Uterine Length Research Articles

Ultrasound Biometry of the Non-pregnant Uterus in Beninese Women

Uterus is a female organ that undergoes enormous variations during her genital life. To study the dimensions of the normal uterine biometry of Beninese women outside pregnancy. This study was a cross-sectional prospective study from November 05, 2009 to July 31, 2010. It involved 119 Beninese women aged 13 to 70 years identified in two ultrasonography services, namely Autonomous Centre of Radiology (CAR) of EPAC-UAC (Polytechnic School of Abomey Calavi) and the Principal Hospital of Ouidah. The study focused on women who came to ACR to undergo pelvic ultrasound. Included in our sample, women who did not present uterine pathologies such as fibroma, synechia, polyp, cancer, with no uterine scar on ultrasound. Excluded from the study, pregnant women, women who had a cesarean section. Measurements were made in longitudinal and transverse sections by supra-pelvic ultrasound. Uterine length and its thickness were performed on the longitudinal section and its width on the cross-section. The average size of the Beninese woman's uterus were: length=86.17 mm; width=49.24 mm; thickness=37.42 mm. According to the parity we have for nulliparous (length=80.08 mm; width=48.02 mm; thicknes=35.70 mm), primiparous (length=88.47 mm; width=48.24 mm; thickness=37.47 mm), multiparous (length=99.33 mm; width=52.43 mm; thickness=41.50 mm). The dimensions of the non-pregnant uterus of Beninese women were 86.17mm (lC 95%: 83.09 - 92.40) for the length, 49.24 mm (95% CI: 47.45 - 51.02) for the width and 37.42 (IC 95%: 36.02 38.81). All these dimensions increase with parity. Parity is a factor which contribute to the uterine size variation.

Uterine size and volume are associated with higher live birth rate in patients undergoing assisted reproduction technology

To investigate how uterine size and volume are associated with live birth rate in patients undergoing assisted reproduction technology.This prospective cohort study was conducted at the Reproductive Medicine Centre from January 2010 to May 2017. Multivariate binary logistic regression was used to evaluate the relations between uterine size, total volume, and live birth outcomes, after they were adjusted for the main influencing factors.A total of 7320 women of clinical pregnancy were enrolled. Compared with uterine lengths of 50 to 59 mm (referent), women with uterine lengths ≥60 mm had a lower live birth rate (RR = 1.541). Compared with uterine widths of ≥50 mm (referent), women with uterine widths <30 mm had a lower live birth rate (RR = 1.430). Compared with uterine anteroposterior diameters of <30 mm (referent), women with uterine anteroposterior diameters ≥50 mm had a lower live birth rate (RR = 1.636). Compared with uterine volumes of 30 to 49 mL (referent), women with volumes <30 mL and ≥70 mL had lower live birth rates (RR = 1.368 and 1.742, respectively).Our findings indicate that uterine sizes and volumes that were too large or too small reduced the live birth rate.

Serum Concentrations of AMH and E2 and Ovarian and Uterine Traits in Gilts.

Simple SummaryPoor sow retention is a common issue amongst piggeries that creates excessive wastage. Premature culling is largely attributed to reproductive inadequacy. Thus, it is clear the traditional methods for selecting breeding females are inefficient and early markers of reproductive success are required. The aim of this study was to examine whether circulating levels of anti-Müllerian hormone and oestradiol could be useful indicators of ovarian and uterine traits in young gilts. The findings suggest that at a young age, anti-Müllerian hormone could be used to mark the ovarian reserve. Further research into whether the two hormones could be used to mark uterine capacity is needed.Poor sow retention due to reproductive failure is a common reproductive inefficiency amongst piggeries. This shows that traditional methods of gilt selection are inadequate and a marker of reproductive success is needed. The aim of this study was to determine whether circulating levels of AMH and E2 at D80 and D160 are associated with uterine and ovarian traits at D160. Uterine weight, horn length and horn diameter were measured, and ovarian follicle counts were determined histologically. There was a negative relationship between both D80 and D160 AMH levels and D160 ovarian follicle populations. There was also a positive relationship between D80 E2 levels and uterine capacity in gilts that were pubertal at D160. The findings indicate that D80 and D160 AMH could be used to predict ovarian reserve and that D80 E2 levels may be indicative of uterine capacity in precocial gilts.

Long-Term Bleeding Status And Hysteroscopic Cavity Access Results Following Water Vapor Endometrial Ablation for Heavy Menstrual Bleeding (HMB) In Subjects Who Have Large Cavities, Uterine Myoma and/or Intratubal Contraceptive Inserts

Study Objective To assess long-term menstrual status and hysteroscopic uterine cavity access a mean 4 years after water vapor endometrial ablation in a subset of patients traditionally not indicated for endometrial ablation treatment. Design Prospective, multicenter, observational. Setting Eight private practice and outpatient locations in North and Central America. Patients or Participants 29 women with large uterine cavities (10-12 cm uterine cavity lengths), non-cavity obstructing myoma up to 4 cm in diameter and/or intratubal contraceptive inserts underwent water vapor endometrial ablation for HMB. Three women had both large cavities and myomas. These 29 women completed 3-year follow-up as part of the AEGEA Pivotal Clinical Trial (NCT01979861). All patients consented to a diagnostic hysteroscopy a mean 4 years from the ablation procedure. Self-reported menstrual status was captured prior to diagnostic hysteroscopy. The degree of hysteroscopic access was judged by an Independent Reviewer blinded to subject history and procedural details. Interventions Diagnostic hysteroscopy. Measurements and Main Results At a mean 4 years post ablation, 93% (27/29) of subjects reported a return to normal, light or no menstrual bleeding. Cavity access was achieved in in 90% (26/29) of subjects. Cornua / ostia were visualized in 88% (23/26) of subjects with cavity access. Conclusion Water vapor endometrial ablation provides enduring reduction in menses and permits long-term cavity access in subjects with longer cavities (up to 12cm), uterine myoma and/or intratubal contraceptive inserts, each of which has been traditionally excluded from endometrial ablation treatment.

Reduced uterine volume after induction of puberty in women with hypogonadism.

Adequate uterine growth is an essential component of pubertal induction with exogenous oestradiol in those with hypogonadism. Poor uterine development will render the individual vulnerable in the context of fertility. We assessed uterine size using ultrasound in those who had undergone pubertal induction treatment compared with a reference group who had experienced spontaneous puberty. This is a single-centre, retrospective, cross-sectional study of women who underwent pubertal induction compared with a reference group. Ninety-five women with hypogonadism who had previously undergone pubertal induction and were receiving maintenance oestrogen replacement as adults were recruited: 48 women with Turner syndrome, 32 with premature ovarian insufficiency and 15 with gonadotrophin deficiency. The reference group consisted of 35 nulliparous women attending with male factor subfertility with a normal pelvis on ultrasonography. Pelvic ultrasound was performed by a single observer. Uterine dimensions (total length, anterior-posterior (AP), transverse, uterine volume and fundal cervical AP ratio (FCR) measurements) were recorded. Clinical details were also recorded. Those with hypogonadism had significantly reduced uterine dimensions compared with the reference group (uterine length 64mm vs 71mm P=<.05, uterine volume 28.9mL vs 43.9mL P=<.05). All women in the reference group attained a mature uterine configuration with a FCR >1, compared with 84% of those with hypogonadism (P=.01). A total of 24% and 48% of the diagnostic group had total uterine length and uterine volume measurements less than the 5th percentile of the reference group, respectively. In a subgroup of 22 women in whom serum oestradiol concentrations could be analysed, there was a positive correlation between this parameter and uterine volume. Despite standard oestrogen therapy, uterine growth is often compromised in those with hypogonadism. Uterine health has historically been overlooked in pubertal induction protocols; however, with increasing options for fertility treatment, adequate uterine development is crucial. Given the variation in uterine size witnessed, a more tailored approach to treatment with regular monitoring of uterine dimensions should be advocated.

Sonographic Study of Normal Uterine Size in Reproductive and Postmenopausal Age in Iraqi Women and related with Parity

Aim: The study included sonographic assessment of normal uterine size in non-gravid adult females at reproductive and postmenopausal women and its relation with parity. The anatomical variations of uterus particularly those concerning the body of uterus are well Known in medical literature. Data on uterine dimensions in parous (prim parous or multiparous) and nulliparous women are vital for public health consideration as the presence of uterine pathology effectively reflects the status of fertility and other gynecological condition in general. The last few decades, sonography has become the most important imaging modality for the study of the uterine pathology The estimation of uterine size has been widely reported by several authors from different parts of the world. Material and methods: this study included 150 non gravid female subjects were distributed into five age groups A(20-29), B(30-39),C (40-49), D(50-59), E(60-69), each group was divided into nulliparous, primiparous and multiparous women were examined sonographically because of abdominal or pelvic problem unrelated to uterus. All groups were subjected to transabdominal technique of uterine examination with a 3.5MHZ transducer. The length, width and anteroposterior diameter of uterus were calculated. The uterine volume was calculated using ellipsoid algorithm. These dimensions correlated with age and parity status of each study groups. Results: The length means increased at 20-49 age and decrease in 49-69 age. Increase the total means of the length of each group was related to parity, nulliparous (5.68±1.24), primiparous (6.15±1.72) and multiparous (7.28±1.33). Depth and width showed mild significant differences between study age groups. Width and depth were recorded increase related to party in all study groups. Uterus volume of uterus decreased with age groups, while total uterus volume increased in multiparous than the primiparous and nulliparous women. Means endometrial thickness was decreased with age groups and total means correlated with parity, in nulliparous (5.46±2.59), primiparous (5.51±3.13) and multiparous (6.35±3.07) Conclusion: Present study the uterine length and total volume showed clear increase with age and correlated with parity, while the width and depth show little changes with age but clear changes related to parity. The endometrial thickness was decreased with age and increased significantly with parity.

Impact of Patient and Procedure-Related Factors on Radiation Exposure from Uterine Artery Embolization.

To determine the range of radiation dose metrics for uterine artery embolization and the impact of patient and procedure factors on those measures. Procedure records of 515 uterine embolization procedures were reviewed and various metrics recorded, including patient demographics, body mass index (BMI), radiation exposure measures and procedure-related details. Descriptive statistics were used to summarize the measures, and appropriate parametric and nonparametric tests were used to compare and assess the correlation between the measures and the cumulative dose (CD), dose area product and fluoroscopy time (FT). Multivariable regression analysis was used to assess the impact of individual factors on the measures of radiation dose. The strongest correlation among the measures compared were between CD and BMI (r = 0.70), while the correlation between BMI and FT was weak (r = 0.23). Dose was higher for those procedures done with aortography and those who had TAGM as the embolic agent. Multivariable analysis demonstrated an increase of 7.4% in CD for each increase in BMI, 5.9% for each increase in cm uterine length. FT was impacted to a lesser extent, with an increase of 2.8% per unit BMI. Increasing procedure time had a greater impact on FT (r = 0.56) than on CD (r = 0.33). Among the measured variables, BMI had the greatest impact on CD and has a substantial impact on the risk of radiation-induced skin injury, even without prolonged FT.

Risk factors for coexistent leiomyoma and adenomyosis compared to coexistent leiomyoma and endometriosis in patients with symptomatic leiomyoma requiring myomectomy

To investigate the risk factors for coexistent leiomyoma with endometriosis and leiomyoma with adenomyosis in a population of women who elect for myomectomy due to symptomatic leiomyoma. Retrospective study. This was a single-center case control study to compare patients with leiomyoma only, to those that had either coexistent leiomyoma and endometriosis or leiomyoma and adenomyosis. Multinomial logistic regression models were used to compute relative-risk ratios (RRR) for the association between patients with endometriosis or adenomyosis in the presence of leiomyoma with patients with leiomyoma only. The analysis was first performed for each independent variable alone and subsequently, a best-subset selection method was used to construct a parsimonious model by selecting the model with lowest Akaike information criteria (AIC). 961 patients underwent surgery for symptomatic leiomyoma only, and either coexistent leiomyoma and adenomyosis or endometriosis (leiomyoma only (L) – 799, leiomyoma and endometriosis (LE) – 98 and leiomyoma and adenomyosis (LA) – 64 patients respectively) between 2013 and 2018 at a free-standing ambulatory surgical setting. The LE group was significantly younger (35.2 +5 years) (RR 0.95 95% C.I. 0.911-0.986) compared to the LA group (39.4 +5 .7 years) (RR 1.08 95% C. I. 1.035 -1.129) ( p<0.001). LE group (RR 0.23 95% C.I 0.08 – 0.661) (p<0.006) had higher nulliparity rate compared to LA group (RR 1.6 95% C.I. 1.193-2.148) ( p<0.002). The uterine length was significantly shorter in the LA group compared to the LE group. (L – 12.3 +3.7 cm, LE 11.7 +3.7, LA 10.4 +3.1 cm (p <0.001)). Age is an important predictor of developing adenomyosis but not endometriosis. The risk of developing adenomyosis in patients with leiomyoma increases by almost 9% for every year of age compared to the leiomyoma only group. Both nulliparity and uterine length are important predictors of both endometriosis and leiomyoma in patients compared to the leiomyoma control group.Table 1Relative-risk ratios (RRR) from most parsimonious* multinomial logistic regression modelRRR95% C.I.p-valueFibroids_only(base outcome)Fibroids + Endo Age0.9600.912, 1.0100.107 Parity0.3080.109, 0.8750.027 Uterine length0.9310.864, 1.0020.058 Constant1.3680.204, 9.1630.747Fibroids + Adeno Age1.0871.032, 1.1460.002 Parity1.3890.993, 1.9430.055 Uterine length0.8250.746, 0.911<0.001 Constant0.0270.003, 0.2560.002Note: Constant estimates baseline relative risk for each outcome.* Based on model with lowest Akaike information criteria (AIC) Open table in a new tab

Characteristics of the uterine tubes in the fetal period: topographic and morphometric parallels

Topicality of the study is stipulated by the importance of objective data for medicine concerning formation of the structure and topographic-anatomical interrelations of the uterine tubes with adjacent organs and structures during the prenatal period of human ontogenesis. Objective: to find and compare tendencies of changes of the uterine tube morphologic parameters in the two groups of fetuses remote in time, and determine age peculiarities of their topography during perinatal period of development. The experimental material (specimens of fetuses) was divided into two groups: І group – 35 specimens of fetuses deceased during 2017-2019; ІІ group – 105 specimens of fetuses taken from the Museum of the Departments of Anatomy, Clinical Anatomy and Operative Surgery at Higher State Educational Establishment of Ukraine “Bukovinian State Medical University”, collected during 1970-1990. Every group was subdivided into 7 subgroups according to 10 months of the fetal period of development (from the 4th to the 10th months). The results obtained were statistically processed in the licensed statistical package “Statistica 6.0” using nonparametric methods to evaluate the results. Regular changes in the topography of the right and left uterine tubes, changes in their shape and histological structure are observed. Both uterine tubes were found to occupy an ascending position in thirty cases out of sixty examined specimens of early fetuses (4-6 months of age). In twenty cases one uterine tube was found to be in an ascending position, and in ten cases both uterine tubes were placed practically horizontally. The study of uterine tube morphogenesis in 7-month fetuses found that the structure and topography of the uterine tubes in different age periods differ. In two 7-month fetuses the uterine tubes were found to be in an ascending position, in eight cases one uterine tube (the left one – in six cases out of eight) was in a horizontal position, and in ten cases two uterine tubes were directed practically horizontally. During the 8th month of the antenatal development one uterine tube was found to be in an ascending position out of eight cases; in ten cases both uterine tubes were in the position close to a horizontal one; and in two cases the left uterine tube was in a descending position. In 9-month fetuses both uterine tubes were found to be in a horizontal position in twelve cases, in eight cases one of the uterine tubes was in the position close to a descending one. In fourteen fetuses 10 months of development one uterine tube was in a descending position, and only in six cases both uterine tubes were located horizontally. The length of the uterine tubes of 4-7-month fetuses deceased during 2017-2019 was not found to differ reliably. Similar regularity was found in the group of fetuses aged from 9 to 10 months. The length of the uterine tubes of the archival specimens increases reliably every two months. In this group of fetuses the parameters of the uterine tube length aged from 9 to 10 months were found to differ reliably contrary to the length of the uterine tubes in the group of modern specimens of a similar age. Comparison of dynamics in changes of the uterine tube length in the two groups of fetuses remote in time showed that within the frame of one group differences in the morphometric parameters between the right and left uterine tubes are not considerable. Therefore, the study of peculiarities in the structure of the uterine tubes at every stage of the perinatal period found certain peculiarities and regularities of their development.

The Efficacy of Long-Term Estrogen Replacement Therapy in Turner Syndrome Women with Premature Ovarian Insufficiency

To evaluate the efficacy of long-term estrogen replacement therapy (ERT) in uterine development and bone mineral density (BMD) of Turner syndrome (TS) women with premature ovarian insufficiency (POI). Retrospective study. Thirty-seven TS women grouped according to ovarian function status: TS women with POI (n=32), aged 11-26years, and those with intact ovarian function (IOF; n=5), aged 13-17years. TS women with POI underwent ERT. Changes in uterine length, anterior-posterior (AP) fundal diameter of the uterus, and BMD were assessed. Statistical methods included Mann-Whitney U test and paired t test. In TS women with POI, uterine length, AP fundal diameter, and BMD significantly increased after ERT (P<.001). TS women with POI were subdivided into classic (n=11) and variant (n=21) types, and there were no significant differences in uterine development and BMD according to types of chromosome. After receiving ERT, AP fundal diameter was significantly longer in classic TS women (P=.034) compared with those with variant type. Long-term ERT increased uterine length (before: 4.4cm; after: 7.2cm) and AP fundal diameter (before: 0.9cm; after: 2.4cm), and improved BMD in TS women with POI. After ERT, in TS women with POI, uterine length, BMD at lumbar 2-4 and femoral neck were similar to those of TS women with IOF. Therefore, TS women with POI can catch up to those with IOF by receiving ERT.

Risk factors for failure of sentinel lymph node mapping using indocyanine green/near-infrared fluorescent imaging in endometrial cancer.

Side-specific systematic lymphadenectomy is suggested if sentinel lymph node (SLN) mapping failed in early stages endometrial cancer. This study aimed to evaluate the risk factors associated with failed mapping which may lead to modify SLN mapping technique, increase the success of SLN mapping and reduce the necessity of systematic lymphadenectomy. Patients with early stage endometrial cancer were included in this study. All patients underwent SLN mapping with indocyanine green/near-infrared compatible surgical platforms. Indocyanine green was injected intracervical. "Bilateral mapping" and "failed bilateral SLN mapping (unilateral or bilateral failed mapping)" groups were compared for demographic, clinical, surgical, and pathological features. 101 cases were analyzed. The overall, unilateral, and bilateral SLN detection rates were 94.1%, 19.8%, and 74.3%, respectively. The failed (unilateral or no mapping) bilateral detection rate was 25.7%. Failed bilateral mapping rates were higher in patients with longer cervical and uterine longitudinal lengths, deep myometrial invasion and larger tumor size without statistical significance. Body mass index and operation type were not related with failed mapping. Increasing number of operations or injection of larger volume of indocyanine green (4mL vs. 2mL) did not improve mapping rate significantly. Cervical indocyanine green injection may overcome the negative effect of obesity on bilateral mapping. Although there was a negative correlation trend between the longitudinal cervical and uterine lengths and bilateral mapping, this possible relation needs to be confirmed in further studies.

Analysis of the reproductive outcomes and the size of the unicornuate uterus measured by magnetic resonance imaging and their relationship.

To evaluate the relationship between the uterine size measured by pelvic magnetic resonance and reproductive outcome in women with a unicornuate uterus. This was a retrospective study including 140 patients affiliated with unicornuate uterus diagnosed by the pelvic MR prior to their first pregnancy in the Obstetrics and Gynecology Hospital of Fudan University from April 2010 to December 2017. All the length of the unicornuate uterus were re-measured and recorded by skilled radiologists during the study period. We divided all the 140 participants with complete pelvic MR imaging into four groups by the best reproductive outcomes, which refers to Group 1 (primary infertility, n = 21), Group 2 ( < 24weeks' gestation, n = 34), Group 3 (preterm delivery, 24-35weeks' gestation, n = 13), Group 4 ( ≥ 35weeks' gestation, n = 72), followed them up and then analyzed the data. Measurements of 140 patients with hemi-uteri were retrieved for analysis. The mean length of the uterine was 4.90 ±0.56cm. There were no significant differences in the uterine cavity length, cervical length, endometrial thickness and uterine wall thickness between the four groups while the uterine length (P=0.001) was statistically significant. Women with uterine lengths ≥ 4.5cm were more likely to experience full-term delivery compared with the other group (P=0.001). Ordinal multiple logistic regression analysis showed that the uterine length [OR=9.03 (95% CI: 2.90-28.13)] and uterine cavity length [OR=0.32 (95% CI: 0.06-2.04)] were independent protective factors for better obstetric outcomes CONCLUSION: The uterine length is a reliable prognostic factor for the gestational week of delivery and an appropriate antenatal surveillance factor of women with unicornuate uterus.

Uterine size and volume are associated with a higher clinical pregnancy rate in patients undergoing assisted reproduction technology: A longitudinal study (A STROBE-compliant article).

The aim of this study was to investigate the relationships between uterine size and volume and clinical pregnancy rate.This longitudinal study was conducted among patients undergoing assisted reproduction technology (ART) treatment at the Reproductive Medicine Center from January 2010 to May 2017, all of whom provided informed consent to participate in the study. The uterine size, for all patients, was measured by transvaginal ultrasonography before ovarian stimulation. Clinical pregnancy was diagnosed by ultrasound confirmation of at least an intrauterine gestational sac and fetal cardiac activity 4 weeks after embryo transfer.A total of 11,924 patients were enrolled in this study. Compared to patients with uterine lengths of 50 to 59 mm (referent), patients with uterine lengths ≥60 mm had a lower clinical pregnancy rate. Compared to patients with uterine widths of 30 to 39 mm (referent), patients with uterine widths of 40 to 49 mm and those with uterine widths of ≥50 mm had a lower clinical pregnancy rate. Compared with those with a uterine anteroposterior diameter of <30 mm (referent), patients with uterine anteroposterior diameters of ≥50 mm had a lower clinical pregnancy rate. Compared with those with a uterine volume of 30 to 49 mL (referent), patients with a uterine volume ≥70 mL had a lower clinical pregnancy rate.The patients with an optimal uterine length, width, anteroposterior diameter, and volume had a higher clinical pregnancy rate than those with suboptimal uterine measurements. Uterine sizes and volumes that were too large reduced the clinical pregnancy rate.

Combined therapeutic effects of HIFU, GnRH-a and LNG-IUS for the treatment of severe adenomyosis

Objective: To evaluate the combined efficacy of high-intensity focused ultrasound (HIFU), gonadotropin-releasing hormone agonist (GnRH-a) and the levonorgestrel-releasing intrauterine system (LNG-IUS) for the treatment of severe adenomyosis.Method: Four hundred and sixty-six patients with adenomyosis admitted to the Department of Gynecology of Shanghai First Maternity and Infant Hospital underwent HIFU treatment, and then were consecutively administered with GnRH-a 1 d, 1 month and 3 months after HIFU treatment. The uterine size was then measured with ultrasound or MRI 2–4 weeks after three cycles of GnRH-a injection. The LNG-IUS was then inserted when the uterine length less than 9 cm. The visual analog scale (VAS), verbal rating scale (VRS), menstrual volume score, uterus volume, MRI, serum levels of hemoglobin and CA125 were measured at pre and 3-, 6-, 12-month post-HIFU.Results: Dysmenorrhea and menorrhagia significantly relieved after combined treatment with HIFU, GnRH-a and the LNS-IUS. The uterine volume shrank and returned to its normal size. The serum CA-125 level was reduced to the normal level after the combined treatment.Conclusions: The combined therapeutic regimen of HIFU, GnRH-a and LNS-IUS is safe, effective and efficient for curing severe adenomyosis.

Re-evaluation of Urinary Trypsin Inhibitor on Pregnancy Course in Patients with Threatened Preterm Delivery: A Single-Center Retrospective Study.

We evaluated the necessity of urinary trypsin inhibitor for patients with threatened premature labor. We enrolled 146 women with singleton pregnancies who were treated for threatened premature labor as inpatients. The uterine cervical length of each patient was ≤ 25 mm at 22-35 weeks of gestation on transvaginal ultrasonography. The patients were divided into two groups: the urinary trypsin inhibitor group (91 patients treated with urinary trypsin inhibitor daily) or non-urinary trypsin inhibitor group (55 patients not treated with urinary trypsin inhibitor). The childbirth outcomes were retrospectively assessed. The median cervical length measured on the day of admission was almost similar between the urinary trypsin inhibitor and non-urinary trypsin inhibitor groups. Depending on the symptoms of uterine contractions, we determined whether ritodrine hydrochloride and/or magnesium sulfate would be appropriate for treatment. The median gestational week at birth was 38 weeks in the urinary trypsin inhibitor group, and no obvious differences were observed when compared with the non-urinary trypsin inhibitor group. With regard to birth weight, no significant difference was found between the two groups (urinary trypsin inhibitor group, 2776 g; non-urinary trypsin inhibitor group, 2800 g). Our data showed no significant beneficial effects of urinary trypsin inhibitor in the maternal course and delivery outcomes.

Comparison of postpartum sonographic findings after uneventful vaginal and cesarean section deliveries.

Objective: To prospectively determine the sonographic findings of the postpartum uterus 24 hours after vaginal delivery and cesarean section. Methods: Women who had uneventful vaginal delivery or cesarean section from July 2015 to May 2018 in a tertiary care hospital were prospectively included. Uterine lengths, endometrium, amout of free fluid, the distance between the uterine fundus-promontorium and uterine fundus-L5 were evaluated 24 hours after delivery. Results: The mean (min–max) endometrial thickness in the vaginal delivery and cesarean section groups were 13.3 (4–25) and 12.4 (4–29) mm, respectively. Fundus-cervix length was significantly higher in the vaginal delivery group compared to the cesarean section group (184.05 ± 16.8 vs 163.6 ± 6.7 mm, p <0.001). The measurements of anterior and anterior-posterior walls of the uterus, anteroposterior uterine length and uterine width were similar in both groups. Promontorium-fundus length was significantly higher in patients who delivered vaginally than those by cesarean section (123.3 ± 13.6 vs 108.7 ± 23.3 mm, p = 0.005). Conclusion: The measurement of L5-fundus distance is a simple and effective technique to evaluate the size of the uterus. Homogenous endometrium up to 30 mm in asymptomatic patients may be a normal finding 24 hours after delivery. The results of this study may be helpful in the decision-making process in cases of early postpartum hemorrhage or hemodynamic instability.

Associations of temporal changes in cervical length and lower uterine segment length with spontaneous preterm delivery risk: a prospective study of 727 Japanese women.

A prospective assessment of the risk of spontaneous preterm delivery (sPTD) by evaluating temporal changes in cervical measurements. We analyzed clinical variables, focusing on cervical length (CL) and lower uterine segment (LUS) length (LUSL) as measured by transvaginal ultrasonography in 727 pregnant Japanese women. In women undergoing term deliveries, CL increased from gestational week (GW) 8-25. In contrast, the combination of CL and LUSL (ComL for "combined length") gradually decreased and sole LUSL became almost 0mm by GW 25. Univariate logistic regression analysis suggested that a history of PTD was a risk factor for sPTD. CL, LUSL, and ComL were not significant predictors of sPTD. To assess the risk of sPTD in the second trimester, it is not necessary to distinguish the cervix from the LUS.

Accuracy and efficacy of embryo transfer based on the previous measurement of cervical length and total uterine length.

Aim of the study was to examine the accuracy of embryo transfer based on the previous measurement of cervical length and total uterine length. The study has taken place in an academic-assisted reproduction clinic. 248 patients with infertility requiring IVF/ICSI treatment have been included. All patients underwent IVF/ICSI cycles with antagonist protocol and were treated with controlled ovarian stimulation using recombinant FSH (100-400IU/day). On the day of oocyte retrieval, all patients were given vaginally natural micronized progesterone in a dose of 200mg/tds. All patients had transvaginal ultrasound measurement of cervical length and endometrial cavity length prior to embryo transfer and measurement of embryo distance (intrauterine air bubbles) from fundal surface of uterine cavity and internal cervical os immediately after embryo transfer. Embryo transfer was performed on days 2-3. Primary outcome was to estimate the accuracy of embryo transfer based on the measurement of the embryo distance from middle of uterine cavity after embryo transfer and secondary outcome was to assess the effect of embryo distance from uterine fundus and internal cervical os to clinical pregnancy rate. The clinical pregnancy rate was 42.7%. The mean embryo distance from the middle of endometrial cavity was 0.48 ± 0.02cm, the mean embryo distance from the uterine fundus was 0.88 ± 0.32cm, and from the internal cervical os was 1.67 ± 0.45cm. Multiple regression analysis showed that the embryo distance from middle of cavity was related to endometrial cavity length and to the embryo distance from the fundus and it was not related to Cx length, total uterine length, embryo distance from internal Cx os, and embryo transfer length. Embryo transfer with the previous measurement of total uterine length and estimation of embryo transfer length can be performed with very good accuracy by a single operator.

Risk Assessment for Preterm Delivery using the Fetal Fibronectin Test Associated with the Measurement of Uterine Cervix Length in Symptomatic Pregnant Women.

To analyze the use of the measurement of uterine cervix length (MUCL) and the fetal fibronectin (fFN) rapid test as predictors of preterm delivery (PTD) in symptomatic pregnant women assisted at the Santa Casa de Misericórdia de Sobral Maternity Hospital. This was a prospective and analytic study involving 53 parturients assisted between September of 2015 and July of 2016; the participants were between 24 and 34 weeks of gestational age (GA) and presented complaints related to preterm labor (PTL) prodromes. Vaginal secretion was collected for fFN testing, and the MUCL was obtained via transvaginal ultrasonography. A total of 58.49% of the subjects showed MUCL < 25 mm, and 41.51% were positive in the fFN rapid test. A total of 48 patients were followed-up until their delivery date, and 54.17% resulted in PTL. The relative risk (RR) for PTD in patients with MUCL < 25 mm was 1.83 (p = 0.09, 0.99-3.36, 95% confidence interval [CI]), with a mean time before delivery of 2.98 weeks. Based on fFN positive results, the RR was 3.50 (p = 0.002, 1.39-8.79, 95%CI) and the mean time until delivery was 1.94 weeks. The RR was 2.70 (p = 0.002, 1.08-6.72, 95%CI) when both tests were used. The RR of PTD within 48 hours, and 7 and 14 days were, respectively, 1.30 (p = 0.11, 95% CI 1.02-1.67), 1.43 (p = 0.12, 95% CI % 0.99-2.06), and 2.03 (p = 0.008, 95% CI 1.26-3.27), when based on the MUCL, and 1.75 (p = 0.0006, 95% CI 1.20-2.53), 2.88 (p = 0.0001, 95% CI, 1.57-5.31), and 3.57 (p = 0.0002, 95% CI 1.63-7.81) when based on positive fFN results. The RR at 48 hours and 7 and 14 days considering both tests was 1.74 (p = 0.0001, 95% CI 1.14-2.64), 2.22 (p = 0.0001, 95% CI 1.22-4.04), and 2.76 (p = 0.0002, 95% CI 1.27-5.96), respectively. In symptomatic pregnant women, we concluded that the MUCL < 25 mm associated with positive fFN rapid test indicate increased the risk for PTD. Further studies with larger sample sizes could contribute in supporting the results presented in the current study.

Neonatal lactocrine deficiency affects the adult porcine endometrial transcriptome at pregnancy day 13.

Reproductive performance of female pigs that do not receive sufficient colostrum from birth is permanently impaired. Whether lactocrine deficiency, reflected by low serum immunoglobulin immunocrit (iCrit), affects patterns of endometrial gene expression during the periattachment period of early pregnancy is unknown. Here, objectives were to determine effects of low iCrit at birth on the adult endometrial transcriptome on pregnancy day (PxD) 13. On the first day of postnatal life, gilts were assigned to high or low iCrit groups. Adult high (n=8) and low (n=7) iCrit gilts were bred (PxD 0), and humanely slaughtered on PxD 13 when tissues and fluids were collected. The endometrial transcriptome was defined for each group using mRNAseq and microRNAseq. Reads were mapped to the Sus scrofa 11.1 genome build. Mature microRNAs were annotated using miRBase 21. Differential expression was defined based on fold change (≥±1.5). Lactocrine deficiency did not affect corpora lutea number, uterine horn length, uterine wet weight, conceptus recovery, or uterine luminal fluid estrogen content on PxD 13. However, mRNAseq revealed 1157 differentially expressed endometrial mRNAs in high versus low iCrit gilts. Differentially expressed genes had functions related to solute transport, endometrial receptivity, and immune response. Six differentially expressed endometrial microRNAs included five predicted to target 62 differentially expressed mRNAs, affecting similar biological processes. Thus, lactocrine deficiency on the first day of postnatal life can alter uterine developmental trajectory with lasting effects on endometrial responses to pregnancy as reflected at the level of the transcriptome on PxD 13.