Uterine Position Research Articles

Ultrasound cesarean scar assessment oneyear postpartum in relation to one- or two-layer uterine suture closure.

IntroductionThis study compared healing of the scars after cesarean section during the first postpartum year using a single‐ or double‐layer suturing technique. Scarring was assessed by a transvaginal ultrasound. We explored the appearance and localization of uterine scars with regard to the obstetric history. Our aim was to compare the position of the scar or defect, if present, its dimensions, and any residual myometrium with respect to the suturing technique during the cesarean section.Material and methodsWomen with uncomplicated singleton pregnancies indicated for elective or acute cesarean section were randomly allocated to the uterine closure technique group. During the first postpartum year, their lower uterine segment was examined with a transvaginal ultrasound in three consecutive visits at 6 weeks, 6 months and 12 months.Results324 women attended the 12‐month visit; of these, 149 underwent single‐layer closure of the uterine incision and 175 double‐layer technique. A higher proportion of the defects is seen in the single‐layer closure technique of suturing. Defects in the single‐layer group were wider (0.002) and the residual myometrial thickness in the single‐layer group were thinner (0.019). Women who underwent cesarean section at the stage of full cervical dilation had scars that were closer to the external cervical os (0.000). The position of the uterus varies greatly between controls (0.000). The combination of uterine position and scar defect presence changed significantly between controls (0.001), and was significantly dependent on the suturing method (0.003). Defects with or without contact with the uterine cavity changed statistically between controls (0.017). Both types of defects were more common in the single‐layer closure technique group.ConclusionsThe findings of this study demonstrate that double‐layer technique with the first continuous nonlocking suture followed by a second continuous nonlocking suture is associated with better suture healing and greater residual myometrial thickness. No difference was observed between single‐ and double‐layer closure for the presence of maternal infectious morbidity, wound infection or blood transfusion.

Intrauterine position and adjacent fetal sex affects fetal and placental growth throughout gestation, but not embryonic viability, in pigs selected for component traits of litter size

Intrauterine position and sex of adjacent fetuses in litter bearing species have been implicated in physiological and behavioral differences of offspring. The effects of uterine position and sex status of flanking fetuses with crowded uterine conditions on fetal and placental growth rate was tested. Gilts were unilaterally hysterectomized-ovariectomized at 160 d of age and mated at approximately 280 d of age, with fetal harvest at 45, 65, 85, or 105 d of gestation. Uterine position relative to the cervix, fetal status (alive, dead, sex), fetal weight, and placental weight were recorded at harvest. Each fetus was coded as adjacent to 0, 1, or 2 opposite sex fetuses and analyzed using an ANOVA fitting contemporary group, line, and flanking fetal sex code as fixed effects with sire as a random effect. The fraction of live fetuses in each classification (0, 1, 2) was 26.4%, 50.1%, and 23.4%, respectively, indicating no effect on fetal survival. Fetal weight was affected by flanking sex status between 65 d (P < 0.05) and 105 d (P < 0.001), with means at 105 d of 800.0 ± 20.3, 748.5 ± 17.8, and 672.7 ± 25.2 g, respectively for flanking sex status codes 0, 1, 2. Placental weight was similarly affected (P < 0.01) by flanking sex code, but only at 105 d. It is concluded that fetal growth and placental development in pigs is influenced by sex status of adjacent fetuses. This could be a potential source of variation in behavioral and reproductive differences later in life.

Intravasation Affects the Diagnostic Image Quality of Transvaginal 4-Dimensional Hysterosalpingo-Contrast Sonography With SonoVue.

We aim to retrospectively analyze the diagnostic image quality of transvaginal 4-dimensional hysterosalpingo-contrast sonography from infertile patients and determine the significant influencing factors. A total of 445 patients visiting infertility clinics were included in the study, of which 167 were primary infertile and 278 were secondary infertile. The factors were recorded, including age; examination time; infertility type; history of pelvic inflammatory disease, pelvic surgery, intrauterine surgery, and ectopic pregnancy; endometrial thickness; uterine position; ovarian position; 2-dimensional image quality; intravasation quantity, position, and time; balloon volume; and the dosage of contrast agent or the sterile saline solution. All the factors were compared among different diagnostic image quality groups. The method of rank logistic regression analysis was adopted to analyze the risk factors affecting the diagnostic image quality. Among the 445 infertile patients, 124 (27.9%) patients had intravasation occur during transvaginal 4-dimensional hysterosalpingo-contrast sonography. The diagnostic image quality between the 2 sonographers was consistent (Cronbach's alpha, 0.993). Different intravasation quantities, positions, and times; increased of balloon volume; and history of pelvic surgery were substantial risk factors for the diagnostic image quality. The diagnostic image quality diminished with the increase of intravasation. In the patient with cornual intravasation, the diagnostic image quality was substantially worse than that with non-cornual intravasation. Moreover, early onset of intravasation seriously affected the diagnostic image quality. In conclusion, intravasation affected the diagnostic image quality, especially early cornual massive intravasation.

Dosimetric study and suitable population between 3-and 2-dimensional brachytherapy for cervical cancer at different locations

Objective To investigate the effect of different uterine positions upon the dose distribution and target area conformability of organ at risk (OAR) and explore the population suitable for 2-dimensional brachytherapy by comparing the dosimetry between CT-guided 3-and 2-dimensional brachytherapy for cervical cancer. Methods Thirty patients with cervical cancer received 72 cycles of 3-dimensional brachytherapy and then 2-dimensional brachytherapy was designed. The deviation angle of the uterus from the longitudinal asix on the coronal and sagittal CT images was measured. The obtained data were divided into the A to D and the group Ⅰ to Ⅳ according to the deviation angle (T) of uterus position from the longitudinal axis on the sagittal CT images and the volume of HRCTV (VHRCTV) to identify the optimal uterine position and range of VHRCTV for 2-dimensional brachytherapy. Statistical analysis was performed by paired t-test. Results The deviation angle of uterine position was not significantly correlated with the target CI index or D90 of HRCTV in both brachytherapy plans (P value between 0.077-0.633), whereas it was positively correlated with the D2 cm3 of bladder (P value between 0.001-0.030) and negatively associated with the D2 cm3 of rectum in both 2-and 3-dimensional brachytherapy (P value between 0.011-0.016). In group B (|T|≤10°) and group Ⅲ(VHRCTVvalue between 86-96 cm3), the OAR parameters and CI index did not significantly differ between two brachytherapy plans (P value between 0.040-0.463), whereas varying degree of statistical differences was observed among other groups (P value between 0.000-0.940). Conclusions Although uterine position exerts no effect upon the conformal index of target area, it can affect the dose distribution of OAR. No statistical significance is noted in the dosimetry between 3-and 2-dimensional brachytherapy plans when the uterine position is almost flat (|T|≤10°) and the radiotherapy target area is appropriate (VHRCTVvalue between 86-96 cm3). In this situation, 2-dimensional brachytherapy is the optimal option. Key words: Cervical neoplasms/brachytherapy; Uterine positions; Dosimetry

Uterine structural abnormality and intrauterine device malposition: analysis of ultrasonographic and demographic variables of 517 patients

Intrauterine devices are currently one of the leading forms of reversible contraception in the world. However, in approximately 10-25% of women, intrauterine devices can become malpositioned, leading to consequences including pain, bleeding, as well as possible decreased contraceptive efficacy. We sought to determine whether certain reproductive and uterine characteristics are associated with an increased risk of intrauterine device malposition. We hypothesized that anatomical characteristics such as the presence of any uterine anomalies, particularly congenital anomalies and fibroids that may lead to cavitary distortion, would be associated with a higher incidence of intrauterine device malposition. We conducted a retrospective case-control study in an academic medical center. All patients presenting for scheduled ultrasound appointments for gynecologic indication between June 2004 and February 2016 were included (1,253 ultrasound reports identified). Of these, 236 demonstrated malpositioned intrauterine devices. With a control group of 281 patients with normal intrauterine device location, a total of 517 patients were included in the study. Transabdominal and transvaginal ultrasounds were performed followed by 3-dimensional rendering (as per our institution's protocol for patients with intrauterine devices) using Voluson 730 and Voluson E8 ultrasound machines. Demographic and reproductive characteristics, indication for ultrasound, intrauterine device, and uterine characteristics were all extrapolated from the electronic medical record. χ2 Tests were performed for categorical variables. Generalized linear models for Poisson distributed variables, and multiple logistic regression were used to ascertain significant independent predictors of IUD malposition. Ninety-five percent confidence intervals and effect sizes were calculated, and P < .05 was considered statistically significant. In this study, we found a cumulative IUD malposition rate of 19%. In patients with malpositioned intrauterine devices, there was increased incidence of retroflexed uterine positions (7.6% vs 1.8%, P= .001), and all uterine anomalies (this includes septate and bicornuate uteri and fibroids, 31.9% vs 23.5%, P= .02) compared with controls. The anterior midline uterine position was more commonly noted in controls (28.5% vs 11%, P < .001). A higher total number of fibroids was noted in the malpositioned group (3.7 vs 1.8, P= .01); however, fibroid size was not statistically significant. In particular, there was an increased incidence of submucosal fibroids in women with malpositioned intrauterine devices (P= .01). Multivariable logistic regression revealed that anterior midline position (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.20-0.57) and absence of uterine anomalies (OR, 0.59; 95% CI, 0.38-0.93) were factors associated with a lower risk of IUD malposition; whereas vaginal bleeding (OR, 2.25; 95% CI, 1.38-3.67), pain (OR, 2.85; 95% CI, 1.84-4.44), or missing IUD strings at time of presentation (OR, 3.58; 95% CI, 1.88-6.82) were associated with an increased risk of malposition. Retroflexed uterine positions and all uterine malformations are associated with higher incidence of malpositioned intrauterine devices. Presence of increased number of fibroids and specifically submucosal fibroids showed a positive association with intrauterine device malposition, as did symptoms of bleeding, pain, and missing IUD strings at time of presentation. These findings pertain to women presenting for gynecologic ultrasound evaluation and may not be generalizable to all women with IUDs.

Induction of cyclicity in dairy cows using GnRH (Gonadotropin releasing hormone) in the region of Batna, Algeria

ABSTRACTThe objective of this study was to evaluate the effect of the GnRH induction of cyclicity in dairy cows during the postpartum period, and to contribute to solve some breeding problems.A total of 96 dairy Holstein cows were randomly divided into two groups to evaluate the effect of a single injection of GnRH on the return of the cyclic activity of cows during the post partum period. During this study, the cows were submitted to rectal palpation at regular intervals to evaluate the uterine involution and check the return of estrus.The results have shown that 90% of the cows have a pelvic uterine position for the treated group against 60% in the group untreated. Additionally, we found that gonadotropin treatment has a positive impact on the reduction of the interval calving-estrus by 66 days compared to the control group.These findings confirm the beneficial effect of the GnRH during the post partum on the reproductive parameters in treated cows, giving particularly a shorter calving to first estrus interval, calving to conception/pregnancy interval, and calving interval.

Sonographically Guided Office Endometrial Sampling: Indications and Results.

The purpose of this study was to identify clinical indications in which endometrial sampling was performed under transabdominal ultrasound (US) guidance and to evaluate the outcomes of this approach in an academic practice. We retrieved data from the electronic medical record for all patients referred to the gynecologic US unit for transabdominal US-guided endometrial sampling from January 2011 to June 2017. Data retrieved included age, parity, previous cesarean delivery or pelvic surgery, indication for endometrial biopsy, US abnormalities, clinical reasoning for US-guided sampling, and pathologic reports. A total of 113 patients were referred for US-guided sampling between January 2011 and June 2017. We identified the following reasons for US-guided biopsy referral: failed blind biopsy attempt, fibroids, uterine position or anomaly, need for targeted sampling, cervical stenosis, and other indications. Ninety-five of the 113 patients (84%) underwent successful US-guided endometrial sampling. Forty of the 113 patients were referred after a failed blind biopsy, with 83% subsequently undergoing successful US-guided endometrial sampling. Of the 30 patients referred for fibroids, 29 (97%) underwent successful US-guided sampling. High success rates were also noted for transabdominal US guidance referrals for the uterine position or anomaly (86%) and the need for targeted sampling (83%). Our results suggest that endometrial sampling performed under US guidance could be considered for patients with a failed blind approach, fibroids, uterine anomalies, and interest in targeted sampling. In such cases, US-guided sampling could be considered before surgical options.

Transvaginal and transperineal ultrasound follow-up after laparoscopic correction of uterine retrodisplacement in women with posterior deep infiltrating endometriosis.

Retrodisplacement of the uterus (retroflexion and/or retroversion) may be associated with pelvic pain symptoms and posterior deep infiltrating endometriosis (DIE). Previous studies in symptomatic women with retrodisplacement of the uterus showed the efficacy of hysteropexy in terms of pain symptoms improvement. To evaluate sonographic, clinical and surgical outcomes of a hysteropexy technique MATERIALS AND METHODS: Laparoscopic round ligament plication and tilting of the uterine fundus in women with uterine retrodisplacement and posterior deep infiltrating endometriosis was performed. Forty-two symptomatic women were enrolled and the sonographic data of each (angle of uterine version and uterine flexion, uterine mobility) was assessed before and after surgery with transvaginal and transperineal approaches. Women were also evaluated at 1, 6 and 12months after surgery for pain symptoms with a numerical rating scale (dysmenorrhoea, dyspareunia and chronic pelvic pain), intraoperative data and surgical complications. The additional mean operative time of hysteropexy procedure was 8±3min. At early follow-up both the uterine angles were significantly (P<0.001) reduced. At 12-month follow-up, seven patients (16.7%) presented a retroverted uterus, while 12 (28.6%) presented a retroflexed uterus; the sliding sign remained negative in four patients (9.5%). A significant improvement of symptoms (P<0.001) was observed during the follow-up. Laparoscopic hysteropexy appears as an effective additional surgical procedure, which can temporarily correct the uterine position in order to reduce the risk of postoperative adhesions.

Does Patient Posture Affect the Ultrasound Evaluation of Pelvic Organ Prolapse?

Translabial ultrasound (US) imaging is an emerging method for the evaluation of pelvic organ prolapse (POP). Normative data to date are limited to imaging in the supine position. The purpose of this study was to evaluate the effect of posture changes on US pelvic organ mobility. This work was a retrospective study of 175 women seen in a tertiary urogynecologic center for symptoms of lower urinary tract and pelvic floor dysfunction. All underwent a standardized interview, POP quantification prolapse assessment, and 4-dimensional translabial US examination in supine and standing positions. Offline measurement of organ descent on the Valsalva maneuver was undertaken at a later date and was blinded against all other data. The mean age was 58 (SD, 13.5; range, 17 to 89) years, with a mean body mass index of 29 (SD, 6.1; range, 18 to 53) kg/m2 . In total, 58.9% (n = 103) presented with symptoms of prolapse. Clinically, 82.8% (n = 145) had substantial prolapse on the POP quantification assessment. On imaging, bladder, uterine, and rectal ampulla positions were significantly lower, and the hiatal area on the Valsalva maneuver was larger in the standing position (P < .03). On receiver operating characteristic statistics assessing correlations between POP symptoms and US pelvic organ descent, the area under the curve was higher in the standing position, but the difference was not statistically significant. Measurements of organ descent and hiatal dimensions are generally higher in the standing position. However, they are not reflected in a stronger association between symptoms and organ descent. Hence, imaging in the standing position can be limited to those patients in whom a false-negative assessment result is suspected.

Laparoscopic Uterosacral Suture Sacrohysteropexy: LUSSH Procedure

Study ObjectiveTo demonstrate a mesh-free laparoscopic uterosacral suture sacrohysteropexy (LUSSH). DesignTechnical video demonstrating LUSSH for uterine prolapse (Canadian Task Force classification III). SettingUniversity hospital. PatientA 37-year-old woman with grade 3 uterine descent requested uterine-sparing surgery for symptomatic prolapse. The patient declined all mesh procedures. InterventionMesh-free laparoscopic uterosacral suture sacrohysteropexy (LUSSH). Measurements and Main ResultsLaparoscopic sacrohysteropexy is a uterine-preserving technique for uterine prolapse with high cure rates (92%) but with a mesh erosion risk of up to 2.5% [1,2]. Complications have resulted in reclassification of transvaginal meshes as restricted-use high-risk medical devices [3,4]. Sacrospinous hysteropexy and uterosacral ligament suspension are mesh-free alternatives, but they have increased rates of anterior-compartment failures and a 20% recurrence rate in the latter [5,6]. Laparoscopic suture sacrohysteropexy has been described with reported success rates of 95% [7]. This video demonstrates a modified-technique offering a simple, robust, and reproducible mesh-free approach to uterine-preserving prolapse surgery. We used 2 horizontal loop mattress sutures acting as a pulley to distribute the force evenly throughout the suture strand, leading to a significantly stronger and more secure hold and reducing risk of avulsion [8]. The technique starts with a careful dissection of the peritoneum from the sacral promontory to the cervix. Two permanent sutures are used, taking bites at the anterior longitudinal ligament, the uterosacral, a loop mattress in the midline at the cervix, the uterosacral on the way back, and finally at the sacral promontory. Damage to the uterine vessels is minimized by maintaining a central uterine position. The stitch is tied with caudal pressure on the uterus, applied via the uterine manipulator, approximating the cervix to the sacral promontory. The peritoneum is closed with dissolvable sutures, burying the Ethibond to prevent exposure and bowel obstruction. ConclusionPost-procedure, the uterus was well supported with a vaginal length of 15 cm.

Identification of early indicators of altered metabolism in normal development using a rodent model system.

ABSTRACTAlthough the existence of a close relationship between the early maternal developmental environment, fetal size at birth and the risk of developing disease in adulthood has been suggested, most studies, however, employed experimentally induced intrauterine growth restriction as a model to link this with later adult disease. Because embryonic size variation also occurs under normal growth and differentiation, elucidating the molecular mechanisms underlying these changes and their relevance to later adult disease risk becomes important. The birth weight of rat pups vary according to the uterine horn positions. Using birth weight as a marker, we compared two groups of rat pups – lower birth weight (LBW, 5th to 25th percentile) and average birth weight (ABW, 50th to 75th percentile) – using morphological, biochemical and molecular biology, and genetic techniques. Our results show that insulin metabolism, Pi3k/Akt and Pparγ signaling and the genes regulating growth and metabolism are significantly different in these groups. Methylation at the promoter of the InsII (Ins2) gene and DNA methyltransferase 1 in LBW pups are both increased. Additionally, the Dnmt1 repressor complex, which includes Hdac1, Rb (Rb1) and E2f1, was also upregulated in LBW pups. We conclude that the Dnmt1 repressor complex, which regulates the restriction point of the cell cycle, retards the rate at which cells traverse the G1 or G0 phase of the cell cycle in LBW pups, thereby slowing down growth. This regulatory mechanism mediated by Dnmt1 might contribute to the production of small-size pups and altered physiology and pathology in adult life.

459: Sonographically measured inferior vena caval diameter in response to different maternal positions in pregnancy

Placing pregnant patients in left lateral tilt (LLT) position to avoid compression of the inferior vena cava (IVC) has long been standard obstetric practice. The American Heart Association recommends continuous manual left uterine displacement (LUD) instead of LLT position during a maternal cardiac arrest. The relationship between maternal position and proximal filling of the IVC is unknown. The hypothesis is that the maternal IVC diameter would increase in response to LLT and LUD compared to supine position. A pilot prospective observational study was performed on 60 healthy gravidas. 30 patients at 20-24 weeks and 30 patients at 37-41 weeks were recruited. Patients were placed in supine, 30 degree left lateral tilt and supine with left uterine displacement positions. The IVC was visualized by ultrasound using the subxiphoid technique. The primary outcome was IVC diameter at end expiration. Descriptive analysis and student's paired t-test were performed. In the 20-24 weeks cohort, patients in LLT position (77.5 +/- 9.8, p=0.03) and LUD position (77.3 +/-9.5, p=0.04) had a significant decrease in heart rate (bpm) compared to supine position (80.5 +/-8.5). Patients in the LUD position (80.7 +/-7.6, p<0.001) had a significant decrease in MAP compared to supine position (83.7 +/- 7.4). No significant differences were seen in the IVC diameter between all 3 positions.In the 37-41 weeks cohort, there were no significant differences in the MAP, heart rate, and IVC measurement between all 3 positions.In the 20-24 weeks cohort, 48.3%, 30%, 18.3% of patients had their largest IVC diameter in the LUD, LLT, and supine position, respectively. In the 37-41 weeks cohort, 33.3%, 28.3%, 30% of patients had their largest IVC diameter in the LUD, LLT, and supine position, respectively. 1 subject in each cohort experienced symptoms consistent with supine hypotension syndrome in the supine position (3.33%). Sonographically the IVC diameters were not statistically different between all 3 positions. Furthermore, 18% in the 20-24 weeks cohort and 30% in the 37-41 weeks cohort had their largest IVC diameter in the supine position. This observation challenges the universal belief of uterine IVC compression with associating decrease in proximal IVC filling among pregnant cohort. This study suggests that LLT or LUD may not be universally beneficial.

Functional pelvic floor anatomy in Nepali women attending a general gynaecology clinic.

Limited existing evidence suggests that there is a high prevalence of female pelvic organ prolapse (POP) amongst Nepali women. However, to date, no comprehensive assessment of pelvic floor functional anatomy has been undertaken in this population. Our study aimed to determine functional pelvic floor anatomy in Nepali women attending a general gynaecology clinic. One hundred and twenty-nine consecutive women attending the clinic were offered an interview, clinical examination [International Continence Society Pelvic Organ Prolapse Quantification system (ICS/POP-Q)] and 4D translabial ultrasound (TLUS). Most presented with general gynaecological complaints. Five were excluded due to previous pelvic surgery, leaving 124. A POP-Q exam was possible in 123 women, of whom 29 (24%) were diagnosed with a significant cystocele, 50 (41%) significant uterine prolapse and seven (6%) significant posterior compartment prolapse. Evaluation of 4D TLUS data sets was possible in 120 women, of whom 25 (21%) had a significant cystocele, 45 (38%) significant uterine prolapse and ten (8%) significant descent of the rectal ampulla. In 13 cases, there was a rectocele with a mean depth of 14 (10-28) mm. Of 114 women in whom uterine position could be determined, 68 (60%) had a retroverted uterus associated with significant uterine prolapse (P 0.038). POP is common in Nepali women attending a general gynaecology clinic, with a high prevalence of uterine prolapse (40%). Uterine retroversion was seen in 60% and was associated with uterine prolapse. Patterns of POP in Nepal seem to be different from patterns observed in Western populations.

Classic versus uterine sound-sparing approach for insertion of copper T380A intrauterine device: A randomized clinical trial

Abstract Objective The current study compares the efficacy of the classic approach and the uterine sounding sparing approach (a new approach) for copper intrauterine device (Cu-IUD) insertion. Study design A randomized clinical trial. Setting Woman's Health Hospital, Assiut, Egypt. Materials and methods The current study was an open parallel randomized clinical study conducted in Assiut Woman’s Health Hospital, Egypt included women requesting Copper IUD insertion. Enrolled women were randomized into 2 groups; group I included women subjected to classic approach for Cu-IUD insertion and group II included women had Cu-IUD insertion using the uterine sound-sparing approach (USSA). This approach utilized transvaginal ultrasound (TV/US) for assessment of the uterine cavity length and position before IUD insertion without using uterine sounding. The primary outcome was the successful Cu-IUD insertion. Results 46 women were analyzed in group I and 46 in group II. The pain during IUD insertion and 5 min post-insertion was significantly lower in group II than group I (p Conclusions Cu-IUD can be inserted successfully without using uterine sound provided using TV/US prior to insertion. This method associated with less pain, greater women satisfaction during insertion with shorter duration.

Sonographically guided insertion of intrauterine device: Indications and results

From 2011 to 2015, a total of 67 patients were referred for IUD insertion guided with transabdominal sonography (TAS). Fifty-six of the 67 patients had successful IUD insertion under TAS guidance. The clinical indications for referral included fibroids, uterine position, previous history of IUD expulsion, and limited tolerance of pelvic examination. Reasons for failed TAS-guided IUD insertion included patient discomfort, cervical stenosis, and inability to remove and replace an existing device. Ultrasound guidance could help broaden the patient population that may benefit from the therapeutic value of an IUD.

Association between uterine position and transvaginal misoprostol treatment for early pregnancy failure.

We aimed to determine the importance of uterine position as a predicting factor of success rate in medically treated early pregnancy failure (EPF). We carried out a retrospective cohort study at the Obstetrics and Gynecology Department of a tertiary medical center between January 2011 and June 2012. We included women diagnosed with EPF, which we defined as women diagnosed with missed abortion up to 13 gestational weeks. Patients were treated with one or two doses of 800 μg of misoprostol vaginally in accordance with the department's protocol. Demographic, clinical, and treatment success data were collected from patient electronic records. A total of 255 women were included in our study. The success rate after treatment with misoprostol for the anterior uterine group was 78.7% as compared to the non-anterior uterine group, which achieved a success rate of 88.1%. This difference was not statistically significant (P = 0.180). In a multivariate analysis comparing patients for whom treatment with misoprostol was successful as opposed to patients for whom treatment failed, only embryonic sac size showed a statistically significant difference, measuring shorter in the success group. Uterine position has no effect on success rate of misoprostol treatment for EPF.

Intrauterine device embedded in omentum of postpartum patient with a markedly retroverted uterus: a case report

BackgroundThe intrauterine device is a popular form of long-acting reversible contraception. Although generally safe, one of the most serious complications of intrauterine device use is uterine perforation. Risk factors for perforation include position of the uterus, force exerted during intrauterine device insertion, postpartum period, and breastfeeding. This case is important and needs to be reported because it highlights the need to assess risk factors for uterine perforation. It adds to the medical literature because it examines the relationship between position of the uterus and the location of uterine perforation. This case report is unusual in that it describes the mechanism and specific location of uterine perforation in relation to the position of the uterus.Case presentationWe present a case of an intrauterine device found in the omentum of a 30-year-old white postpartum woman with a significantly retroverted uterus after the intrauterine device threads were not visualized on speculum examination during a 6-week placement check. The intrauterine device was located and removed via laparoscopy without complication.ConclusionsThis case report will be of interest to women’s health practitioners because it illustrates the importance of identifying patients with risk factors for uterine perforation, examining the relationship between uterine position and location of perforation. This is especially significant because the true incidence of perforation may be higher than the numbers reported in the literature. There is no specific diagnostic code for uterine perforation and it is unlikely that retrospective studies can accurately identify all cases.

Endometrial Biopsy: American College of Nurse-Midwives.

Endometrial biopsy can be used to diagnose endometrial hyperplasia, endometrial cancer, and uterine infections. This cost-effective procedure has minimal side effects, and complications are rare. The purpose of this clinical bulletin is to provide clinicians with guidance about endometrial biopsy including the procedure's advantages and disadvantages, indications and contraindications, and side effects. In addition, step-by-step instructions for performing endometrial biopsy, the equipment required, selection of sampling devices, and care before and after the procedure are discussed.

Swine foetal myogenesis in different gestation periods.

This experiment was conducted to evaluate the effects of sex and uterus position on swine foetal myogenesis at different gestational ages. Fifteen primiparous sows were divided into three groups according to gestational age: 50, 80, and 106days. The experiment was a block randomized factorial design with two sexes (male and female) and three uterine regions (apex, middle, and base). After slaughter, each uterus horn was divided into three segments of equal length: apex region near the ovary; base region near the uterine body; and the middle region, lying between the apex and base regions. The foetuses were weighed, identified, and longitudinally opened to harvest the semitendinosus muscle for later morphological analysis. After 50days of pregnancy, male foetuses had greater (p<.05) weight than females. The number of primary fibres at 50days of gestation was negatively correlated (r=-.29, p=.04) with the number of foetuses in utero. After 80days, foetuses in the base region had less (p<.05) secondary area of muscle fibres compared to the apex region, which was accompanied by differences in the weight of the foetuses, the lowest weight were for foetuses located in the base region (p<.05). In the same period, the ratio of secondary to primary fibres had a positive correlation with weight. In conclusion, sex did not influence myogenesis in the gestational ages studied and the development of secondary muscle fibres of the foetuses at 80days of gestation was affected by their uterine position with foetuses at the base of the uterine horn being less developed.

Detection of Placental Proteomes at Different Uterine Positions in Large White and Meishan Gilts on Gestational Day 90.

Within-litter uniformity in pigs is a major factor affecting piglet survival and growth performance. We know that Meishan (MS) gilts have higher piglet survival rate than Large White (LW) gilts because their foetal weight is less varied. To understand the molecular basis for placental nutritional transport during the late stages of gestation in LW and MS, we employed the isobaric tags for relative and absolute quantification (iTRAQ) method to investigate alterations in the placental proteomes of LW and MS gilts on gestational day 90. Investigation of foetal weight at different uterine positions revealed that the foetal and placental weights as well as the foetal concentration of glucose were significantly higher in LW gilts positioned towards the utero-tubal junction than in those positioned toward the cervix; however, no such differences were observed in MS gilts, and MS gilts had a greater uniformity in foetal weight on day 90 of gestation. Comparisons of the proteomes between placentas positioned toward the cervix and those positioned toward the utero-tubal junction identified 38 differentially expressed proteins in the two breeds. These proteins play a central role in nutrient transport and metabolism, as well as in transcriptional and translational regulation. Of particular interest is the finding that the placentas of LW gilts showed 14 differential expression of proteins mainly related to lipid transport and energy metabolism (including solute carrier family 27, mitochondrial trifunctional protein, and NADH dehydrogenase [ubiquinone] flavoprotein 2), but only 2 proteins in MS gilts. In contrast, the differentially expressed proteins in MS gilts were primarily involved in transcriptional and translational regulation (such as ribosome-sec61 and 40S ribosomal protein S23), with a few related to glucose and coenzyme transport and metabolism (including glucose transport protein and ferrochelatase). Our results revealed that placental lipid and energy metabolism might play a crucial role in the regulation of foetal weight, based on uterine position in two distinct pig breeds. These findings provide a deeper understanding of placental efficiency that can be utilized to provide a new method to enhance the efficiency of livestock production.