of the cervical canal to be separated for aerobic and facultative anaerobic microorganisms with the determination of sensitivity to antibiotics, ultrasound examination (ultrasound) of the pelvic organs and morphological examination of endometrial biopsy samples before and after treatment. All women of the study group were divided into 2 subgroups. Patients of the 1st subgroup (n=30) received standard treatment for CE antibacterial and non-steroidal anti-inflammatory drugs; in the 2nd (n=60) an additional course of immunostimulating therapy with a bacterial lipopolysaccharide preparation was prescribed.
 Results. According to the cultural method, repeated cultures from the cervical canal after treatment turned out to be sterile more often in women of the 2nd subgroup. Ultrasound diffuse-focal changes in the subendometrial zone of the myometrium occurred in all patients before and after treatment. In the 2nd subgroup, after treatment, significant changes in the endometrium were noted in the form of an increase in its thickness and a 4-fold decrease in the number of hyperechoic inclusions in the basal layer, as well as the disappearance of the irregularity of the endometrial closure line. In the endometrial biopsies of women of the 2nd subgroup, a significant decrease in the specific area of the inflammatory infiltrate, the absence of foci of fibrosis, and an increase in the thickness of the vessel wall were noted.
 Conclusion. The addition of a bacterial lipopolysaccharide to the standard CE treatment regimen not only improves the microbiological environment of the female genital tract, but also significantly affects the morphofunctional state of the endometrium.

An endometrial receptivity scoring system basing on the endometrial thickness, volume, echo, peristalsis, and blood flow evaluated by ultrasonography.

BackgroundEstablishing a successful pregnancy depends on the endometrium and the embryo. It is estimated that suboptimal endometrial receptivity account for one-third of implantation failures. Despite the indepth understanding of the processes associated with embryo-endometrial cross-talk, little progress has been achieved for diagnosis and treatments for suboptimal endometrial receptivity.MethodsThis retrospective study included women undergoing their first frozen-thawed embryo transfer (FET) cycles at our reproductive medicine center from March 2021 to August 2021. Transvaginal three-dimensional (3D) ultrasound was performed in the morning on the day of embryo transfer for all the thawed embryo transfer patients, to evaluate endometrial receptivity, including endometrial thickness, echogenicity, volume, movement and blood flow.ResultsA total number of 562 patients of FET with 315 pregnancies (56.0%) was analyzed. It was found that only the echo of the endometrial central line was different between the pregnant group and non-pregnant group. Other parameters, such as endometrial thickness, volume, endometrial peristalsis, or the endometrial blood flow were not statistically different between the two groups. Then, according to the relationship between the different groups and the clinical pregnancy rate, a score of 0 to 2 was respectively scored. The sum of the scores for the six items was the patient’s endometrial receptivity score. It showed that the clinical pregnancy rate increased as the endometrial receptivity score increased, and when the receptivity score reaches at least 5, the clinical pregnancy rate is significantly improved (63.7% versus 49.5%, P=0.001).ConclusionWe developed an endometrial receptivity scoring system and demonstrated its validity. It may aid clinicians in choosing the useful marker in clinical practice and for informing further research.

Morphological Uterus Sonographic Assessment Criteria for Adenomyosis Diagnostic: A Case Report

BACKGROUND : The MUSA (Morphological Uterus Sonographic Assessment) statement is a consensus statement on terms, definitions and measurements that may be used to describe and report the sonographic features of the myometrium using gray-scale sonography, color/power Doppler and three-dimensional ultrasound imaging. MUSA Adenomyosis ultrasound features : Asymmetrical thickening, fan shape shadowing, cyst, hyperechoic island, Echogenic sub endometrial lines and buds, trans lesion vascularity, Irregular junctional zone, Interrupted junctional zone. Classification and descriptions of the MUSA criteria for adenomyosis are presented : location, classification (diffuse/focal), cystic, layer involvement (type), extent, size of the lesion.

Ten ultrasound endometrial issues

Abnormal uterine bleeding is probably the most frequent gynecological issue that leads women to a consult with a subsequent ultrasound. Transvaginal ultrasonographic evaluation represents the most sensitive method of endometrial evaluation, being more adequate than the transabdominal approach, especially when differentiating the benign lesions from the malignant ones. Transvaginal ultrasound is extremely useful in measurement, morphology and vascularization examination of the uterine cavity, especially the endometrium. We present 10 endometrial issues in which transvaginal ultrasound has proven its utility in the paraclinical evaluation of the patient: endometrial cycle phase, endometrial thickness, endomyometrial junction, endometrial vacuum line, cystic endometrium, endometrial vascularization, endometrial polyp, intracavitary development of leiomyomas, thick endometrium and endometrial cancer.

Spontaneous angular dichorionic diamniotic twin pregnancy: a case report

To report a peculiar case of ultrasound diagnosis of spontaneous angular twin pregnancy. In literature, the terms "angular," "interstitial," and "cornual" pregnancies are often used inappropriately. Confusion in terminology may have contributed to difficulties in developing diagnostic ultrasound criteria to differentiate these ectopic pregnancies. Case report. Obstetrics and Gynecology, Community Hospital "S. Maria delle Croci." A 28-year-old patient with a previous cesarean delivery was admitted to our hospital for management of a presumed angular ectopic pregnancy. Transvaginal ultrasound confirmed an ectopic dichorionic diamniotic twin pregnancy eccentrically located in the right superior angle of the uterine cavity: the first gestational sac appeared to have right angular implantation, whereas the second gestational sac seemed to deepen inside the myometrium, with a thin myometrial margin of only 3 mm. After discussing the risks, the patient requested to proceed with termination. A single intramuscular injection of 75 mg of methotrexate was administered, followed by ultrasound-guided hysterosuction after 19 days due to severe vaginal bleeding. An early and accurate ultrasound diagnosis of a high-risk condition allowed for conservative medical treatment. The serum beta-human chorionic gonadotropin levels progressively decreased. After 1 month, a clinical and ultrasound examination showed a regular endometrial line with a regular reappearance of menstrual bleeding. Although there are remarkable advances in ultrasound techniques, angular pregnancy remains a condition of difficult diagnosis and management; it is potentially dangerous and may lead to severe complications. An early and accurate diagnosis of this condition is necessary to avoid complications and individualize the subsequent management.

Understanding the natural selection of human embryos: Blastocyst quality modulates the inflammatory response during the peri-implantation period.

Decidualized cells display an active role during embryo implantation sensing blastocyst quality, allowing the implantation of normal developed blastocysts and preventing the invasion of impaired developed ones. Here, we characterized the immune microenvironment generated by decidualized cells in response to soluble factors secreted by blastocysts that shape the receptive milieu. We used an in vitro model of decidualization based on the Human Endometrial Stromal Cells line (HESC) differentiated with medroxiprogesterone and dibutyryl-cAMP, then treated with human blastocysts-conditioned media (BCM) classified according to their quality. Decidualized cells treated with BCM from impaired developed blastocysts increased IL-1β production. Next, we evaluated the ability of decidualized cells to modulate other mediators associated with menstruation as chemokines. Decidualized cells responded to stimulation with BCM from impaired developed blastocysts increasing CXCL12 expression and CXCL8 secretion. The modulation of these markers was associated with the recruitment and activation of neutrophils, while regulatory T cells recruitment was restrained. These changes were not observed in the presence of BCM from normal developed blastocysts. Soluble factors released by impaired developed blastocysts induce an exacerbated inflammatory response associated with neutrophils recruitment and activation, providing new clues to understand the molecular basis of the embryo-endometrial dialogue.

Autocross-linked hyaluronic acid gel and adipose-derived mesenchymal stem cell composites for the treatment intrauterine adhesions

ObjectiveTo evaluate the effect of adding adipose-derived mesenchymal stem cells (ASCs) to autocross-linked hyaluronic acid (HA) gel for intrauterine adhesion (IUA) treatment. MethodsA rat IUA model was established by mechanical curettage and infection, and then different treatments were administered to the rats on day 7 after modeling. Ninety-six rats were randomly divided into the following groups: IUA model group, gel therapy group, and combination therapy group (HA gel combined with ASCs). Eight rats per group were sacrificed on days 7, 10, 14 and 21 for the subsequent experiments. Morphological changes were determined by hematoxylin-eosin staining and Masson staining. Smad3 and leukocyte inhibitory factor (LIF) were analyzed by quantitative real-time polymerase chain reaction and immunohistochemistry. ResultsThe endometrial lines in the gel therapy group and the combination therapy group were more complete than those in the model group. Masson staining showed that fibrosis area rates in the gel therapy group and the combination therapy group were significantly lower than those in the model group on day 7(P < 0.05). During the observation period, the fibrosis area rates in the combination therapy group remained lower than those in the model group (P < 0.05). The mRNA expression of Smad3 in the combination therapy group was lower than that in the model group and gel therapy group during the observation period (P < 0.05). The mRNA expression level of LIF in the combination therapy group was higher than that in the model group and the gel therapy group throughout the observation period (P < 0.05). ConclusionsHA gel was effective in preventing the IUA adhesion formation at the early stage of the observation period, while ASC enhanced this effect throughout the observation period. Gel and ASC composites helped to improve endometrial receptivity.

METABOLIC, REPRODUCTIVE OUTCOMES AND SIDE EFFECTS AFTER THE ADMINISTRATION OF 100 MG DEHYDROEPIANDROSTERONE (DHEA) IN WOMEN WITH AN ADEQUATE OVARIAN RESERVE

Describe the metabolic, reproductive outcomes and side effects after the administration of 100 mg DHEA in women with an adequate ovarian reserve Self-controlled study of 27 women (29 to 45 years old), with an adequate ovarian reserve according to the POSEIDON criteria. During the period from February 2020 to September 2020. Participants were administered 100 mg of DHEA daily for 16 weeks and the metabolic (clinical and biochemical), reproductive (clinical, ultrasound and biochemical) outcomes and side effects were evaluated. We define clinical metabolic results as body mass index, abdominal circumference, mean arterial pressure, and the Ferriman Gallwey scale, while biochemical results are levels of hematocrit, glucose, insulin, HOMA index, triglycerides, total, HDL, LDL cholesterol and microalbuminuria. The clinical reproductive results were the frequency and duration of the menstrual cycle and ultrasound scans to the antral follicular count, ovarian volume and endometrial line. And finally, the biochemicals to the follicle-stimulating, luteinizing, estradiol and anti-Müllerian hormones. The adverse effects were determined by the presence of allergies, mastalgia, mammary nodules, ovarian tumors, acne and hair loss. All participants had a history of at least one pregnancy and were using a non-hormonal contraceptive method. The average age of the women studied was 35.88 ± 3.80. For clinical and biochemical metabolic outcomes, there was no statistically significant difference compared to baseline measurement. The frequency and duration of the menstrual cycle during the four months remained without significant changes compared to baseline, as well as the ultrasonographic characteristics. Difference was found in the antral follicular count from the 3rd (14.61 ± 2.07) and 4th (14.57 ± 2.08) months compared with the baseline measurement (11.51 ± 3.93, p <0.001). The levels of follicle stimulating hormone, luteinizing and estradiol during the four months were maintained without significant changes compared to baseline. A difference was found in anti-Müllerian hormone levels from the 3rd (2.03 ± 0.43) month compared to the baseline (1.50 ± 0.36, p <0.001). In only one case the presence of acne appeared from the second month (3.70%, p = 0.40). When studying only the age group older than 34 years, it was found that the antral follicular count improved from the second month (13.24 ± 2.16, p = 0.03), the third month (14.56 ± 2, 16, p <0.01), fourth month (14.25 ± 2.14, p<0.01) with a baseline (10.65 ± 3.52). And the anti Müllerian hormone improved from the third month (2.03 ± 0.41, p <0.01), fourth month (2.15 ± 0.32, p <0.01) with a baseline (1, 49 ± 0.36). In the population studied, the administration of 100mg of DHEA per day for 16 weeks. There was no modification in the metabolic and reproductive variables, uncommon side effects and the adequate ovarian reserve is maintained.

The Effect of Twisted Uterus Caused by Endometriosis or Myomatosis on Reproductive Treatment Outcomes.

Objective: Twisted uterus is detected when the body of the uterus is rotated from the cervical canal. This anomaly may be due to different causes, such as uterine fibroids, endometriosis or the presence of both. The study has aimed to compare the effect of the twisted uterus cause in terms of reproductive treatment outcomes. Materials and methods: It consisted of a retrospective study of twisted uterus cases with repeated implantation failure (more than three embryo transfers or four blastocysts transferred unsuccessfully) in our ultrasound department. The twisted uterus was defined when the vaginal probe needed to be rotated to assess the endometrial line thoroughly or when the coronal view was seen by 2D scan. From 2017 to 2020, 879 gynecological ultrasounds were performed. For statistical analysis, we carried out a logistical regression analysis adjusted by confounding factors. Results: From 145 patients included only 92 patients underwent reproductive treatments. With the known cause of uterine torsion. 56 patients with endometriosis, 18 with uterine myoma and the remaining 18 suffered from both. After assisted reproductive treatment, the endometriosis group showed the highest clinical pregnancy rate (53.57%) compared to myoma (22.22%) and endometriosis and myoma (38.89%) groups. Conclusion: Uterine myoma capable of causing uterine torsion may affect embryo implantation more than endometriosis. Prospective randomized studies with a larger number of patients would be needed to confirm these findings.

Infrahepatic Implantation of an Ectopic Pregnancy

Background: Ectopic pregnancies occur predominantly in the fallopian tubes or ovaries. Very rarely, the distal part of the greater omentum may have close contact to the fallopian tubes and implantation of the embryo may occur in this part of the greater omentum. In the absence of signs of pregnancy in the uterus or the fallopian tubes, the greater omentum has to be closely examined for ectopic pregnancy. Case Presentation: A 22-year-old woman in her 4th week of pregnancy presents with spotting and severe pain in the right lower abdomen with a history of 2 cesarean sections. The sonographic examination showed a normal uterus with a thin endometrial line. The uterine cavity did not present with any signs of a gestational sac. A great amount of free fluid in the Douglas cavity suspicious of a hemoperitoneum. ßhCG-values in serum was highly elevated up to 16749 mU/ml and confirmed the suspicion of an ectopic pregnancy. A diagnostic laparoscopy was performed, during which a blood clot reaching from the right lower abdomen to the greater omentum was detected. After removing the blood clot, a normal-sized uterus with regular ovaries and no signs of a pregnancy in the fallopian tubes were seen. However, an abdominal adhesion in the right upper part of the omentum close to the liver with bleeding was seen. While examining the abdominal cavity for the cause of bleeding, a small cystic lesion adherent to the greater omentum – close the offspring from the colon – representing an ectopic pregnancy became apparent. A partial omentectomy of 9,5 cm x 5,5 cm x 2,5 cm was performed with the finding of trophoblast and embryoblast implantated in the infrahepatic part of the greater omentum. Conclusion: In cases of ectopic pregnancy with hemoperitoneum, special care has to be taken examining not only the fallopian tubes or ovaries but also the greater omentum, which may harbour an implanted trophoblast and embryoblast – even in the upper part directly beneath the liver – as presented in this case. In cases of ruptured ectopic pregnancy of the greater omentum, the cases may be dealt with laparoscopic partial omentectomy if the case is early detected.

Pro-angiogenic effects of pregnancy-specific glycoproteins in endothelial and extravillous trophoblast cells.

We previously reported that binding to heparan sulfate (HS) is required for the ability of the placentally secreted pregnancy-specific glycoprotein 1 (PSG1) to induce endothelial tubulogenesis. PSG1 is composed of four immunoglobulin-like domains but which domains of the protein bind to HS remains unknown. To analyze the interaction of PSG1 with HS, we generated several recombinant proteins, including the individual domains, chimeric proteins between two PSG1 domains, and mutants. Using flow cytometric and surface plasmon resonance studies, we determined that the B2 domain of PSG1 binds to HS and that the positively charged amino acids encompassed between amino acids 43-59 are required for this interaction. Furthermore, we showed that the B2 domain of PSG1 is required for the increase in the formation of tubes by endothelial cells (EC) including a human endometrial EC line and two extravillous trophoblast (EVT) cell lines and for the pro-angiogenic activity of PSG1 observed in an aortic ring assay. PSG1 enhanced the migration of ECs while it increased the expression of matrix metalloproteinase-2 in EVTs, indicating that the pro-angiogenic effect of PSG1 on these two cell types may be mediated by different mechanisms. Despite differences in amino acid sequence, we observed that all human PSGs bound to HS proteoglycans and confirmed that at least two other members of the family, PSG6 and PSG9, induce tube formation. These findings contribute to a better understanding of the pro-angiogenic activity of human PSGs and strongly suggest conservation of this function among all PSG family members.

Puerperal Sepsis Caused by Clostridium Innocuum in a Patient with Placenta Accreta and Literature Review

Puerperal Sepsis Caused by Clostridium Innocuum in a Patient with Placenta Accreta and Literature Review