Location Of Endometriosis Research Articles

Vaginal and rectal microbiome contribute to genital inflammation in chronic pelvic pain

BackgroundChronic pelvic pain (CPP) is a multifactorial syndrome that can substantially affect a patient’s quality of life. Endometriosis is one cause of CPP, and alterations of the immune and microbiome profiles have been observed in patients with endometriosis. The objective of this pilot study was to investigate differences in the vaginal and gastrointestinal microbiomes and cervicovaginal immune microenvironment in patients with CPP and endometriosis diagnosis compared to those with CPP without endometriosis and no CPP.MethodsVaginal swabs, rectal swabs, and cervicovaginal lavages (CVL) were collected among individuals undergoing gynecologic laparoscopy. Participants were grouped based on patients seeking care for chronic pain and/or pathology results: CPP and endometriosis (CPP-Endo) (n = 35), CPP without endometriosis (n = 23), or patients without CPP or endometriosis (controls) (n = 15). Sensitivity analyses were performed on CPP with endometriosis location, stage, and co-occurring gynecologic conditions (abnormal uterine bleeding, fibroids). 16S rRNA sequencing was performed to profile the microbiome, and a panel of soluble immune mediators was quantified using a multiplex assay. Statistical analysis was conducted with SAS, R, MicrobiomeAnalyst, MetaboAnalyst, and QIIME 2.ResultsSignificant differences were observed between participants with CPP alone, CPP-Endo, and surgical controls for body mass index, ethnicity, diagnosis of ovarian cysts, and diagnosis of fibroids. In rectal microbiome analysis, both CPP alone and CPP-Endo exhibited lower alpha diversity than controls, and both CPP groups revealed enrichment of irritable bowel syndrome-associated bacteria. CPP-Endo exhibited an increased abundance of vaginal Streptococcus anginosus and rectal Ruminococcus. Patients with CPP and endometrioma (s) demonstrated increased vaginal Streptococcus, Lactobacillus, and Prevotella compared to other endometriosis sites. Further, abnormal uterine bleeding was associated with an increased abundance of bacterial vaginosis-associated bacteria. Immunoproteomic profiles were distinctly clustered by CPP alone and CPP-Endo compared to controls. CPP-Endo was enriched in TNF⍺, MDC, and IL-1⍺.ConclusionsVaginal and rectal microbiomes were observed to differ between patients with CPP alone and CPP with endometriosis, which may be useful in personalized treatment for individuals with CPP and endometriosis from those with other causes of CPP. Further investigation is warranted in patients with additional co-occurring conditions, such as AUB/fibroids, which add additional complexity to these conditions and reveal the enrichment of distinct pathogenic bacteria in both mucosal sites. This study provides foundational microbiome-immunoproteomic knowledge related to chronic pelvic pain, endometriosis, and co-occurring gynecologic conditions that can help improve the treatment of patients seeking care for pain.

P-279 Significant increased isolation of escherichia coli in Iranian women with endometriosis: a case control – study

Abstract Study question Considering the role of bacterial infection in causing endometriosis, we decided to compare the cultures of endometriosis-affected women a in this study Summary answer Considering the possible role of E. coli in the progression and/or recurrence of endometriosis and also infertility What is known already (5). Due to the finding of endotoxin of E. coli species in the peritoneal cavity and menstrual fluid of endometriosis patients, infection with this bacterium has recently been proposed as an effective factor in the occurrence and growth of endometriosis lesions. Study design, size, duration This prospective case-control study was carried out in the Women’s Department of Shiraz University of Medical Sciences in collaboration with the Bacteriology and Virology Department between 60 participants. Participants/materials, setting, methods 30 women with endometriosis in stages 3 and 4 of the disease, and 30 women without endometriosis who were candidates for surgery due to benign uterine diseases, underwent endometrial biopsy with Novak Kort in sterile conditions before starting their operation, and the results of their endometrial culture were analyzed and compared in terms of the presence of Enterobacter spp., Klebsiella spp., and E. coli species. Main results and the role of chance Based on the comparison between the two groups, only E. coli species had a significant association with the presence of endometriosis (P = 0.001). There was no significant relationship between the location of endometriosis in the pelvic cavity and culture results. Parity among the E. coli negative group was significantly higher compared to the E. coli positive group (P < 0.001). Limitations, reasons for caution Lack of sample trail for repeat testing and antibiotic susceptibility testing, low taxonomical resolution, and costly laboratory setup and maintenance are other limitations of this technology Wider implications of the findings we suggest that in women who have endometriosis and recurrent IVF failure and also in cases of endometriosis recurrence after surgical treatment, treatment of couples with appropriate antibiotics and repeated culture along with subsequent antibiotic susceptibility testing until their culture becomes negative could be beneficial. Trial registration number IR.SUMS.MED.REC.1400.097

Significant increased isolation of Escherichia coli in Iranian women with endometriosis: a case control – study

BackgroundThe role of bacterial contamination in the development and progression of endometriosis lesions is currently a hot topic for gynecologists. In this study, we decided to compare the endometrial cultures of women affected by endometriosis with those of non-endometriotic women, focusing on specific microbial pathogens.Material and methodIn this cross-sectional case-control study, 30 women with endometriosis in stages 4 of the disease whose endometriosis was confirmed based on clinical, ultrasound, and histopathological findings, and 30 women without endometriosis who were candidates for surgery due to benign uterine diseases with regular menstrual cycle, underwent endometrial biopsy with Novak Kort in sterile conditions before starting their operation, and the results of their endometrial culture were analyzed and compared.ResultsResults of the study indicate that there were no significant differences in terms of age, BMI, smoking, education level, place of residency, use of the intrauterine device, or vaginal douche, and age of menarche between the case and control groups. The only demographic difference observed was in parity, where the control group had a significantly higher parity than the case group (P = 0.001). Out of the 60 cultures, only 15 samples were positive in the endometriosis group, and E. coli was the most prevalent species, with 10 (33.3%) samples testing positive for it. Klebsiella spp. and Enterobacteria spp. were also detected in 3 (10.0%) and 2 (6.7%) samples, respectively. The comparison between the two groups showed that only E. coli had a significant association with the presence of endometriosis (P = 0.001). There was no significant relationship between the location of endometriosis in the pelvic cavity and culture results. It was observed that parity among the E. coli negative group was significantly higher compared to the E. coli positive group (P < 0.001).ConclusionBased on The high occurrence of E. coli in women with endometriosis, along with its potential involvement in the progression and/or recurrence of this condition, the researchers propose that treating women with endometriosis and recurrent IVF failure, as well as those with endometriosis recurrence after surgical treatment, with suitable antibiotics and repeated culture until the culture becomes negative, could be beneficial.

Pregnancy with endometriosis: Assessment of national-level trends, characteristics, and maternal morbidity at delivery

ObjectiveTo examine pregnancy characteristics and maternal morbidity at delivery among pregnant patients with a diagnosis of endometriosis. Study designThis cross-sectional study queried the Healthcare Cost and Utilization Project’s National Inpatient Sample. Study population was 17,796,365 hospital deliveries from 2016 to 2020, excluded adenomyosis and uterine myoma. The exposure was endometriosis diagnosis. Main outcome measures were clinical and pregnancy characteristics and severe maternal morbidity at delivery related to endometriosis, assessed with multivariable regression model. ResultsEndometriosis was diagnosed in 17,590 patients. The prevalence of endometriosis increased by 24 % from one in 1,191 patients in 2016 to one in 853 patients in 2020 (adjusted-odds ratio [aOR] 1.24, 95% confidence interval [CI] 1.19–1.30). Clinical and pregnancy characteristics that had greater than two-fold association to endometriosis included polycystic ovary syndrome, placenta previa, cesarean delivery, maternal age of ≥30 years, prior pregnancy loss, and anxiety disorder. Pregnant patients with endometriosis were more likely to have the diagnosis of measured severe maternal morbidity during the index hospitalization for delivery (47.8 vs 17.3 per 1,000 deliveries, aOR 1.91, 95%CI 1.78–2.06); these associations were more prominent following vaginal (aOR 2.82, 95%CI 2.41–3.30) compared to cesarean (aOR 1.85, 95%CI 1.71–2.00) deliveries. Among the individual morbidity indicators, endometriosis was most strongly associated with thromboembolism (aOR 5.05, 95%CI 3.70–6.91), followed by sepsis (aOR 2.39, 95%CI 1.85–3.09) and hysterectomy (aOR 2.18, 95%CI 1.85–2.56). When stratified for endometriosis anatomical site, odds of thromboembolism was increased in endometriosis at distant site (aOR 9.10, 95%CI 3.76–22.02) and adnexa (aOR 7.37, 95%CI 4.43–12.28); odds of sepsis was most increased in endometriosis at multi-classifier locations (aOR 7.33, 95%CI 2.93–18.31) followed by pelvic peritoneum (aOR 5.54, 95%CI 2.95–10.40); and odds of hysterectomy exceeded three-fold in endometriosis at adnexa (aOR 3.00, 95%CI 2.30–3.90), distant site (aOR 5.36, 95%CI 3.48–8.24), and multi-classifier location (aOR 4.46, 95%CI 2.11–9.41). ConclusionThe results of this nationwide analysis suggest that pregnancy with endometriosis is uncommon but gradually increasing over time in the United States. The data also suggest that endometriosis during pregnancy is associated with increased risk of severe maternal morbidity at delivery, especially for thromboembolism, sepsis, and hysterectomy. These morbidity risks differed by the anatomical location of endometriosis.

Causal effects of endometriosis stages and locations on menstruation, ovulation, reproductive function, and delivery modes: a two-sample Mendelian randomization study.

Endometriosis is a chronic inflammatory disease of women during their reproductive years. The relationship between the severity and location of endometriosis and menstruation, ovulation, reproductive function, and mode of delivery remains unclear. We explored the association between the various phenotypes of endometriosis and menstruation, ovulation, reproductive function, and mode of delivery, using two-sample Mendelian randomization (MR) and summary data on endometriosis stages and locations from the FinnGen consortium and women's menstruation, ovulation, reproductive function, and mode of delivery from OpenGWAS and ReproGen. Inverse-variance weighting was used for the primary MR analysis. In addition, a series of sensitivity analyses, confounding analyses, co-localization analyses, and multivariate MR analyses were performed. MR analysis showed a negative effect of moderate to severe endometriosis on age at last live birth (OR = 0.973, 95% CI: 0.960-0.986) and normal delivery (OR = 0.999, 95% CI: 0.998-1.000; values for endpoint were excluded), ovarian endometriosis on age at last live birth (OR = 0.976, 95% CI: 0.965-0.988) and normal delivery (OR = 0.999, 95% CI: 0.998-1.000; values for endpoint were excluded), and fallopian tubal endometriosis on excessive irregular menstruation (OR = 0.966, 95% CI: 0.942-0.990). Bidirectional MR analysis showed that age at menarche had a negative causal effect on intestinal endometriosis (OR = 0.417, 95% CI: 0.216-0.804). All MR analyses were confirmed by sensitivity analyses, and only the genetic effects of moderate to severe endometriosis on normal delivery and age at last live birth were supported by co-localization evidence. Our findings deepen the understanding of the relationship between various types of endometriosis and menstruation, ovulation, reproductive function, and mode of delivery and clarify the important role of moderate to severe endometriosis.

Bladder Endometriosis: Case Report and Literature Review

Bladder endometriosis is a rare location of endometriosis. We present a case of female patient with an inter vesical-uterine septum mass that was an incidental finding during the realization of a pelvis IMR to characterize an ovarian tumor. We performed a surgical resection. Histopathological examination revealed a bladder adenomyomas.

The accuracy of ultrasound compared to magnetic resonance imaging in the diagnosis of deep infiltrating endometriosis: A narrative review

AbstractEndometriosis is defined as the presence of endometrium‐like epithelial cells and/or stroma located outside the uterus, generally with associated inflammatory response. Commonly located on the ovaries and peritoneum, endometriosis can also infiltrate the retroperitoneal space and pelvic organs, known as deep endometriosis (DE). This narrative review aims to compare the accuracy of transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) for detecting deep endometriosis. A literature search was performed mid‐2021 and again in December 2022 using PubMed, SAGE and Wiley databases, and limited to studies published between 2011 and 2021. Key words deep infiltrating endometriosis, transvaginal ultrasound, magnetic resonance imaging and diagnostic accuracy identified 16 studies which addressed the aim. The authenticity and reliability were determined by the Standards for Reporting of Diagnostic Accuracy. When the studies were analysed, the diagnosis of DE mean sensitivity values ranged from 40% to 100% for TVUS and 50% to 100% for MRI. Mean specificity values ranged from 81.5% to 99.9% and 84.4% to 97.5%, respectively. This indicates that both MRI and TVUS have similarly accurate performance in the detection of DE. Endometriosis detection is possible with TVUS and MRI, however accuracy is dependent on the location and severity as well as limitations due to operator and image interpretation reliability. In the presence of a correctly performed dynamic TVUS examination for the diagnosis of DE, MRI adds little diagnostic value. Further research is recommended using a standardised protocol in a wider study of affected patients, including accurate clinical assessments for each location of endometriosis to inform the choice of imaging for that region.

Association between preoperative pelvic exam findings and locations of endometriosis

Association between preoperative pelvic exam findings and locations of endometriosis

Early noninvasive diagnosis of endometriosis: dysmenorrhea and specific ultrasound findings are important indicators in young women

To diagnose endometriosis in young patients ≤25y with severe dysmenorrhea through specific ultrasonographic examination findings and to correlate the symptoms to its different forms: ovarian, deep infiltrating endometriosis, and adenomyosis. A retrospective observational study. University Hospital. Women aged 12-25 years with severe dysmenorrhea and a visual analog scale score ≥7. This study included 371 women aged 12-25 years referred to our gynecological ultrasound (US) Unit between January 2016 and December 2021 with severe dysmenorrhea and a visual analog scale score ≥7. Two dimensional, 3 dimensional, and power Doppler US pelvic examinations (transvaginal or transrectal in presexually active girls) were performed on all patients. Medical history and symptoms were collected routinely for each patient before the scan. All possible locations of endometriosis, isolated or combined occurrence, were evaluated, and recorded using an US dedicated mapping sheet. Painful symptoms were evaluated by visual analog scale and correlated to the different endometriosis forms. At least one US endometriosis feature was identified in 131 (35.3%) patients, whereas the US findings of 170 (45.8%) were normal despite the referred dysmenorrhea. Of the 131 patients with endometriosis, ovarian endometrioma was found in 54 (41.2%), and 22 (16.8%) had an isolated endometrioma. Adenomyosis was detected in 67 (51.1%) patients, and 28 (21.4%) showed its isolated indications. Posterior deep infiltrating endometriosis was found in 70 (53.4%) patients, and uterosacral ligament (USL) fibrotic thickening was found in 63 (48.1%). In 23 patients, the USL lesion was completely isolated. The combined occurrence of dysmenorrhea with dyspareunia, bowel symptoms, and heavy menstrual bleeding increases the presence of endometriosis up to 59%, 63%, and 45%, respectively. In young patients with severe dysmenorrhea, the US-based detection rate of pelvic endometriosis was one-third. USL fibrotic thickening and mild adenomyosis are often the only findings, so an accurate pelvic US scan can provide an early diagnosis by identifying small endometriotic lesions. Young patients with dysmenorrhea should be referred to an expert sonographer to minimize the delay between the onset of symptoms and diagnosis.

Management options for primary umbilical endometriosis: a case report

Background: The common location of Endometriosis is in genitalia organs, for instance, the ovary, uterus, fallopian tube, and sometimes even in the intestine, bladder, and in rare locations such as the navel, lungs, or brain. Umbilical Endometriosis is the most irregular form of Endometriosis and the most common cutaneous form of Endometriosis. Primary umbilical endometriosis diagnosis is often biased and delayed; the exact etiopathology remains unclear. Our case report discusses the diagnosis and management options for this rare disease. Case presentation: We reported a Primary Umbilical Endometriosis case, confirmed by a history of the nodule with pain, swelling, and bleeding at the umbilicus, which occurs during menstruation. The nodule was surgically removed, and histopathological analysis shows fibromycsoid tissue with multiple forms of subepithelial endometrial glands and surrounding stroma, confirmed as Endometriosis. Conclusion: The definitive treatment for umbilical Endometriosis is surgical excision with total removal of the umbilicus. The prognosis is good, and the recurrence rate is meager if complete excision is successfully performed.

Automated segmentation of endometriosis using transfer learning technique

Background: This paper focuses on segmenting the exact location of endometriosis using the state-of-art technique known as U-Net. Endometriosis is a progressive disorder that has a significant impact on women. The lesion-like appearance that grows inside the uterus and sheds for every periodical cycle is known as endometriosis. If the lesion exists and is transferred to other locations in the women’s reproductive system, it may lead to a serious problem. Besides radiologists deep learning techniques exist for recognizing the presence and aggravation of endometriosis. Methods: The proposed method known as structural similarity analysis of endometriosis (SSAE) identifies the similarity between pathologically identified and annotated images obtained from standardized dataset known as GLENDA v1.5 by implementing two systematic approaches. The first approach is based on semantic segmentation and the second approach uses statistical analysis. Semantic segmentation is a cutting-edge technology for identifying exact locations by performing pixel-level classification. In semantic segmentation, U-Net is a transfer-learning architecture that works effectively for biomedical image classification. The SSAE implements the U-Net architecture for segmenting endometriosis based on the region of occurrence. The second approach proves the similarity between pathologically identified images and the corresponding annotated images using a statistical evaluation. Statistical analysis was performed using calculation of both the mean and standard deviation of all four regions by implementing systematic sampling procedure. Results: The SSAE obtains the intersection over union value of 0.72 and the F1 score of 0.74 for the trained dataset. The means of both the laparoscopic and annotated images for all regions were similar. Consequently, the SSAE facilitated the presence of abnormalities in a specific region. Conclusions: The proposed SSAE approach identifies the affected region using U-Net architecture and systematic sampling procedure.

Outcomes after Laparoscopic Excision of Bladder Endometriosis Using a CO2 Laser: A Review of 207 Cases in a Single Center

Assess efficacy, safety, fertility outcomes and recurrence after laparoscopic resection of bladder endometriosis (BE) using a CO2 laser. Retrospective cohort study. University gynecologic surgery unit, referral center for endometriosis. A total of 207 women having undergone laparoscopic BE excision between January 1998and January 2019. None. Intra- and postoperative complication rates. Disease recurrence and fertility outcomes in patients with a minimum 1-year follow-up (n=176) for "isolated" and "non-isolated" BE groups. Forty-three patients presented with isolated BE. Bladder "shaving" without mucosae opening was performed in 50.7% cases. No intraoperative complications were noted. One postoperative grade 3 complication was related to BE excision: a bladder breach requiring closure by repeat laparoscopy. Mean (± SD) follow-up was 7.05 (± 4.65) years. In patients wishing to conceive (n=132), the total pregnancy rate (PR) was 75% (48.5% spontaneous), 76.19% in the isolated BE group (56.3% spontaneous). Among the 94 patients with previous infertility, 74.5% conceived, 50% spontaneously. No statistical difference was found in PR and need for in vitro fertilization between isolated and nonisolated BE groups. BE recurrence rate was 3.4%. No difference was observed between groups with full-thickness bladder resection (4/88) and shaving (2/88) (p=.406). Age at surgery (hazard ratio 0.91 [0.84-0.98], p=.016) and postoperative pregnancy (hazard ratio 0.07 [0.01-0.91], p=.042) showed influence on disease recurrence. The study demonstrates that laparoscopic BE removal is feasible with very low complications rates and was associated with high PR (both spontaneous and in vitro fertilization), even in patients with previous infertility. BE recurrence is lower than for other endometriosis locations. Bladder endometriosis; Laparoscopy; Deep infiltrating endometriosis; Fertility; Partial bladder resection.

Impact of Race and Ethnicity on Perioperative Outcomes During Hysterectomy for Endometriosis

To assess whether complications incurred during hysterectomy for the treatment of endometriosis differ among racial-ethnic groups. Retrospective cohort study. American College of Surgeons National Surgical Quality Improvement Program database from 2014 to 2019. This database is a robust, comprehensive, multi-institutional database with nearly 700 participating hospitals. Patients with a diagnosis of endometriosis or with an endometriosis-associated symptom as the primary indication for surgery and surgical intraoperative documentation of endometriosis. Compare perioperative complications based on patient race and ethnicity. A total of 5639 patients underwent hysterectomy for endometriosis; of these, 4368 were White patients (77.5%), 528 Black patients (9.4%), 491 Hispanic patients (8.7%), 252 Asian patients (4.5%). There was no association between location of endometriosis and patient race and ethnicity. However, White patients had highest rate, and Asian patients had the lowest rate of laparoscopic hysterectomy, 85.3% vs 69.8%, respectively (p <.01). In addition, there were differences in concomitant procedures performed at time of hysterectomy based on race and ethnicity, with White patients having the highest rates of adnexal/peritoneal surgery at 12.5% (p <.01) compared with patients of the other racial and ethnic groups. Asian patients had the highest rate of ureteral surgery at 6.8% (p <.01) and highest rate of intestinal surgery at 16.3% (p <.01) compared with patients of other racial and ethnic groups. There was no association of rates of concomitant bladder surgery, appendectomy, or rectal surgery with patient race and ethnicity. Black patients had the highest rate of minor complications at 13.5% (p <.01) and the highest rate of major complications at 6.6% (p <.01) compared with patients of other racial and ethnic groups. After multivariable analysis, Black patients still had increased odds of having a major complication compared with patients of other racial and ethnic groups even after controlling for patient characteristics and perioperative factors such as endometriosis lesion location, surgical approach, and concomitant procedures (odds ratio 1.64; 95% confidence interval, 1.10-2.45). Endometriosis lesion location did not differ with patient race and ethnicity. However, patient race and ethnicity did have an impact on the surgical approach and the concomitant surgical procedures performed at time of hysterectomy. Black patients had the highest odds of major complications.

Endometriosis: Locations and coexistence with other uterine conditions, single-center experience.

Objective: To see the association of endometriosis with other uterine conditions in our setup. Study Design: Descriptive Retrospective study. Setting: Private Lab in Faisalabad. Period: January 2010 to December 2019. Material &amp; Methods: A total of 297 cases were evaluated in this study. We have included all endometriosis cases with associated other conditions of the uterus. In this study paraffin blocks and previous slides along with clinical data were analyzed according to the standard protocols. All the data including age, location of endometriosis, and association with other uterine conditions were noted and reported as percentages. Results: In this study, we analyzed 297 endometriosis cases, received during ten years. The age group ranges from 15 years to 75 years. The most common age group ranges from 26-30 years, 87(29%) cases, and the least commonly affected group was 71-75 years, only one case. The most common site of endometriosis was in the ovaries, 169(57%) cases. The most common associated other condition was benign tumor leiomyoma, 65(43%) cases while only one case of endometrial carcinoma was noted. Conclusion: This study concludes that ovarian endometriosis is the most common location and there is a strong association with another co-existing benign tumor such as leiomyoma. This signifies the possibility of common risk factors such as hyperestrogenism. Thus it is important to be aware of the possibility of co-existence of other conditions so that they can be treated at once in a single surgery.

Learning Curve for the Detection of Deep Infiltrating Endometriosis and Adenomyosis with 3-D Transvaginal Water Contrast Sonography.

Three-dimensional rectosonography (RSG) is a transvaginal sonography technique using rectal water contrast and 3-D acquisitions. The main points of interest of 3-D RSG could be its easy accessibility and its quick learning curve, especially with respect to rectosigmoid lesions. The objective of this prospective observational study was to assess the learning curve of 3-D RSG for the diagnosis of rectosigmoid lesions and for various other locations of deep endometriosis (DE), endometriomas and adenomyosis. From April 2017 to November 2017, 116 patients with suspected pelvic endometriosis were referred to the Croix-Rousse University Hospital, and those who underwent 3-D RSG were included in our study. After a short training period, four residents were asked to perform 3-D RSG by themselves. Each procedure was systematically controlled immediately afterward by a single expert sonographer. The success of the procedure involved the correct identification of various locations of endometriosis (rectosigmoid, uterosacral ligament, retrocervical space, vagina, bladder and ovaries) and adenomyosis, using the expert sonographer's examination as the reference technique. The learning curve was generated using these data and assessed using the Learning Curve Cumulative Summation Test (LC-CUSUM) method. The pooled LC-CUSUM revealed that the required level of achievement was reached after 24 3-D RSGs were performed for the diagnosis of rectosigmoid lesions. All four residents were significantly competent in diagnosing rectosigmoid lesions at the end of their training period, with an α risk <0.05 (T1, p=0.03; T2, p=0.0002; T3, p=0.05; T4, p=0.02). The LC-CUSUM analysis confirmed that competency was achieved for vaginal DE, torus uterinum DE, US DE, bladder DE, endometriomas and adenomyosis within 17, 27, 38, 19, 17 and 33 scans, respectively. This study provides evidence that the skills required to diagnose endometriosis lesions and adenomyosis with 3-D RSG can be acquired after a brief learning period in an expert center.

EPH88 Epidemiological Disease Burden of Ovarian Endometriosis Based on Real-World Health Insurance Claims Data

Ovaries are one of the most common locations of endometriosis, causing chronic pelvic pain. Even so, ovarian endometrioma can also increase the risk of ovarian cancer. The aim of our study was to determine the epidemiological disease burden of ovarian endometriosis in Hungary.

Automated segmentation of endometriosis using transfer learning technique

Background: This paper focuses on segmenting the exact location of endometriosis using the state-of-art technique known as U-Net. Endometriosis is a progressive disorder that has a significant impact on women. The lesion-like appearance that grows inside the uterus and sheds for every periodical cycle is known as endometriosis. If the lesion exists and is transferred to other locations in the women’s reproductive system, it may lead to a serious problem. Besides radiologists deep learning techniques exist for recognizing the presence and aggravation of endometriosis. Methods: The proposed method known as structural similarity analysis of endometriosis (SSAE) identifies the similarity between pathologically identified and annotated images obtained from standardized dataset known as GLENDA v1.5 by implementing two systematic approaches. The first approach is based on semantic segmentation and the second approach uses statistical analysis. Semantic segmentation is a cutting-edge technology for identifying exact locations by performing pixel-level classification. In semantic segmentation, U-Net is a transfer-learning architecture that works effectively for biomedical image classification. The SSAE implements the U-Net architecture for segmenting endometriosis based on the region of occurrence. The second approach proves the similarity between pathologically identified images and the corresponding annotated images using a statistical evaluation. Statistical analysis was performed using calculation of both the mean and standard deviation of all four regions by implementing systematic sampling procedure. Results: The SSAE obtains the intersection over union value of 0.72 and the F1 score of 0.74 for the trained dataset. The means of both the laparoscopic and annotated images for all regions were similar. Consequently, the SSAE facilitated the presence of abnormalities in a specific region. Conclusions: The proposed SSAE approach identifies the affected region using U-Net architecture and systematic sampling procedure.

Characteristics of Endometriosis Patients in Dr. Mohammad Hoesin General Hospital on 2018 to 2020

Background. Endometriosis is defined as the presence of endometrial-like tissue outside the uterus. The prevalence of endometriosis is not known with certainty because it is necessary to perform a laparoscopy to confirm the diagnosis of endometriosis and is usually found during examination for other indications. This study aims to explore the characteristics of endometriosis patients at Dr. Mohammad Hoesin General Hospital Palembang.&#x0D; Methods. This research is descriptive observational research. The research data were obtained from the medical records of endometriosis patients treated at Dr. Mohammad Hoesin General Hospital Palembang from 2018 to 2020.&#x0D; Results. Of the 105 sample data studied, the most distribution of endometriosis patients was in the reproductive age group (15-49 years) (99%), menarche 12-14 years (67.6%), the location of endometriosis in the ovaries (58.1%), status indoor workers (99%), marital status (85.7%), fertile (43.8%), and infertile patients (41.9%), the chief complaint of dysmenorrhea (66.7%), stage IV disease (63, 8%), nullipara (60%), surgical management (79%).&#x0D; Conclusion. Most of the characteristics of endometriosis patients were in the reproductive age group (15 – 49 years), menarche 12-14 years, endometriosis location in the ovary, indoor worker status, marital status, infertility, the main complaint of dysmenorrhea, stage IV disease, nullipara, surgical treatment.

Clinical significance of predictive and diagnostic indices of fetal pathology associated with placental insufficiency in women with endometriosis

BACKGROUND: Modern achievements of pharmacology, surgery and reproductive medicine have determined an increase in the implementation of reproductive function in endometriosis of various localization. The onset of pregnancy in presence of impaired endometrial receptivity and progesterone resistance, pro-inflammatory and pro-thrombotic status, abnormal functioning of the immune system, structural changes in the reproductive organs leads to impaired formation of the embryo (feto) placental system, early reproductive losses, complicated pregnancy and adverse perinatal outcomes. In this regard, the endometriosis and pregnancy issue requires close study and specific proposals to optimize pregnancy management.&#x0D; AIM: The aim of this study was to develop predictive (PIs) and diagnostic (DIs) indices of placenta-associated fetal pathology in pregnant women with endometriosis, to determine their prognostically and diagnostically significant parameters.&#x0D; MATERIALS AND METHODS: This prospective study in the dynamics of gestation included a comprehensive clinical and laboratory examination of 175 pregnant women with endometriosis (100 subjects with adenomyosis and 75 subjects with ovarian endometriosis). To develop PIs and DIs, two comparison groups with fetal pathology due to placental insufficiency were retrospectively identified, depending on the location of endometriosis. Group I consisted of 49 pregnant women with adenomyosis and placental insufficiency isolated from other pregnancy complications, accompanied by growth retardation and/or chronic fetal hypoxia; Group II comprised 29 pregnant women with ovarian endometriosis and placental insufficiency isolated from other pregnancy complications, accompanied by growth retardation and/or chronic fetal hypoxia. The control group (Group III) included 30 healthy pregnant women with a normal course of gestation. The examination was performed at 10-14 weeks, 20-24 weeks, and 28-34 weeks of gestation and included an assessment of placental insufficiency markers such as placental growth factor (PlGF), placental -1-microglobulin (PAMG-1), tumor necrosis factor (TNF), lymphocytes with membrane receptor FasR (L CD95+), C-reactive protein, placental alkaline phosphatase (PAPh), and fetal hemoglobin (HbF). The information value of individual parameters and indices was determined by ROC analysis, odds ratio, and clinical epidemiology tests.&#x0D; RESULTS: Pregnancy in presence of endometriosis in 100% of cases was complicated by placental insufficiency of varying severity (with fetal pathology in 81.5% of cases), the frequency of which had statistically significant differences between the groups of pregnant women with adenomyosis and ovarian endometriosis (2 = 4.06, p = 0.04). To predict growth retardation and / or chronic fetal hypoxia, we have developed PI I (PlGF / TNF 100) and PI II (PAMG-1 / PlGF 100), which characterize the state of placental angio-and vasculogenesis depending on systemic inflammatory response level. For early diagnosis of fetal pathology, we have proposed DI I (CRP / PAPh 100), DI II (HbF / PlGF 100) and DI III (L CD95+ / PAPh 100), which allow for diagnosing placental alterations with impaired placental energy supply due to an increase in inflammatory status. Evaluation of prognostic and diagnostic significance of PIs and DIs showed that the most informative tools are PI I (Se = 86.1%, Sp = 80.5%) and DI I (Se = 88.3%, Sp = 83.7%).&#x0D; CONCLUSIONS: The use of PIs allows for risk stratification of pregnant women from the 1st trimester of gestation to address the issue of the prevention method. The clinical capabilities of DIs optimize obstetric tactics for the timely prescription of therapy for placental insufficiency and targeted diagnosis of fetal pathology. Pregnant women with endometriosis should be classified as a high perinatal risk group, and therefore the proposed PIs and DIs should be included in the dynamic examination complex.

Variations in Endometriosis Location and Surgical Outcomes By Race

<h3>Study Objective</h3> To evaluate the frequency and outcomes of endometriosis surgery by race. <h3>Design</h3> Retrospective cohort (Canadian Task Force Classification II-2). <h3>Setting</h3> Data from the American College of Surgeons National Surgical Quality Improvement Program from 2014 to 2019. <h3>Patients or Participants</h3> 4211 women undergoing surgery for endometriosis were identified by ICD codes. <h3>Interventions</h3> Surgical interventions and outcomes were evaluated by race. <h3>Measurements and Main Results</h3> 4211 patients were identified, of whom 3% were Asian, 7.5% were Hispanic, 9% were Black, 11% were Other race, and 69% were White. The most common diagnoses were unspecified endometriosis (28%), pelvic peritoneal endometriosis (20%), ovarian endometriosis (13%), and uterine endometriosis (4%). Asian women had ovarian endometriosis most frequently (31%) and Black women had uterine endometriosis most frequently (22%). Laparoscopic excision/fulguration was completed for 11% of women. Compared to White women, Black, Hispanic, Asian and Other race women were more likely to undergo abdominal hysterectomy (8% vs 28-29%, p≤.0001) and to have operative times > 180 min (19% vs 21-35%, p<.0001). Black and Other race women had higher odds of bleeding requiring transfusion. Black, Asian, and Other race women also had higher odds of length of stay > 4 days. <h3>Conclusion</h3> Location of endometriosis varied by race. Few women of any race had laparoscopic excision/fulguration of endometriosis. More than a quarter of minority women underwent an abdominal hysterectomy for endometriosis, which varied from White women. Minority women also had worse surgical outcomes and longer surgeries. Interpretation of these results is limited by ICD and CPT codes that don't fully describe the presentation and surgeries performed for endometriosis.