Thickness Of Myometrium Research Articles

Analysis of the relationship between MRI imaging characteristics and clinical symptoms and therapeutic efficacy in adenomyosis patients

Objective: To investigate the relationship between magnetic resonance imaging (MRI) imaging characteristics and clinical symptoms and therapeutic efficacy in adenomyosis patients. Methods: The clinical characteristics of the adenomyosis questionnaire was self-designed. This was a retrospective study. From September 2015 to September 2020, totally 459 patients were diagnosed with adenomyosis and underwent pelvic MRI examination at Peking University Third Hospital. Clinical characteristics and treatment were collected, MRI was used to determine the lesion location, and to measure the maximum lesion thickness, the maximum myometrium thickness, uterine cavity length, uterine volume, the minimum distance between the lesion and serosa or endometrium, and whether combined with ovarian endometrioma. The difference of MRI imaging characteristics in patients with adenomyosis and its relationship with clinical symptoms and therapeutic efficacy were analyzed. Results: (1) Among the 459 patients, the age was (39.1±6.4) years. There were 376 patients (81.9%, 376/459) with dysmenorrhea. Whether patients had dysmenorrhea were related to uterine cavity length, uterine volume, ratio of the maximum lesion thickness to the maximum myometrium thickness, and whether patients had ovarian endometrioma (all P<0.001). Multivariate analysis suggested that ovarian endometrioma was the risk factor for dysmenorrhea (OR=0.438, 95%CI: 0.226-0.850, P=0.015). There were 195 patients (42.5%, 195/459) with menorrhagia. Whether patients had menorrhagia were related to age, whether patients had ovarian endometrioma, uterine cavity length, the minimum distance between lesion and endometrium or serosa, uterine volume, ratio of the maximum lesion thickness to the maximum myometrium thickness (all P<0.001). Multivariate analysis suggested that ratio of the maximum lesion thickness to the maximum myometrium thickness was the risk factor for menorrhagia (OR=774.791, 95%CI: 3.500-1.715×105, P=0.016). There were 145 patients (31.6%, 145/459) with infertility. Whether the patients had infertility were related to age, the minimum distance between lesion and endometrium or serosa, and whether patients had ovarian endometrioma (all P<0.01). Multivariate analysis suggested that young and large uterine volume were risk factors for infertility (OR=0.845, 95%CI: 0.809-0.882, P<0.001; OR=1.001, 95%CI: 1.000-1.002, P=0.009). (2) The success rate of in vitro fertilization-embryo transfer (IVF-ET) was 39.2% (20/51). Dysmenorrhea, high maximum visual analogue scale score and large uterine volume affected the success rate of IVF-ET (all P<0.05). The smaller the maximum lesion thickness, the smaller the distance between the lesion and serosa, the larger the distance between the lesion and endometrium, the smaller the uterine volume, and the smaller the ratio of the maximum lesion thickness to the maximum myometrium thickness, the better the therapeutic efficacy of progesterones (all P<0.05). Conclusions: Concomitant ovarian endometrioma increases the risk of dysmenorrhea in patients with adenomyosis. The ratio of the maximum lesion thickness to the maximum myometrium thickness is an independent risk factor for menorrhagia. Young and large uterine volume may increase the risk of infertility. Severe dysmenorrhea and large uterine volume affect the success rate of IVF-ET. The therapeutic efficacy of progesterones is relatively better when the lesion is small and far away from the endometrium.

Cesarean Scar Ectopic Pregnancy Clinical Classification System With Recommended Surgical Strategy.

To establish a new cesarean scar ectopic pregnancy clinical classification system with recommended individual surgical strategy and to evaluate its clinical efficacy in treatment of cesarean scar ectopic pregnancy. This retrospective cohort study included patients with cesarean scar ectopic pregnancy in Qilu Hospital in Shandong, China. From 2008 to 2015, patients with cesarean scar ectopic pregnancy were included to determine risk factors for intraoperative hemorrhage during cesarean scar ectopic pregnancy treatment. Univariable analysis and multivariable logistic regression analyses were used to explore the independent risk factors for hemorrhage (300 mL or greater) during a cesarean scar ectopic pregnancy surgical procedure. The model was internally validated with a separate cohort. Receiver operating characteristic curve methodology was used to identify optimal thresholds for the identified risk factors to further classify cesarean scar ectopic pregnancy risk, and the recommended operative treatment was established for each classification group by expert consensus. A final cohort of patients from 2014 to 2022 were classified according to the new classification system, and the recommended surgical procedure and clinical outcomes were abstracted from the medical record. Overall, 955 patients with first-trimester cesarean scar ectopic pregnancy were included; 273 were used to develop a model to predict intraoperative hemorrhage with cesarean scar ectopic pregnancy, and 118 served as an internal validation group for the model. Anterior myometrium thickness at the scar (adjusted odds ratio [aOR] 0.51, 95% CI 0.36-0.73) and average diameter of the gestational sac or mass (aOR 1.10, 95% CI 1.07-1.14) were independent risk factors for intraoperative hemorrhage of cesarean scar ectopic pregnancy. Five clinical classifications of cesarean scar ectopic pregnancy were established on the basis of the thickness and gestational sac diameter, and the optimal surgical option for each type was recommended by clinical experts. When the classification system was applied to a separate cohort of 564 patients with cesarean scar ectopic pregnancy, the overall success rate of recommended first-line treatment with the new classification grouping was 97.5% (550/564). No patients needed to undergo hysterectomy. Eighty-five percent of patients had a negative serum β-hCG level within 3 weeks after the surgical procedure; 95.2% of patients resumed their menstrual cycles within 8 weeks. Anterior myometrium thickness at the scar and the diameter of the gestational sac were confirmed to be independent risk factors for intraoperative hemorrhage during cesarean scar ectopic pregnancy treatment. A new clinical classification system based on these factors with recommended surgical strategy resulted in high treatment success rates with minimal complications.

Fertility outcomes after hysteroscopic niche resection compared with expectant management in women with a niche in the uterine cesarean scar

ObjectiveTo determine whether hysteroscopic niche resection (HNR) and expectant management are suitable in women with fertility desire and a niche with a residual myometrium thickness (RMT) ≥ 2.5 mm. Study designThis retrospective cohort study was conducted at International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China between September 2016 and December 2021. We reported the fertility outcomes between women (with fertility desire and a niche with RMT ≥ 2.5 mm) who received HNR or expectant management. ResultsWe studied 166 women, of whom 72 accepted HNR and 94 accepted expectant management. The HNR group included more symptomatic women, in terms of postmenstrual spotting or infertility. No differences were found regarding niche measures before treatment. The live birth rate was comparable in both groups (HNR versus expectant management as 55.5% versus 45.7%, risk ratio = 1.48, 95% Cl 0.80–2.75, p = 0.21). The pregnancy rate was higher in HNR group than that in expectant management group (n = 72.2% versus n = 56.4%, risk ratio = 2.01, 95% CI 1.04–3.88, p = 0.04). In a subgroup of women with infertility before entry in the study, HNR resulted in a significant higher live birth rate (p = 0.04) and pregnancy rate (p = 0.01). ConclusionIn women with infertility with a symptomatic niche with RMT ≥ 2.5 mm, HNR may be superior to expectant management. This retrospective cohort biased selection against a randomized study, our results still need to be validated in the future with larger clinical multicenter randomized controlled trials.

Hysteroscopy-assisted Transvaginal Repair without Scar Defect Resection: A Novel Technique for the Treatment of Uterine Niche

To describe hysteroscopy-assisted transvaginal repair technique without scar defect resection for uterine niche. Surgical video article (Supplemental Videos 1-3). Stepwise narrated video demonstration of the novel technique. A total of 15 women diagnosed as having niche in the uterus were enrolled in our study. Patients provided a signed consent and there are no conflicts of interest. Niche in the uterus is defined as an indentation in the myometrium at the uterine incision owing to healing defects [1]. Surgical treatment options for niche include hysteroscopic, laparoscopic, and vaginal surgery [2]. Compared with hysteroscopic surgery, regular vaginal surgery may effectively increase the residual myometrium thickness, reducing the risk of subsequent pregnancy [3-5]. However, regular vaginal surgery removes the original scar defect followed by suture, which can lead to a new niche after the surgery and may postpone conception because of the new uterine incision [6]. Here we describe a new technique of hysteroscopy-assisted transvaginal repair for the niche, which does not remove the original scar defect [7]. This surgery may be beneficial for those who plan conceive as soon as possible after the operation. Hysteroscopy-assisted vaginal surgery without scar defect resection was selected as ideal surgical approach. Hysteroscopy was used for abnormal structures in the niche [8,9]. Opening the peritoneum through the vaginal wall confirmed the position of the niche, and a 2-0 absorbable suture was used to interruptedly suture the upper and lower margins of the scar defect and close the niche (or reduce its size), rather than resection. Hysteroscopy was used again to assess the status of the niche after suture and confirm repair. If unsatisfactory, suture procedure was repeated to close the remaining part of the niche. Our novel technique, described and demonstrated in this video article, is an efficacious and viable approach to treat uterine niche. Chinese experts recommend at least a 1-year gap between conventional scar defect resection with suturing and conception, because of the new uterine incision [6]. In contrast, this novel procedure avoids removal of the original scar defect and the surrounding scar tissue by directly repairing the lower uterine segment. Meanwhile, hysteroscopy can treat abnormal structures in the niche and improve effectiveness. Given that the integrity of the uterine myometrium is retained, this technique may help shorten contraception time after operation. Further studies with larger sample size, longer follow-up time, and more postoperative follow-up indicators, such as fertility outcomes, are needed to comprehensively evaluate the restorative effect of this novel technique.

Retracted: Carbetocin Controls Intraoperative Blood Loss and Thickness of Myometrium in Scar Uterus Cases.

[This retracts the article DOI: 10.1155/2022/5477432.].

Хирургическая коррекция дефекта рубца на матке после кесарева сечения. Есть ли место для оперативной гистероскопии?

Among the complications of abdominal delivery, a special place is occupied by a defect (failure) of the scar on the uterus after a cesarean section, a cesarean scar defect (CSD). The main problem of CSD is the risk of uterine rupture during subsequent pregnancies and births. However, CSD can cause several gynecological and obstetric disorders, including abnormal uterine bleeding, dysmenorrhea, infertility, and ectopic pregnancy. In addition to abdominal or vaginal metroplasty, treatment options for CSD include operative hysteroscopy, which has been emphasized in recent years. However, as our studies have shown, its potential to correct CSD is strictly limited and concerns primarily the management of gynecological symptoms in women not planning pregnancy. As an independent method, it can be used only in patients with deep but not wide isthmocele. The thickness of the residual myometrium in such cases is not of fundamental importance. Key words: cesarean scar defect, metroplasty, operative hysteroscopy, indications, conditions

Assessment of postpartum haemorrhage for placenta accreta: Is measurement of myometrium thickness and dark intraplacental bands using MRI helpful?

BackgroundThis study aimed to investigate the predictive values of magnetic resonance imaging (MRI) myometrial thickness grading and dark intraplacental band (DIB) volumetry for blood loss in patients with placenta accreta spectrum (PAS).MethodsImages and clinical data were acquired from patients who underwent placenta MRI examinations and were diagnosed with PAS from March 2015 to January 2021. Two radiologists jointly diagnosed, processed, and analysed the MR images of each patient. The analysis included MRI-based determination of placental attachment, as well as myometrial thickness grading and DIB volumetry. The patients included in the study were divided into three groups according to the estimated blood loss volume: in the general blood loss (GBL) group, the estimated blood loss volume was < 1000 ml; in the massive blood loss (MBL) group, the estimated blood loss volume was ≥ 1000 ml and < 2000 ml; and in the extremely massive blood loss (ex-MBL) group, the estimated blood loss volume was ≥ 2000 ml. The categorical, normally distributed, and non-normally distributed data were respectively analysed by the Chi-square, single-factor analysis of variance, and Kruskal–Wallis tests, respectively. The verification of correlation was completed by Spearman correlation analysis. The evaluation capabilities of indicators were assessed using receiver operating characteristic curves.ResultsAmong 75 patients, 25 were included in the GBL group, 26 in the MBL group, and 24 in the ex-MBL group. A significant negative correlation was observed between the grade of myometrial thickness and the estimated blood loss (P < 0.001, ρ = − 0.604). There was a significant positive correlation between the volume of the DIB and the estimated blood loss (P < 0.001, ρ = 0.653). The areas under the receiver operating characteristic curve of the two MRI features for predicting blood loss ≥ 2000 ml were 0.776 and 0.897, respectively.ConclusionsThe grading and volumetric MRI features, myometrial thickness, and volume of DIB, can be used as good prediction indicators of the risk of postpartum haemorrhage in patients with PAS.

Carbetocin Controls Intraoperative Blood Loss and Thickness of Myometrium in Scar Uterus Cases.

Objective To study the effect of carbetocin on intraoperative blood loss and thickness of myometrium during cesarean section with the scarred uterus at term pregnancy. Methods Pregnant women with full-term gestational scar uterus who underwent cesarean section from March 1, 2021, to April 30, 2022, were retrospectively collected and divided into a reference group (using oxytocin) or a study group (using carbetocin). The clinical data of the two groups were retrospectively analyzed, and the operation time, intraoperative blood loss, hospital stay, uterine contraction effect, changes in the myometrium, and complications were compared between the two groups. Results A total of 103 pregnant women were retrieved. There were 44 cases in the reference group and 59 cases in the study group. There were significant differences in operation time, intraoperative bleeding, hospital stay, postoperative adverse events, uterine fundus wall thickness, anterior wall thickness, posterior wall thickness, and uterine contraction effect between the two groups (p=0.0001, 0.005, 0.006, 0.001, 0.0004, 0.003, 0.001, and 0.005, respectively). There were no significant differences in estradiol (E2), luteinizing hormone (LH), or follicle-stimulating hormone (FSH) between the two groups before the surgery (p=0.596, 0.840, and 0.940, respectively), but there were significant differences after the surgery (p=0.011, 0.001, and 0.005, respectively). Conclusion The use of carbetocin in the cesarean section of a full-term scar uterus is significantly effective in shortening the operation time, reducing the amount of intraoperative blood loss, and promoting the recovery of the uterus.

Histomorphometric changes in the ovaries of thymectomized guinea pigs

Hypothalamic-pituitary-gonadal axis function is necessary for maintaining proper female reproductive cycle. This study aimed to evaluate the ovarian histomorphometric and histoarchitectural changes in neonatal, prepubertal and pubertal thymectomized female guinea pigs. A total of 30 female guinea pigs, sham-operated (n-5) and thymectomized (n-5) were studied in each group. The diameter and number of ovarian follicles among the thymectomized and sham operated female guinea pigs during estrus phase of estrous cycle was compared. Gonadal and accessory reproductive organs weights and microscopic features were studied in the sham operated guinea pigs and thymectomized. There were statistically significant changes in the number and diameter of follicles in the ovary in neonatal thymectomized female guinea pigs, but no significant changes were observed in prepubertal and pubertal female guinea pigs. Neonatal thymectomized female guinea pigs showed significant changes in their weight as well as changes in the microscopic features including reduced thickness of myometrium of uterus and less mucosal folding in the fallopian tube compared to the sham-operated group. But prepubertal and pubertal thymectomy did not affect the weight and microscopic features of gonads and accessory reproductive organs. Depending on the time of thymectomy, these results indicate morphological changes in the ovaries after thymectomy in females.

Circadian desynchronization in pregnancy of Golden hamster following long time light exposure: Involvement of Akt/FoxO1 pathway.

Coordination between central and peripheral reproductive clocks in females is poorly understood. Long light is having a hazardous effect on reproductive health. Hence, explored the effect of long-time light exposure (LLD; 16L:8D) on the central and peripheral reproductive (ovary and uterus) clock genes (Bmal1, Clock, Per1, Per2, Cry1 and Cry2) and its downstream regulators (Aanat, Egf, Cx26, Cx43, ERα, pAktS-473, pAktT-308, pFoxO1T-24, 14-3-3, HoxA10, HoxA11 and Pibf) expression in non-pregnant and pregnant Golden hamster. Young adult Golden hamsters were exposed to LLD for 30days and then were mated. We observed that LLD exposure increased the thickness of the endometrium and reduced myometrium thickness, resembling uterine adenomyosis. In non-pregnant females LLD altered the expressions of clock genes in suprachiasmatic nuclei (SCN), ovary and the uterus along with serum estradiol rhythm. LLD upregulated Egf and downregulated Aanat, Cx26, and Cx43 mRNA levels in uterus. LLD upregulated Akt/FoxO1 phosphorylation and 14-3-3 expressions in the uterus of nonpregnant females. LLD exposure to pregnant females lowered serum progesterone, Aanat, Pibf, Hoxa10, and Hoxa11 mRNA expressions on D4 (peri-implantation) and D8 (post-implantation) resulting in a low implantation rate on D8 (post-implantation). Hence it is evident that the frequent pregnancy anomalies noted under a long light schedule might be due to desynchronization in Aanat, Pibf, Hoxa10, and Hoxa11 as well as the central and peripheral clock genes (Bmal1, Clock, Per1, Per2, Cry1 and Cry2). LLD exposure desynchronized the central and peripheral reproductive clock affecting uterine physiology via Akt/FoxO1 pathway in Golden hamsters. Thus, LLD is a risk factor for female reproductive health and fertility.

Prediction of uterine dehiscence via machine learning by using lower uterine segment thickness and clinical features

With the global increase of cesarean delivery rates, the long-term effects of cesarean delivery have started to become clearer. One of the most prominent complications of cesarean delivery in recurrent pregnancies is uterine rupture. Assessing the risk of uterine rupture by accurately predicting dehiscence is very important to prevent untimely operations and/or maternal and fetal complications. This study aimed to assess whether machine learning can be used to predict uterine dehiscence by using patients' ultrasonographic findings, clinical findings, and demographic data as features. Hence, we investigated a potential method for preventing uterine rupture and its maternal and fetal complications. The study was conducted on 317 patients with term (>37 weeks' gestation) singleton pregnancies and no medical complications or medications that may affect uterine wound healing. Demographics, body mass indices, smoking and drinking habits, clinical features, past pregnancies, number and history of abortions, interdelivery period, gestational week, number of previous cesarean deliveries, fetal presentation, fetal weight, tocography data, transabdominal ultrasonographic measurement of lower uterine segment full thickness and myometrium thickness, and lower uterine segment findings during cesarean delivery were collected and analyzed using machine learning techniques. Logistic regression, multilayer perceptron, support vector machine, random forest, and naive Bayes algorithms were used for classification. The dataset was evaluated using 10-fold cross-validation. Correct classification rate, F-score, Matthews correlation coefficient, precision-recall curve area, and receiver operating characteristic area were used as performance metrics. Among the machine learning techniques tested in this study, the naive Bayes algorithm showed the best predictive performance. Among the various combinations of features used for prediction, the essential features of parity, gravidity, tocographic contraction, cervical dilation, dilation and curettage, and sonographic thickness of lower uterine segment myometrium yielded the best results. The second-best performance was achieved with sonographic full thickness of lower uterine segment added to the base features. The base features alone could classify patients with 90.5% accuracy, whereas adding the myometrium measurement increased the classification performance by 5.1% to 95.6%. Adding the full thickness measurement to the base features raised the classification performance by 4.8% to 95.3% in terms of correct classification rate. The naive Bayes algorithm can correctly classify uterine dehiscence with a correct classification rate of 0.953, an F-score of 0.952, and a Matthews correlation coefficient value of 0.641. This result can be interpreted as indicating that by using clinical features and lower uterine segment ultrasonography findings, machine learning can be used to accurately predict uterine dehiscence.

P-752 Fertility outcomes after hysteroscopic niche resection compared with expectant management in patients with a niche in the uterine cesarean scar

Abstract Study question Whether hysteroscopic niche resection is suitable for patients with a niche in the uterine cesarean scar and with fertility desire compared with expectant management. Summary answer Hysteroscopic niche resection is a effective treatment for patients with fertility desire compared with expectant management and satisfactory obstetrical outcomes could be achieved. What is known already The specific treatment method for niche should be determined according to the patient’s symptoms, fertility desire and niche features,up to now, hysteroscopic niche resection has been shown effective to reduce abnormal uterine bleeding. However, similar to expectant treatment, hysteroscopic niche resection does not reconstruct the lower uterine segment, whether hysteroscopic niche resection affect fertility outcomes remains controversial. Study design, size, duration We designed a single-center retrospective cohort study. We included patients with desire to conceive that underwent hysteroscopic niche resection or expectant management between 2016.9-2020.12. The date of entry for each woman was the date of treatment or the date that the niche was diagnosed. The last day of analysis was the date of the first delivery or the last follow-up visit in women who remained non-livebirth. Participants/materials, setting, methods This study was conducted in a university-affiliated gynecology hospital. A total of 71 patients that underwent hysteroscopic niche resection and 97 patients that underwent expectant management were recruited. All women were followed up yearly until December 2021 for the occurrence of live birth. A Cox proportional hazards regression model with potential variables to identify predictors of pregnancy was also processed. Main results and the role of chance Baseline characteristics of age, gravidity, parity, previous cesarean section, and anatomical indicators of niche were not significantly different between the groups. However patients in the hysteroscopic niche resection had a longer menstruation duration (hysteroscopic niche resection vs expectant management as 12(10/14) vs 7(7/10), P &amp;lt;0.001) and a longer infertility period before treatment(hysteroscopic niche resection vs expectant management as 48.00±36.28 vs 23.11±20.34, P = 0.014). The overall live birth rate was similar in both groups (hysteroscopic niche resection vs expectant management as 37/71 [52.11%] vs 40/97 [41.23%], P = 0.162). For the live births in the two groups, no uterine rupture occurred.The total pregnancy rate was higher in the hysteroscopic niche resection group (hysteroscopic niche resection vs expectant management as 50/71 [70.40%] vs 50/97 [51.54%], P = 0.014). What’s more, for patients with infertility before treatment,there was a statistically significant difference regarding time to pregnancy between the two groups (P = 0.049). After adjustment for confounding factors including age, numbers of cesarean section, infertility peroid before treatment, anatomical indicators of niche and menstruation duration, cox proportional hazards analysis revealed that women underwent hysteroscopic niche resection were positively correlated to pregnancy (AHR = 1.646, 95% CI [1.081-2.506]). Limitations, reasons for caution This study was a single-center retrospective cohort study, to strengthen the conclusion, more prospective studies that include larger sample sizes and multiple centers should be conducted. Wider implications of the findings For asymptomatic cesarean scar defect patients whose residual myometrium thickness is sufficient, the expectant treatment is practical. However, for patients with abnormal uterine bleeding or infertility, hysteroscopic niche resection should be recommended. Trial registration number not applicable

Comparative analysis of classical primary continuous and novel technique uterine suturing methods on uterine scar formation after caesarian section: a prospective clinical study.

The study investigated isthmocele rate, residual myometrium thickness, blood loss, and closure lengths through comparing the classical primary continuous suturing (CPCS) and novel technique uterine suturing (NTUS) after caesarian section. A total of 402 C/S patients were included in this single-center prospective clinical study. All patients were divided into two groups according to suture technique. Classical primary continuous suturing (CPCS) was applied to the patients in Group 1, while the novel technique uterine suturing (NTUS) was applied in Group 2 as Z suture on both corners and 8 sutures in the remaining middle part incision closure. Patients in the NTUS group bled less than in the CPCS groups (p < 0.0001). Incision length after closure was longer in the CPCS than in the NTUS (p < 0.0001). Similarly, the number of sutures we applied was higher in the CPCS (p < 0.0001). In comparison of residual myometrium thickness, the mean values measured 197 ± 50 mm in the NTUS and 146 ± 39 mm in the CPCS (p < 0.0001). Residual myometrium thickness showed a negative strong correlation with incision length after closure (r = -0.436; p < 0.0001), how many times the needles have been passed (r = -0.423; p < 0.0001) and time for suturing (r = -0.237; p < 0.0001). NTUS and CPCS groups were similar in comparison to isthmocele. The NTUS, termed as Erkayiran's suture, showed a successful reflection in our surgical cesarean section application compared to the classical suture. Although the occurrence of isthmocele in patients was similar, results were quite successful operationally in terms of both minimal blood loss and increased residual myometrium thickness.

Definition and sonographic reporting system for Cesarean scar pregnancy in early gestation: modified Delphi method.

ABSTRACTObjectiveTo develop a standardized sonographic evaluation and reporting system for Cesarean scar pregnancy (CSP) in the first trimester, for use by both general gynecology and expert clinics.MethodsA modified Delphi procedure was carried out, in which 28 international experts in obstetric and gynecological ultrasonography were invited to participate. Extensive experience in the use of ultrasound to evaluate Cesarean section (CS) scars in early pregnancy and/or publications concerning CSP or niche evaluation was required to participate. Relevant items for the detection and evaluation of CSP were determined based on the results of a literature search. Consensus was predefined as a level of agreement of at least 70% for each item, and a minimum of three Delphi rounds were planned (two online questionnaires and one group meeting).ResultsSixteen experts participated in the Delphi study and four Delphi rounds were performed. In total, 58 items were determined to be relevant. We differentiated between basic measurements to be performed in general practice and advanced measurements for expert centers or for research purposes. The panel also formulated advice on indications for referral to an expert clinic. Consensus was reached for all 58 items on the definition, terminology, relevant items for evaluation and reporting of CSP. It was recommended that the first CS scar evaluation to determine the location of the pregnancy should be performed at 6–7 weeks' gestation using transvaginal ultrasound. The use of magnetic resonance imaging was not considered to add value in the diagnosis of CSP. A CSP was defined as a pregnancy with implantation in, or in close contact with, the niche. The experts agreed that a CSP can occur only when a niche is present and not in relation to a healed CS scar. Relevant sonographic items to record included gestational sac (GS) size, vascularity, location in relation to the uterine vessels, thickness of the residual myometrium and location of the pregnancy in relation to the uterine cavity and serosa. According to its location, a CSP can be classified as: (1) CSP in which the largest part of the GS protrudes towards the uterine cavity; (2) CSP in which the largest part of the GS is embedded in the myometrium but does not cross the serosal contour; and (3) CSP in which the GS is partially located beyond the outer contour of the cervix or uterus. The type of CSP may change with advancing gestation. Future studies are needed to validate this reporting system and the value of the different CSP types.ConclusionConsensus was achieved among experts regarding the sonographic evaluation and reporting of CSP in the first trimester. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Association between the occurrence of adenomyosis and the clinical outcomes of vaginal repair of cesarean section scar defects: an observational study

BackgroundTo examine the correlation between the occurrence of adenomyosis and the outcome of vaginal repair of cesarean section scar defects (CSDs).MethodsA total of 278 women with CSD were enrolled in this retrospective observational cohort study at the Shanghai First Maternity & Infant Hospital between January 2013 and August 2017. Patients were divided into two groups according to preoperative magnetic resonance imaging (MRI) findings: the adenomyosis group and the non-adenomyosis group. They all underwent vaginal excision and suturing of CSDs and were required to undergo examinations 3 and 6 months after surgery. Preoperative and postoperative clinical information was collected. Optimal healing was defined as a duration of menstruation of no more than 7 days and a thickness of the residual myometrium (TRM) of no less than 5.8 mm after vaginal repair.ResultsBefore vaginal repair, for patients in the adenomyosis group, the mean duration of menstruation was longer and TRM was significantly thinner than those in patients in the non-adenomyosis group (p < 0.05). The TRM and duration of menstruation 3 and 6 months after surgery were significantly improved in both groups (p < 0.05). There were more patients with optimal healing in the non-adenomyosis group than in the adenomyosis group (44.7% vs. 30.0%; p < 0.05). Furthermore, 59.3% (32/54) of the women tried to conceive after vaginal repair. The pregnancy rates of women with and without adenomyosis were 66.7% (8/12) and 61.9% (26/42), respectively. The duration of menstruation decreased significantly from 13.4 ± 3.3 days before vaginal repair to 7.6 ± 2.3 days after vaginal repair in 25 patients (p < 0.001). The TRM increased significantly from 2.3 ± 0.8 mm before vaginal repair to 7.6 ± 2.9 mm after vaginal repair (p < 0.001).ConclusionsVaginal repair reduced postmenstrual spotting and may have improved fertility in patients with CSDs. Patients with adenomyosis are more likely to have suboptimal menstruation and suboptimal healing of CSDs. Adenomyosis might be an adverse factor in the repair of uterine incisions.

472. Case report of successful pregnancy after hysteroscopic repair щa isthmocele with residual myometrium thickness of less than 3mm

Issues of isthmocele (IC) treatment are actual as frequency of cesarean sections (CS) continues to grow. IC can cause abnormal uterine bleeding, dysmenorrhea, fertility impairment and pregnancy complications. Currently the following approaches to surgical treatment of IC are used: for women not planning pregnancy, with residual myometrium thickness (RMT) >3mm, hysteroscopy is most appropriate; for women planning pregnancy, especially with RMT<3mm, laparoscopic repair is advised. Though comparative studies are lacking.

A Comparative Study of Transvaginal Sonography and Pelvic MRI in Patients with Endometrial Cancer

Background: The most prevalent type of gynecological cancer is endometrial cancer. Accurate surgical staging is the most important aspect in the management of endometrial cancer. Preoperative evaluation of myometrial invasion and appropriate management could be achieved by transvaginal sonography and pelvic MRI. Methods: A total of 53 patients with endometrial cancer, who were referred to a gynecology oncology department of an academic hospital in Mashhad University of Medical Sciences from 2018 to 2020, were evaluated in this study. Data were collected using a questionnaire on endometrial cancer. All the patients underwent preoperative transvaginal sonography and pelvic MRI to evaluate myometrial invasion. The involvement of myometrium thickness and histological findings were compared between two imaging modalities, and SPSS 23.0 was used to analyze the data. Results: Junctional irregularity was the most prevalent finding on transvaginal sonography. Based on transvaginal sonography, myometrial invasion of less than 50% was found in 73% of patients, while invasion of more than 50% was observed in 26.31%. In 57.44% of MRIs, there was less than 50% myometrial invasion, while in 42.55% of MRIs, there was more than 50% myometrial invasion. In both modalities, the most common finding was myometrial invasion of less than 50%. The accuracy, sensitivity, and specificity of transvaginal sonography were 0.47, 0.27, and 0.75, respectively, whereas the accuracy, sensitivity, and specificity of MRI were 0.54, 0.45, and 0.61, respectively. Conclusion: MRI can be the modality of choice for evaluating myometrial invasion and optimizing endometrial cancer treatment planning, as well as reducing the complications of non-indicated lymphadenectomy.

Safety and efficacy of microwave endometrial ablation for patients with previous uterine surgery: a pilot study

MEA (microwave endometrial ablation) is a treatment that can control hypermenorrhea. With the increase in the number of caesarean sections and myomectomies, an increasing number of patients with MEA have undergone previous incision of the uterine myometrium. Uterine perforation is major complication. Here we compared the incidence of complications and recurrence between groups with or without previous uterine surgery. 35 patients who underwent MEA were enrolled in the study. We assessed the thickness of uterine myometrium by MRI and transvaginal ultrasonography (TV-US). 12 patients (34%) had previous uterine surgery; Among 12 patients with previous uterine surgery, 6 (50%) showed thinning of the myometrium. No patient showed any complications. There was no difference in recurrence rate between two groups (1/12 = 8% and 2/23 = 8%, respectively). MEA can be performed safely and effectively even for patients with previous uterine surgery. IMPACT STATEMENT What is already known on this subject? MEA (microwave endometrial ablation) is a treatment that can control hypermenorrhea.A few serious complications have been reported, including uterine perforation and intestinal injury. There have been no collective reports on women with a history of uterine surgery, and the decision to perform MEA and the detailed procedures have not been clarified. What do the results of this study add? No patient who received MEA showed any complication regardless of previous uterine surgery. There was no difference in recurrence rate of hypermenorrhea between groups with and without previous uterine surgery. MEA could be performed safely and effectively in patients with previous uterine surgery preoperative imaging and intraoperative ultrasounds What are the implications of these findings for clinical practice and/or further research? Curently, with the increase in the number of caesarean sections and myomectomies, the increasing number of patients with MEA have undergone previous incision of the uterine myometrium and this causes thinning of the myometrium. MEA can be safely performed without losing any therapeutic effect, even in patients with a history of uterine surgery, by using MRI and TV-US as preoperative evaluations.

Improvement of symptoms after hysteroscopic isthmoplasty in women with abnormal uterine bleeding and expected pregnancy: A prospective study

BackgroundCesarean scar myometrial defect as known as niche is associated with postmenstrual spotting, suprapubic pain and secondary infertility. Hysteroscopic isthmoplasty has been proposed in the treatment of niche. This study aims to determine the safety and effectiveness of hysteroscopic isthmoplasty in postmenstrual spotting treatment and improvement of spontaneous conceiving. Materials and methodA prospective study was performed at Hanoi Obstetrics and Gynecology Hospital, Vietnam. We studied women who developed postmenstrual spotting related to niches and had desired to conceive for more than six months. Women with residual myometrium less than 2.5 mm were excluded. Twenty-three eligible women underwent hysteroscopic isthmoplasty with four main steps, including identification of relevant anatomy, resection of the cephalad edge of fibrosis, resection of the caudal edge of fibrosis, and ablation of the niche base. Participants were followed up at 1, 3, and 6 months postoperatively. ResultsThe mean surgical duration was 17 min, and no complications took place. The number of women with improved postmenstrual spotting symptoms after 1, 3, and 6 months were 39.1% (9/23), 61.9% (13/21) and 68.8% (11/16), respectively. Suprapubic pain resolved in 94% (15/16) of the women in the first month. The rate of spontaneous pregnancies within 6 months of isthmoplasty was 30.4% (7/23). There were no differences in depth niche and residual myometrium thickness on ultrasound in the period before and after hysteroscopy. ConclusionOur study supports that hysteroscopic isthmoplasty is a safe and effective procedure for women with a niche and postmenstrual spotting and wish to conceive.

Effects of isoflavone supplementation on endometrial thickness, endometrial hyperplasia, and cancer in ovariectomized cats.

Ovariectomy is identified as a standard treatment in different European countries. Isoflavones, as nonsteroidal compounds in plants, are common constituents of soy and soy products. Some available cat diets contain different concentrations of soy products. This study aimed to examine the effects of isoflavone supplementation on endometrial hyperplasia and endometrial thickness in ovariectomized cats. Fifteen neutered adult cats were divided into control, estradiol, and isoflavone groups (five cats per group). Subcutaneous injection of estradiol (0.5 μg) in sesame oil (100 μL) was done for 30 days in estradiol-treated cats. Isoflavone-treated cats ingested a single oral tablet of soy extract for 30 days, while the controls received subcutaneous injections of the vehicle and oral placebo for 30 days. Histopathological findings of hematoxylin and eosin-stained sections revealed a significant difference between the estradiol group and other groups in terms of hyperplastic epithelium and simple hyperplasia. Thickness of myometrium was greater in the estradiol group compared to the isoflavone and control groups. Higher concentrations of estrogen can affect the endometrium and myometrium, while 30-day ingestion of isoflavone didn't have any uterine effect.