Posterior Uterine Wall Research Articles

The predictive role of uterocervical angle in labor outcomes: a narrative review.

Uterocervical angle (UCA) is the angle between the anterior or posterior uterine wall and the cervical canal, and it has become an unique ultrasonographic marker in the recent years. The predictive role of the UCA in spontaneous preterm births (sPTB) has been examined by numerous authors, however few data are available on UCA as predictor of labor outcome at term of pregnancy. Therefore, the purpose of this review is to evaluate the effectiveness of transvaginal ultrasound measurement of UCA at term, and its clinical implications in obstetrics' practice. A literature search was conducted including all studies regarding the predictive role of ultrasonographic evaluation of the UCA on labor outcomes from 1990 to 2023. A narrative synthesis was subsequently performed dividing studies that considered posterior and anterior UCA. Five studies were included for the anterior UCA, and ten for the posterior UCA. UCA was then evaluated as predictor of prolonged latent phase and predictor of the onset and mode of delivery. It is likely that the combination of multiple cervical parameters, rather than UCA assessment alone, together with clinical information, can achieve higher levels of accuracy in predicting delivery outcomes. Future prospective studies are needed to define with greater certainty the role of UCA as a useful screening tool before laboring, but, until then, the use of UCA as a screening test to predict labor outcome should remain investigational.

Robotic-assisted excision of diffuse adenomyosis.

Adenomyosis is a chronic, debilitating condition characterised by the presence of endometrial- like glands and stroma within the myometrium. While hysterectomy remains the definitive treatment, uterus- sparing surgeries may be a possible option for patients desiring to maintain fertility. Surgical management, along with medical treatment and/or Assisted Reproductive Technology (ART), can improve outcomes. To provide a step-by-step video demonstration of robotic-assisted excision of diffuse adenomyosis affecting the posterior uterine wall. This video article describes the use of a robotic platform in conjunction with intracavitary indocyanine green (ICG) for the uterus-sparing excision of diffuse adenomyosis. Perioperative data, specifics of the surgical approach, and both objective and subjective outcomes of this surgical approach. A 38-year-old nulligravid patient with a history of chronic pelvic pain and infertility underwent surgical management of adenomyosis following two unsuccessful IVF cycles. The excisional surgery resulted in minimal blood loss (60 ml) and the patient was discharged on the same day of surgery with no complications. In select patients, robotic-assisted surgical management of diffuse adenomyosis can be advantageous. Leveraging the benefits of robotic technology, combined with appropriate surgical techniques, facilitates the performance of extensive surgeries with minimal morbidity and favourable outcomes.

Low transverse caesarean section through the posterior uterine wall in a pregnant patient with asymptomatic uterine torsion of 180°: A case report

IntroductionExcessive torsion of a pregnant uterus is a rare and potentially extremely dangerous pathology for both the mother and fetus. The diagnosis is most often made intraoperatively.AimThe main aim was to show that when it is impossible to detort the uterus, a low transverse caesarean section through the posterior uterine wall can be safely performed.Case studyWe report a case of a 41-year-old multiparous woman at G II P II 39/40 weeks' gestation, who presented to the Gynecology and Obstetrics Department for an elective caesarean section due to a breech presentation of the fetus. During the caesarean section, a uterine torsion of 180° was found. As the uterus could not be detorted to its normal position, a low transverse caesarean section was performed through the posterior uterine wall. At follow-up visits after 8 weeks and 12 months, normal healing of the uterine muscle was confirmed.Results and discussionThe treatment of torsion of the pregnant uterus depends on gestational age and symptoms, in particular the presence of significant hemodynamic and ischemic lesions.ConclusionsThe procedure of choice in a full-term pregnancy should be an attempt to detort the uterus to its normal position and then perform a cesarean section through the anterior uterine wall. If detorsion of the uterus is not possible, a caesarean section through the posterior uterine wall should be performed. Based on the literature review and the case presented, it appears that this procedure is safe.

Interesting case of uterine inversion-managed laparoscopically

Abstract 32-year-old unmarried woman presented with complaints of severe abdominal pain for 2 hours. The pain was sudden in origin, continuous in nature associated with giddiness and vomiting. She had got her menses a day prior , bleeding was heavy with passage of clots. She had menorrhagia for 5 months. On examination, pulse was 112 beats per minute, blood pressure was 100/60mmHg, severe pallor was present. On per vagina examination large fleshy mass was seen protruding in the vagina, cervix was not seen. On per vaginal examination, a globular mass was felt, while cervix could not be palpated separately. Uterine fundus was not palpable. A provisional diagnosis of Uterine inversion was made with a probable prolapsed fibroid or polyp. MRI pelvis confirmed the diagnosis. Her haemoglobin was 5 gm%, and coagulation profile was normal. On laparoscopy, uterine fundus was not visible, the fallopian tubes and ovaries seemed to be pulled into the vagina. Vasopressin was injected and incision was taken on posterior uterine wall (Haultain’s method ) to correct inversion. The uterine walls were slowly pulled upwards using tissue grasping forceps. The myoma was seen after incising the uterine walls. Myoma screw was used to completely enucleate the myoma from uterine bed. The bleeders in myoma bed were coagulated. Posterior uterine wall was sutured using barbed sutures. Bilateral round ligaments were plicated to provide additional strength. An adhesion barrier was placed over the sutured uterine wall to prevent adhesions. She received a total of 4 units of whole blood and 4 units of fresh frozen plasma. She was discharged on day 5 post surgery. Her post-operative course was uneventful. We are presenting this case due to its rare presentation in unmarried female and laparoscopic management of this case by Haultain’s method.

Clinical experience with postpartum treatment of a patient with arteriovenous malformation of uterine vessels

Uterine arteriovenous malformation is a rare vascular dysplasia where the uterine veins communicate with the branches of arteries of varying calibers. Patient K., a 37-years-old patient, presented with genital tract bleeding. Her medical history included operative labor at 37 weeks with dichorionic diamniotic twins, with the placental site on the posterior uterine wall exhibited firm attachment. The uterine cavity walls were scraped, and the bleeding vessel in the placental site was sutured. The blood loss amounted to 750 mL, and reinfusion was conducted. Fourteen days after giving birth, a heavy bloody discharge with blood clots from the genital tract occurred. The blood tests revealed no abnormalities. Echography detected multiple tubular structures that were anechoic on the posterior wall of the uterus, from the endometrium to the serosa, with the CDC mode blood flow. Magnetic resonance angiography revealed hypervascularization with premature arteriovenous discharge. Superselective embolization was performed on uterine artery afferents, and complete blood flow reduction was achieved, leading to the cessation of bleeding. On postoperative day 17, the patient experienced considerable bloody discharge from the genital tract, causing the hemoglobin level to decrease to 88 g/L. The presence of an arteriovenous malformation in the uterine vessels accompanied by ineffective embolization necessitated uterine extirpation. The postoperative phase was uneventful, and the patient was discharged from the hospital in satisfactory condition, with no evidence of anemia (hemoglobin, 115 g/L).

Effiacy of nausicaa compression sutures in terms of PPH management

ABSTRACT;
 BACKGROUND:Postpartum haemorrhage(PPH) is the most importantr cause of maternal death in Pakistan.Over 125,000 maternal deaths have been reported each year due to PPH. Major causes of PPH include uterine atony and haemorrhage from the placental bed. There is a recent increase in the rate of cesarean section which has increased the incidence of Placenta previa as well as placenta accreta spectrum. Apart from medical management, there are various conservative surgical interventions before imparting to hysterectomy such as uterine compression sutures which effectively secure hemostasis. The Nausicaa compression suture has been a new technique which effectively controls PPH in patients with uterine atony, placenta previa and accrete spectrum.
 OBJECTIVE: The objective of this study is to determine the efficacy of Nausicaa compression sutures in patientswith PPH undergoing cesarean section.
 PATIENTS AND METHOD: This study was conducted in the Obstetrics and Gynaecology department of Sir Ganga Ram Hospital,Lahore from 1st September2020 to 30th June,2022. Total of 80 patients who had PPH during cesarean section due to uterine atony or placenta previa spectrum were enrolled after informed consent. Nausicaa compression suture was applied to the anterior, posterior and both uterine walls where required.Successful procedure was those where only Nausicaa compression suture was sufficient to control PPH.
 RESULTS:The average age of patients was 30.3±4.2 years. There were 24(30%) primigravidas, 28(35%) were G2P1+0 and 28(35%) were multigravidas. The mean gestational age of patients was 37.58 weeks. 46 patients were operated on for indication of placenta previa. 6 patients had placenta accrete. 28 patients had other indications of LSCS. In 9 patients Nausicaa sutures were applied to the anterior uterine wall while in 71 patients to anterior and posterior uterine walls. In 62 patients Nausicaa suture was sufficient to control PPH. 10 patients required other interventions, while 8 patients required emergency hysterectomy due to intractable hemorrhage.
 CONCLUSION: The Nausicaa compression suture is an effective suture to control postpartum hemorrhage in patients with placenta previa and atonic uterus. It is most effective when applied to anterior and posterior both uterine walls separately.
 KEY WORDS: Post partum hemorrhage(PPH), Nausicaa Compression suture, Cesarean section.

Feasibility and Effectiveness of Hysteroscopic Suture Fixation of the Levonorgestrel-Releasing Intrauterine System in the Treatment of Adenomyosis

To evaluate the feasibility and effectiveness of hysteroscopic suture fixation of the levonorgestrel-releasing intrauterine system (LNG-IUS) for the treatment of adenomyosis. A retrospective case series. Two teaching hospitals with the technology of hysteroscopic suture fixation of the LNG-IUS. The study reviewed 79 adenomyosis patients who received the hysteroscopic suture fixation of the LNG-IUS from January 2021 to May 2022. Hysteroscopic suture fixation of the LNG-IUS to the posterior uterine wall with nondissolvable suture. All patients underwent one-year postoperative follow-up to evaluate the LNG-IUS expulsion rate, postoperative efficacy, and side effects. Two patients (2.6%) experienced expulsion of the LNG-IUS at 8 months and 12 months postoperatively, respectively. The visual analog pain scale, pictorial blood loss assessment chart score and carbohydrate antigen 125 markedly decreased after the suture fixation of the LNG-IUS compared with baseline in all patients (p <.001). Hemoglobin increased significantly (p <.001). The most common side effect was irregular bleeding, which accounted for 44.3%. The second common side effect was weight gain, which accounted for 29.2%. The composite effectiveness based on pain and bleeding showed that the effective treatment rates at 1, 3, 6, and 12 months after surgery were 92.4%, 97.4%, 96.2%, and 97.4% respectively. Hysteroscopic suture fixation of the LNG-IUS to the uterine fundus was associated with low expulsion rates and significantly improved dysmenorrhea and bleeding.

Two Cases of Posterior Uterine Rupture After Foetal Pillow Use; Is It Time To Think Twice About Using the Foetal Pillow?

Introduction: The incidence of caesarean section at full dilatation is increasing, with 10% being emergency cases. The Fetal Pillow device helps elevate the foetal head during such caesarean sections, potentially reducing blood loss and neonatal complications, however the evidence for this has recently been called into question. The authors presented 2 cases of possible complications associated with fetal pillow use. Case 1: A 40-year-old woman with a history of one previous caesarean section opted for vaginal birth after caesarean. After induced labor, the patient experienced fetal distress during pushing, leading to an emergency caesarean section using a Fetal Pillow. During the surgery, a 10cm vertical full-thickness posterior uterine wall rupture was noted, but the baby was delivered safely. The woman recovered well, but in future pregnancies, the patient was advised to have a planned caesarean section at 37 weeks. Case 2: A 36-year-old woman with two previous vaginal deliveries presented in spontaneous labor and ruptured membranes. An emergency caesarean section using a Fetal Pillow was performed due to a delay in the second stage of labour. Intraoperatively a 6cm vertical partial thickness posterior wall dehiscence was noted. The patient delivered a healthy baby boy with an uneventful recovery and was advised for a planned caesarean section in future pregnancies. Discussion: Posterior uterine wall ruptures are very rare but known to occur in labour. The authors reported the first 2 cases in the literature following Fetal Pillow use, raising the question as to whether the Fetal Pillow had any role in causing this rare uterine injury. Evidence on the efficacy and safety of Fetal Pillow remains limited and recent concerns have led to a recall of a significant study. These complications should be reported to ensure patient safety and regulatory awareness. Conclusion: This report presents two cases of posterior uterine wall rupture following the use of Fetal Pillow. It calls for a larger, well run, randomized control trial to analyze the safety of Fetal Pillow use and suggests that all Obstetricians should be educated on alternative strategies for foetal head disimpaction during cesarean sections.

Hysteroscopic suture of levonorgestrel-releasing intrauterine system: learning curve for in vitro simulation training.

To simulate hysteroscopic suturing in vitro and analyze the learning curve of gynecologists with different experience levels. Three gynecologists were trained on uterine models in a circulating water box. The posterior uterine wall was sutured 10 times under hysteroscopy for 5 consecutive days, and the time of each suture procedure was recorded. Doctors A, B, and C completed 50 posterior uterine sutures. After Dr. C completed 50 sutures on the posterior wall, he added 50 sutures on the anterior wall (Group D). The mean suturing time was 71.54 ± 68.158 s in Group A, 50.10 ± 28.060 s in Group B, 34.04 ± 10.457 s in Group C, and 30.38 ± 8.734 s in Group D. The difference between Groups C and B and between Groups B and A was statistically significant. There was no statistically significant difference between Groups C and D. Simulation curves were created using the number of features as the abscissa and cumulative sum as the coordinate, with peak curves of 19, 27, and 18 cases for Group A, B, and C, respectively. Doctors with experience in single-hole laparoscopic surgery or hysteroscopic suture surgery can significantly shorten the hysteroscopic suturing time.

Outcomes of cesarean myomectomy via trans-endometrial approach in women with single intramural fibroid in the posterior uterine wall

Objective To evaluate the feasibility and effectiveness of cesarean myomectomy (CM) via trans-endometrial approach in pregnant women with single intramural fibroid in the posterior uterine wall. Methods Ninety-eight patients with single intramural fibroids in the posterior uterine wall who underwent CM were divided into two groups depending on surgical style. The study group consisted of 50 patients who underwent trans-endometrial myomectomy (EM), whereas the control group included 48 patients who had trans-serosal myomectomy (SM). Patients’ demographic data, intraoperative and postoperative outcomes were analyzed retrospectively. Results No significant differences were found in the baseline characteristics of the two groups, including demographic data, size, location of fibroids, comorbidities, and indications for cesarean section. During the perioperative period, we did not observe significant differences between the two groups in terms of intraoperative hemorrhage, blood transfusion rate, postoperative fever incidence and postoperative hospitalization (all p > .05). It’s worth noting that the time of operation and postoperative ventilation in the EM group was shorter than that in the SM group (p < .05). More importantly, estimated blood loss and postoperative hemoglobin decline were less in the EM group than in the SM group (p < .05). Conclusion EM seems to be a viable approach to CM for the treatment of single intramural fibroids in the posterior wall, with the potential advantages of short operative time, low intraoperative bleeding, and low risk of pelvic adhesions.

Efficacy and safety of percutaneous microwave ablation for adenomyosis in the posterior uterine wall.

To evaluate the efficacy and safety of percutaneous microwave ablation (PMWA) for treating adenomyosis in the posterior uterine wall. Thirty-six patients with symptomatic adenomyosis in the posterior uterine wall who had been subjected to PMWA were retrospectively enrolled in this study. 20 patients who had no ideal transabdominal puncture path due to the retroverted or retroflexed uterine position were treated with PMWA combined with Yu's uteropexy (Group 1). The other 16 patients were treated with PMWA only (Group 2). The non-perfused volume (NPV) ratio, symptomatic relief rate, recurrence rate, changes in clinical symptom scores, economic cost, and complications were compared. The mean NPV ratio for the 36 patients was 90.2±18.3%, and the percentage of patients who obtained complete relief of dysmenorrhea and menorrhagia was 81.3% (26/32), and 69.6% (16/23) respectively. The recurrence rate was 11.1% (4/36). No major complication was observed. Minor complications included lower abdominal pain, fever, vaginal discharge, nausea, and/or vomiting after ablation, with incidences of 55.6%, 41.7%, 47.2%, and 19.4% respectively. Subgroup analysis showed no significant difference in the median value of NPV ratio, symptomatic relief rate of dysmenorrhea and menorrhagia, changes in clinical symptom scores, recurrence rate and economic cost between the two groups (all p > 0.05). PMWA is an effective and safe treatment for adenomyosis in the posterior uterine wall. This study focused on the ultrasound-guided PMWA treatment for adenomyosis in the posterior uterine wall. Yu's uteropexy, a new ancillary technique allowing safe PMWA for deep posterior uterine wall lesions in retroverted uterus, expanded the indications of PMWA for symptomatic adenomyosis.

Реконструктивно-пластическая хирургия с сохранением репродуктивной функции у молодой пациентки с «гигантской» миомой матки

This article presents a clinical case of successful organ-preserving surgical treatment of giant uterine leiomyoma in a 29-year old patient. The tumor had an average diameter of 35 cm and was localized in the posterior uterine wall and cervical-pericervical region. The following procedures were performed: midline laparotomy, temporary occlusion of the internal iliac arteries, myomectomy with uterine cavity dissection, endometrial biopsy, and metroplasty. Key words: giant leiomyoma, myomectomy, reproductive potential, temporary vascular occlusion

Endometriosis and posterior uterine wall adhesions are often detected in placenta previa and low-lying placenta in assisted reproductive technology pregnancies.

Endometriosis and posterior uterine wall adhesions are often detected in placenta previa and low-lying placenta in assisted reproductive technology pregnancies.

Comprehensive surgical staging for placenta accreta spectrum

Objective To analyze how precise the surgical staging is after prenatal diagnosis of patients with placenta accreta spectrum (PAS). Material and methods This was a retrospective cohort study that included 622 women diagnosed with placenta accreta spectrum who underwent surgery between 1 January 2000, and 1 January 2020, in public, private, and university hospitals in Buenos Aires, Argentina. Prenatal diagnosis included abdominal and transvaginal ultrasounds and T2-weighted MRI scans. Comprehensive surgical staging (CSS) was performed by dissecting the coalescence spaces of the pelvic fasciae, including the broad ligament and the colpouterine and retrouterine spaces. Once the compromised uterine wall (lateral, anterior or posterior) was identified, the characteristics of the lesion were evaluated. The lateral invasion was classified as type A when there was no placental tissue in the parametrial zone; type B when the placental tissue protruded laterally and was covered by serosa, and type C when the placental tissue included neoformed vessels. Involvement of the retrovesical space (anterior uterine wall) was classified as type A when no neoformed vessels and no firm adherence between nearby organs were present, type B when the retrovesical area partially adhered but the planes could be dissected, and type C when the lower dissection of the vesicouterine space was extremely adhered or impossible. The posterior uterine aspect was classified after exteriorizing the organ, with the placenta still inside. It was determined as type A when there was no evidence of placental invasion, type B when there was organ adherence or it showed a heterogeneous appearance of the posterior uterine wall above the peritoneal reflection, and type C when there was adherence to other organs or when the invasion or neovascularization was below the peritoneal reflection. Results CSS increases the efficacy of prenatal studies, including ultrasound and MRI, by up to 50%. The diagnosis of type 2 (parametrial) PAS or low retrovesical invasion implied an immediate modification of the surgical tactics, vascular control, or a specific type of surgery. Additionally, deep interfacial dissection allowed the identification of healthy uterine tissue, modifying the initial indication of hysterectomy for a conservative reconstructive procedure. Conclusions Comprehensive surgical staging of PAS proved to be an excellent tool for determining the extent and specific topography of placental invasion

8144 Laparoscopic Robot-Assisted Hysterectomy with Vaginal Specimen Extraction Using Excite Technique of a Large Uterus

<h3>Study Objective</h3> Demonstrate a safe and didactic step-by-step hysterectomy of a leiomyoma large uterus using robotic platform and its vaginal specimen removal using Extracorporeal C-Incision Tissue Extraction (ExCITE) technique. <h3>Design</h3> Case report illustrated with a video. <h3>Setting</h3> Patient was placed in semi gynecological position, arms alongside the body and legs 80 grades abducted in adjustable leggings. Three 8mm robotic portals were placed on umbilical scar and both flanks. One additional 5mm portal was set in the right flank, for laparoscopic assistance. <h3>Patients or Participants</h3> 48-year-old woman reports abdominal bulge and pelvic pain for 6 months, with progressive worsening, radiating to lumbar region and legs. She also reports increased menstrual flow, with important loss of quality of life. MRI of the pelvis showed uterus with estimated volume of 920 cm³, heterogeneous myometrium due to multiple fibroids, the largest with 9.0 × 6.6 × 6.5 cm (vol 200 cm³), vascularized, determining compression on the upper wall of the bladder. <h3>Interventions</h3> Robot-assisted laparoscopic total hysterectomy was indicated. In the abdominal inventory, an 8x enlarged uterus was observed with multiple intramural and subserosal myomas, as well as thin adhesions between mesorectal and posterior uterine wall. Procedure was performed safely with practically no blood loss at all, and uterus was removed by vaginal access, with cold-knife morcellation, using ExCITE technique. <h3>Measurements and Main Results</h3> We obtained a safe and efficient surgical treatment on a large uterus hysterectomy using robotic surgery, with specimen removal by cold-knife morcellation. Patient evolved with complete resolution of symptoms and satisfactory postoperative recovery. <h3>Conclusion</h3> We showed with our case report a safe and reproducible step-by-step of a large uterus robotic hysterectomy, showing that robotic platform can be an important tool when dealing with challenging large uterus. Moreover, large specimen removal, which can also be tricky, can be easily and safely performed using ExCITE technique.

Spontaneous hemoperitoneum in pregnancy: Italian prospective population-based cohort study.

Spontaneous hemoperitoneum in pregnancy is defined as a sudden non-traumatic intraperitoneal bleeding in pregnancy and up to 42 days postpartum. In the present study we aim to estimate the incidence and investigate the risk factors, the management and the outcomes of spontaneous hemoperitoneum in pregnancy in order to improve its clinical identification and reduce avoidable maternal deaths. This is a prospective population-based cohort study, set in maternity units from nine Italian regions covering 75% of the national births. The study population comprises all women admitted for spontaneous intraperitoneal hemorrhage during pregnancy and up to 42 days postpartum between November 2017 and March 2020. Incident cases were reported by trained clinicians through electronic data collection forms. Descriptive statistics were performed. The main outcome measures included incidence rate of spontaneous hemoperitoneum in pregnancy, association with potential risk factors, clinical management and maternal and perinatal outcomes. Twenty-nine cases met the adopted definition of spontaneous hemoperitoneum in pregnancy with an estimated incidence rate of 0.04 per 1000 births. An increased risk ratio (RR) of this condition was observed in pregnancies conceived by assisted reproductive technology (RR=6.60, 95% CI 2.52-17.29), in the case of multiple pregnancies (RR=6.57, 95% CI 1.99-21.69) and maternal age ≥35 years (RR 2.10, 95% CI 1.01-4.35). In 17/29 cases the bleeding site was intra-pelvic (23.5% in the posterior uterine wall and 35.2% in the left hemipelvis). Laparotomy represented the surgical treatment in 27 cases (93%), and most women underwent a cesarean delivery (92.6%). Median blood loss was 1900 mL, one hysterectomy was necessary, and two women died. Twenty-two preterm births were recorded. Spontaneous hemoperitoneum in pregnancy is a rare, life-threatening condition associated with high perinatal morbidity and mortality. Maternal age ≥35 years, multiple pregnancies and assisted reproductive technology were associated to a higher risk of the condition. Two women of 29 died and 70% of births occurred preterm.

Endometrial polyps and their insinuation in the pregnancy rates of patients undergoing ICSI-FET cycles: A retrospective cohort study

To study the effect of endometrial polyps in infertility patients and their insinuation in pregnancy rates in patients undergoing ICSI-FET cycles following polypectomy.This is a retrospective study in 345 infertility patients attending Reproductive center of Sudha Hospital, Erode. Infertile women with endometrial polyps diagnosed by transvaginal ultrasound were subjected to hysteroscopic polypectomy. Vitrified embryo transfer was done one to three months following polypectomy and the clinical pregnancy rates were analysed. The age, body mass index, the type of infertility (primary or secondary), duration of infertility, pattern of menstruation, were precisely evaluated. An endometrial polyp based on their location inside the uterine cavity is assessed by hysteroscopy and the significance of the polyp location with pregnancy rates is evaluated.Of the 345 women who underwent hysteroscopic polypectomy 229 became pregnant and 116 women were non pregnant in ICSI-FET cycles. There is a strong positive association between endometrial polypectomy and pregnancy rate in ICSI-FET cycles. The incidence of Endometrial Polyps in pregnant and non-pregnant group was not related to the age, gravida and parity. Pregnancy rate after polypectomy based on polyp location is statistically insignificant. Multiple polyps are common compared to solitary polyp. Polyps are more common in posterior uterine wall than anterior, lateral walls and uterotubal junction.Hysteroscopic polypectomy gives promising results in infertility patients undergoing ICSI cycles prior to vitrified embryo transfer and location of polyps does not determine the pregnancy outcomes.

Basaloid Squamous Cell Carcinoma of the Uterine Cervix in a Northern Nigerian Hospital: A Case Report and Review of Literature

Basaloid squamous cell carcinoma occurs very rarely in the uterine cervix. Basaloid squamous cell carcinoma is a form of squamous cell carcinoma with a poor prognosis that primarily affects persons in their late sixties and early seventies. This paper describes a case of Basaloid squamous cell carcinoma in the fifth decade that had spread to the myometrium, ovaries, and fallopian tubes. The macroscopic findings of a total abdominal hysterectomy and bilateral salphingo-oophorectomy revealed an ulcerative fungating tumor distorting the whole cervix and macroscopic invasion of the posterior uterine wall. Histologic features revealed a Basaloid tumour disposed in nest exhibiting peripheral palisading and stromal retraction with most of the nest having comedo pattern of necrosis. The tumour cells are fairly small uniform round cells, with scanty cytoplasm having increased nuclei cytoplasmic ratio with vesicular to open nuclei. Immunohistochemical stains; Cytokeratins, EMA, p63 and Ki-67 showed cytokeratin positivity and EMA strong and diffuse positivity. Keywords: Basaloid Squamous cell Carcinoma, uterine cervix, p63, EMA, Ber-EP4

P-312 Effect on pregnancy outcomes of depot GnRH agonist pre-treatment before frozen-thawed embryo transfer cycles in patients with adenomyosis

Abstract Study question Is there any difference between using or not using depot GnRH agonist pre-treatment on pregnancy outcomes in patients with adenomyosis before frozen-thawed embryo transfer cycles? Summary answer GnRH agonist pre-treatment before frozen-thawed embryo transfer has no effect on pregnancy outcomes in adenomyosis patients. What is known already Uterine adenomyosis negatively affects implantation and clinical pregnancy rates and also increases the risk of early pregnancy loss. Increased inflammatory markers and increased myometrial peristalsis are thought to decrease the rate of implantation. Depot GnRH agonist pre-treatment is thought to increase implantation rate by both decreasing myometrial contractility and reducing inflammatory marker production. Study design, size, duration This retrospective cohort study was conducted at ART and Reproductive Genetics Centre, Memorial Sisli Hospital, Istanbul, Turkey. Patients with adenomyosis undergoing a FET cycle between 2011 and 2021 were evaluated. Patients between 25-45 years old with good and top-quality blastocysts were included and preimplantation genetic diagnosis (PGD) was applied to patients who were &amp;gt;37 years old. A total of 144 frozen embryo transfer cycles were examined. Participants/materials, setting, methods Diagnosis of adenomyosis was made using transvaginal ultrasound and/or pelvic magnetic resonance imaging which revealed an asymmetrically thickening between the anterior and posterior uterine walls, focal adenomyosis, myometrial cysts and irregular/interrupted junctional zone of the endometrium. 65 patients in the study group (Group I) who received depot GnRH agonist pre-treatment for minimum 2 and maximum 6 months and 79 patients without GnRH agonist pre-treatment (Group 2) were evaluated. Main results and the role of chance There was no significant difference in patient characteristics such as age, endometrial thickness on embryo transfer day, BMI, infertility duration, and anti mullerian hormone levels between groups 1 and 2. Endometrial preparation was done using artificial cycle in the depot agonist group, whereas both artificial and modified natural cycle were used in patients without depot GnRH agonist pre-treatment.The pregnancy rate was 53.8%(n = 35) in group 1 and 54.4%(n = 43) in group 2. The clinical pregnancy loss rate was 20% (n = 9) in group 1 and 15.7% (n = 6)in group 2. The live birth rate was 40% (n = 26) in group I and 39.2. (n = 31) in group II. There were no statistically significant differences in pregnancy rates, clinical pregnancy losses, and live birth rates between the groups. Limitations, reasons for caution The limitation of the study is its retrospective nature. Wider implications of the findings The lack of any statistically significant differences in pregnancy outcomes in this study suggests the need for further evaluation of the value/effectiveness of GnRHa treatment in adenomyosis patients before embryo transfer cycles. Trial registration number not applicable

Focal Resection of Lower Uterine Segment for Morbidly Adherent Placenta. An Alternative to Obstetric Hysterectomy-(Better Modality with Better Outcome)

Objectives: To focus on the benefits of focal resection of the lower uterine segment as compared to obstetric hysterectomy in patients with morbidly adherent placenta.Study Design: Quasi-experimental study.Place and Duration of Study: Combined Military Hospital Okara, Oct 2019 to Nov 2020.Methodology: Fifty-two women between 34 to 38 weeks of gestation were operated for morbidly adherent placenta. Group-I women (focal resection of the lower uterine segment) and Group-II (obstetric hysterectomy) were twenty-six each. In Group-I, hemostasis was secured by a figure of 8 sutures, purse-string sutures or continuous sutures. In Group-II, hemostasis was secured, and internal iliac artery ligation was done as required. &#x0D; Results: Group-I undergoing focal resection of lower uterine segment hemostasis was addressed by the figure of 8 sutures in 21 (80%) women and purse-string sutures in 7 women (27%). Hemostasis of the posterior uterine wall was done in 12 (47%) women. Balloon tamponade was used in 10 (40%) women and B-Lynch suture in 5 (20%) women. Internal iliac artery ligation was done in 4 (11%) women, and the bladder was injured in 10 (40%) women. Group-II undergoing obstetric hysterectomy hemostasis was secured for leftover placental tissue in 5 (18%) women, and internal iliac artery ligation was done in 9 (35%) women. Bladder repair was done in 12 (47%) cases. Conclusion: Although time-consuming, focal resection of the lower uterine segment and hemostasis are associated with less morbidity.