Uterine Cavity Research Articles

RISK FACTORS OF LOW PLACENTATION

The purpose of the study – to assess the risk factors for the occurrence of low placentationin the early stages of gestation.Materials and methods. A clinical and statistical analysis of 150 individual charts ofpregnant women and women in labor in women with a low lying placenta (main group)and 80 pregnant women with a normal localization of the placenta in the fundus andbody of the uterus (control group), who were under dispensary supervision in a women’sconsultation, was carried ou.tThe results. After conducting the analysis, it was established that the main groupwas dominated by women over 30 years old (40.7 % of cases), compared to 25.0 %of pregnant women in the control group (p<0.05). The age of onset of menarche after14 years is marked significantly more often in pregnant women with low placentation –in 22.7 %, compared to normal localization of the placenta – in 8.8 % of cases. Thedevelopment of the menstrual cycle by one year in the main group was 2.5 times lessfrequent than in the control group. 58.7 % of pregnant women with low placentationhad 2 or more artificial abortions, 46 % had a history of spontaneous miscarriages, inpregnant women with normal placentation, these indicators were 32.5 % and 18.8 % ofpregnant women, respectively (p<0.05). In 20.7 % of cases of women in the main group,childbirth was completed by cesarean section, and in the control group – in 7.5 % ofcases. In pregnant women with low placentation, 26.0 % had inflammatory diseases ofthe uterine appendages, 50.7 % had cervical erosion, 10.7 % had uterine fibroids, 16.7 %had endometriosis, compared to the control group in 17 .5 %, 36.3 %, 3.8 % and in 6.3 %of cases, respectively (p<0.05). Conservative myomectomy was performed in 30 % ofcases of the main group and 12.5 % of women in the control group. Conclusions. Risk factors for low placentation are a woman’s age over 30 years, latemenarche and late onset of menstrual function, history of gynecological diseases, highbirth parity, history of spontaneous miscarriages and artificial abortions, uterine scar,and manual revision of the uterine cavity walls. Identifying the risk factors for lowplacentation will reduce the level of perinatal and obstetric complications.

Endometrial carcinoma with cervical stromal invasion: Three case reports

BACKGROUND Endometrial cancer is a kind of well-known tumors of female genitourinary system. Cervical stromal invasion is an adverse factor for poor prognosis of endometrial cancer. There is still controversy regarding the use of magnetic resonance imaging (MRI) in the diagnosis of cervical stromal invasion of endometrial cancer. The diagnosis of cervical stromal invasion varies significantly between different observers and institutions. We present a limited case series of the particular pattern of endometrial cancer, which infiltrates the cervical stroma and is often overlooked. CASE SUMMARY We present three cases of endometrial carcinoma with cervical stromal invasion with cancer-free uterine cavity. One patient, a reproductive-aged woman, exhibited irregular menstruation and was diagnosed with endometrial polyps by hysteroscopy and segmental curettage. A MRI scan revealed polypoid nodules within the internal cervical orifice. The other two cases were postmenopausal women who presented with abnormal vaginal bleeding. Hysteroscopy and segmental curettage suggested atypical hyperplasia of the endometrium. MRI scans did not detect any malignant signs in the endometrium. In one case, a non-thickened endometrium was observed, while in another, hyperplasia of the endometrium was seen. Notably, none of these patients had malignant tumors identified in the uterine cavity via MRI scans. However, postoperative pathological results following hysterectomy consistently indicated cervical stromal invasion. CONCLUSION Cervical stromal invasion is easily missed if no cancer is found in the uterine body on MRI. Immunohistochemistry of endoscopic curettage specimens should be conducted to avoid underestimation of the disease.

Hysteroscopic Management of Complete Vaginal and Uterine Septum with Double Cervix: Tips & Tricks for a Safe Surgery

The septate uterus is the most common uterine abnormality, comprising 35% of all identified uterine malformations. According to the ESHRE/ESGE 2013 classification, the class U2bC2V1 is a rare congenital malformation characterized by a complete septate uterus with double cervix and nonobstructive longitudinal vaginal septum. to share the decision-making process, the preoperative ultrasonographic assessment and our step-by-step hysteroscopic surgery technique to manage this complex malformation: including how to access the septate uterine cavity, the resection of the septum and its post-operative management. The goal of the surgical treatment is to restore the regular morphology of the vaginal canal and the uterine cavity with the right amount of myometrium. we present video footage of a hysteroscopic approach at a tertiary care academic medical center for managing a 21-year-old patient with a symptomatic uterine septum with double cervix and non-obstructive longitudinal vaginal septum. Both the Intraoperative and postoperative periods were uneventful: a complete resolution of the vaginal septum and creation of a single uterine cavity were obtained. Due to the significant anatomic variability of this condition, this type of surgery can be challenging. The goal of this video is also educational, aiming to illustrate a reproducible technique that can be utilized by younger or less experienced surgeons. In our experience, this hysteroscopic technique appears to be a valid option for patients with symptomatic Mullerian malformation or those with a history of recurrent miscarriages or unexplained infertility.

Good practice with fluid management in operative hysteroscopy.

Hysteroscopic surgery requires a balance of continuous controlled irrigation and aspiration to distend the endometrial cavity to a degree that provides the clear and stable visual environment necessary for diagnostic and therapeutic procedures. Whereas the preferred distending solution should be isotonic and isonatremic, radiofrequency (RF) electrosurgery with monopolar instrumentation can only be performed with non-ionic (hyponatremic) solutions. Absorption of as little as 500 mL and certainly more than 1000 mL of non-ionic solutions can result in fluid overload and/or dilutional hyponatremia with potentially serious adverse effects under certain conditions and patient characteristics. Both hysteroscopic RF electrosurgery with bipolar instrumentation and electro-mechanical morcellation and aspiration systems use isotonic and isonatremic solutions. Depending on the clinical context, absorption of more than 1500 mL of isonatremic solutions can also result in serious adverse effects. Automated fluid management systems are preferred and recommended, and surgeons should aim to maintain the maximum allowable intravasation of distending media below 1000 and 1500 mL for non-ionic and ionic fluids, respectively.

Pseudo-myometrial thinning in placental site trophoblastic tumors: a case series with multiparametric MRI.

Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic neoplasm with few previous imaging case reports. We report multiparametric MRI findings in four cases of PSTT with special emphasis on the "pseudo-myometrial thinning" underlying the tumor. We reviewed multiparametric MRI and pathologic findings in four cases of PSTT from four institutions. Signal intensity, enhancement pattern, margins, and location of the tumors were evaluated, and myometrial thickness underlying the tumor and normal myometrial thickness contralateral to the tumor were measured on MRI. The myometrial thickness underlying the tumor was also measured in the resected specimen and compared with the myometrial thickness measured on MRI using the Friedman test. All tumors showed heterogeneous signal intensity on T1-weighted imaging, T2-weighted imaging (T2WI), and diffusion-weighted imaging. Three of the four tumors had a hypervascular area on dynamic contrast-enhanced (DCE) MRI. A hypointense rim on T2WI and DCE-MRI was seen in all tumors. All tumors protruded into the uterine cavity to varying degrees and extended into the myometrium close to the serosa. The myometrial thickness underlying the tumor measured on MRI (median thickness, 1.2mm) was significantly thinner than that measured on pathology (median thickness, 9.5mm) and normal myometrial thickness contralateral to the tumor on MRI (median thickness, 10.3mm) (P = 0.02), and there was no significant difference between the latter two. The thickness of the myometrium underlying the tumor on MRI was approximately one tenth of the thickness on pathology. Thus, the tumors appeared to have almost transmural invasion even when pathologically located within the superficial myometrium. This "pseudo-thinning" of the underlying myometrium and the hypointense rim on MRI could be caused by focal compression of the myometrium by the tumor, possibly due to the fragility of the myometrium at the placental site.

The Synergic Effect of Tubal Endometriosis and Women's Aging on Fallopian Tube Function: Insights from a 3D Mechanical Model.

The fallopian tubes are essential for human fertility, facilitating the movement of sperm and oocytes to the fertilization site and transporting fertilized oocytes to the uterus. Infertility can result from changes in the fallopian tubes due to tubal endometriosis and women's aging. In this study, we modeled human fallopian tubes with and without endometriosis for different women's age groups to evaluate the chances of normal sperm cells reaching the fertilization site and oocytes arriving at the uterine cavity. For this purpose, we employed a distinctive combination of simulation tools to develop a dynamic three-dimensional (3D) model of normal human sperm cells and oocytes swimming inside normal and endometriosis-affected human fallopian tubes for different women's group ages. We observed that in tubal endometriosis cases, fewer sperm cells reach the fertilization site and more oocytes become trapped in the tube walls compared to normal tubes. Additionally, aging decreases the number of sperm cells and oocytes reaching the fertilization site in normal and endometriosis-affected tubes. Our model evaluates the mechanisms of sperm and oocyte behaviors due to women's aging and fallopian tube issues caused by endometriosis, presenting new avenues for developing diagnostic and treatment tools for tubal endometriosis and age-related infertility issues.

Apelin-13 alleviates intrauterine adhesion by inhibiting epithelial-mesenchymal transition of endometrial epithelial cells and promoting angiogenesis.

Intrauterine adhesion (IUA) is a common complication of surgical manipulation of the uterine cavity such as abortion. The pathology of IUA is characterized by fibrosis, but the pathogenesis is not fully understood. The function of Apelin-13 in IUA and related mechanisms were investigated in this study. The IUA rat model was established. The pathological changes and fibrosis degree of rat uterine tissues were detected by HE and Masson staining after intraperitoneal injection of Apelin-13. Epithelial-mesenchymal transition (EMT) of endometrial epithelial cells and endothelial-mesenchymal transition (EnMT) of vein endothelial cells were induced by TGF-β1. Tube-forming assay using HUVEC was implemented to detect the effect of Apelin-13 upon angiogenesis. IHC staining, immunofluorescence staining, and Western blot were conducted to detect the expression levels of EMT markers, angiogenesis, and key proteins of the TGF-β1/Smad signaling. Apelin-13 significantly alleviated IUA and fibrosis, and increased endometrial thickness and gland number in IUA rats. In addition, Apelin-13 significantly reversed EMT and EnMT induced by IUA modeling and TGF-β1, promoted the tube-forming ability of HUVEC, and up-regulated the expression of angiogenesis-related proteins. Mechanistically, Apelin-13 significantly suppressed smad2/3 phosphorylation and inhibited the TGF-β1/Smad signaling via its receptor APJ. Apelin-13 might alleviate IUA via repressing the TGF-β1/Smad pathway and is expected to be a potent therapeutic option for the clinical treatment of IUA.

A Case of Unilateral Spontaneous Live Twin Ectopic Pregnancy

Aim: Ectopic pregnancy (EP) is the placement of the fertilized ovum in an area other than the endometrial cavity. A one-sided twin EP, on the other hand, is a rare case. It is estimated to occur in approximately 1 in 200 EPs and 1 in 125,000 spontaneous pregnancies. Materials and methods: In this case, we presented the diagnosis and treatment process of a 40-year-old patient who applied to our clinic with complaints of delayed menstruation, abdominal pain and vaginal bleeding, and then diagnosed with twin EP. Results, conclusion: EP is the most important cause of death in the first trimester. This risk increases in twin EP. Therefore, timely diagnosis and appropriate treatment options are critical. Especially in pregnancies in the first trimester, anamnesis, laboratory, TA and TV USG evaluation should be performed.

Thinking in context: Fibroids-to-uterine volume ratio in pre-surgical fertility evaluation for intramural fibroids

ObjectiveTo explore the utility of the total fibroids-to-uterine volume (FTUV) ratio as a simple, preoperative tool to assist in counseling patients seeking pregnancy who are undergoing myomectomy for intramural (IM) fibroids. Study designThis is an historical cohort study on reproductive-aged patients seeking pregnancy who underwent laparotomic myomectomy for intramural fibroids from January 2017 to December 2021. Only G3 to G5 fibroids, according to the 2011 International Federation of Gynecology and Obstetrics (FIGO) classification, were included. Pre-operative transvaginal ultrasound (TVUS) was performed to measure the volume of intramural myomas (diameter1*diameter2*diameter3*0.52) and to calculate their total volume. The total fibroids-to-uterine volume (FTUV) ratio was calculated as the proportion of the uterine volume occupied by the sum of IM fibroids volumes. ResultsA total of 166 women with pre-surgical TVUS evaluation of IM fibroids were included, with a mean age of 36.22 ± 5.15 years. The FTUV ratio was identified as a positive predictor of clinical pregnancy after surgery (adjOR, 1.04; 95 % CI, 1.02–1.06; p = 0.0001), whereas age showed a negative association (adjOR, 0.90; 95 % CI, 0.83–0.98; p = 0.012). Endometrial cavity distortion prior to surgery was also positively associated with pregnancy post-surgery (adjOR, 3.50; 95 % CI, 1.51–8.08; p = 0.003). Consistent results were found for live births, with the FTUV ratio being a significant positive predictor of live birth after surgery (adjOR, 1.03; 95 % CI, 1.01–1.05; p = 0.001) and age showing a negative association (adjOR, 0.88; 95 % CI, 0.80–0.96; p = 0.004). Parity prior to surgery also positively impacted live birth post-surgery (adjOR, 2.65; 95 % CI, 1.30–5.40; p = 0.007). An FTUV ratio threshold of 53.39 % accurately predicted clinical pregnancy in 68.46 % of cases (sensitivity of 71.70 % and specificity of 66.67 %). For live births, a higher FTUV ratio threshold of 59.21 % predicted outcomes accurately in 69.13 % of cases (sensitivity of 65.85 % and specificity of 70.37 %). ConclusionThe use of the FTUV ratio in pre-operative ultrasound evaluation of IM fibroids may improve counseling for patients desiring to conceive after myomectomy. By providing a personalized assessment of the amount of myometrial volume occupied by fibroids, the FTUV ratio can help predict fertility outcomes after surgery, enabling better-informed decisions and treatment planning.

The Effect of the Levonorgestrel-Releasing Intrauterine System on Myometrial Blood Flow in Patients With Heavy Menstrual Bleeding.

Background Abnormal uterine bleeding constitutes a vexing issue among female patients, substantially impacting their quality of life. Surgical interventions, particularly hysterectomy, contribute to the psychological, physical, and financial burden on families and, by extension, the healthcare system. Levonorgestrel-releasing intrauterine system (LNG-IUS) represents a conservative management approach and emerges as a beneficial option for affected patients. The present study aims to elucidate color Doppler changes in the uterine artery pre- and post-LNG-IUS insertion. Objective The primary objectives encompass an investigation into the variations in Doppler indices (resistance index (RI) and pulsatility index (PI)) within the arcuate and radial branches of the uterine artery, as well as the assessment of endometrial thickness before LNG-IUD insertion, at three months, and six months post-insertion. Secondary outcomes include evaluating changes in pictorial blood assessment chart (PBAC) scores before insertion, at three months, and at six months after LNG-IUS insertion. Methods A cross-sectional study was conducted at the Department of Obstetrics and Gynecology at All India Institute Of Medical Sciences (AIIMS), Nagpur. A cohort of 25 women underwent LNG-IUS insertion. The endometrial cavity, RI, and PI of both arcuate and radial arteries were assessed before LNG-IUS insertion and at three and six months after insertion. Results The PI of the arcuate artery exhibited minimal alteration over the six-month duration, with a p-value of 0.43. Conversely, the RI demonstrated a statistically significant increase over the same period (p = 0.03). Conversely, the radial artery exhibited no statistically significant changes in either PI or RI (p = 0.39 or 0.13, respectively). Conclusion Following six months of LNG-IUS utilization, a substantial reduction in endometrial thickness and menstrual flow was observed, concomitant with an improvement in hemoglobin levels. Notably, the PI of both the arcuate and radial arteries demonstrated no significant change. Although the RI of the arcuate artery increased, its clinical relevance may be limited. Consequently, the observed reduction in menstrual bleeding cannot conclusively be ascribed to diminished blood flow in uterine arteries.

Cesarean scar choriocarcinoma following a cesarean scar molar pregnancy: A case report

Gestational choriocarcinoma, a rare variant of gestational trophoblastic disease, typically arises from abnormal trophoblastic cell proliferation post-pregnancy, often associated with a hydatidiform mole. While most choriocarcinoma cases develop within the uterine cavity, an exceedingly rare manifestation occurs within a previous cesarean section scar. In our study, a 31-year-old woman with a history of hydatidiform mole presented with amenorrhea and spotting. Initial assessments revealed elevated beta-human chorionic gonadotropin (βhCG) levels and a heteroechoic mass at her prior cesarean section scar in sonographic examination. Histopathologic findings and the metastatic workup categorized the patient as FIGO stage I, indicating no metastasis. Due to the absence of metastasis, adjuvant chemotherapy was omitted. Total abdominal hysterectomy confirmed choriocarcinoma. Post-surgery, βhCG levels notably decreased, remaining negative during the two-year follow-up with no reported symptoms. Our findings suggest that surgical resection and meticulous βhCG monitoring may be a promising treatment strategy for non-metastatic choriocarcinoma.

(Invited) Developing Optical Nanosensors for Biomedical Applications

Novel biomedical application technologies have been rapidly improved in the past few decades. Despite recent technological progress, significant challenges persist toward more accessible, precise, inexpensive, rapid, automated, and patient-facing methods. Optical spectroscopic and imaging technologies have multiple advantages to current practices, such as versatility, fast and robust signal, and noninvasive and nondestructive probing techniques that can be easily integrated into current medical devices such as catheters, endoscopes, or biopsy needle channels. Single-walled carbon nanotubes (SWCNTs) have been developed as near-infrared (NIR) fluorescent nanosensors and demonstrated in vitro and in vivo with great interest for using them in biological and clinical applications and the methods designed to probe them. The advantages of SWCNT include resistance to photobleaching and high sensitivity towards biological environments.Gynecologic cancers are challenging to diagnose. Patient prognosis and quality of life are affected substantially by this problem. In this talk, I will present recent work on developing new technologies to improve gynecological cancer detection and grant new research tools for understanding fundamental mechanisms in cancer development using liquid biopsy and in vitro and in vivo sensor approaches. With artificial intelligence algorithms, we harness SWCNTs' unique optical properties and sensitivity to develop intelligent optical sensors. We developed platforms to detect multiple gynecological cancer biomarkers as implantable devices in patient biofluids and the uterine cavity. Applying machine learning algorithms to analyze the optical response of the sensors enabled the precise detection of multiplexed biomarkers. In addition, when implanted in human uteri, the sensors detected the biomarkers and successfully differentiated between benign and malignant cases. These technologies will significantly improve diagnostics and cancer research, leading to robust, point-of-care technologies for early-stage diagnosis.

Acupuncture for clinical improvement of endometriosis-related pain: a systematic review and meta-analysis

BackgroundEndometriosis is a common chronic gynecological condition characterized by the presence of endometrial tissue outside the uterine cavity, leading to chronic inflammation, pelvic nodules and masses, pelvic pain, and infertility. Acupuncture has been shown to improve pain associated with endometriosis by modulating abnormal levels of prostaglandins, β-endorphins, dynorphins, electrolytes, and substance P. This review aims to evaluate the clinical efficacy of acupuncture in treating endometriosis, specifically focusing on its efficacy in relieving pain associated with endometriosis.MethodsA comprehensive search was conducted in eight databases (PubMed, EMBASE, Cochrane, Web of Science, China National Knowledge Infrastructure (CNKI), the China Biology Medicine (CBM), Wanfang, and Weipu database) to identify randomized controlled trials (RCTs) published from database inception to December 16, 2022, which investigated the use of acupuncture for endometriosis-related pain. Two researchers independently screened articles, extracted data, and assessed methodological quality using the Cochrane Collaboration’s risk of bias tool. Meta-analysis was performed using Stata statistical software.ResultsA total of 1991 articles were identified, and ultimately, 14 studies involving 793 patients (387 in the acupuncture group and 359 in the control group) were included. The control interventions in the included studies included placebo, traditional Chinese medicine (TCM), and Western medicine treatments. Meta-analysis results showed that compared to the control group, acupuncture treatment for pain associated with endometriosis demonstrated significant reductions in pain severity [SMD = − 1.10, 95% CI (− 1.45, − 0.75), P < 0.001], improved response rate [RR = 1.25, 95% CI (1.09, 1.44), P = 0.02], and decreased serum CA-125 levels [SMD = − 0.62, 95% CI (− 1.15, − 0.08), P = 0.024]. Furthermore, subgroup analysis revealed that electroacupuncture and auricular acupuncture were superior to the control group in reducing pain severity, while auricular acupuncture and warm needling showed greater clinical efficacy compared to the control group. However, there were no significant differences between electroacupuncture or fire needling and the control group in terms of pain relief. The findings suggest that acupuncture is effective in improving pain associated with endometriosis.ConclusionsIn conclusion, acupuncture is effective in alleviating dysmenorrhea and pelvic pain associated with endometriosis, reducing serum CA-125 levels, decreasing the size of nodules, improving patients’ quality of life, and lowering the recurrence rate. However, it should be noted that the current evidence is limited by the design and quality flaws of the original studies, as well as a lack of research specifically focusing on subtypes of acupuncture. Therefore, caution should be exercised when interpreting the results.

Nursing process for a patient with ectopic pregnancy in the Gynecology Department of a hospital in Arequipa

Introduction: Ectopic Pregnancy is the implantation and subsequent development of the fertilized ovum outside the endometrial cavity, with greater prevalence in the uterine tubes.Tubal rupture and hemorrhage causes morbimortality and is considered a true medical emergency. Objective: To elaborate the nursing care process oriented to a patient with ectopic pregnancy. Methodology: This is a descriptive qualitative research work, with a single case design, aimed at a 35-year-old patient. The Nursing Care Process was used, applying Margory Gordon's functional patterns as an assessment instrument. Result: 6 nursing diagnoses were identified, prioritizing the main diagnosis: Acute pain r/c biological injury agent manifested by verbal expressions and VAS scale 10/8. Nursing interventions were applied with effective result achieving improvement with change score +2; before PC extrauterine pregnancy and Shock CR are still in the process of improvement. Conclusions: The clinical manifestations of an ectopic pregnancy were identified in the patient; the complication risk factors were determined and the nursing role was described by applying preventive care in hypovolemic shock. Collaborative problems and risks were identified and addressed through the nursing interventions and activities included in the EAP for ectopic pregnancy, achieving better health status.

Unexpected Rupture of Ectopic Pregnancy with Shock: A Warning to Always Enhance Alertness

Introduction: Ectopic pregnancy (EP) describes a pregnancy that develops outside the uterine cavity. The fallopian tube, specifically the ampulla is the most common site. Positive blood β-hCG levels can identify EP with no ultrasound confirmation of intrauterine or extrauterine pregnancy. Case Presentation: We report a 37-year-old woman was referred from primary health care with a diagnosis of ileus. The patient complained of abdominal pain, spotting, vomiting, and no defecating since the day before; gestational age was estimated at around seven weeks. Vital signs indicated shock; the physical examination revealed slight abdominal distention, decreased bowel sounds, tenderness throughout the abdominal area, slightly defans muscular, and hyper tympanic. Vaginal touch didn't reveal cervical dilation, absent portio swaying pain. The laboratory found anemia and leukocytosis with a predominance of neutrophils. The pregnancy test was positive in the emergency department. Previously, the primary health care facility did not undergo a pregnancy test. Abdominal x-ray showed low-lying obstructive ileus and ascites in the pelvic cavity. Transabdominal ultrasound revealed free fluid in the rectouterine cavity. The patient underwent an emergency laparotomy, and a rupture in the ampulla segment was found, then a salpingectomy was performed. Conclusion: Clinicians must be able to diagnose EP correctly and as quickly as possible. In women of childbearing age presenting with acute abdominal complaints and a known or unknown history of menstruation, we strongly recommend a qualitative β-hCG examination, which can be carried out in health facilities with limited resources and at affordable costs, will be very useful for diagnosing and screening ectopic pregnancy.

Intrauterine administration of paternal and maternal peripheral blood mononuclear cells mix as solution for repeated implantation failure.

To date, implantation is the rate-limiting step for the success of in vitro fertilization (IVF) treatment. Accumulating evidence suggests that immune cells contribute to embryo implantation, and several therapeutic approaches have been proposed for the treatment of recurrent implantation failure (RIF). Endometrial immune modulation with autologous activated peripheral blood mononuclear cells (PBMCs) is one of the most widely used protocols. However, the effect of intrauterine insemination of mixed paternal and maternal-activated PBMCs has not yet been attempted and studied. The aim of our study is to test the effect of the addition of paternal lymphocytes on the implantation rate in RIF patients. Mononuclear cells were isolated from the peripheral blood of 98 RIF patients and cultured for 72h before insemination into the endometrial cavity 48h before embryo transfer. Our patients were divided into 4 groups according to the type and number of PBMCs inseminations. Our study shows that activated PBMCs promoted clinical pregnancy rates (CPR) in all groups. Moreover, we found that the groups injected with more than 2 million cells showed a better clinical outcome and, more interestingly, patients inseminated with both paternal and maternal activated PBMCs showed the highest CPR, reaching 47.2%, in addition to the highest implantation rate 31. 2% and the live birth rate 41.39%. Our work demonstrates the importance of administering a large number of activated PBMCs with the addition of paternal activated PBMCs to immunomodulate the endometrium for the success of in vitro fertilization in RIF patients.

Prevalence, Determinants, and Management Options of Scar Site Pregnancy in Women With Previous Cesarean Section: A Study From the Al-Qassim Region.

Pregnancy located outside the uterine cavity following a cesarean section has become more prevalent in recent years due to the increase in cesarean section delivery. This study sought to investigate the prevalence, determinants, and treatment options of scar site pregnancy among women who sought maternal and child health services in a hospital in Buraydah, Al-Qassim region, Saudi Arabia. Utilizing a quantitative retrospective case-control design, 50 women were recruited and assigned to the two groups evenly. Demographic data and risk factors were assessed using a questionnaire, and data were analyzed using SPSS version 27 at a 95% confidence interval and presented intables and figures. Fifty-eight percent of the participants were aged 35 years and above, with 38% reporting a parity of 1-3. Logistic regression revealed that parity (odds ratio (OR) = 10.975, 95% confidence interval (CI) = 0.887-135.861, and p-value = 0.062), the interval between the last and present pregnancies (OR = 0.056, 95% CI = 0.005-0.668, p-value = 0.023), intrauterine contraceptive device (IUCD) use in the last year(OR = 0.070, 95% CI = 0.006 -0.780, p-value = 0.031) were statistically significant in predicting cesarean scar pregnancy. Combined methotrexate and aspiration were the most prevalent treatment options for scar site pregnancy in this study. Scar site pregnancy is a maternal health complication that affects women across all healthcare settings, and its prevalence is not clear due to underdiagnosis and underreporting. The risk of scar site pregnancy increased with an increase in the number of childbirths (parity) and the interval between the last and current pregnancies.

IVF pregnancy in a case of Asherman’s syndrome

Asherman’s syndrome (AS), an increasingly diagnosed cause of infertility owing to improvement in diagnostic modalities, poses a challenge in achieving pregnancy. Intrauterine adhesions due to breach in the basalis layer of the endometrium interfere with implantation or obstruct tubal ostia. AS occurs subsequent to curettage performed for pregnancy related conditions more commonly than gynaecological conditions. Patients may present with infertility with or without menstrual complaints. Here we present a case of 29-year-old woman, P0L0A1 who presented to our clinic with secondary infertility for one year. The patient had undergone hystero-laparoscopic myomectomy with uterine artery ligation in view of multiple fibroids. A relook hysteroscopy on follow-up revealed a normal uterine cavity with synechiae formation at right cornua for which synechiolysis was done. Upon failure to conceive for the next six months, another hysteroscopy was performed which showed that the cavity was small with pale endometrium and right ostia could not be visualized. Subsequently a hysteroscopic reconstruction of the uterine cavity was done with bilateral lateral wall and fundal metroplasty followed by estrogen and progesterone therapy to avoid post-operative adhesion formation. The couple underwent an IVF cycle in the following month. Controlled ovarian stimulation was done and ovum pick up was performed on day 12 with intra-uterine PRP instillation. A fresh transfer was performed on day 5 after pick up. Luteal phase support was given with vaginal and subcutaneous progesterone support. A UPT 14 days later was positive and the patient is under follow-up for her antenatal care at present.

Biomaterial Fg/P(LLA-CL) regulates macrophage polarization and recruitment of mesenchymal stem cells after endometrial injury

The process of endometrial repair after injury involves the synergistic action of various cells including immune cells and stem cells. In this study, after combing Fibrinogen(Fg) with poly(L-lacticacid)-co-poly(ε-caprolactone)(P(LLA-CL)) by electrospinning, we placed Fg/P(LLA-CL) into the uterine cavity of endometrium-injured rats, and bioinformatic analysis revealed that Fg/P(LLA-CL) may affect inflammatory response and stem cell biological behavior. Therefore, we verified that Fg/P(LLA-CL) could inhibit the lipopolysaccharide (LPS)-stimulated macrophages from switching to the pro-inflammatory M1 phenotype in vitro. Moreover, in the rat model of endometrial injury, Fg/P(LLA-CL) effectively promoted the polarization of macrophages towards the anti-inflammatory M2 phenotype and enhanced the presence of mesenchymal stem cells at the injury site. Overall, Fg/P(LLA-CL) exhibits significant influence on macrophage polarization and stem cell behavior in endometrial injury, justifying further exploration for potential therapeutic applications in endometrial and other tissue injuries.Graphical

Experiences of patients with endometriosis with a digital health application: a qualitative analysis

BackgroundEndometriosis is a frequent disease in women of reproductive age in which the endometrium occurs outside the uterine cavity. Multimodal treatment approaches are necessary due to loss of quality of life and the chronic nature of the disease. Digital health applications (DiGa) are becoming increasingly important. This research project investigates how a healthcare app can influence the subjective experience of illness in patients with endometriosis.MethodsEmpiric data were collected through semi-structured interviews. Data analysis was carried out using qualitative focussed interview analysis. Reliability was ensured by joint interdisciplinary and interprofessional evaluation of the interviews by experts and those affected.ResultsTen patients with endometriosis and the prescribed healthcare app Endo-App© were examined. Categories were defined from the superordinate categories “Factors influencing the experience of illness” and “Evaluation of the app”. The app provided reliable information, promoted self-efficacy through exercises and strengthened the perception of the individuality of the illness. It helped to minimise nocebo effects from internet research and enabled a positive change of perspective. Patients criticised the time required for data input and had data protection concerns. The educational elements were often seen as redundant. Some patients only used the app briefly, or not at all.ConclusionOnce a DiGa has been prescribed, it may be useful to explain its use on an outpatient basis and validate regular use. Blind re-prescribing of DiGas should be avoided. Younger patients with a recent diagnosis or patients following rehabilitation may benefit more from prescribing.