Endometrial thickness in patients with postmenopausal bleeding and endometrial cancer: A retrospective cohort study.

Adenomyosis is characterized by the presence of ectopic endometrial glands and tissue within the myometrium. The diagnosis and detection of adenomyosis on imaging have been hindered by a lack of consensus among clinicians and the historical view that diagnosis can only be made through histopathology posthysterectomy. The purpose of this review is to discuss updates in imaging findings for adenomyosis and summarize the current literature regarding ultrasonography. The Morphological Uterus Sonographic Assessment consensus published in 2015, with updates in 2018 and 2022, has provided novel criteria for ultrasound diagnosis of adenomyosis. Studies comparing ultrasound with MRI have found that these imaging methodologies have similar sensitivity, specificity, and accuracy. However, concerns remain about the repeatability and reproducibility of these features in ultrasound imaging. There is a strong need for universal adoption to enhance ultrasound reporting and access for adenomyosis. Transvaginal ultrasonography is a widely available, time- and cost-effective imaging modality with excellent detection rates of adenomyosis. Common terms, definitions, and diagnostic criteria are needed among clinicians worldwide. Early recognition and diagnosis of adenomyosis and associated endometriosis are essential for streamlined treatment, improved quality of life, and prevention of disease progression.

Diagnosis of acute and chronic pelvic inflammatory disease continues to be a challenge despite advances in investigative procedures. Complications of PID include infertility, chronic pelvic pain and ectopic pregnancy. Currently, transvaginal ultrasonography is primarily used to detect tubo-ovarian abscesses (TOA) or pyosalpinx. We present a case where dynamic transvaginal ultrasound can detect filmy adhesions in the posterior the cul-de-sac corresponding to surgically confirmed PID. A 19-year-old nulliparous female with chronic pelvic pain and presumed endometriosis underwent an advanced pelvic ultrasound demonstrating an anteverted uterus, a normal right ovary with mild thickening and erythema of the right fallopian tube, and a normal left ovary and fallopian tube. There were no signs of adhesions within the anterior compartment. A positive sliding sign was noted, suggesting a non-obliterated cul-de-sac. However, multiple filmy adhesions were detected along the right rectouterine pouch, aided by the presence of pelvic-free fluid. There were no findings of hydro/pyosalpinx or TOA. Using ultrasound, deep and ovarian endometriosis were also ruled out. During surgical evaluation, there were clear findings of PID, including filmy adhesions within the rectouterine pouch and Fitz-Hugh-Curtis adhesions in the right upper quadrant. Given this unique finding, we propose using transvaginal ultrasonography to enhance the diagnosis of chronic PID for patients suffering from pelvic pain. While superficial endometriosis can also present with similar findings, we believe there is a quantification difference whereby PID presents with more diffuse adhesions in the absence of other features of endometriosis.

Infertility affects 17.5% of adults globally, with women facing severe social consequences. Early diagnosis and treatment are crucial in addressing this significant health issue. This cross-sectional study aimed to evaluate the clinico-radiological status of infertility among Bangladeshi women and identify associated factors. A total of 35 women aged 18 and above who sought infertility care at Popular Diagnostic Centre, Dhaka, were included. After consent, participants underwent Hysterosalpingography (HSG) and Transvaginal Sonography (TVS). Data were collected via interviews and analyzed using SPSS (Version 23.0). The participants, all married, had an average age of 29.0±6.30 years. Most were Muslim (88.6%) and homemakers (80.0%), with 25.7% having a college/university education. Secondary infertility (65.8%) was more common than primary infertility (34.3%). The average marriage duration was 8.93±5.26 years. Comorbidities were noted in 74.3%, including anxiety/depression (34.3%), obesity (25.7%), thyroid dysfunction (25.7%) and diabetes (8.6%). Hysterosalpingography (HSG) showed normal findings in 60.0%, while others had abnormalities like a bicornuate uterus, tubal blockages, or cervical incompetence. Only 11.6% had normal Transvaginal Sonography (TVS) results. Common findings included absent dominant follicles (28.6%), PCOS (20.0%) and a right ovarian chocolate cyst (5.8%). All participants were undergoing hormonal or fertility treatment during TVS. No statistically significant associations were found between participants' diagnoses, their husbands' semen analysis, or age and abnormal HSG or TVS findings. The revelations of this study underscore the urgency of addressing infertility in Bangladesh, aiding strategy development and resource allocation for better management in resource-limited settings.

This Clinical Practice Update provides revised guidance on the use of transvaginal ultrasonography to triage patients with postmenopausal bleeding. This document is a focused update of related content in Committee Opinion No. 734, The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding (Obstet Gynecol 2018;131:e124-9).

Early endometrial metastasis from triple-positive breast cancer is a rare phenomenon in young patients, especially when anti-human epidermal growth factor receptor 2 (HER2) target therapy is used as the primary treatment. We present a case of a 24-year-old patient with advanced triple positive breast cancer. The patient developed abnormal uterine bleeding during chemotherapy combined with anti-HER2 therapy (trastuzumab plus pyrotinib). Due to the transvaginal sonography are not characteristic and the low incidence rate of endometrial metastasis from breast cancer, this potential diagnosis was overlooked. The disease progressed rapidly thereafter, and the overall survival was only 13 months. The swift and devastating progression highlight the immense challenges in managing such complex cases. It remains a current challenge to identify such cases at an early stage and explore more effective therapeutic regimens. Based on this case review and previous studies, we speculate that disease progression might be attributed to the absence of endocrine therapy, chemotherapy resistance, or insufficient anti-HER2 therapeutic intensity. This case provides new insights into the metastatic pattern of HER2-positive breast cancer under targeted drug resistance. Clinicians should be alert to the possibility of reproductive system metastasis during anti-tumor treatment. Timely diagnosis and appropriate treatment are expected to improve patient prognosis.

To assess the impact of serial versus once-only transvaginal ultrasound (TVU) cervical length (CL) screening in twin pregnancies. Multicenter retrospective cohort study including twin pregnancies who underwent TVU CL screening from 160/7 to 236/7 weeks of gestation between 2017 and 2022. Twin pregnancies resulting from multifetal pregnancy reduction after 14 weeks of gestation, monochorionic monoamniotic twins, and those undergoing a history-indicated cerclage were excluded. Cases were stratified into two groups based on number of TVU CL assessments: twins who had more than one CL assessment from 160/7 to 236/7 weeks' gestation (i.e., serial CL group) versus twins who had only one CL assessment at the time of their detailed fetal anatomy ultrasound from 180/7 to 216/7 weeks' gestation (i.e., once-only CL group). Sensitivity, specificity, positive predictive value, and negative predictive value of CL screening for predicting preterm birth (PTB) at various gestational age cutoffs (<34, <32, and <28 weeks of gestation) were calculated using thresholds of both ≤25 and ≤30 mm and compared between the two groups. Statistical significance was set at p < 0.05. Of the 1,917 patients included, 962 (50.2%) were in the serial CL group and 955 (49.8%) were in the once-only CL group. The incidence of a short CL ≤ 25 mm was significantly higher in the serial CL group compared with the once-only CL group (12.6 vs. 0.9%, p <0.001). The sensitivity of CL screening for predicting PTB, when using a threshold of ≤25 mm, was higher in the serial CL group compared with the once-only CL group for each PTB cut-off (<34 weeks: 27.9 vs. 4.2%; <32 weeks: 40.7 vs. 7.4%; <28 weeks: 47.2 vs. 11.8%, respectively). Serial TVU CL screening from 160/7 to 236/7 weeks of gestation should be considered in twin pregnancies. · Serial CL screening increased the detection of a short cervix compared with once-only screening.. · Serial CL screening improved sensitivity for predicting PTB compared with once-only screening.. · Serial transvaginal CL screening from 16 to 236/7 weeks should be considered in twin pregnancies..

To evaluate a multimodal deep learning model integrating preoperative transvaginal ultrasound (TVUS)-based radiomics features and clinical indicators for predicting 1-year postoperative recurrence of endometrial polyps (EP) after hysteroscopic polypectomy. A total of 116 patients with pathologically confirmed EP were assigned to a training cohort (n=81) and validation cohort (n=35). Radiomics features were extracted from TVUS images, and deep learning features were obtained using ResNet-based networks. These features, with clinical variables, were combined to build a multimodal model. Feature selection in the training cohort used reproducibility filtering (intraclass correlation coefficient [ICC] >0.80), univariate analysis, Pearson correlation (|r|>0.90), and least absolute shrinkage and selection operator (LASSO) regression. Model performance was evaluated by receiver operating characteristic (ROC) curves, area under the curve (AUC), calibration, and decision curve analysis (DCA). The multimodal model achieved AUCs of 0.941 (95 % CI: 0.897-0.985) and 0.922 (95 % CI: 0.852-0.992) in training and validation cohorts, outperforming clinical (0.812, 0.791) and radiomics-only models (0.871, 0.843). DeLong tests were significant (p<0.05). DCA showed higher clinical net benefit. This multimodal model effectively predicts 1-year recurrence after hysteroscopic EP resection, supporting individualized postoperative management.

Rectal endometriosis is a severe form of deep endometriosis affecting up to 12% of patients, causing significant pain and bowel dysfunction. The optimal surgical approach can be individually tailored based on lesion size and localization as assessed by preoperative imaging. To compare the postoperative and long-term clinical results of two alternative surgical approaches to symptomatic rectal endometriosis. A retrospective single-centre study of 115 patients who had surgical resection of rectal endometriosis either by complete nodular resection (CNR) (n=55) or segmental rectal resection (SRR) (n=60). The surgical approach was indicated based on #Enzian related presurgical transvaginal sonography. #Enzian C1-2 lesions were planned for CNR, and #Enzian C3 lesion for SRR. Postoperative pain and satisfaction data were collected. Satisfaction and change in pre-operative and post-operative pain symptoms and overall improvement in symptoms, urinary and bowel dysfunction measured at follow-up and complications following surgery. 68/115 (59%) women provided follow up data. There were significant reductions in dysmenorrhoea, dyspareunia and dyschezia following surgical resection compared to pre-operative levels in both groups (P≤0.001). Patients treated with CNR had significantly lower postoperative defecation dysfunction compared to SRR (12.1% vs. 42.9%, P=0.007) and lower postoperative C-reactive protein (CRP) levels (P<0.001), but satisfaction and complication rates were comparable between the two surgical approaches. One case of leakage occurred following SRR and no cases of fistulisation or bowel stenosis were observed. CNR and SRR are both safe and effective in treating symptomatic rectal endometriosis. CNR may be associated with lower postoperative defecation dysfunction rates and lower postoperative CRP levels. Complete nodular mucosa-sparing resection of rectal endometriosis seems to be feasible and potentially efficacious in lesions up to 3 cm. Compared to SRR, CNR may be associated with less post-operative defecation dysfunction.

Holoprosencephaly (HPE) is a rare congenital condition encompassing incomplete midline cleavage of the prosencephalon and associated craniofacial abnormalities. We report a rare case of a 34-year-old Memon woman, gravida 3 para 2, with no known comorbidities or exposure to teratogens, who presented for her 12-week scan which revealed a single alive fetus having an absent falx cerebri with fused thalami, a single large posterior ventricle, and facial anomalies suggestive of alobar HPE. A follow-up ultrasound showed abnormally fused portions of the brain and a high amniotic fluid index (AFI), indicating polyhydramnios. The fetus had intrauterine death at 7months of gestation. This case highlights the importance of early prenatal diagnosis of alobar HPE, the most severe form, using transabdominal ultrasonography (USG) and transvaginal USG. Prompt prenatal imaging is crucial for early diagnosis of alobar HPE, enhancing antenatal care, and facilitating improved family planning strategies to alleviate potential psychological distress due to its poor prognosis. Our documentation of such a rare condition is essential to help create a comprehensive database of similar cases.

Infertility affects a substantial proportion of couples worldwide, with female factors, such as uterine and tubal abnormalities, contributing significantly to its burden. Transvaginal ultrasonography (TVUS) and hysterosalpingography (HSG) are routinely used in the evaluation of female infertility. This study was done to evaluate the correlation between endometrial cavity volume measured on hysterosalpingography (HSG) and uterine volume and endometrial thickness measured on transvaginal ultrasonography (TVUS) in infertile Indian women. A secondary objective was to determine the prevalence of uterine and fallopian tube abnormalities in this population. This descriptive observational study was conducted at a tertiary care center in Maharashtra, India, from July 2023 to December 2024. A total of 307 infertile women aged 18 to 45 years undergoing HSG were included. TVUS was performed prior to HSG to measure uterine dimensions, calculate uterine volume using the ellipsoid formula, and assess endometrial thickness. Endometrial cavity volume was calculated from HSG measurements using the same formula. Statistical analysis was performed to determine correlations between uterine volume, endometrial thickness, and endometrial cavity volume. The mean age of participants was 29.73 ± 4.89 years. Mean uterine volume, endometrial thickness, and endometrial cavity volume were 48.93 ± 37.15 mL, 6.10 ± 2.20 mm, and 4.57 ± 2.71 mL, respectively. A statistically significant positive correlation was observed between uterine volume and endometrial cavity volume (r = 0.372, p = 0.00001), uterine volume and endometrial thickness (r = 0.197, p = 0.001), and endometrial thickness and endometrial cavity volume (r = 0.152, p = 0.008). Abnormal uterine findings were identified in 30% of women, while tubal abnormalities were present in 75.9%. Peritubal adhesions were the most common tubal abnormality. TVUS was superior for detecting myometrial abnormalities such as fibroids and adenomyosis, whereas HSG was more effective in evaluating endometrial cavity morphology and tubal patency. A significant positive correlation exists between uterine volume measured on TVUS and endometrial cavity volume measured on HSG in infertile women. TVUS and HSG provide complementary information and together offer a comprehensive assessment of uterine and tubal factors contributing to female infertility.

The dairy industry has seen remarkable increases in milk yield per cow; however, these gains are often offset by declining fertility and a reduced lifespan. This review discusses strategies to enhance lifetime productivity, focusing on three key research areas: 1) Age at first calving (AFC): Retrospective analysis indicates that reducing AFC to <22.5 months enhances lifetime daily milk yield without adverse effects through the third lactation, provided that the heifer reaches a body weight of ≥ 600 kg before first calving. 2) Double Ovulation: Sequential ultrasonic observation of the ovaries characterizes the pathophysiology of spontaneous double ovulation in high-producing cows during the early postpartum period. Multiparous cows exhibit a higher incidence of double ovulation that leads to twin pregnancies, which is associated with a negative energy balance. This metabolic state can be monitored using milk components such as lactose as a potential metabolic indicator of follicular dynamics. 3) Postpartum uterine health: Diagnostic strategies for endometritis have been optimized. Integrating vaginal discharge scoring and ultrasonography ensures a reliable assessment. This multimodal approach significantly improves the sensitivity of predicting reproductive performance compared to single-method assessments. Improving the lifetime productivity of modern dairy cattle requires precise management across various life stages. Automation and labor-saving technologies, particularly in routine husbandry, reproductive management, and veterinary practices, will become increasingly important for maintaining sustainable dairy operations.

Leiomyomas remain highly prevalent by midlife, with persistent racial disparities in age at onset and tumor burden. Although they are traditionally expected to regress after menopause, longitudinal data demonstrate variable behavior, with many leiomyomas persisting, some regressing modestly, and a subset continuing to grow. This structured, nonsystematic review of the contemporary literature was conducted using PubMed and Embase, supplemented by guideline and reference review, with the objective of guiding the evaluation and management of uterine leiomyomas across the menopausal transition. In perimenopausal and postmenopausal patients, abnormal uterine bleeding and pelvic pain require systematic evaluation to exclude endometrial pathology and alternative causes. Transvaginal ultrasonography with structured assessment provides the foundation for evaluation, and magnetic resonance imaging serves as an adjunct when findings are indeterminate or clinical concern is elevated. No single imaging feature reliably distinguishes benign leiomyoma from leiomyosarcoma, and the prevalence of unsuspected leiomyosarcoma at surgery remains low, increasing with age. Management should be individualized and symptom driven, incorporating patient age, comorbidities, hormonal exposures, imaging findings, and preferences, with expectant management appropriate for asymptomatic patients and intervention reserved for refractory symptoms or diagnostic uncertainty.

ABSTRACTAimTo assess the utility of intraoperative transvaginal ultrasonography (TVUS) in evaluating the duration of blood flow in cervical hypervascularity as a real time diagnostic marker for placenta accreta spectrum (PAS) in placenta previa.MethodsThis single‐center historical cohort study included patients with placenta previa with intraoperative TVUS. The primary outcome was blood flow persistence time, defined as the interval from fetal delivery to disappearance of low‐velocity (≤ 2.0 cm/s) color Doppler signals in cervical hypervascularity. Two obstetricians independently reviewed surgical video recordings. Receiver operating characteristic curve analysis was performed to evaluate the diagnostic performance of flow persistence time for predicting PAS. The AUC was calculated to assess discrimination. Optimal cutoffs were based on sensitivity and specificity. Independent predictors of PAS were identified by multivariate regression.ResultsPAS was diagnosed in 20 cases (38.5%). Flow persistence time was significantly longer in PAS cases (20.20 ± 14.31 min) than in non‐PAS cases (5.69 ± 2.46 min). A cut‐off of 7 min achieved 100% sensitivity and 72% specificity (AUC = 0.94), reliably excluding PAS when flow ceased within this period. A threshold of ≥ 14 min yielded 100% positive predictive value for PAS and 96% specificity for predicting hysterectomy. Flow duration remained an independent predictor in multivariable analysis (AUC = 0.95).ConclusionsIntraoperative assessment of cervical hypervascularity blood flow duration using TVUS may serve as a supportive indicator when PAS is suspected. A flow duration of < 7 min may help rule out PAS, while ≥ 14 min may suggest its presence and guide safer intraoperative management.

Factors affecting the prognosis of cesarean scar pregnancy-An analysis of 118 cases.

Ectopic pregnancy (EP) remains a major cause of early pregnancy-related morbidity and mortality. It can significantly impact future fertility and is associated with various risk factors. To investigate the incidence, clinical profile, and risk factors of EP among admitted women to the tertiary hospital. A prospective, cross-sectional study was conducted on 393 women with early pregnancy at the Maternity Teaching Hospital, Sulaymaniyah, Iraq from January 2024 to April 2025. Collected data included patients’ demographic characteristics, clinical data, and risk factors for EP, using a structured questionnaire. Then, diagnosis of EP was confirmed by serum β-hCG test and transvaginal ultrasonography. Management approaches were applied (manual, expectant, or surgical). Among studied women (n = 393) with early pregnancy, 79 (20.1%) were diagnosed with EP. The mean age of EP patients was 31 ± 4.47 years and mostly aged 30 to 39 years (44.3%), from urban area (68.4%), housewives (86.1%), gave birth to 2–4 children (62%), had 1–2 pregnancies (%). Frequent symptoms included lower abdominal pain (82.3%) and vaginal bleeding (67.1%) (P = .047). Major observed risk factors were previous C/S (54.4%), pelvic inflammatory disease (48.1%), and prior EP (11.4%) (P < .001). Tubal pregnancies constituted 82.3%, followed by C/S scar (15.2%), and rare cervical and ovarian sites (1.3%) (P < .001). Management was mainly surgical (50.6%), then expectant (25.3%) approach, and medical treatments (24.1%) (P = .049). The incidence of EP was higher than global estimates, likely due to the study population characteristics. However, this single-center study is not a representative of the regional epidemiology of ectopic pregnancy.

Transvaginal ultrasound (TVUS) is widely used for diagnosing ovarian endometriosis but remains limited by significant operator dependency. This systematic review and meta-analysis evaluated the diagnostic accuracy of ultrasound-based artificial intelligence (AI) models for ovarian endometriosis and directly compared their performance with that of human readers. We conducted a comprehensive search of five databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) up to 5 December 2025 to identify studies reporting diagnostic metrics for AI models, compared with human readers, for detecting ovarian endometriomas. Pooled sensitivity, specificity, and area under the curve (AUC) were calculated using a bivariate random-effects model. Seven studies with 2737 patients (6061 images) were included. AI models demonstrated a pooled sensitivity of 91% (confidence interval 81%-96%) and specificity of 95% (confidence interval 92%-96%). Human readers achieved a pooled sensitivity of 80% (95% confidence interval 65-90) and specificity of 85% (95% confidence interval 74-92). AI models significantly outperformed readers in specificity (p = 0.001) and overall diagnostic discrimination, with an AUC of 0.97 (95% confidence interval 0.95-0.98) compared with 0.84 (95% confidence interval 0.82-0.88) for human readers (p < 0.001), while sensitivity remained comparable (p = 0.10). Heterogeneity across included studies was minimal (0%). AI algorithms show indications of promising but preliminary diagnostic performance relative to human readers in specificity and overall discrimination metrics. These results raise the possibility that AI might serve as a supplementary tool in sonographic evaluation of ovarian endometriosis, potentially contributing to more standardized interpretation and reduced false-positive diagnoses.

Adenomyosis is a benign gynecologic condition characterized by ectopic endometrial glands and stroma present within the myometrium. Background/Objectives: The gold standard in diagnosis is the histology of hysterectomy specimens. Due to the heterogeneity of this disease, there is a lack of valid classification. The most important symptoms are chronic pelvic pain and abnormal uterine bleeding, followed by infertility. Noninvasive diagnostic tools have been sought, with ultrasound being a valuable option. The objective of our study was to evaluate the correlation of transvaginal ultrasound, used in addition to three-dimensional ultrasonography and Doppler, with the histology of adenomyosis. Methods: An observational retrospective study was conducted between January 2015 and November 2018 on 160 women with adenomyosis managed by hysterectomy. All patients underwent transvaginal sonography combined with 3D and Doppler sonography. Results: Comparing the location of adenomyosis in the myometrium observed using ultrasound with histological findings, a statistically significant correlation was observed (p = 0.0001). Symptoms were associated with the location of the lesions, heavy period in internal adenomyosis (p ≤ 0.001), and infertility (p = 0.001), while pelvic pain was observed in external adenomyosis (p = 0.03). Deep endometriosis was associated with external adenomyosis (p = 0.001). An ill-defined junctional zone was observed via Doppler investigation in internal adenomyosis (p = 0.0001), also correlated with the symptoms. Histology confirmed all cases of adenomyosis, with statistically significant similarities regarding pattern, location, and depth (p < 0.001). Conclusions: The increasing use of 3D and Doppler evaluations enhances TVUS importance, and 3D TVUS offers high diagnostic capacity for adenomyosis, in accordance with histological findings. This procedure facilitates the adoption of therapeutic modalities other than surgery with uterus preservation.

To evaluate concordance between the number of uterine fibroids deemed clinically significant on preoperative transvaginal sonography (TVS) and the number of fibroids treated intraoperatively during transcervical radiofrequency ablation (RFA) under intrauterine ultrasound guidance. This is a retrospective, paired-sample cohort study that is conducted in two tertiary care centers. Sixty-seven women underwent transcervical RFA for symptomatic uterine fibroids. This study compares TVS-significant with intraoperatively treated fibroid counts. TVS identified a mean of 1.60 ± 0.94 clinically significant fibroids, whereas 1.90 ± 1.23 were treated intraoperatively (mean paired difference + 0.30; 95% CI 0.11-0.49, P = .0036). Intraoperative counts exceeded TVS in 28%, were identical in 66%, and were lower in 6% of patients. Categorized exact agreement was 73.1% with substantial concordance (weighted κ = 0.61; 95% CI 0.42-0.76). In the a priori multifibroid subgroup (≥2 clinically significant fibroids on TVS; n = 23), the mean paired difference (+0.26) was not statistically significant (P = .266). Treated fibroid count correlated strongly with TVS count (ρ = 0.72, P < .001) and modestly with ablation time (ρ = 0.26, P = .033), but not with postoperative changes in hemoglobin or inflammatory markers (all P > .10). Preoperative TVS demonstrates substantial diagnostic agreement with the fibroid burden treated during transcervical RFA. While TVS may numerically underrepresent the actionable fibroid count in a subset, systematic underestimation is not confirmed in multifibroid disease. The potential for intraoperative expansion should be considered during procedural planning.

Focal excision for placenta percreta based on pathoanatomy: the challenge of neovascularization.