History Of Myomectomy Research Articles

Association of Placental Umbilical Cord Insertion Site with Maternal and Fetal Outcomes: A Prospective Study

Abstract Introduction Adequate fetal growth during pregnancy depends upon the normal development and insertion of the umbilical cord. Central/paracentral placental cord insertion is considered normal, while marginal/velamentous cord insertion is considered abnormal. Although the location of placental umbilical cord insertion can be determined by ultrasound (US), it is not included in the routine protocol of a targeted anomaly scan. Through this study, we determined different placental umbilical cord insertion sites by US and categorized them as normal and abnormal, identified the risk factors involved, and evaluated the outcome of pregnancies using standard protocols. The rationale of this study was to identify pregnancies that require frequent monitoring and surveillance for an optimal perinatal outcome. Methods A prospective cohort study was conducted in a tertiary care hospital for 18 months. A total of 345 pregnant women who attended the antenatal outpatient department between 18 and 22 weeks for targeted imaging for fetal anomalies scan were included in the study after informed consent. Detailed history followed by US documentation of the cord insertion site on the placenta was done and women were followed up throughout pregnancy to look for development of complications including hypertensive disorders, antepartum hemorrhage (APH), and fetal growth restriction (FGR). Intrapartum adverse events like fetal distress and intrapartum hemorrhage were assessed. Confirmation of US findings was done by macroscopic examination of the placenta and measuring the distance between the placental cord insertion and the edge of the placenta. The weight of the placenta was also documented. Newborns were evaluated for adverse outcomes like preterm birth, low birth weight, need for resuscitation, and neonatal intensive care unit (NICU) admission. Follow up of neonates and mothers was done till discharge. Results Placental cord insertion was accurately determined at the anomaly scan with 100% sensitivity and specificity. The study showed 44 abnormal placental cord insertions (ACIs)—42 had marginal and 2 had velamentous cord insertions. There was a high incidence of ACI noted in women aged more than 28 years, with body mass index of more than 26.38, multiparity, previous history of myomectomy, first trimester miscarriage, and conceived by assisted reproductive technology. Women with ACI had an increased risk of small for gestational age/FGR and APH and had an average baby weight of 2.7 kg, which was 200 g less than babies with normal cord insertion. They also had lower mean Apgar scores at 5 minutes and required resuscitation and NICU admission. Conclusion Our study concluded that it will be a good practice to document the placental cord insertion during the mid trimester anomaly scan so that we can identify the subset of pregnant women who are prone to develop complications, thereby providing adequate surveillance for an optimal perinatal outcome.

Strangulated Transmural Hernia of the Uterus After Myomectomy: A Rare Cause of Bowel Obstruction

Consultation for mechanical bowel obstruction is one of the most common reasons in emergency and surgical departments. Transmural hernia of the strangulated uterus after myomectomy is a rare etiology of intestinal obstruction. Their diagnosis is increasingly complex and is discovered during an exploratory laparotomy. In this observation, we report the case of this 34-year-old patient with a history of myomectomy, nulliparous admitted for persistent abdominal pain and vomiting. an abdominopelvic ultrasound showed images of uterine myomas in necrobiosis. the patient presented an occlusive syndrome for which an abdominopelvic MRI which confirmed the diagnosis of aseptic necrobiosis. This unusual image mimicking that of a necrobiosis of uterine myoma was the difficulty which allowed this diagnostic error and the delay in the treatment of this patient. As this philosophy emphasizes (never let the sun rise or set in case of mechanical obstruction of the small intestine). Given the persistence of clinical signs, an abdominal CT scan was requested and confirmed the diagnosis of occlusive syndrome. conclusion: Faced with the diagnosis of an acute intestinal obstruction following a myomectomy by a combination of persistent abdominal pain, vomiting, cessation of materials and gas, systematically look for an obstruction of internal hernia by incarceration in a myomectomy cubicle. Exploratory laparotomy makes it possible to find the etiology and treat it.

Risk of Placenta Accreta Spectrum Following Myomectomy: A Nationwide Cohort Study

ABSTRACT Placenta accreta spectrum (PAS) is described as a partial or total lack of decidua with adherence or invasion of the placenta to the myometrium and is a major cause of postpartum hemorrhage and peripartum hysterectomy. The risk of PAS is approximately 1 in 272 in the United States. Prior uterine surgeries including myomectomy disrupt the integrity of the endometrium and myometrium and may increase the risk of PAS. However, the association between myomectomy and PAS remains controversial. This retrospective nationwide cohort study aimed to investigate the effect of myomectomy, stratified by method of myomectomy, on the risk of PAS. Data were obtained from the Taiwan National Health Insurance Research Database, which includes prenatal, perinatal, demographic, and treatment data on nearly all pregnant patients in Taiwan. All pregnant people who gave birth after 20 weeks of gestation between January 2008 and December 2017 were included. Patients with incomplete data, previous history of PAS before myomectomy, robotic-assisted myomectomy, or a diagnosis of adenomyosis were excluded. Patients were classified into 3 groups according to method of myomectomy: laparotomic, laparoscopic, and hysteroscopic. A 1:1 propensity-score estimation matching with logistic regression was used for patients with and without history of myomectomy to minimize selection bias. The primary outcome was placenta accreta, whereas secondary outcomes included placenta previa, postpartum hemorrhage, placenta abruption, uterine rupture, and preterm delivery. Logistic regression models were used to analyze the association between myomectomy and adverse pregnancy outcomes and the risk of placenta accreta for the entire population. Analysis of variance and post hoc tests were used to analyze differences in clinical characteristics and adverse pregnancy outcomes according to different methods of myomectomy. A total of 1,393,628 patients were included in this study. Among them, 11,255 patients had a history of myomectomy. Placenta accreta spectrum occurred in 0.96% of those with a history of myomectomy and 0.20% of those without. The risk of PAS was significantly higher in patients with a history of myomectomy, compared with those without (adjusted odds ratio, 2.28; confidence interval [CI], 1.85–2.81; P < 0.01). There was an elevated risk of other adverse pregnancy outcomes including placenta previa, postpartum hemorrhage, cesarean hysterectomy, uterine rupture, preterm delivery, and placenta abruption among those with a history of myomectomy compared with those without. The presence of placenta previa significantly increased risk of PAS, as did the number of prior myomectomies. The propensity score–matched cohort analysis found a similar increase in PAS risk associated with myomectomy. Compared with subjects without a history of myomectomy, the risk of PAS was greater after hysteroscopic (adjusted odds ratio, 3.88; 95% CI, 2.68–5.63), laparoscopic (2.02; 95% CI, 2.79–5.62), and laparotomic myomectomy (1.86; 95% CI, 1.33–2.60). The results of this study find that a history of myomectomy is significantly associated with increased risk of PAS in subsequent pregnancies. Hysteroscopic myomectomy was associated with the highest risk of PAS, and the presence of placenta previa or history of multiple myomectomies further increased the risk.

The Incidence and Risk Factors for the Presence of Type 1B or Type 3 Utero-ovarian Anastomoses During Uterine Artery Embolization

Background/Aims: Demonstration of possible utero-ovarian anastomoses (UOA) before or during uterine artery embolization (UAE) is important to preserve ovarian reserve. This study aimed to evaluate the incidence and risk factors for the presence of type 1b or type 3 UOA in patients undergoing UAE for the treatment of uterine myomas. Methods: Procedural angiographies of patients who underwent UAE were evaluated in a single academic center. Patients’ demographics, indication for UAE, presence and type of UOA, presence of adnexal pathology at preprocedural MRI, history of pelvic surgery, and total uterine volume at preprocedural MRI were retrospectively evaluated. Analysis of the aforementioned variables between patients with and without UOA was performed. Results: This study included 30 patients with a mean age of 41.97±5.72 years (range 32 - 56). UOA was found in 17 (56.6%) patients, 10 (33.3%) of them were type 1b, and 7 (23.3%) of them were type 3. Five patients (17.2%) had adnexal pathology at pre-procedural MRI and 12 patients (40%) had a history of pelvic surgery. The mean total uterine volume was 607.1 cm3. In the analysis of variables between patients with and without UOA, UOA presence was significantly higher in patients with a history of pelvic surgery (p=0.005). All of the patients with a history of myomectomy were found to have type 1b or type 3 UOA. No significant relation between UOA and age, the presence of adnexal pathology, and uterine volume were detected. Conclusion: Utero-ovarian anastomoses are commonly encountered during UAE. A history of pelvic surgery was found to be a risk factor for the presence of type 1b and type 3 UOA.

Факторы риска рецидивирования внутриматочных синехий в репродуктивном возрасте

Aim. To identify risk factors for recurrent intrauterine synechiae in women of reproductive age. Design. A comparative prospective study. Materials and methods. The study enrolled 89 female patients of reproductive age with confirmed intrauterine adhesions (IUA), according to hysteroscopy and morphology. Patients were divided into two groups depending on the course of IUA: main group (n = 45) — women with recurrent IUA (at least one episode during the year), and reference group (n = 44) — patients with IUA de novo. The mean age of patients in the main and reference groups was 36 ± 6 and 30 ± 3 years old, respectively. Results. A history of emmeniopathy was statistically more common in patients with recurrent IUA (odd ratio (OR) = 4.5; 95% confidence interval (CI): 1.7–12.3) as compared to women with IUA de novo (p < 0.05), diffuse adenomyosis (OR = 5.4; 95% CI: 2.2–13.6) (p < 0.05). Patients with morphologically confirmed chronic endometritis had a high risk of recurrent IUA (OR = 4.0; 95% CI: 1.6–9.7) (p < 0.05). The risk is several times higher after surgeries: repeated curettage of uterine cavity due to abnormal uterine bleeding (OR = 17.3; 95% CI: 5.8–51.3) (p < 0.001), a history of myomectomy due to a submucous myomatous nodule (OR = 7.4; 95% CI: 2.9–18.8) (p < 0.001), hysteroresectoscopic adhesiolysis with monopolar energy (OR = 4.4; 95% CI: 1.7–11.3) (p < 0.001). Conclusion. The mentioned risk factors of recurrent IUA make it possible to timely identify women with a high risk of the disease and undertake preventive measures. Keywords: intrauterine synechiae, recurrence, risk factors, reproductive age.

Risk of placenta accreta spectrum following myomectomy: a nationwide cohort study

BackgroundWhether myomectomy increases the risk of placenta accreta spectrum (PAS) in the following pregnancies remains controversial. ObjectiveThis study aimed to investigate the effect of myomectomy on the risk of placenta accreta spectrum in the following pregnancies. Different methods of myomectomy on the risk of placenta accreta spectrum were also explored. Study designA nationwide cohort study was conducted using data from the Taiwan National Health Insurance Research Database including all pregnant patients in Taiwan who gave birth between January 2008 and December 2017. A 1:1 propensity-score estimation matching was performed for the analysis of myomectomy on the risk of placenta accreta spectrum. Among pregnant patients who received myomectomy, different methods of myomectomy on the risk of placenta accreta spectrum were compared with control group. ResultsAmong the 1,371,458 pregnant patients in this study, there were 11,255 pregnant patients who had history of myomectomy. The risk of PAS in pregnant patients with history of myomectomy was higher than pregnant patients without history of myomectomy (incidence 0.96% vs. 0.20%, adjusted odds ratio 2.28, 95% CI 1.85-2.81, p<0.01). Among pregnant patients with history of myomectomy, 5,045 (46.87%) pregnant patients received laparotomic myomectomy, 3,973 (36.93%) received laparoscopic myomectomy, and 1,742 (16.20%) received hysteroscopic myomectomy. The incidence of PAS in the hysteroscopic group was higher than that in the laparotomic group or the laparoscopic group (1.89%, 0.71%, and 0.81% respectively, p<0.05 vs. the hysteroscopic group). The adjusted odds ratio for PAS was 3.88 (95% CI 2.68-5.63) in the hysteroscopic group compared to subjects without history of myomectomy (p<0.05). ConclusionMyomectomy, especially hysteroscopic myomectomy, is associated with increased risk of PAS in the subsequent pregnancy.

Clinical features of uterine sarcomas presenting mainly with uterine masses: a retrospective study

BackgroundUterine sarcomas are uncommon mesenchymal tumors of the uterus. The clinical problem is that the features of uterine sarcomas can sometimes mimic uterine fibroids. This study aims to investigate the clinical characteristics of patients with uterine sarcomas who were preoperative presenting mainly with uterine masses.MethodsA retrospective analysis of patients who underwent gynecological surgery for uterine sarcomas at the Obstetrics & Gynecology Hospital of Fudan University, between January 2016 and December 2021.ResultsOver the 5-year period, 277 patients were final diagnosed of uterine sarcomas. A total of 162 patients were preoperatively diagnosed as uterine fibroids for surgical treatment, the majority of whom were diagnosed of uterine leiomyosarcoma (uLMS) (49/162) and low-grade endometrial stromal sarcoma (LG-ESS) (100/162). Ninety people underwent total hysterectomy and bilateral salpingo-oophorectomy (TH + BSO), while 72 underwent myomectomy followed by supplemental TH + BSO. The group with direct hysterectomy had a higher average age than the group with prior myomectomy (47.20 ± 8.94 vs. 40.86 ± 5.88, p < 0.001). Among patients preoperatively diagnosed as uterine fibroids, patients with uLMS had a higher proportion of previous myomectomy (26.53% vs. 5.00%, p < 0.001), a larger uterine mass diameter on ultrasound (8.38 ± 3.39 cm vs. 6.41 ± 1.92 cm, p < 0.001), and richer hypervascularity (34.69% vs. 18%, p = 0.024) compared with LG-ESS.ConclusionsAnalysis of our data showed that a large proportion of uterine sarcomas, especially uLMS and LG-ESS, present mainly with uterine masses. Ultrasound features including a large uterine mass diameter and rich hypervascularity, and with a history of myomectomy may alert clinicians in suspicion of uLMS when compared with LG-ESS.

Impact of myomectomy on the obstetric complications: A large cohort study in Japan.

The authors conducted a large-scale cohort study using the Japan Society of Obstetrics and Gynecology's perinatal registry database to determine the effect of myomectomy on perinatal outcomes. This retrospective cohort study enrolled 203 745 women who gave birth between January and December 2020 in Japan. The participants were classified into two groups based on their history of myomectomy (open/laparoscopic) to investigate fertility treatment, delivery information, obstetric complications, maternal treatment, infant information, fetal appendages, obstetric history, underlying disease, infectious disease, drugs used, and case information regarding maternal and infant death. In total, 1161 pregnant women had a history of myomectomy and 202 584 did not. Compared with the nonmyomectomy group, the myomectomy group had a higher occurrence rate of uterine rupture (0.9% vs 0.06%, P < 0.01) and placenta accreta (1.5% vs 0.5%, P < 0.01). In addition, history of myomectomy (odds ratio [OR], 2.62 [95% confidence interval (CI), 1.500-4.226]; P < 0.001) was found to be an independent factor for placenta accrete and uterine rupture (OR, 14.4 [95% CI, 6.75-27.02]; P < 0.001). Furthermore, myomectomy increased the risk of uterine rupture by 14 times. Postmyomectomy pregnancy may increase the risk of placenta accreta and uterine rupture.

The nightmare of obstetricians - the placenta accreta spectrum in primiparous pregnant women.

The incidence of PAS is increasing day by day as a life-threatening condition. The purpose of the present study was to determine the factors affecting PAS formation in primiparous pregnant women and to define possible risk factors for the mother and the baby. Bursa Yüksek İhtisas Training and Research Hospital, department of obstetrics and gynecology, Bursa, Turkey, between June 2016 and December 2020. A total of 58,895 patients were included in the study. After the exclusion criteria, the study was continued with 27 primiparous PAS and 54 non-primiparous PAS patients. The primary purpose is to evaluate PAS risk factors. The secondary aim is to examine maternal and neonatal characteristics. When the parameters that are significant in terms of PAS risk factors were analyzed by Logistic Regression Analysis, it was found that the increase in age also increased the development of PAS 1.552 times (95% CI: 1.236-1.948) and a history of abortion was 7.928. times (95% CI: 1.408-44.654) and 11,007 times (95% CI: 2.059-58.832) with history of myomectomy; postoperative HB values (p < 0.001), an estimated amount of bleeding (p < 0.001), need for transfusion (p = 0.002), and use of drains ( < 0.001) were statistically significant different between two groups. When the neonatal results between patients with and without PAS were examined, birth weight (p < 0.001) and gestational week ( < 0.001) were statistically significant. PAS does not occur only in multiparous patients who have a history of previous cesarean section. It may also occur in primiparous patients and is a life-threatening condition.

LBMON236 Investigating The Effect Of Social Vulnerability Index On Fibroid Recurrence And Metabolic Dysfunction

Abstract Fibroids and metabolic dysfunction disproportionately affect women of color. We have previously shown that recurrent fibroids and metabolic dysfunction lead to increased healthcare utilization. The impact of socioeconomic factors on access to care for these women is poorly understood. Our objective was to evaluate the social vulnerability indices of women with fibroids with and without metabolic dysfunction, and determine the association of social vulnerability with fibroid recurrence. We conducted a retrospective cohort study of 918 geocoded patients who underwent myomectomy at a tertiary health care system. The primary exposure was the Social Vulnerability Index (SVI), a measure of socioeconomic disadvantage developed by the CDC with four thematic subgroups (socioeconomic status, household composition, Race/Ethnicity/Language, and Housing/Transportation). The primary outcome was clinically significant fibroid recurrence after initial myomectomy, defined as symptomatic fibroids requiring re-imaging or surgery. SVI was analyzed as an overall score and by quartiles. Models were adjusted for age, race, and insurance status, with metabolic dysfunction analyzed separately as a covariate. Patients were classified as having metabolic dysfunction (MD) if they met any 2 of 5 WHO or NCEP ATP III criteria for metabolic syndrome with BMI as proxy for waist circumference. Appropriate parametric and non-parametric tests and logistic regression were used to determine the association of SVI with fibroid recurrence. The mean SVI score for the cohort was 0.58 (SD 0.31). Mean SVI scores for patients with and without clinically significant fibroid recurrence were similar at 0.56 (SD 0.30) and 0.57 (SD 0.30), respectively. There remained no association between mean SVI score and odds of fibroid recurrence in adjusted models (OR 0.35, CI 0.10-1.24, p 0.11). Notably, there was a decreased rate of radiologic fibroid recurrence in the highest quartile of SVI (p=0. 011) and an increased rate in the third quartile (p=0. 015). When isolating the individual themes of the SVI index, there was a significant decrease in surgical and radiologic fibroid recurrence in individuals with the highest quartile of minority and language vulnerability (p=0. 03). The odds of metabolic dysfunction increased by 2.9 with each unit increase in SVI (OR 2.85, CI 1.34-6. 07, p 0. 006) after adjusting for age, race, and insurance status. We report that while patients with a higher SVI have increased risk of metabolic dysfunction, this does not translate to higher rates of clinical significant fibroid recurrence. Higher SVI is associated with lower resourced settings and reduced access to care and can therefore be used as a starting point for public health policy. SVI should be considered when studying fibroids, and may illuminate potential barriers in access to care for fibroid recurrence in patients with a history of myomectomy. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Uterine Surgery and Risk of Adenomyosis: A Retrospective Study

<h3>Study Objective</h3> To determine an association between adenomyosis and history of uterine surgery, including cesarean section, dilation & curettage (D&C), and myomectomy. Also, if repeat uterine surgery increases the risk of adenomyosis development. <h3>Design</h3> Retrospective case control study. <h3>Setting</h3> Large academic center, Parkland Hospital in Dallas, TX. <h3>Patients or Participants</h3> Data was collected from electronic medical records of women who underwent hysterectomy for benign indications at Parkland Hospital between January 2014-December 2018. A total of 2911 women were included, 1184 with adenomyosis and 1727 without adenomyosis. <h3>Interventions</h3> Variables included gravidity/parity, number of vaginal deliveries, number of cesarean sections, number of D&C procedures, and number of myomectomies. Pathology of uterine specimens were noted for presence of adenomyosis, leiomyomata, and endometriosis. Non-parametric rank sum test compared medians of continuous variables, Chi-square or Fisher exact tests compared categorical variables. Logistic regression was used to generate odds ratios for adenomyosis and clinical factors. <h3>Measurements and Main Results</h3> History of any uterine surgery was associated with an increased risk of adenomyosis (OR 1.28, 95% CI 1.11-1.49). Patients with a history of D&C were significantly more likely to have adenomyosis on pathology (OR 1.57, 95% CI 1.30-1.90). Repeat D&C was also associated with increased risk of adenomyosis (OR 1.31, 95% CI 1.01-1.72). The association between history of prior cesarean section and adenomyosis was not statistically significant (OR 1.12, 95% CI 1.00-1.37). A history of myomectomy was not significantly associated with adenomyosis (OR 0.95, 95% CI 0.59-1.54). <h3>Conclusion</h3> Of the risk factors explored, history of any uterine surgery, D&C and repeat D&C were associated with an increased risk of adenomyosis. However, there was not a significant association between history of cesarean section or increasing numbers of repeat cesarean delivery with the development of adenomyosis. This is the largest known retrospective study thus far investigating this association and we concluded that cesarean sections do not individually increase the risk of adenomyosis.

Safety and effectiveness of uterine fibroid embolization in patients with scarred uterus.

To evaluate the safety and effectiveness of uterine fibroid embolization (UFE) in patients with a scarred uterus caused by a previous myomectomy or cesarean section. A total of 140 patients who underwent embolization for symptomatic fibroids were included in this retrospective study. The patients were divided into two groups, those with a history of myomectomy and/or cesarean section (scarred uterus group, n=56), and those without surgical history involving the uterus (no-scar group, n=84). Demographics, embolization details, outcomes, and complications were analyzed. The overall clinical success rate was 89.28% in the scarred uterus group and 95.24% in the no-scar group. There was no statistical difference in infarction rate or change in fibroid volume in follow-up magnetic resonance imaging between the groups. There was one major complication in the no-scar group, but there was no statistical difference in complications between the groups. The mean follow-up period was 25.9months. The mean symptom-free time was 27.2months in the scarred uterus group and 21.9months in the no-scar group without a significant difference. There were no statistically significant differences in symptom changes, recurrence, and complication rates between the groups. Recurrence seen on imaging or regrowth was more common in the group with myomectomy history. However, there was no significant difference in symptom recurrence rates. No statistically significant difference in technical and clinical outcomes was observed between the two groups. There was no significant increase in complication rates of UFE in scarred uterus group.

Colombian Consensus on the Treatment of Placenta Accreta Spectrum (PAS)

Colombian Consensus on the Treatment of Placenta Accreta Spectrum (PAS)

Preterm Spontaneous Rupture of A Scarred Unicornuate Pregnant Uterus: A case report

&lt;p&gt;Uterine rupture is a life-threatening obstetrical complication. Most cases of uterine rupture are associated with a trial of labor with previous cesarean delivery or having a history of myomectomy. Herein, we describe a 33 year-old female with a spontaneous uterine rupture at 28 + 4 weeks gestation age resulting in a demised fetus. Fetal bradycardia and an irregular protruding &amp;ldquo;mass&amp;rdquo; over the left upper abdomen with no fetus in a boggy uterus were identified by sonography. An emergent cesarean section was performed and on entering the peritoneal cavity, a complete expulsion of the fetus and placenta from the uterine cavity was noted. A flaccid fetus without heartbeat with a large uterine ruptured scar extending from the left lower segment to left lateral wall were found. A right unicornuate uterus was confirmed later by hysterosalpingography and MRI. Spontaneous uterine rupture should be listed in the differential diagnosis of an acute abdomen during pregnancy.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

O-257 The effect of the presence of intramural myomas smaller than 6 cm on reproductive outcome in IVF treatment: a systematic review and meta-analysis

Abstract Study question What is the effect of small intramural myomas on the reproductive outcome of in vitro fertilization (IVF) treatment? Summary answer Non-cavity-distorting intramural myomas with the size of &amp;lt; 6 cm have a significant adverse effect on reproductive outcomes in IVF treatment. What is known already There is a consensus that submucous myomas have a significant unfavorable impact on reproductive outcomes, whereas subserosal myomas do not seem to have any adverse effects. Women with large (≥6 cm) non-cavity-distorting intramural myomas should be evaluated individually, considering their reproductive history. However, there is scarce data on the effect of relatively smaller intramural myomas (&amp;lt;6 cm) on reproductive outcomes and how to manage them before IVF treatment. Study design, size, duration This study is a systematic review and meta-analysis according to PRISMA guidelines. We performed a comprehensive search of PubMed, Web of Science, and Cochrane Library databases to identify relevant studies from inception until 31 November 2021. Search terms were used as “intramural fibroid*” [tw] OR “intramural leiomyom*” [tw] OR “intramural myom*” [tw]. English language and human subjects were applied to search filters. Participants/materials, setting, methods The target population was infertile women undergoing IVF treatment with non-cavity-distorting intramural myomas &amp;lt;6 cm in diameter. History of myomectomy and the presence of predominant subserous myomas, submucous myomas, or other cavity distorting pathologies were exclusion criteria. The primary outcome measures were live birth rate (LBR) and miscarriage rate (MR). Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of included studies. All statistical analyses were performed using RevMan 5.4.1. Main results and the role of chance The initial search strategy yielded 378 studies. After adopting exclusion criteria, eight studies were included in the final analysis. Six of these studies had a NOS score of 8 out of 10, and the remaining two studies had 9 out of 10. Three studies had a prospective design, and five studies had a retrospective design. Two of eight studies did not report LBR as an outcome. In pooling data analysis of six studies including 2058 cycles (1980 women), 41% relative reduction in LBR was observed in women with non-cavity-distorting intramural myomas with the size of &amp;lt; 6 cm compared to women without myomas (RR = 0.59, 95%CI: 0.49–0.71, I2=0%, p&amp;lt;0.00001). A sub-group analysis for smaller intramural myomas (&amp;lt;3 cm) was also performed and concordantly 27% decrease in the LBR (RR = 0.73, 95% CI: 0.57–0.93, I2=0%, p=0.01) was found. Regarding the MR, for women with non-cavity-distorting intramural myomas with the size of &amp;lt; 6 cm, 50% relative increase in MR was found when compared with women without myomas (RR = 1.50, 95%CI: 1.11–2.04, I2=0%, 8 studies, p=0.009). Limitations, reasons for caution Lack of information regarding the distance of myomas from endometrium and the number of myomas in most of the included studies is a limitation. Differences in IVF treatment and uterine cavity evaluation methods among studies may limit generalizability of the findings. Future RCTs are warranted to confirm our findings. Wider implications of the findings This study is the first meta-analysis with overall moderate-quality evidence from observational studies to demonstrate the adverse effect of the presence of small (&amp;lt;6 cm) intramural myomas on reproductive outcomes in IVF treatment. Surgical removal of such small myomas should be considered before IVF treatment. Trial registration number not applicable

Minimally invasive abdominal curettage for an intramural twin pregnancy: a new twist to the traditional D&C

Less than 1% of ectopic pregnancies are intramural and are located within the myometrium without connection to the fallopian tubes or endometrial cavity. Known risk factors include prior hysterotomy, uterine instrumentation, and myometrial pathology such as adenomyosis. The timely diagnosis and treatment of intramural pregnancies is important to reduce patient morbidity. This video demonstrates the laparoscopic removal of a twin intramural pregnancy in a 32-year-old primiparous patient with a history of myomectomy eight months prior to presentation. Two gestational sacs were visualized in the right fundal myometrium surrounded by only 4-6 millimeters of myometrial tissue. One sac was empty and the other with a live embryo measuring eight weeks gestation with fetal cardiac activity. After extensive counseling, the patient desired to proceed with surgical intervention. To safely excise the pregnancy without inadvertent injury to the fallopian tubes, a reverse U-shaped incision was made with electrosurgery. Dilute vasopressin was utilized to minimize blood loss and hydro-dissection was performed to assist with myometrial separation from the gestational sac. Finally, sharp curettage was performed laparoscopically to remove any remaining products of conception from the myometrium. This unique approach to curettage laparoscopically decreases the risk of endometrial disruption and perforation of a fresh hysterotomy repair, rather than if performed vaginally. We repaired the myometrial defect in multiple layers with barbed suture to avoid uterine wall weakness, which can be associated with spontaneous uterine rupture in future pregnancy. In conclusion, this video demonstrates a minimally invasive approach to the surgical treatment of an intramural pregnancy with laparoscopic resection and curettage.

Acute Colonic Pseudo-obstruction (Adynamic Ileus) after Cesarean Section: A Case Series

Background. Maternal mortality is still high. The case that we will report below is an example of cases that can be happened in the hospital and can be ended with maternal mortality.&#x0D; Case presentation. A 30 years old disabled primigravida with ileus post- Caesarean Section day 5 was managed by relaparotomy and partial resection of caecum and ileum due to intestinal perforation, and die on the fifth days after relaparotomy due to sepsis. A-33 years old secundigravida with history of relaparotomy on 4 days after caesarean delivery in the first pregnancy due to ileus, was performed re-caesarean section due to unprogressed labor. Twelve hours after the operation the abdomen becomes distended and can be managed successfully by conservative early diagnosis management. A 29 years old primigravida has performed caesarean section with history of myomectomy 3 years ago. Twenty four hours after Caesarean Section, the abdomen becomes distended and early conservative management was done, but at 72 hours after the operation, there was intestinal perforation and performed colostomy.&#x0D; Conclusion. Acute colonic pseudoobstructive after caesarean section is a rare case, and delayed diagnosis and management increase the morbidity and mortality.

Association Between Endometriosis Phenotype and Preterm Birth in France

Endometriosis is an inflammatory disease with a heterogeneous presentation that affects women of childbearing age. Given the limitations of previous retrospective studies, it is still unclear whether endometriosis has adverse implications for pregnancy outcomes. To evaluate the association between the presence of endometriosis and preterm birth and whether the risk varied according to the disease phenotype. This cohort study with exposed and unexposed groups was conducted in 7 maternity units in France from February 4, 2016, to June 28, 2018. Participants included women with singleton pregnancies who were followed up before 22 weeks' gestation along with their newborns delivered at or after 22 weeks' gestation. The final follow-up occurred in July 2019. Data were analyzed from October 7, 2020, to February 7, 2021. Women in the endometriosis group had a documented history of endometriosis and were classified according to 3 endometriosis phenotypes: isolated superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA; potentially associated with SUP), and deep endometriosis (DE; potentially associated with SUP and OMA). Women in the control group did not have a history of clinical symptoms of endometriosis before their current pregnancy. The primary outcome was preterm birth between 22 weeks and 36 weeks 6 days of gestation. Association between endometriosis and the primary outcome was assessed through univariate and multivariate logistic regression analyses and was adjusted for the following risk factors associated with preterm birth: maternal age, body mass index (calculated as weight in kilograms divided by height in meters squared) before pregnancy, country of birth, parity, previous cesarean delivery, history of myomectomy and hysteroscopy, and preterm birth. The same analysis was performed according to the 3 endometriosis phenotypes (SUP, OMA, and DE). Of the 1351 study participants (mean [SD] age, 32.9 [5.0] years) who had a singleton delivery after 22 weeks of gestation, 470 were assigned to the endometriosis group (48 had SUP [10.2%], 83 had OMA [17.7%], and 339 had DE [72.1%]) and 881 were assigned to the control group. No difference was observed in the rate of preterm deliveries before 37 weeks 0 days of gestation between the endometriosis and control groups (34 of 470 [7.2%] vs 53 of 881 [6.0%]; P = .38). After adjusting for confounding factors, endometriosis was not associated with preterm birth before 37 weeks' gestation (adjusted odds ratio, 1.07; 95% CI, 0.64-1.77). The results were comparable for the different disease phenotypes (SUP: 6.2% [3 of 48]; OMA: 7.2% [6 of 83]; and DE: 7.4% [25 of 339]; P = .84). This cohort study found no association between endometriosis and preterm birth, and the disease phenotype did not appear to alter the result. Monitoring the pregnancy beyond the normal protocols or changing management strategies for women with endometriosis may not be warranted to prevent preterm birth.

Perineal Hernia another Complication That Influences the Quality of Life after Amputation of the Rectum: Case Report

Introduction: Perineal eventration or perineal hernia is a protrusion of the pelvic floor containing intra-abdominal viscera. The occurrence of postoperative perineal hernia after abdominoperineal resection (APR) is rare, but has increased recently affecting the quality of life of the patient. Presentation of case: Here, we report a 68 -year-old women with history of myomectomy was diagnosed with a low rectal cancer. She has abdominoperineale resection after radiotherapy. She was operated for white line hernia 2 years after with mesh fixation. She presented to us 5 months after the operation, with perineal bulge and discomfort. The diagnosis of a perineal hernia was made clinically and was complemented by a CT scan. Abdominal CT scan showed that part of the small intestine was slightly protruding from a large defect of the pelvis. Discussion: Recurrence rates of perineal eventration has increased recently. Many approaches have been described, but there is still no consensus as to the optimal repair technique for perineal eventration. Conclusion: This case report confirm that perineal eventration is frequent in women such as literature with other risk factors like APR radiotherapy and a history of pelvic surgery.

The History of Myomectomy

The History of Myomectomy