Lower Uterine Segment Research Articles

Association of Placenta Previa with Previously Scarred and Non Scarred Uterus: A Descriptive Cross-Sectional Study

Introduction: Placenta previa, where the placenta is partially or completely placed in the lower uterine segment, is a major contributor to vaginal bleeding during pregnancy and affects 0.4-0.5% of all labors. Its exact cause is uncertain but is believed to be linked to aberrant endometrial vascularization caused by scarring or atrophy from prior trauma, surgery, or infection. Objective: The objective of this study was to establish an association between the placenta previa and the scarring of uterus. Methods: A cross-sectional study was conducted on pregnant women at Nobel Medical College Teaching Hospital, Biratnagar, from November 2021 to October, 2023. Ethical approval and written consent were obtained from all participants. Using convenient sampling technique, the study involved 57 participants out of 3576 patients who were admitted for Lower Segment Cesarian Section. Results: A study of 3576 patients admitted for Lower Segment Cesarian Section at Nobel Medical College Teaching Hospital, we found 57 cases of placenta previa over 24 months. The incidence was 1.59%, with 1.82% in patients with a previous history of LSCS and 1.51% without any history of scarring. The results showed no association between placenta previa and uterine scarring. Conclusion: The study found no association between the incidence of placenta previa and scarred/non-scarred uterus, but a slightly higher likelihood of having placenta previa in those with a history of uterine scarring.

The role of the lower uterine segment thickness in predicting preterm birth in twin pregnancies presenting with threatened preterm labor.

To examine the relationship between the lower uterine segment (LUS) thickness and the onset of labor in dichorionic twin pregnancies experiencing threatened preterm labor. This prospective cohort study included dichorionic twin pregnancies between 24 and 32weeks of gestation, presenting with symptoms of preterm labor. The LUS thickness and mid-anterior wall thickness were measured via transabdominal ultrasonography, cervical length, and posterior cervical lip thickness were measured transvaginally. The presence of the cervical sliding sign and funneling findings were recorded. Among the patients with an onset of labor before the 34th week, the mean LUS thickness was 3.8±0.9 mm, compared to 4.6±1.1 mm in those with an onset of labor at or after 340/7 GW, indicating a statistically significant difference (p=0.012). Similarly, accepting the GW threshold as 350/7 weeks, a statistically significant difference was found in the mean LUS thickness, which was 4.0±1.0 mm in those with an earlier onset of labor and 4.7±1.0 mm in those with a later onset of labor (p=0.022). While univariate analysis indicated that the LUS thickness was a significant predictor (p=0.017 for <34 GW and p=0.028 for <35 GW), multivariate analysis showed a reduced effect (p=0.04 and p=0.06, respectively). LUS was significantly thinner in pregnancies with an onset of labor before the 34th and 35th GW. The measurement of the LUS thickness can be considered an alternative method for predicting spontaneous preterm birth in dichorionic twin pregnancies.

Uterine layers hypervascularization in atypical placentation: the comparison of magnetic resonance imaging with vascular pathomorphology

Rationale: One in five women worldwide delivers through cesarean section, which is associated to a high rate of placenta previa and abnormal placenta attachment to the uterine wall. The grade of placenta accreta spectrum (PAS) correlates with blood loss volume, which could be related to vascularization characteristics. Up to now, there have been no studies on the diagnostic value of magnetic resonance criteria for hypervascularization of the uterine wall and their correlation with an assumed grade of PAS according to the International Federation of Gynecology and Obstetrics (FIGO) classification. Also, abnormal vessels location and their wall structure have not been studied with state-of-the-art pathomorphological methods. Aim: To develop a classification for various types of the uterine wall hypervascularization depending on the depth of placental invasion assessed by magnetic resonance imaging (MRI). Methods: We retrospectively analyzed medical files of 66 patients aged 18 to 45 years, who were assumed to have PAS based on their sonography results. To clarify the extent and localization of the placental invasion, all patients had MRI performed at 24 to 32 weeks of gestation. In all patients, the PAS grade was verified pathologically; in 30 of them (45,5%), a detailed pathological examination was additionally performed. The PAS grades were classified according to Morbidly Adherent Placenta Imaging Reporting and Data System (MAPI-RADS). The MRI data were correlated with the PAS (FIGO) grade estimated from intraoperative data and with intraoperative blood loss. At the final study step, the MRI data was correlated with abnormal pathomorphology, with the assessment of the degree of vascularization and the visual picture of abnormal uteroplacental vasculature. Results: We have proposed a classification of MRI signs of hypervascularization in the lower uterine segment correlating with the depth of placenta accreta. Type 1. Single small vessels in the myometrium, medium caliber arteries in the projection of the uterine serosa (normal variation for the 3rd trimester of gestation). Type 2. Numerous small confluent vessels, mainly in the uteroplacental region, and retroplacental hematomas (typical for placenta accreta, or FIGO PAS 1). Type 3. Intrauterine hypervascularization with a deficient myometrium thickness, predominantly vessels of the middle layer (typical for placenta increta, or FIGO PAS 2). Type 4. Thinning of the lower uterine segment due to significant bulging of the placenta in the presence of curved anastomosing vessels of vast caliber over 4 mm (typical for placenta increta – FIGO PAS 2, as well as placenta percreta – FIGO PAS 3a). Type 5. Hypervascularization outside the uterus, over its surface and in the parametrial tissues: at the border with the bladder, uterine isthmus, including signs of fibrosis and growing into the posterior bladder wall (typical for various grades of placenta percreta – FIGO PAS 3b, 3c). Conclusion: The proposed classification of uterine wall hypervascularization in accordance with the grades of placenta accreta spectrum (FIGO PAS) could be useful for its practical implementation by radiologists.

A case of isolated malrotation without midgut volvulus diagnosed prenatally and treated by laparoscopic surgery

BackgroundMalrotation is a congenital condition that predisposes individuals to midgut volvulus, which can result in significant bowel resection. While most cases of malrotation are diagnosed by the age of 1 year, typically presenting with symptoms related to volvulus or bowel obstruction, some cases remain asymptomatic. In children with visceral malposition, gastroschisis, omphalocele, or diaphragmatic hernia, malrotation may be suspected before symptoms manifest. However, isolated malrotation without midgut volvulus diagnosed prenatally is rare. We herein present a case of isolated malrotation without midgut volvulus that was prenatally diagnosed and successfully treated with laparoscopic surgery.Case presentationA 30-year-old woman (gravida 3, para 1) underwent routine obstetric ultrasound, which revealed increased blood flow in the lower uterine segment and abnormal placental attachment. To rule out placenta percreta, magnetic resonance imaging was performed at 34 weeks of gestation. Incidentally, abnormal fetal intestinal arrangement was noted, with the colon localized in the left hemi-abdomen and the small intestine distributed in the right hemi-abdomen, raising suspicion of malrotation. Postnatal contrast studies confirmed the diagnosis of malrotation without midgut volvulus. Given the risk of midgut volvulus, a laparoscopic Ladd’s procedure was performed on day 6 of life. The postoperative course was uneventful, and the patient was still symptom-free 1 year postoperatively.ConclusionsThis case illustrates that malrotation can be prenatally diagnosed using fetal magnetic resonance imaging. Considering the risk of midgut volvulus, prophylactic Ladd’s procedure should be performed in neonatal period. In cases where malrotation is not complicated by midgut volvulus, a laparoscopic Ladd procedure can be safely performed in neonates.

Diagnostic value and efficacy evaluation value of transvaginal color doppler ultrasound parameters for uterine scar pregnancy and sub-type after cesarean section

ObjectiveWe aimed to probe the diagnostic value of transvaginal color Doppler ultrasound (TV-CDU) parameters in cesarean scar pregnancy (CSP) and CSP sub-types, and the relevant factors affecting patients’ surgical effects.MethodsSeventy-five CSP patients (all requested termination of pregnancy) were selected as the observation group, and 75 normal pregnant women with a history of cesarean section were selected as the control group. All the study subjects underwent TV-CDU and their cesarean scar muscle (CSM) thickness, minimum sagittal muscle thickness and resistance index (RI) of blood flow in the anterior wall of the lower uterine segment were calculated. The diagnostic value of CSM, minimum sagittal muscle thickness, and RI for CSP and CSP sub-types was analyzed. The patients in the observation group were grouped into the effective group and the ineffective group according to whether the surgical treatment was effective or not, and the independent factors affecting CSP efficacy were analyzed.ResultsThe observation group had lower CSM, minimum sagittal muscle thickness and RI than the control group. CSM, RI, and minimum sagittal thickness in patients with type II CSP were lower than those in patients with type I, and these indicators in patients with type III were lower than those in patients with type II. The area under the curve (AUC) of CSM, RI and minimum sagittal muscle thickness in combination for CSP diagnosis and the AUC for CSP sub-types were higher than those of each indicator alone. Gestational sac size and CSM were independent factors affecting CSP treatment.ConclusionChanges in TV-CDU parameters facilitates CSP diagnosis after cesarean section. CSM, minimum sagittal muscle thickness changes, and RI in combination possesses high value for CSP diagnosis and CSP sub-types. Gestational sac size and CSM are independent factors affecting CSP treatment.

Frequency of Placenta Previa among Women with Previous Cesarean-Section

Placenta Previa was defined as when the placenta was attached to the lower uterine segment, poses significant risks, including antepartum hemorrhage and maternal mortality. The incidence was rising, attributed partly to increased cesarean sections and advanced maternal age. Objective: To determine the frequency of placenta Previa among women with previous cesarean-sections. Methods: This cross sectional study was carried out at a Teaching Hospital of Sialkot, from June to December 2021. The sample size was 147 pregnant females. These pregnant females have a history of cesarean section. The non-probability Consecutive sampling technique was used, and data were analyzed by using SPSS version 25.0. Results: Among those, 16.3% had placenta Previa, which increased significantly in women with &gt;2 previous cesarean sections to 26.4% (p = 0.003). Regarding parity, the increase in the risk of placenta Previa was not significant: 12.8% for parity &lt; 3 and 20.3% for parity ≥ 3 (p = 0.087). However, in the stratified analysis by BMI, this became significant: 11.0% for normal-weight, 18.6% for overweight, and 66.7% for obese women (p = 0.001). There was no significant difference concerning age groups, p = 0.177. Such findings of the significant associations of placenta Previa with such factors as BMI and number of cesarean sections indicate that great attention to monitoring should be paid. Conclusion: Hence concluded that previous cesarean sections strongly correlate with placenta previa in subsequent pregnancies. Such findings underscore the need for rigorous monitoring and proactive measures, especially in cases of multiple cesarean deliveries, in the management of associated complications.

Prenatal identification of invasive placentation using ultrasound in women with placenta previa and prior cesarean delivery

ObjectiveTo evaluate the performance of ultrasound for antenatal identification of invasive placentation in women with placenta previa in the setting of prior cesarean delivery. Study designThis was a multicenter, retrospective, cohort study. Singleton pregnancies at risk of placenta accreta because of persistent placenta previa in the setting of prior cesarean delivery who delivered at four centers, from January 2010 to May 2020, were included in the study. For this study, pregnancies with diagnosis of accreta, increta, or percreta were considered under the umbrella term of placenta accreta. All women with placenta previa identified in the second trimester had a follow-up ultrasound at 32–34 weeks. Only those with prior cesarean delivery were considered at risk of placenta accreta. Women were considered with suspected accreta in case of suspected prenatal ultrasound. Women with suspected placenta accreta had delivery planned via cesarean hysterectomy at 34+0 – 35+6 weeks, without any attempt to remove the placenta. The primary endpoint of the study was the performance of ultrasound for antenatal identification of invasive placentation. The following ultrasound signs were evaluated: placenta lacunae; loss of clear space; increased vascularity between myometrium and placenta; intracervical lake; rail sign; uterovesical hypervascularity; increased vascularity in the inferior part of the lower uterine segment potentially extending into the parametrial region; and disruption of bladder-myometrial interface. Results180 singleton pregnancies with placenta previa in the setting of prior cesarean delivery were identified. Of them, 155 (86.1%) had antenatal suspected placenta accreta based on ultrasound, having at least one sign of invasive placentation. Of the 155 suspected cases, 99 had confirmed placenta accreta at the time of delivery. Among the 99 cases of confirmed placenta accreta, all of them had at least one sign of invasive placentation at ultrasound. Among the 81 cases with placenta previa, prior cesarean delivery, without placenta accreta, 25/81 (30.9%) had ultrasound scan negative for sign of invasive placentation, and 56/81 (69.1%) had at least one sign of invasive placentation). In particular, 12/81 (14.8%) had placenta lacunae, 16/81 (19.8%) had loss of clear space, 20/81 (24.7%) had increased vascularity between myometrium and placenta, 9/81 (11.1%) had intracervical lake, 14/81 (17.3%) had rail sign, 14 (17.3%) had uterovesical hypervascularity, 5/81 (6.2%) had increased vascularity in the inferior part of the lower uterine segment potentially extending into the parametrial region, 8/81 (9.9%) had disruption of bladder-myometrial interface. In the group of women with confirmed placenta accreta, the most common sign recorded was the disruption of bladder-myometrial interface, being recorded in 88/99 women. Disruption of bladder-myometrial interface had the highest sensitivity in detection placenta accreta. Women with disruption of bladder-myometrial interface at ultrasound had 73-fold increase in the risk of placenta accreta compared to those who did not. ConclusionPrenatal ultrasound has an excellent diagnostic accuracy in identifying invasive placentation in women with placenta previa and prior cesarean delivery.

Maternal Outcome of Pregnancy with Previous History of Caesarean Section with Central Placenta Previa Admitted into DMCH Gynae Department (6 months study)

Background: Placenta previa, a condition where the placenta is abnormally positioned in the lower uterine segment, poses significant risks to both maternal and neonatal health. It has become more prevalent with increasing cesarean deliveries, advanced maternal age, high parity, and assisted reproductive technologies. The impact of placenta previa on subsequent pregnancies, especially in women with a history of cesarean sections, remains an area of concern due to potential complications such as hemorrhage, transfusion needs, and adverse outcomes like peripartum hysterectomy. Objective: This study aimed to assess the maternal and neonatal outcomes in pregnancies with a history of cesarean sections complicated by central placenta previa, admitted to the Department of Obstetrics and Gynecology at DMCH from January 2023 to June 2023. Methodology: A Descriptive Cross sectional study was conducted using medical records from the Department of Obstetrics and Gynecology at DMCH. We analyzed data from 104 women with central placenta previa and previous cesarean sections. Diagnostic criteria were based on trans-abdominal or transvaginal ultrasound. Statistical analysis was performed using SPSS v21.0, employing chi-square and Mann–Whitney U tests for categorical and continuous variables, respectively. Multivariate analysis assessed the association between a history of placenta previa and adverse maternal and neonatal outcomes, with significance set at P &lt; 0.05. Results: The majority of patients were aged between 29-39 years (58.7%). Most had a parity of 1 or 2 (75.0%) and were in their 3rd or 4th gravida category (64.4%). A predominant number were between 35-38 weeks gestation (68.3%). APH was present in 65.4% of patients, and the average number of transfusions required was 4. The uterus was preserved in 63.5% of cases. 36.5% cases peripartum hysterectomy was performed. Maternal outcomes showed a 93.3% improvement rate, with 6.7% mortality. Neonatal outcomes included 86.5% .....

Diagnostic accuracy of magnetic resonance imaging to predict peripartum hysterectomy and neonatal mortality in total placenta previa: A retrospective cohort study

ObjectivesTo assess the reliability of placental magnetic resonance imaging measurements in predicting peripartum hysterectomy and neonatal outcomes in patients with total placenta previa. Study DesignThis retrospective cohort study, conducted at a single tertiary center, identified 372 pregnant women diagnosed with placenta previa. 277 singleton pregnancies that met the inclusion criteria and were diagnosed with total placenta previa in the third trimester were divided into two groups according to whether a placental MRI was performed. Two radiologists analyzed the MRI findings of 150 pregnant women with total placenta previa. Measurements were conducted for the placental volume of the upper and lower uterine sectors, cervical canal length, and cervical canal dilatation. A comparison was made between the surgical progression of these pregnant women and 127 pregnant women with total placenta previa who did not undergo an MRI. After pathological examination, 122 (63.2%) of 193 pregnant women diagnosed with placenta accreta spectrum underwent peripartum total abdominal hysterectomy. The results were compared using logistic regression analysis. ResultsReduced placental volume in the upper uterine segment and increased volume in the lower uterine segment significantly correlated with a higher probability of peripartum hysterectomy (cut-off: ≤343.4 and ≥ 403.4 cm3; OR: 0.993, 95 % CI: 0.990–0.995 and OR: 1.007, 95 % CI: 1.005–1.009, respectively). Shortened cervical canal length and increased dilatation raise the risk of peripartum hysterectomy (cut-off: ≤34, ≥11 mm; OR: 0.82, 95 % CI: 0.77 − 0.88 and OR: 1.7, 95 % CI: 1.4 − 2.1, respectively). The risk of neonatal death is 32 times higher in those < 34 weeks than in those 34 weeks or higher (95 % CI: 4.2–250, p = 0.001). ConclusionsPlacental MRI significantly contributes to predicting peripartum total abdominal hysterectomy and neonatal mortality in patients with total placenta previa associated with placenta accreta spectrum.

The Role of Lower Uterine Segment Thickness in Predicting Cesarean Scar Defects: Two-Dimensional Transvaginal Ultrasound Vs. Intraoperative Findings

The Role of Lower Uterine Segment Thickness in Predicting Cesarean Scar Defects: Two-Dimensional Transvaginal Ultrasound Vs. Intraoperative Findings

Ultrasound evaluation of scar thickness for prediction of uterine dehiscence in term women with previous caesarean sections.

To determine the role of ultrasound in evaluation of scar thickness for prediction of uterine dehiscence. This retrospective cross-sectional study was conducted in the Radiology department of Aga Khan University Hospital from 1st July to 31st December 2021 after approval from the University Ethic Committee. In this study pregnant women 18 to 40 years with a live singleton fetus with vertex presentation, at term, with history of prior caesarean section and availability of medical record were included. Using a curvilinear ultrasound transducer with optimally distended urinary bladder, the myometrial thickness was measured in the sagittal plane. The intraoperative visual findings of the lower uterine segment outcome at the time of C-section were recorded and categorized into two groups i.e., with and without dehiscence for statistical analysis. A total of 126 women were included. The mean age of the study participants was 29.8±4.1. The median gestational age was 35 (34-37) weeks. The highest AUC 0.58 was recorded for the scar thickness of ≤2.5mm with a sensitivity, specificity, PPV and NPV of 80.9%, 36.4%, 36.3% and 80.8% respectively. Similarly, the AUC for the scar thickness of ≤2mm was 0.55 with a sensitivity, specificity, PPV and NPV of 93%, 18.2%, 18.2% and 93% respectively. Transabdominal Sonography is a safe technique to determine the LUS thickness during antenatal ultrasound at term. A cutoff value of ≤2mm showed a high sensitivity and negative predictive value of 93% for evaluating the risk of uterine dehiscence.

The Clinicopathological Features and Prognoses of Lower Uterine Segment Cancer: A Retrospective, Single-Center Cohort Study.

This study used single-center data to analyze the clinicopathological features of site-specific endometrial cancer. Patients with endometrial carcinoma who had undergone surgery at Peking Union Medical College Hospital, China, between March 2016 and January 2022 were enrolled. Clinical information and pathological characteristics were summarized, and microsatellite status was analyzed using the immunohistochemical method. Patient prognoses were measured in terms of the rates of overall survival and progression-free survival. The mean patient age was 49 years (ranging: from 25 to 76 years old), and there was no difference in clinicopathological features between endometrioid and type II endometrial carcinoma in LUSC. The ER and PR expression ratios were 80.4% and 64.3%, respectively, in this LUSC cohort, and the MMR deficiency ratio was 33.9%, including 39.6% in endometrioid carcinoma and 15.4% in type II endometrial carcinoma. Combined MSH2&MSH6 loss was more common than combined MLH1&PMS2 being unexpressed (16.1% vs 12.5%), and dMMR patients differed significantly from the pMMR group in terms of vascular invasion (P=0.003). The combination of chemotherapy and radiotherapy did not provide a statistically significant improvement in prognosis compared to chemotherapy alone. The results of this study showed that LUSC patients tended to be younger and their tumors had less expression of hormone markers. The biological behavior of both endometrioid cancer and type II EC may be similar when EC occurs in this area. Furthermore, this type of tumor also showed a higher incidence of vascular invasion, and the combination of chemotherapy and radiotherapy did not provide significant improvement. Thus, successful treatment of LUSC tumors requires aggressive surgical intervention and a more effective postoperative treatment approach.

Prognostic Significance of "High" Tumor Budding and "High" Poorly Differentiated Clusters in Endometrial Carcinomas: Independent Predictors of Lymphovascular Space Invasion and Lymph Node Metastasis.

Tumor budding (TB) and poorly differentiated clusters (PDCs) are well-established prognostic factors in various cancers. This study aimed to assess the independent prognostic role of these markers in endometrial carcinomas. Retrospective analysis of endometrial carcinoma resection specimens by examining traditional histologic prognostic parameters. TB and PDC were observed at 20× magnification in ten fields at the invasive front and categorized as present or absent. In addition, a count of ≥5 was stratified as "high." Clinical and follow-up details were extracted from Gynecologic Oncology records. Sixty-five endometrial carcinomas were studied and were predominantly endometrioid (n=47, 72.3%). TB was identified in 52.3% of cases, with high TB observed in 38.5%. PDC was evident in 44.6%, with high PDC seen in 29.2%. Associations were significant between the presence of TB/high TB and higher tumor grade (P < 0.001), deep myometrial invasion (P = 0.006/P = 0.002), diffuse pattern of invasion (P = 0.007/P = 0.03), microcystic elongated and fragmented pattern (P < 0.001), lymphovascular space invasion, lymph node metastasis (P=<0.001) and International Federation of Gynecology and Obstetrics stage (P = 0.000/P = 0.002). PDC/high PDC showed similar associations, and, in addition, with nonendometrioid histologic type (P = 0.02) and tumor location in a lower uterine segment (high PDC, P = 0.009). After adjusting for other significant parameters, both high TB (P = 0.03) and high PDC (P = 0.031) emerged as independent prognostic parameters for lymphovascular space invasion or Lymph node metastasis. No recorded deaths or significant events occurred, precluding commentary on overall survival status. High TB and PDC are independent predictors of Lymph node metastasis in endometrial carcinomas. Their association with the microcystic elongated and fragmented pattern makes them histologic predictors of epithelial-mesenchymal transition. Their simple application underscores their potential as valuable additional prognostic indicators for endometrial carcinomas.

A personalized approach to the surgical treatment of early-stage uterine body cancer with tumor involvement in the lower uterine segment. Clinical observation

A personalized approach to the surgical treatment of early-stage uterine body cancer with tumor involvement in the lower uterine segment. Clinical observation

Innovative hemostasis technique for cesarean section in placenta previa: A retrospective study.

To evaluate hemostatic efficacy, complications, and subsequent pregnancy outcomes in women with placenta previa who underwent combined vertical compression sutures in the lower uterine segment and intrauterine balloon tamponade (Hot-Dog method) to achieve hemostasis after cesarean section. We retrospectively reviewed data for 117 women with singleton pregnancy diagnosed with placenta previa who underwent cesarean section between 29 and 38 weeks' gestation. Treatments were as follows: (1) conventional-intravenous oxytocin administration after placental detachment and suturing of bleeding points at the detachment site as needed (conventional group) (n = 47). (2) Intrauterine balloon tamponade alone (balloon group) (n = 41). (3) Vertical compression sutures + intrauterine balloon tamponade (Hot-Dog group) (n = 29). The placenta accreta spectrum prevalence was significantly higher in the balloon and Hot-Dog groups versus the conventional group. The prevalence of anteriorly located placenta was significantly higher in the Hot-Dog versus balloon groups. Intraoperative and total blood loss were significantly higher in the Hot-Dog versus conventional groups. Postoperative blood loss was significantly lower in the Hot-Dog versus balloon groups. Fewer additional procedures for managing postoperative hemorrhage were required in the Hot-Dog versus conventional and balloon groups. The number of subsequent pregnancies in the conventional, balloon, and Hot-Dog groups was 11 (23.4%), 8 (19.5%), and 4 (13.8%), respectively; all resulted in live births at term without serious obstetric complications. The Hot-Dog method is a straightforward and safe hemostasis technique for placenta previa that preserves fertility and controls severe bleeding.

P-438 Association of uterine cavity immune cells at the time of frozen embryo transfer with live birth

Abstract Study question Is there an association between live birth and uterine cavity immune cell subsets collected at the time of frozen embryo transfer (FET)? Summary answer A positive correlation exists between live birth and number of uterine cavity immune cells, as well as T regulatory cells at the time of FET. What is known already Several strategies have been deployed to improve pregnancy rate during IVF, with little success. Although selecting the euploid embryo was thought to improve pregnancy rate, implantation rate of 50-60% has been reported. Endometrial receptivity plays a critical role in the success of implantation and could be the missing link in improving pregnancy rate. While certain cytokines within the endometrium are recognized for influencing implantation, information on uterine milieu at time of implantation is limited. Immune cell profile at the time of FET may reflect on endometrial receptivity and could be utilized as a marker for predicting implantation and successful pregnancy. Study design, size, duration Institutional Review Board approval was obtained for this study (#49174). This prospective observational cohort study was conducted at a single academic-based fertility clinic. A total of 24 subjects were recruited between May 2021 through December 2022. Eligible participants were those who had undergone at least one cycle of IVF with at least one frozen embryo available for FET. Live birth was defined as birth of one of more live-born infants. Participants/materials, setting, methods Under ultrasound guidance, trial transfer catheter was placed in lower uterine segment, then rinsed in IMDN medium with 10% FBS (lower). Embryo was placed in the upper uterus and the transfer catheter tip was rinsed in separate sample of above media (upper). Collected cells were centrifuged and stained for the following surface markers: CD45, CD3, CD19, CD4, CD8, gamma delta TCR, CD25, CD127, CD66b, CD14, CD16, CD56. Statistical analysis was performed with Pearson correlation test. Main results and the role of chance All participants underwent elective single embryo transfer under ultrasound guidance. Out of the 24 patients participating in the study, 13 patients had a live birth (54%), one patient had a biochemical pregnancy (4%), 10 patients did not achieve pregnancy (42%), and there were no miscarriages. When patients with a live birth were compared to those without a live birth, there was no significant difference in their age (P 0.87), body mass index (P 0.64) or ethnicity (P 0.94). There was no association between the relative expression and subtypes of different immune cells isolated from the lower uterine segment and pregnancy outcome. However, in cells isolated from upper uterus, there was a positive correlation between live birth and total immune cells (CD45+; P 0.04) and T regulatory cells (P 0.03) at the time of FET. There was no statistically significant association with live birth noted with the remainder of the analyzed cells, including neutrophils (CD66b), NK cells (CD56), T cells (CD3) and other subsets (GDT, CD8, CD4), B cells (CD19), monocytes (CD14), and Fc receptor positive cells (CD16). Limitations, reasons for caution Our study’s limitations include the number of participants and the range of flow cytometry parameters that were analyzed. With the use of multicolor flow cytometry, additional detailed data can be obtained on immune cell diversity and expression. Wider implications of the findings We posit that the uterine milieu during embryo transfer could influence implantation. Analyzing immune cell association with live birth can direct future studies toward identifying conditions conducive to implantation, paving the way for novel diagnostics and treatments to enhance implantation and subsequently live birth rate. Trial registration number not applicable

P-742 In-vitro fertilization outcomes after laparoscopic repair of cesarean scar defect

Abstract Study question Does laparoscopic repair of cesarean scar defect improve in-vitro fertilization (IVF) outcomes? Summary answer Laparoscopic (LSC) repair of cesarean scar defect (CSD) should selectively indicated to patients experiencing repetitive pregnancy failure or having an increased depth of niche What is known already Cesarean section (CS) rate has markedly from 7% in 1990 to an estimated 29% of all births by 2030. CSD, also known as isthmocele or uterine niche, has emerged as a cause of secondary infertility, frequently encountered with recurrent implantation failures and cycle cancellations because of the endometrial fluid collection both in endometrium and uterine lower segment of cesarean scar. Study design, size, duration This is a retrospective study encompassing total of 62 patients. With 50 patients undergoing expectant management, 12 undergoing LSC repair of CSD at a single IVF center from 2019 to 2023. Primary outcomes included the clinical pregnancy rate and time to pregnancy, while secondary outcomes were the depth of CSD and residual myometrial thickness. Of the 72 patients, 68 patients underwent frozen embryo transfer. Participants/materials, setting, methods Patients with secondary infertility who had experienced more than two instances of implantation failure or cycle cancellation due to endometrial fluid collection were included. Laparoscopic repair of CSD was performed by a single gynecologic oncologist in accordance with the physician’s preference and patient consent. For patients in expectant management, diagnostic hysteroscopy and endometrial fluid suction were conducted prior to embryo transfer. Main results and the role of chance The age, BMI, gravidity, parity, or the number of previous cesarean section showed no statistical differences between the expectant management and the LSC repair group. The uterine position, either anteflexion was similar across groups. (all p value &amp;gt;0.05). Both the clinical pregnancy rate and live birth rate did not significantly differ between the expectant management group and the LSC repair group (26.0% vs 50.0%, p = 0.149, and 32.0% vs 60.0%, p = 0.149, respectively). The mean time to pregnancy was 7.38 months in the expectant management group and 9.80 months in LSC repair group, showed no significant difference (p = 0.240). Correlation analysis revealed a significantly moderate correlation between the initial depth of CSD and the depth of CSD at embryo transfer with clinical pregnancy (r = -0.424, P = 0.001). Furthermore, our data indicated that the CSD depth at embryo transfer was significantly impacted on clinical pregnancy outcomes from the multivariate regression logistic analysis (OR = 0.522, 95% CI [0.332 – 0.823]). Limitations, reasons for caution This study is retrospectively designed and including small sample size, caution is required in interpreting the findings. Wider implications of the findings This study suggests that the depth of niche influences clinical pregnancy outcomes. Laparoscopic repair may offer a viable treatment option who have experienced multiple failed cycles and increased depth of niche. Future studies with larger population studies may further indicate the LSC repair based on the depth of CSD. Trial registration number not applicable

Comparison of Transabdominal versus Transvaginal Ultrasound to Measure Thickness of The Lower Uterine Segment at Term

Comparison of Transabdominal versus Transvaginal Ultrasound to Measure Thickness of The Lower Uterine Segment at Term

Predicting Uterine Rupture Risk Using Lower Uterine Segment Measurement During Pregnancy With Cesarean History: How Reliable Is It? A Review

Predicting Uterine Rupture Risk Using Lower Uterine Segment Measurement During Pregnancy With Cesarean History: How Reliable Is It? A Review

Predicting Uterine Rupture Risk Using Lower Uterine Segment Measurement During Pregnancy With Cesarean History: How Reliable Is It? A Review

Predicting Uterine Rupture Risk Using Lower Uterine Segment Measurement During Pregnancy With Cesarean History: How Reliable Is It? A Review