Gynecologic Pathology Research Articles

(O-32) PRIMARY DEPTH DYSPAREUNIA IS CAUSED BY THE INCOMPATIBILITY OF THE SIZE OF THE PENIS WITH THE VAGINA

Abstract Introduction/Objective Dyspareunia, to this day, is not yet fully understood. It is known that the size of the distended vagina is variable, as well as the size of the penis. A vagina distended by a larger penis, suffers trauma and pain. The work aims to measure the flexibility of the human vagina, to guide professionals, who treat women with this complaint. Methods Women who signed the informed consent form and underwent vaginal surgeries under anesthesia had their vagina measured in the specular examination according to the POP-Q (total length of the vagina, measurement from the hymen to the deepest portion of the vagina) and also the same measurement with maximum distension of the vagina verified by the resistance to the introduction of a centimetric device. The difference in the measurements obtained determined the flexibility of the vagina in centimeters. Results A total of 120 vaginas were measured. The smallest vagina, measured without distention, was 5 centimeters and with distension of 10 centimeters. The largest, without distension, was 13.5 centimeters and with distension of 16 centimeters. Women with genital prolapse showed greater flexibility, ranging from 0.5 cm to 8 cm. Conclusions 1-The largest measured distention of a vagina was 16 centimeters, which implies that penises larger than 16 centimeters, if penetrated completely, will cause some degree of vaginal trauma. 2-The smallest distended vagina measured 10 centimeters, so any penis that penetrates 10 centimeters into the female vagina will not cause trauma. 3-Women with complaints of pelvic pain associated with depth dyspareunia should be advised about trauma to the vaginal fundus or presence of gynecological pathology, as well as Relative Short Vagina Syndrome. 4-Professionals who serve women and couples need to understand this new concept of depth dyspareunia. However, further well-controlled studies should be conducted to consolidate this new knowledge. Financing No conflict.

Evaluation of Pathology Results of Patients with a History of Breast Cancer who were Operated on for Gynecological Pathologies or Prophylaxis

Objectives: The present study aimed to evaluate the operation results of patients who were followed up due to breast cancer and were operated on due to gynecological pathologies or for prophylactic purposes, and determine the distribution of gynecological pathologies in breast cancer patients Study design: Patients with breast cancer who had gynecological surgery in our institution between December 2015 and January 2023 were retrospectively analyzed in this cross-sectional study. The pathological reports and medical records of the included patients were obtained from the gynecologic oncology electronic database system and the patient files. The study is approved by the institution’s local ethics committee. Results: Totally 57 patients with a history of breast cancer had gynecological operations between December 2015 and January 2023. The median age of the patients was 49. Benign pathologies were detected in the majority of patients with a history of breast cancer, this rate was found to be 87.7%. The pathology revealed malignant/premalignant disease in seven (12.2%) patients. Among these seven patients, four patients had malignant disease one patient had microinvasive cervical cancer, one patient had ovarian serous cancer, one patient had cervical and ovarian metastasis of breast cancer, and one patient had ovarian metastasis of breast cancer. Conclusions: Patients with a history of breast cancer have increased rates of gynecological pathology development compared to the normal population.

Abstract 6166: A whole-organ ex vivo optical imaging technique for non-destructive, more precise identification of serous tubal intraepithelial carcinoma (STIC) in fallopian tubes

Abstract Objective With the recent discovery of the fallopian tube (FT) origin of the most common and lethal type of ovarian cancer, high grade serous cancer (HGSC), engineering solutions to overcome the limitations of standard histopathology to more reliably identify incipient HGSCs and their serous tubal intraepithelial carcinoma (STIC) precursors are much needed. This investigation tests the potential of whole-organ ex vivo optical imaging of freshly excised FTs to label and sample abnormal tubal epithelium prior to formalin fixation and paraffin embedding for standard histopathology. Methods This investigation prototyped “OVASEEK”, a whole-organ, near-infrared optical imaging platform for identification of STICs. This prospective biospecimen protocol with annotated clinical data was approved by the IRB. Following salpingectomy at the time of hysterectomy for benign indications, FTs from study participants are longitudinally bivalved. Half of the FT is retained for routine evaluation using the Sectioning and Extensively Examining the Fimbriated end (SEE-FIM) protocol by Johns Hopkins gynecologic pathologists (Gyn Path), while the other half is sent overnight in organ transplant media to MIT for imaging on OVASEEK. Hyperspectral “label free” first pass imaging is performed using a series of band-pass filters. Second pass fluorescence imaging is then performed using nanoparticles tagged with anti-LAMC1 antibodies targeting laminin γ1, a known STIC surface marker. Abnormal signal(s) on OVASEEK imaging of the FT epithelium are tattooed with black ink, the tissue is formalin fixed and returned to Gyn Path for serial sectioning. Research findings are reported in an addendum to the formal pathology report in the electronic medical record and discussed with the patient by the gynecologic oncologist co-investigator. Results OVASEEK enabled non-destructive imaging over a wide field-of-view ~ 12×12 cm, with features of interest in the 1,050-1,550 nm range. In this pilot study, OVASEEK identified histopathologic abnormalities missed by standard SEE-FIM in 20% of FTs (n=2 out of 10). In each case, OVASEEK found microscopic (~200 µm) foci of salpingitis, a lymphoplasmacytic infiltrate consistent with inflammation. Performance of serial sectioning and histopathologic examination of the tattooed epithelium yielded this diagnosis. Conclusion Work is ongoing to improve the resolution, speed and sensitivity of OVASEEK for STIC detection. Identification of µm-sized foci of inflammation using OVASEEK is proof-of-principle that whole-organ ex vivo imaging of freshly excised FTs may be an innovation that improves the diagnostic performance of routine histopathology. Accurate and reproducible diagnosis of STIC and concurrent microscopic HGSC is imperative to the understanding of the early pathogenesis of HGSC in clinically actionable ways. Citation Format: Neelkanth M. Bardhan, Vivek Rastogi, Rebecca L. Stone, Angela M. Belcher. A whole-organ ex vivo optical imaging technique for non-destructive, more precise identification of serous tubal intraepithelial carcinoma (STIC) in fallopian tubes [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6166.

Intraepithelial tumor-infiltrating lymphocytes shape loco-regional PET/CT spread of locally advanced cervical cancer

BackgroundData suggest an association between positron emission tomography/CT (PET/CT) metabolic metrics and tumor microenvironment in several malignancies, and a potential role of PET/CT to monitor response to immunotherapy.ObjectiveTo evaluate the...

Impact of pharmacogenomic profiles on post-surgical pain following laparotomy for gynecologic pathology

ObjectivesThe aim of this prospective study was to compare perioperative opioid use in women by status of CYP2D6, a highly polymorphic pharmacogene relevant to opioid metabolism. MethodsPatients undergoing laparotomy were prospectively recruited and provided a preoperative saliva swab for a pharmacogenomic (PGx) gene panel. Postoperative opioid usage and pain scores were evaluated via chart review and a phone survey. Pharmacogenes known to be relevant to opioid metabolism were genotyped, and opioid metabolizing activity predicted by CYP2D6 genotyping. Patient and procedural factors were compared using Fisher's exact and Kruskal-Wallis tests. ResultsThe 96 enrolled patients were classified as ultra-rapid (N = 3, 3%), normal (58, 60%), intermediate (27, 28%), and poor (8, 8%) opioid metabolizers. There was no difference in surgical complexity across CYP2D6 categories (p = 0.61). Morphine Milligram Equivalents (MME) consumed during the first 24 h after peri-operative suite exit were significantly different between groups: ultrarapid metabolizers had the highest median MME (75, IQR 45–88) compared to the other three groups (normal metabolizers 23 [8–45], intermediate metabolizers 48 [20–63], poor metabolizers 31 [12–53], p = 0.03). Opioid requirements were clinically greater in ultrarapid metabolizers during the second 24 h and last 24 h but were statistically similar (p = 0.07). There was no difference in MME prescribed at discharge (p = 0.22) or patient satisfaction with pain control (p = 0.64) between groups. ConclusionsA positive association existed between increased CYP2D6 activity and in-hospital opioid requirements, especially in the first 24 h after surgery. This provides important information to further individualize opioid prescriptions for patients undergoing laparotomy for gynecologic pathology.

Role of gut microbiota derived short chain fatty acid metabolites in modulating female reproductive health

Short chain fatty acids (SCFA) have been linked to women's reproductive health, though to a lesser extent, alteration in the production of SCFA and SCFA-producing bacteria has been associated significantly with pregnancy-related complications, unfavourable pregnancy outcomes, menstrual anomalies, and gynaecological cancer.The female reproductive system is a delicate, intricate, hormone-dependent group of tissues required for the continuity of life and the species' survival. Reproductive health impacts the ovarian function to implantation and foetal development. Several environmental and physiological factors contribute to mammalian infertility concerns caused by a change in reproductive health status. Several lifestyle factors have been demonstrated to affect reproductive health, including age, body weight, smoking, alcohol consumption, work stress, exercise, diet, and nutrition. Nutrition influences puberty, the menstrual cycle, ovulation, conception, implantation and early foetal development. This review provides an overview of how intestinal derived SCFAs maintains female reproductive health summarizing the current knowledge and future perspectives. Microbial SCFAs improve human metabolism by interfering with, glucose homeostasis, appetite regulation and lipid metabolism. Also affect host immunity and intestinal barrier integrity via primary by inhibition of Histone deacetylases (HDAC) mechanism. Therefore, SCFAs exhibit anti-inflammatory, anti-obesity, immunoregulatory, anti-diabetes, anti-cancer, hepatoprotective, cardiovascular protective and neuroprotective properties.This review highlights recent findings on SCFA and gynaecological pathologies such as preeclampsia, gestational diabetes, pregnancy complications, polycystic ovary syndrome, bacterial vaginosis, and endometriosis to describe current knowledge of the relationship between SCFA and reproductive health and disease in women.

Robot Assisted Laparoscopic Surgery in Gynaecology: An Evolving Assistive Technology.

Laparoscopic surgery is extensively utilized to treat a range of gynaecological conditions and pathologies. The advantages of laparoscopic surgery include the minimalization of blood loss and scarring, improved recovery times, and shorter hospital admissions. However, robotic technologies have had an increasing presence within gynaecological laparoscopic surgery in recent decades. This literature review therefore aims to discuss laparoscopy from 3 perspectives. First, the evolution of laparoscopy is reviewed with a focus on its origins, its transition from a diagnostic to an operative tool, and its role in present-day gynaecology. Second, interventions for benign gynaecological conditions (including excision of benign ovarian tumours, total laparoscopic hysterectomy, and laparoscopic myomectomy) are reviewed. The laparoscopic management of malignant gynaecology (including ovarian cancer, endometrial cancer, and cervical cancer) is also discussed. Finally, whilst robot-assisted laparoscopic surgery is experiencing rapid technological advancement, it is pertinent to consider the extent of its benefits when compared to open or conventional laparoscopic approaches in gynaecological surgery.

Abstract B099: A common WNT4 polymorphism drives gynecologic cancer phenotypes and health disparities

Abstract Introduction: Beyond BRCA1/2 mutations, there is a limited understanding of gynecologic cancer etiology and risk. An underexplored risk factor is Wnt ligand WNT4, central to ovarian and uterine organogenesis. A single nucleotide polymorphism (SNP) at a key WNT4 regulatory site (rs3820282) is associated with 10-25% increased risk for gynecologic pathologies, including ovarian cancer (OvCa), but the mechanism is unknown. Importantly, rs3820282 variant allele frequency (VAF) is ~0% in African populations, ~15% in Caucasians, 20-40% in Latinx populations, and 45-55% in Asian populations, paralleling increased incidence of aggressive OvCa subtypes in Asian populations. We hypothesize the rs3820282 variant drives OvCa health disparities by aberrant activation of WNT4, mediating distinct cancer etiology, therapy resistance, and poor patient outcomes. Methods: To address our hypothesis, we employed global untargeted metabolomics, SNP genotyping, WNT4 overexpression, WNT4 siRNA-mediated knockdown, cell viability assays, and Reverse Phase Protein Array (RPPA). We assessed both OvCa cell lines, murine syngeneic tumor models (ID8 Tp53-/- and ID8 Tp53-/-, Brca2-/-), formalin-fixed pre- and post-chemotherapy primary human tumors (18 pairs), and snap frozen primary gynecologic tumors (n=103). Statistical tests performed in Prism GraphPad and include multi-comparison ANOVA, paired t-test, and unpaired t-test. Results: WNT4-overexpression in the ID8 model drove cisplatin resistance in vitro, and resistance and metastatic outgrowth in vivo (n=5 mice/model; post-treatment metastatic nodule mass: control = 5±8mg; WNT4 = 42±18mg; p=0.0078). In paired OvCa tumors pre-/post-treatment with chemotherapy (n=18 pairs), we found WNT4 in the top 10 most-strongly induced genes post-chemotherapy (>4-fold, p =0.0005). In OvCa cell lines, WNT4 siRNA only suppressed growth in WNT4 variant lines (60% reduced growth in n=4 variants, vs n=4 wild-type p=0.010). WNT4 siRNA dysregulated mitochondrial function only in WNT4 variant lines, linking the rs3820282 variant to WNT4-driven metabolic remodeling. RPPA analysis of gynecologic tumors (52% het.+variant); note this is one of the largest proteomic studies enriched for patient diversity (47% from non-White). We identified differential metabolic signaling; AMPK activation was increased in variant tumors (AMPKα1-pT172 + AMPKα2-pS345; p=0.031) along with AMPK signaling targets. Conversely, glucose metabolism proteins were increased in wild-type tumors, and inversely correlated with AMPK activation (Spearman ρ=-0.34, p=0.0005), suggesting that WNT4 genotype underpins AMPK activation and metabolic remodeling. Conclusions: The rs3820282 variant permits aberrant activation of WNT4, driving AMPK-mediated metabolic remodeling and therapy resistance. As the rs3820282 VAF differs widely across populations, WNT4 polymorphism may drive disparities in gynecologic cancer risk and outcomes. Understanding WNT4 signaling and regulation via the rs3820282 variant can lead to precision treatments exploiting cellular dependencies on WNT4 signaling. Citation Format: Benjamin G. Bitler, Madeleine T. Shackleford, Lindsey Trevino, Linda S. Cook, Matthew J. Sikora. A common WNT4 polymorphism drives gynecologic cancer phenotypes and health disparities [abstract]. In: Proceedings of the AACR Special Conference on Ovarian Cancer; 2023 Oct 5-7; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_2):Abstract nr B099.

The effectiveness of treatment of chronic generalized periodontitis with the use of substitution therapy in women with hormonal status disorders

Relevance. In clinical observations, a combination of somatic pathology with various forms of periodontal tissue diseases has long been established. Hormonal status is of particular interest in this direction, since hormonal failure causes disturbances in the hormonal background of a person.Goal. The aim is to increase the effectiveness of treatment of women with chronic generalized periodontitis on the background of hormonal imbalance by correcting the receptor status of the gingival epithelium.Materials and methods of research. The research methodology provided for the integration of clinical, laboratory, histological and immunohistochemical methods. To realize the purpose of the study, a systematic approach was used, which was based on the analysis of the content of interrelated sources of primary information. The object of the study were women aged 18 to 59 years, who were assessed for periodontal status against the background of gynecological pathology and hormonal imbalance with the use of substitution therapy.Conclusions. The inclusion in the complex treatment of periodontal tissue diseases of drugs with receptor-modulating and anti-inflammatory effect normalizes the work of the receptor apparatus of the gingival epithelium, which increases the effectiveness of the treatment of periodontal pathology.

Sex Cord-Stromal Tumors of the Ovary: An Update and Review. Part II - Pure Sex Cord and Sex Cord-Stromal Tumors.

We review the time honored but still frequently challenging features of ovarian sex cord-stromal tumors and also emphasize new developments, including unusual morphologic appearances that, despite the relative rarity of many of the tumors, result in a disproportionate number of differential diagnostic problems, variant immunohistochemical profiles, and specific molecular and syndromic associations. These neoplasms are also of historical interest as current knowledge is still based in significant part to the contributions of 2 giants of gynecologic pathology, Dr Robert Meyer and Dr. Robert E. Scully. In part I, we reviewed the pure ovarian stromal tumors. Now, in part II, we present the major clinical, pathologic, and genomic features of pure sex cord and sex cord-stromal tumors.

Sex Cord-Stromal Tumors of the Ovary: An Update and Review. Part I - Pure Ovarian Stromal Tumors.

In two separate reviews, we review the time-honored but still frequently challenging features of ovarian sex cord-stromal tumors, and also emphasize new developments including unusual morphologic appearances that, despite the relative rarity of many of the tumors, result in a disproportionate number of differential diagnostic problems, variant immunohistochemical profiles, and specific molecular and syndromic associations. These neoplasms are also of historical interest as current knowledge is still based in significant part on the contributions of 2 giants of gynecologic pathology, Dr Robert Meyer and Dr Robert E. Scully. In part I, we present the major clinical, pathologic, and genomic features of the pure ovarian stromal tumors including comments on differential diagnosis and briefly note significant historical contributions. In part II we will discuss pure sex cord and sex cord-stromal tumors.

The effect of androgens on the risk of endometriosis sub-phenotypes and ovarian neoplasms: A Mendelian randomization study

Endometriosis is a complex gynecological pathology with a broad spectrum of symptoms, affecting around 10% of reproductive-aged women. Ovarian cancer (OC) is a heterogeneous disease for which we lack effective diagnostic and therapeutic strategies. The etiology and pathogenesis of both diseases remain ambiguous. Androgens in endometriosis could have a distinct role beyond serving as estrogen sources, whereas in the case of serous OC could be important in the formation of precursor lesions which ultimately lead to tumor formation. Here we performed two-sample Mendelian randomization (MR) analysis to examine the causal relationship between the androgen precursor - dehydroepiandrosterone sulphate (DHEAS), bioactive androgen - testosterone (T), androgen metabolite - androsterone sulphate, steroid hormone binding globulin (SHBG) and albumin and the risk of endometrioses of various sub-phenotypes and ovarian neoplasms across the benign-borderline-malignant spectrum. Stringent quality control procedures were followed to select eligible instrumental variables that were strongly associated with the selected exposures, sensitivity analyses were performed to assess the heterogeneities, horizontal pleiotropy, and stabilities of SNPs in endometriosis and ovarian neoplasms. We discovered an inverse association between genetically predicted levels of all androgens and risk of endometriosis, the same trend was most evident in the ovarian sub-phenotype. Total T levels were also inversely associated with peritoneal sub-phenotype of endometriosis. Likewise, T was causally associated with decreased risk of clear-cell OC, an endometriosis-associated OC subtype, and with malignant serous OC of both low- and high-grade, but with higher risk of their counterpart of low malignant potential. These findings support further investigation of androgen’s action at a molecular level in ovary-associated endometriotic lesions, clear cell ovarian tumors and serous precursor lesions.

Gynecological Cancers and Microbiota Dynamics: Insights into Pathogenesis and Therapy.

In recent years, the relationship between the microbiota and various aspects of health has become a focal point of scientific investigation. Although the most studied microbiota concern the gastrointestinal tract, recently, the interest has also been extended to other body districts. Female genital tract dysbiosis and its possible impact on pathologies such as endometriosis, polycystic ovary syndrome (PCOS), pelvic inflammatory disease (PID), and gynecological cancers have been unveiled. The incursion of pathogenic microbes alters the ecological equilibrium of the vagina, triggering inflammation and compromising immune defense, potentially fostering an environment conducive to cancer development. The most common types of gynecological cancer include cervical, endometrial, and ovarian cancer, which occur in women of any age but especially in postmenopausal women. Several studies highlighted that a low presence of lactobacilli at the vaginal level, and consequently, in related areas (such as the endometrium and ovary), correlates with a higher risk of gynecological pathology and likely contributes to increased incidence and worse prognosis of gynecological cancers. The complex interplay between microbial communities and the development, progression, and treatment of gynecologic malignancies is a burgeoning field not yet fully understood. The intricate crosstalk between the gut microbiota and systemic inflammation introduces a new dimension to our understanding of gynecologic cancers. The objective of this review is to focus attention on the association between vaginal microbiota and gynecological malignancies and provide detailed knowledge for future diagnostic and therapeutic strategies.

Morphologic and Molecular Heterogeneity of High-grade Serous Carcinoma Precursor Lesions.

Serous tubal intraepithelial carcinoma (STIC) is the fallopian tube precursor lesion for most cases of pelvic high-grade serous carcinoma (HGSC). To date, the morphologic, molecular, and clinical heterogeneity of STIC and a less atypical putative precursor lesion, termed serous tubal intraepithelial lesion, has not been well characterized. Better understanding of precursor heterogeneity could impact the clinical management of women with incidental STICs (without concurrent carcinoma) identified in cases of prophylactic or opportunistic salpingectomy. This study analyzed morphologic and molecular features of 171 STICs and 21 serous tubal intraepithelial lesions. We assessed their histologic features, Ki-67 and p53 staining patterns, and genome-wide DNA copy number alterations. We classified all precursor lesions into 2 morphologic subtypes, one with a flat surface (Flat) and the other characterized by budding, loosely adherent, or detached (BLAD) morphology. On the basis of pathology review by a panel of 8 gynecologic pathologists, we found 87 BLAD, 96 Flat, and 9 indeterminate lesions. As compared with Flat lesions, BLAD lesions were more frequently diagnostic of STIC ( P <0.0001) and were found concurrently with HGSC ( P <0.0001). BLAD morphology was also characterized by higher Ki-67 proliferation index ( P <0.0001), presence of epithelial stratification ( P <0.0001), and increased lymphocyte density ( P <0.0001). BLAD lesions also exhibited more frequent DNA copy number gain/amplification at the CCNE1 or CMYC loci canonical to HGSCs ( P <0.0001). Both BLAD morphology and STIC diagnoses are independent risk factors for an elevated Ki-67 proliferation index. No correlation was observed between BLAD and Flat lesions with respect to patient age, presence of germline BRCA1/2 mutation, or p53 staining pattern. These findings suggest that tubal precursor lesions are morphologically and molecularly heterogeneous, laying the foundation for further studies on the pathogenesis of HGSC initiation and identifying histologic features predictive of poor patient outcomes.

Interdisciplinary surgical spectrum in cooperation of abdominal surgery and gynecology : What must the (general/abdominal) surgeon know?

This short overview aims to concisely outline the most important gynecological issues from a predominantly operative point of view, which could also be relevant for general and abdominal surgeons as well as important gynecological aspects of primarily visceral surgical pathologies. Narrative review on the topic of interdisciplinary cooperation in gynecological/general and abdominal surgery through the use of PubMed® as well as the Cochrane Library with search terms, such as "operative profile of abdominal surgery and gynecology", "interdisciplinary surgery aspects of gynecology/abdominal surgery" as well as "interdisciplinary surgical approach-surgical complication". As the close anatomical relationship suggests, numerous primarily gynecological pathologies can also occur in abdominal organs. Likewise, predominantly surgical pathologies can result in involvement of gynecological organs. This can make an intraoperative collaboration necessary. In addition, as a result of diagnostic uncertainty or within the context of complications, interdisciplinary collaboration can also be required preoperatively and postoperatively. Multidisciplinary knowledge as well as close cooperation of the involved specialties can improve the outcome of affected patients. Many pathologies extend not only to the boundaries of an individual discipline but can also affect physiological systems exceeding those limits. Therefore, for an optimal treatment it is necessary to be aware of such aspects of the diseases and to establish structured procedures for interdisciplinary cooperation.

Easy of calving cows for dairy pro- ductivity

Data are presented on the dependence of the ease of calving on the duration of the dry period, gender, the number of gestated fetuses and its influence on the frequency of occurrence of specific pathologies of childbirth and the postpartum period and the frequency of insemination in dairy cows of productivity in the conditions of Sibirskaya Niva LLC, Novosibirsk region. More often, childbirth proceeded normally (easy), without outside intervention - 91.36 %, mild and moderate pathology was observed in 3.35 and 4.41 % of cows, and in rare cases, calving was accompanied by severe pathology - 0.87 %. The severity of the birth process increased with a decrease in the duration of the dry period. Thus, in animals with easy labour, the dry period was 54.73 ± 0.27 days; in animals with severe pathology, it was three days less - 51.74 ± 1.33 days. In cows with mild labour, the birth of one calf was more often observed; the number of twins did not exceed 8.95 %. The severity of labour was accompanied by an increase in the number of twins; in the group of animals with arduous labour, it reached 84.21 %. With a problematic labour process, the frequency of stillbirths in groups increases by 4.41 %. Animals with difficult births have an increased risk of obstetric and gynaecological pathology. Thus, in cows with a severe course of the birth process, in 26.32 % of cases, pathology of the third stage of labour was observed, accompanied by retention of the placenta. In the postpartum period, postpartum paresis was often recorded - 42.11 % and various types of metritis - 21.05 %. In contrast, with a mild course of labour, all the pathologies we studied were recorded in aggregate only in 29.35 % of cows. In animals with arduous labour, 1.05 more doses of semen were spent on fertile insemination than in animals with normal labour.

Comportamiento de la urgencia ginecológica durante la pandemia de COVID-19

Introduction: The COVID-19 pandemic has meant a decrease in gynecological visits to the emergency department. Objective: To characterize the attending in the gynecological emergency service, evaluating the amount of admissions, hospitalizations, need for surgical intervention, morbidity factors, among others, compared to the pre-pandemic situation. Method: A non-concurrent cohort study of hospitalized patients was carried out through a spontaneous attending to the gynecological emergency service between weeks 12 and 28 of 2019 and 2020 at the Hospital Clinico of the Pontificia Universidad Catolica, in Santiago (Chile). Different morbidity factors were measured: admission diagnosis, surgical intervention, surgical complication, hospital stay, admission hemoglobin, and need for transfusion of blood units. Results: A total of 511 visitors to the emergency service were registered between weeks 12 and 28 of 2019, compared to 196 in 2020. In 2019 and 2020, 103 and 72 women were hospitalized respectively (odds ratio [OR]: 2.3). Admission for pregnancy loss decreased (24 vs. 12;p = 0.01), while admission for postmenopausal bleeding increased (9 vs. 22;p = 0.01). There was no change in the surgical interventions performed (86.4% vs. 84.7%;p = 0.7). The hospital stays increased (2.3 vs. 3.1;p < 0.0001) and the need for blood transfusion (2 vs. 7;p = 0.02;OR: 5.4;confidence interval: 1.09-26). Conclusions: The COVID-19 pandemic caused a decrease in spontaneous attending for gynecological pathology at the emergency service, causing an increase in the attend/admission ratio and greater morbidity in hospitalized patients characterized by a greater need for blood transfusion and an increase on the hospital stay. © 2021 Sociedad Chilena de Obstetricia y Ginecologia.

Robotic-assisted surgery for gynecological indications in children and adolescents: European multicenter report

Robotic-assisted surgery (RAS) is increasingly adopted in the pediatric population. This retrospective multicenter study aimed to report application of RAS for gynecological indications in pediatric patients. The medical records of all girls with gynecological pathology, operated in 4 different institutions over a 3-year period, were retrospectively collected. Robot docking time, total operative time, length of stay (LOS), requirement time of pain medication, complication rate, conversion rate, and pathology were analyzed. Twenty-three girls, with median age of 12.3 years (range 0.6–17.8) and median weight of 47.2 kg (range 9–73), received the following RAS procedures: ovarian cystectomy for ovarian cyst/mass (n = 10), salpingo-oophorectomy for ovarian complex mass (n = 6), bilateral gonadectomy for Turner syndrome SRY + (n = 1), salpingectomy for fallopian tube lesion (n = 1), paratubal cyst excision (n = 1), Gartner cyst excision (n = 1), paravaginal ganglioneuroma resection (n = 1), fistula closure in urogenital sinus (n = 1), and vaginoplasty using ileal flap in cloaca malformation (n = 1). Median operative time was 144.9 min (range 64–360), and median docking time was 17.3 min (range 7–50). Conversion to open or laparoscopy was not necessary in any case. Median LOS was 2.1 days (range 1–7), and median analgesic requirement was 2.2 days (range 1–6). One patient (4.3%) needed redo-surgery for recurrent Gartner cyst (Clavien 3b). This preliminary experience showed that RAS is safe and feasible for surgical treatment of gynecological pathology in pediatric patients, although no conclusive data are available to confirm its superiority over traditional laparoscopy. Randomized, prospective, comparative studies are needed to identify the gold standard approach for such indication.

Monitoring Contractility of Junctional Zone Endometrium across Menstrual Cycle Using the ElectroUteroGraph (EUG): A Clinical Evaluation

(1) Background: Abnormal uterine contractility for nonpregnant women has been associated with gynecological pathologies and infertility. The objective of this study was to evaluate the ability of a novel monitoring technique to assess the contractility of the nongravid uterus using a simple, standardized, direct, in vivo methodology during the different phases of the menstrual cycle. (2) Methods: Twenty-six healthy women of reproductive age (28–48 years) were recruited. An ElectroUteroGraph (EUG) was used to measure the electrical activity from the contractility of the junctional zone endometrium (JZE) across the menstrual cycle. Derived recordings were separated into the early proliferative (EP) (n = 10), late proliferative (LP) (n = 31), early luteal (EL) (n = 27), and late luteal (LL) (n = 12) phases of the menstrual cycle. EUG recordings were performed by inserting a flexible electrode array into the endometrial cavity. (3) Results: Waveforms that were measured from the electrode closer to the fundus (1 cm distance) were processed. The Root-Mean-Square (RMS) Voltage Amplitude (VJZE-RMS) (in μV) and the Mean Frequency (fJZE-mean) (in cycles/min) of the JZE’s electrical activity, as direct indicators of the intensity and frequency changes in the JZE’s contractions, were extracted from the recorded waveforms. There was a trend in the median values of the VJZE-RMS decreasing from the EP to the LP phase (247–158 μV). During the EL phase, an upward trend was observed (158–374 μV, p &lt; 0.05), reaching its highest value during the LL phase (374–477 μV, p &lt; 0.05) when compared to the LP phase. The fJZE-mean showed the opposite trend, increasing from 2.5 cycles/min during the EP phase to 2.96 cycles/min during the LP phase. During the EL phase, a downward trend was observed (2.96–2.37 cycles/min), continuing to fall to 1.33 cycles/min, in the LL phase, with p &lt; 0.05 when compared to the previous three phases. (4) Conclusions: The novel in vivo monitoring technique has shown clinically, for the first time, significant electrical activity differences in the different sub-phases of the menstrual cycle, recorded in a safe and painless way.

Rate of Vaginal Cuff Dehiscence When Using Vicryl (Poliglactyn 910) Compared to PDS (Polydioxanone) for Vaginal Cuff Closure in Laparoscopic Hysterectomy.

Objective: To compare the vaginal cuff dehiscence (VCD) rates using Vicryl (Poliglactyn 910) and Polydioxanone (PDS) in patients who underwent laparoscopic hysterectomy. Materials and methods: A retrospective, monocentric study was conducted, including all patients undergoing laparoscopic hysterectomy at the Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, Catania, between January 2014 and December 2021. Patients underwent hysterectomy for benign gynecologic pathologies (endometriosis, leiomyomas, or benign pelvic pathologies) or malignant gynecologic pathologies (endometrium cancer, complex endometrial hyperplasia, ovarian cancer, cervix cancer, or uterine carcinosarcoma). The Z-score calculation was performed to find eventual statistically significant differences between the two populations regarding VCD rates. Results: Laparoscopic vaginal cuff closure was performed, with Vicryl sutures in 202 patients and PDS sutures in 184 women. Demographic and baseline characteristics were not significantly different in the two groups. VCD occurred in three patients in the Vicryl group and did not occur in the PDS group. The three cases of VCD were precipitated by intercourses that occurred within 90 days of surgery. However, there was not a significant statistical difference between the two groups regarding VCD (p = 0.09). Conclusions: Vicryl and PDS sutures seem to be similar for vaginal cuff closure in laparoscopic hysterectomy. The VCD rate was low, and the observed differences between the Vicryl and PDS groups did not reach statistical significance. Further research through prospective studies is essential.