Uterine Size Research Articles

Serum Calcium and Magnesium Levels in Women with Uterine Fibroids in Southwest Nigeria: a Cross-sectional Study.

Studies have suggested the potential roles of serum macronutrients such as calcium and magnesium in the development of uterine fibroids. The primary objective was to assess the association between serum magnesium and calcium levels and the prevalence of uterine fibroids in women of reproductive age. A cross-sectional study of 194 parity-matched women with or without a sonographic diagnosis of uterine fibroids enrolled at a university teaching hospital in Lagos, Southwest Nigeria. Participants' sociodemographic, ultrasound, and anthropometric information as well as the estimated serum levels of calcium and magnesium were collected for statistical analyses. This study found significant negative associations between low serum calcium levels and uterine fibroids (adjusted odds ratio = 0.06), uterine size, and the number of fibroid nodules. However, no significant association was observed between serum magnesium levels and uterine fibroids. This study found significant inverse associations between low serum calcium levels and uterine fibroids, uterine size, and the number of fibroid nodules.

Pregnancy is associated with reduced progression of symptomatic adenomyosis: a retrospective pilot study

BackgroundAdenomyosis is a common gynecological disease in women of reproductive age and causes various symptoms such as dysmenorrhea and heavy menstrual bleeding. However, the influence of pregnancy on the progression of adenomyosis remains unclear. The insight into whether the size of adenomyosis is increased, decreased, or unchanged during pregnancy is also undetermined. The current study aimed to evaluate the influence of pregnancy in patients with symptomatic adenomyosis.MethodsThis study retrospectively enrolled patients diagnosed with adenomyosis by magnetic resonance imaging between 2015 and 2022 at The University of Tokyo Hospital. Uterine size changes were evaluated by two imaging examinations. In the pregnancy group, the patients did not receive any hormonal and surgical treatments, except cesarean section, but experienced pregnancy and delivery between the first and second imaging examinations. In the control group (nonpregnancy group), the patients experienced neither hormonal and surgical treatments nor pregnancy from at least 1 year before the first imaging to the second imaging. The enlargement rate of the uterine size per year (percentage) was calculated by the uterine volume changes (cm3) divided by the interval (years) between two imaging examinations. The enlargement rate of the uterine size per year was compared between the pregnancy group and the control group.ResultsThirteen and 11 patients with symptomatic adenomyosis were included in the pregnancy group and in the control group, respectively. The pregnancy group had a lower enlargement rate per year than the control group (mean ± SE: −7.4% ± 3.6% vs. 48.0% ± 18.5%, P < 0.001), indicating that the size of the uterus with adenomyosis did not change in the pregnancy group.ConclusionsPregnancy is associated with reduced progression of symptomatic adenomyosis.

Vaginal Vault Infiltration With Bupivacaine for Postoperative Pain Control After Total Laparoscopic Hysterectomy: A Randomized Control Trial

ABSTRACT A viable alternative to total abdominal hysterectomy is total laparoscopic hysterectomy (TLH), which offers abdominal route advantages for women in need of total hysterectomy for benign diseases. Fewer complications, faster recovery, and less pain are ensured by laparoscopy, although this method is not entirely devoid of pain. Reports from various authors indicate that up to 80% of laparoscopic surgery patients require opioid analgesia, which could increase hospital-stay duration and delay mobilization/recovery. Because of these statistics, opioid analgesic usages ought to be minimized, for the aforementioned reasons and also to prevent additional adverse effects. This study was performed to evaluate efficacy of reducing postoperative pain by infiltration of bupivacaine, a long-acting anesthetic agent, into the vaginal vault after TLH. This study was a randomized control trial designed as a 2-arm double-blinded study conducted at a North-Indian Apical Center in the Department of Obstetrics and Gynecology. After written informed consent from all patients, computer-generated randomization software placed them in 1 of 2 groups: group 1, the intervention group (received the infiltration of bupivacaine in the vaginal vault following TLH), or group 2 (the control group). The inclusion criteria were a uterine size of ≤12 weeks' pregnancy and patients requiring TLH with or without bilateral salpingo-oophorectomy for uterine size and benign conditions. Exclusion criteria were contraindication to any medication used by the study, presence of malignancy, history of multiple surgeries, and history of inflammatory disease. Postoperative pain outcome measured in both groups at 1, 3, 6, 12, and 24 hours via a visual analog score was the primary outcome. The secondary outcome was the need for rescue analgesia. A complete profile of each patient was created, using eligibility criteria, body mass index, and demographic profile, and a complete gynecological and physical examination was performed, along with preoperative investigations for fitness to general anesthesia. Per standard protocol, general anesthesia was administered for all surgeries. After vault closure, a fine-tipped aspiration needle was used to administer 10 mL of bupivacaine, which was infiltrated laparoscopically at 2 different locations, approximately 2–4 cm apart. The control group omitted this step. In the first 24 hours after operation, pain was treated using 1 g intravenous paracetamol every 6 hours. For the next 5 days, patients were given nonsteroidal anti-inflammatory drugs (diclofenac) 3 times daily for 5 days. Participants scaled their pain using the visual analog scale (VAS) score at the 1, 2, 6, 12, and 24 hours intervals postsurgery. Scores greater than 4 initiated the distribution of tramadol 50 mg intramuscular. Also recorded were the uterine weight, the operative time, complications, and the amount of operative bleeding. Group 1 patients exhibited VAS scores of less than 4 at 1 hour postsurgery (100%), 3 hours postsurgery (100%), 6 hours postsurgery (97%), 12 hours postsurgery (96.7%), and 24 hours postsurgery (36.7%). The control group VAS scores of less than 4 for the respective times were as follows: 1 hour (93%), 3 hours (86.6%), 6 hours (30%), 12 hours (10%), and 24 hours (3.3%). From these data, it is clear that the infiltration with a local analgesia was effective in reducing postoperative pain. Overall, a feasible and safe option for postoperative pain relief is vaginal cuff infiltration with local anesthetic. A significant increase in the number of women experiencing minimal postoperative pain for 24 hours after laparoscopic hysterectomy took place due to infiltration of the vaginal vault with 10 mL of 0.25% bupivacaine (with no complications). Furthermore, this method reduces requirements of additional opioid/analgesia usage. The beneficial use of local vault infiltration with bupivacaine after TLH within the first 24 postoperative hours is highlighted by this study.

Comparison of classic single-layer uterin suture and double-layer purse-string suture techniques for uterus closure in terms of postoperative short-term uterine isthmocele: A prospective randomized controlled trial.

To compare the short-term results of classic single-layer uterine closure and double-layer purse-string uterine closure (Turan technique) techniques in cesarean section in terms of the incidence of ischiocele formation. This was a prospective randomized controlled trial study. Participants undergoing first-time cesarean delivery were randomized into two groups. Fifty-eight participants were included in the double-layered uterine closure group (study group), while 53 participants were randomized into the classical single-layered uterine closure group (control group). For comparison of isthmocele formation, transvaginal ultrasound examination was planned in all patients 6 weeks after surgery. The operation data,the formation of isthmocele, its dimensions and volume were recorded. A total of 111 women were included in the study. The incidence of ischiocele at 6 weeks after birth was not significantly different between the groups (p=0.128). Isthmosel was detected in 20.8% of single-layer closures, and this rate was determined as 10.3% in the purse technique. In the Kerr incision made during surgery, the uterine incision size did not differ in either group, but the uterine incision length after suturing was significantly smaller in the purse technique compared with the other group (p<0.001). The incidence of ischiocele formation after cesarean section and the depth of the ischiocele was independent of the uterotomy closure technique.

Advantages and limitations of estrogen replacement therapy on hypogonadal survivors of childhood cancer.

Hypogonadism is a significant late complication in childhood cancer survivors (CCS). The aim of this study was to elucidate the advantages and limitations of estrogen replacement therapy (ERT) for CCS with hypogonadism. Seventeen CCS were divided into two groups: gonadal hypogonadism (GH) group (n = 8) and central hypogonadism (CH) group (n = 9). Pearson correlation coefficients were used to investigate the impact of cancer management on final height, bone density, and uterine development. Seven of GH group had hematologic malignancies, and all of them underwent total body irradiation before bone marrow transplantation. The GH group showed significant positive correlations between the onset age of disease treatment and final height (p < 0.05, R = 0.712) and uterine size following ERT (p < 0.05, R = 0.775). All CCS in the CH group had brain tumors, and seven of them received chemotherapy. There were trends towards positive and negative correlations between the onset age of disease treatment and final height (p = 0.09, R = 0.598) or uterine size (p = 0.07, R = -0.669), respectively. A negative correlation trend was observed between the age at ERT initiation and final height (p = 0.07, R =-0.769) or bone density (p = 0.18, R = -0.626) in six CH patients who received growth hormone therapy. Five CCS in both groups experienced osteoporosis, despite receiving ERT. Individualized management strategies beyond ERT are essential to reduce long-term complications in CCS with hypogonadism, considering the type and timing of cancer treatment.

Effects of Heliotropium indicum L. on Uterine Involution and Its Underlying Mechanisms: an in vivo and in vitro Study.

To investigate the effect of Heliotropium indicum L. (H. indicum L.) on uterine involution and its underlying mechanisms in both in vivo and in vitro study. For in vivo studies, postpartum rats were randomly divided into 2 groups (n=24 for each): control group and treated group which were orally and daily administered with ethanolic extract of H. indicum L. (250 mg/kg body weight) until day 5 of postpartum. Uteri were collected for analysis of weight, cross-sectional area, collagen cross-sectional area, and collagen content on postpartum day 1, 3, and 5 (n=8 for each) from both groups. Blood samples were collected for hepatotoxicity and 17β-estradiol (E2) measurement. For in vitro studies, the extract effects on uterine contraction at half maximum effective concentration of 2.50 mg/mL were studied in organ bath system for at least 20 min. Uterine parameters were significantly decreased after treated with extract of H. indicum L. (P<0.05). H. indicum L. extract significantly accelerated the reduction of those parameters and significantly decreased E2 (P<0.05). The extract facilitated uterine involution with no hepatotoxicity. H. indicum L. extract significantly stimulated uterine contraction (P<0.05) and synergized with oxytocin, prostaglandin and its precursor, linoleic acid. By investigating the different sequencing of the extract with the additional stimulants (added before or after), the two showed antagonistic effects, but still showed potentiated force when compared with control (without the stimulants). The underlying mechanisms by which H. indicum L. facilitated uterine involution might be due to reducing E2 which induces collagenase activity, leading to decreases in uterine weight and size and stimulating uterine contraction. Our study provides new findings for future drug development for facilitating uterine involution with H. indicum L.

Recurrent Implantation Failure: Reality or a Statistical Mirage?: Consensus Statement From the July 1, 2022 Lugano Workshop on Recurrent Implantation Failure

ABSTRACT Despite advancements in assisted reproductive technologies over the past few decades, a 35% failure rate is still observed for unexplained reasons when transferring euploid embryos to an anatomically normal uterus. Recurrent implantation failure (RIF) is defined based on cumulative ART cycles failing; however, there is an absence in consensus on the diagnostic criteria, which leads to the risk of overdiagnosing and overtreating the condition. This consensus statement by the Lugano RIF Workshop aimed to merge variation in the clinical concept and management of RIF, focusing primarily on euploid blastocyst transfers in hormone replacement-primed cycles. The workshop comprised a panel of 27 international experts selected on the basis of overall research activities and publications on the subject. A literature search as conducted for all relevant titles and abstracts published between January 2015 and May 2022 for review. Consensus conclusions were based on the literature search and expert opinions. Consideration of an RIF diagnosis was determined to focus on failure to achieve sustained implantation (defined as a gestational sac identified on ultrasound). Historically, RIF was defined as the failed transfer of &gt;10 embryos; however, today, a common number used is 3, which is also similar to the rate of failure based on a 95% confidence interval. Based on large clinical data sets, approximately 2%–5% of patients pursuing ART treatment may have RIF, and the decline in future implantation rate with each cycle fits more to an exponential delay curve than a linear decrease. The diagnosis of RIF should not be considered based on a single cohort of embryos, but rather on the number of euploid blastocyst transferred adjusted to patient’s age. In the absence of abnormal uterine bleeding and normal uterine size, further evaluation of asymptomatic adenomyosis is not warranted. Testing for biomarkers of endometrial receptivity and the endometrial microbiome have not been validated using RCTs and should not be used. The role of chronic inflammation in RIF remains unclear, but evidence suggests chronic endometritis does not directly play a role in ART outcome as assessed by sustained implantation rate after euploid embryo transfer. Substantial evidence exists that is low progesterone on the day of embryo transfer results in worse ART outcomes, and that IM progesterone may be superior to vaginal progesterone. There are no effective treatments for RIF currently, and immunomodulatory treatments that may be offered including glucocorticoids, IVIG, and GCSF have a lack of comprehensive data. This consensus document finds that RIF is likely present in fewer than 5% of patients undergoing ART and has been overdiagnosed and overtreated without sufficient critical evaluation of the presumed condition. It also highlights areas where future research is needed, both in the pathophysiologic cause of RIF and hypothetical treatment modalities.

Cow and management factors and their association with estimates of uterine size and position at the time of insemination of dairy cattle.

This study examines factors affecting uterine size and position determined at 30-36 days postpartum in dairy cattle. The final study population consisted of 328 dairy cows, all calving during the warm season. Uterus position (pelvic, pelvic-abdominal, abdominal) and uterus size (small, medium, large) was measured by ultrasound on Day 30-36 postpartum. Multiparous cows had a larger uterus positioned in the abdominal cavity (p = .03) and a male newborn was associated with a larger uterus (p = .022). The number of cows with the uterus in the abdominal cavity was higher among multiparous and high producer (p < .0001) cows. High producers were 0.41 times more likely to have a small uterus in a pelvic position. The most important finding of this study was that the delivery of a male dairy, rather than beef, calf was related to the least optimal maternal uterus size and position.

Value of pelvic ultrasound combined with pituitary MRI in diagnosis of central precocious puberty in girls.

This study aimed to investigate the value of pelvic ultrasound combined with pituitary magnetic resonance imaging (MRI) based on an artificial intelligence algorithm in the diagnosis of girls with central precocious puberty (CPP), providing reference for the prevention and control of CPP in girls. 75 girls with CPP and 75 normal girls in Nantong First People's Hospital were studied. Pelvic ultrasound parameters were compared between the two groups based on an artificial intelligence algorithm. Pituitary MRI parameters were analyzed, and pituitary function parameters were explored. The results showed that the diagnostic sensitivity, specificity, and accuracy of the convolutional neural network (CNN) algorithm were 72.3%, 74.6%, and 78.3%, respectively. The sensitivity, specificity, and accuracy of CNN algorithm were significantly higher (p<0.05). The long diameter, anteroposterior diameter, and transverse diameter of the uterus in the precocious puberty (PP) group were significantly larger than those in the normal group (NG). The ovarian long diameter, ovarian anteroposterior diameter, and ovarian transverse diameter in PP group were significantly larger than those in NG. Uterine volume and ovarian volume in PP group were clearly higher than those in NG. The largest follicle diameter was clearly larger in PP patients than in NG patients. The coronal height, coronal width, sagittal height, and sagittal anteroposterior diameter of PP group were clearly higher than those of NG (p<0.05). The sagittal cross-sectional area of pituitary MRI morphology in PP group was significantly greater than that in NG. The pituitary MRI morphology pituitary volume was 272.68 mm in PP group and 191.37 mm in NG, and the pituitary volume was clearly larger in PP group than in NG. The pituitary function parameters estradiol (E2), luteinizing hormone (LH) peak, follicle-stimulating hormone (FSH) peak, and LH peak/FSH peak were greater in PP group than in NG. In summary, the uterine size and ovarian size of girls and the pituitary function index in PP group were larger. Pelvic ultrasound and pituitary MRI indexes can better diagnose CPP and can be widely used in clinical practice with positive diagnostic value.

Ovarian Volume of Saudi Children and Adolescents in the Southern Region Based on Ultrasound Imaging.

Introduction Sonography is a non-invasive and painless technique used for assessing pelvic anatomy and disorder in children and adolescents. Ovarian growth patterns during infancy and puberty are not completely understood. No consensus exists about the normal measures and morphologic appearance of the ovaries in the southern region of Saudi Arabia. Therefore, this study determined the pattern of ovarian and uterine sizes among Saudi girls and their correlation with age. Methods This study was conductedin the radiology department at Abha Maternity and ChildrenHospital among girls between 0-13 years. All the participants underwent transabdominal ultrasound, and we measured ovarian volume, uterine length, and endometrial thickness to correlate with chronologic age using the Chi-squared test. Results A Total of152 females were included in this study. The median agewas 72 months, with a minimum of one month and a maximum of 156 months. The Chi-squared test showed a significant correlation between age and ovarian measurement. Age was positively associated with ovarian volume, uterine length, and endometrial thickness (p<0.001). Conclusion The studyconcluded that age strongly correlated with the sizeof the uterus and ovaries, which is crucial in interpreting ultrasound measurements of the pelvic organs correctly.

The impact of obesity on vaginal hysterectomy and laparoscopically-assisted vaginal hysterectomy outcomes: A randomised control trial

ObjectivesThis prospective randomised control trial aimed to compare outcome measures of vaginal hysterectomy (VH) and laparoscopically-assisted vaginal hysterectomy (LAVH) in obese vs. non-obese women undergoing hysterectomy for benign uterine conditions with a non-prolapsed uterus. The primary objective of the study was to estimate operation time, uterine weight and blood loss amongst obese and non-obese patients undergoing VH and LAVH. The secondary objective was to determine any difference in hospital stay, the need for post-operative analgesia, intra- and immediate post-operative complications, and the rate of conversion to laparotomy for obese vs. non-obese patients undergoing VH and LAVH. Study designA prospective randomised control study was undertaken in the Department of Obstetrics and Gynaecology of the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Women admitted between January 2017 and December 2019 for hysterectomy due to benign conditions, meeting the inclusion criteria set by the unit (vaginally accessible uterus, uterine size ≤ 12 weeks of gestation or ≤ 280gr on ultrasound examination, pathology confined to the uterus) were included in the study. The VH procedures were performed by the residents in training, under the supervision of specialists with large experience in vaginal surgery. All the LAVHs were performed by one surgeon (AC). In addition to the patient characteristics and surgical approach to hysterectomy, operative time, estimated blood loss, uterine weight, length of hospital stay, intra-operative and immediate post-operative complications were also recorded in obese and non-obese patient groups and comparatively analysed. ResultsA total of 227 women were included in the study. 151 patients underwent VH and 76 LAVH, upon randomisation on a 2:1 basis, reflecting the habitual proportion of hysterectomy cases in the Urogynaecology and Endoscopy Unit at CMJAH.No significant differences were found in mean shift of pre-operative to post-operative serum haemoglobin, uterine weight, intra- and immediate post-operative complications, and convalescence period when comparing obese and non-obese patients in both the VH and LAVH groups. There was a statistically significant difference in operating time between the two procedures. The LAVHs took longer compared to the VHs to be performed (62.8 ± 9.3 vs. 29.9 ± 6.6 min in non-obese patients, and 62.7 ± 9.8 vs 30.0 ± 6,9 min for obese patients). All VHs and LAVHs were successfully accomplished without major complications. ConclusionVH and LAVH for the non-prolapsed uterus is a feasible and safe alternative for obese patients demonstrating similar perioperative outcome measures as non-obese women undergoing VH and LAVH. Where possible, VH should be preferred to LAVH as it is a safe route of hysterectomy, with operation time being significantly shorter.

Medical Management of Incomplete Abortion Using Pervaginal Misoprostol in Chittagong Medical College Hospital

Background: A miscarriage is a pregnancy that ends before the baby can survive outside the womb because it has not yet reached viability. A miscarriage may be early - during the first 14 weeks of pregnancy, or late. Objective of the study was to see the outcome of pervaginal misoprostol in the medical management of incomplete abortion.&#x0D; Methods: This cross-sectional study was performed between July and December 2015 on patients with incomplete abortion, who wanted to undergo medical management at the Department of Gynecology and Obstetrics, Chittagong Medical College Hospital. 100 consecutive incomplete abortion cases, who fulfilled the inclusion and exclusion criteria were enrolled for the study. Information about management with per vaginal misoprostol, possible side effects and success rate was given to the women. 600 microgram misoprostol was given per vaginally. Interval between administration of misoprostol and expulsion of product of conception was recorded.&#x0D; Result: The mean age was found 25.0±6.4 years and the mean gestational age was found 10.2±2.0 weeks. The mean duration of bleeding was found 8.6±10.9 days. No side effect was found in 86 (86%), nausea in 7(7%), vomiting in 5 (5%) and cramping in 2 (2%) patients. For majority (76%) of the patients, single dose of Misoprostol was enough to achieve the goal. However, 24 patients didn’t respond and received a second dose. The mean induction expulsion interval was 10.83±5.45 hours. Retained product of conception was found in 14 patients. Medical management failed in these 14 patients and ultimately Dilatation &amp; Curettage (D &amp; C) was done.&#x0D; Conclusion: Pervaginal Misoprostol is as effective as method of treating incomplete abortion at uterine size of &lt;12 weeks. Treatment with misoprostol can reduce the demand for surgical evacuation in cases of incomplete abortion. The acceptability of misoprostol appears higher. Pervaginal Misoprostol appears suitable for the treatment of incomplete abortion in the developing countries.&#x0D; Bangladesh J Obstet Gynaecol, 2021; Vol. 36(1): 42-48

Comparative characteristics of uterine size in the frst period of adulthood and old age according to ultrasound examination

The aim of the study was to carry out a comparative analysis of the linear size of the uterus in women during the frst period of adulthood and old age according to ultrasound examination data. Material and methods. The study was based on the results of ultrasound examination of 53 women with normal pelvic dimensions who were examined at the gynecology department of the Perm Krai Clinical Hospital during the period from 2021 to 2022. All the women consented to the examination, which was performed according to the indications in order to exclude probable pathology of the reproductive system. The ultrasound examination consisted of measuring the longitudinal (length), transverse (width) and anteroposterior (thickness) dimensions of the uterus using transvaginal access. Women were divided into two groups: the frst group consisted of 27 subjects of the frst period of mature age (22 to 35 years), the second group included 26 subjects of advanced age (75 to 88 years). Results. When comparing the indicators of uterine size, their statistically signifcant decrease from the frst period of adulthood to old age: uterine length decreased by 54.5 % (p &lt; 0.001), width – by 57.8 % (p &lt; 0.001), thickness – by 67.8 % (p &lt; 0.001). We believe that this pattern can be substantiated by the onset of postmenopause and a decrease in estrogenic hormone content from reproductive age to senile age. Conclusions. The obtained results of the intravital comparative analysis of the uterus linear dimensions in women of the frst period of adulthood and old age expand the scientifc ideas about age-related features of this organ of the reproductive system, are the basis for further research and can be used by physicians of clinical specialties such as gynecology, gerontology, ultrasound diagnostics.

Ayurvedic Intervention of Garbhashyagata Granthi (Uterine Fibroid) - A Case Report

Uterine fibroid is most common solid benign tumors in women of reproductive age. The symptoms of uterine fibroid adversely affect social and recreational activities, women's quality of life, and productivity at work. Uterine fibroid occur in 50–60% of women, rising to 70% by the age of 50 and in 30% of cases cause morbidity. A 40-year-old married woman consulted in the outpatient department (OPD) of P.G. department of Prasutitanta and Striroga with a complaint of heavy and prolong menstrual bleeding with painful menstruation since 5 years. It is associated with lower back pain, lower abdominal pain, frequent urination, mild constipation and pain in both lower extremities. Her Ultrasonography report shows bulky uterus and intramural uterine fibroid size of 19x17x25 mm. Patient was treated according to Ayurvedic management of Granthi. So the drug having properties Raktstambhak, Lekhana, Raktshodhak, Shothahara, etc. are used with advice of Pathya Aahar-Vihara.Treatment was continued for one years with a follow up once in 15days and a repeat scan revealed shrinking size of the fibroid and relief in all symptoms.

Abstract 4236: Obesity-associated endometrial cancer: Identifying the contributions of TMEM205 expression to the pathogenesis of disease

Abstract Background &amp; Objective: Endometrial cancer (EC) is the most common gynecologic malignancy in the US. EC is more strongly associated with obesity than any other cancer type, with 57% of cases linked to obesity. As rates of obesity increase, the incidence of EC is also rising with worsening prognosis. The objective of this study is to identify the molecular mechanisms of TMEM205 expression that regulate exosome secretion, and the oncogenic proteins that underlie this transformation. Our findings are critical to understanding the pathways of obesity mediated EC and essential for developing novel strategies for preventing and treating EC. Methods: The exosomes were then quantified using nanoparticle tracking analyzer (NTA) and their size measured by Transmission electron microscopy (TEM). TMEM205, STAT5, FAS and PIAS3 expression was confirmed by IHC, WB and RT-PCR in patient and high fat diet treated mouse tissue. Endometrial hyperplasia was developed in immunocompetent mice using high fat diet (HFD; 45 kcal% fat diet) for 16 weeks. Results: To examine the effect of a continuous HFD (45 kcal% fat diet) on adipose, uterine and endometrial tissue, we first investigated body weight and uterine morphology in mice after 24 weeks of treatment. As expected, mice fed a HFD had a significantly higher body weight and increased adipose tissue when compared to control. In addition, mice in the HFD group showed marked enlargement in uterine horn size (hyperplasia) and inflammation with increased cell proliferation in the endometrial layer. The HFD treated mice were associated with increased exosome secretion and expression of the oncogenic proteins TMEM205 and STAT5. Expression of the tumor suppressor gene PIAS3 wasdownregulated in adipose and uterine tissues. L-2265 is a small molecule inhibitor that selectively inhibits TMEM205 and exosome secretion in EC cancer cells. To examine the effect of L-2263 in the context of obesity, we fed mice a HFD and treatment with L-2263 (2mg/kg/) weekly for 3 doses. L-2263 treatment resulted in significantly decreased body weight (BW) and decreased accumulation of adipose tissue relative to control HFD treated mice. Mice in the HFD group showed marked enlargement in uterine horn size (hyperplasia), whereas mice that received L-2263 treatment had normal uterine morphology of mouse age. L-2263 treated mice also demonstrated a significant decrease in the expression of proteins involved in exosome secretion (e.g., TMEM205 and STAT5) and those found in exosomes. Conclusion: This study provides fundamental insight into the mechanism of obesity-mediated TMEM205 expression and exosome secretion and their contribution to the pathogenesis of EC. This study is also provides pre-clinical evidence for the development of the first in-human studies of exosome-targeted therapies to prevent obesity-mediated EC. Citation Format: Takahiko Sakaue, Roman Zingarelli, Wafa Khadraoui, Uksha Saini, John Wallbillich, Muralidharan Anbazhakan, Ross Warner, Kalpana Deepa Priya Dorayappan, Deepika Kalaiyarasan, Molly Morton, Casey Cosgrove, Adrian Suarez, Larry J. Maxwell, David O'Malley, David E. Cohn, Karuppaiyah Selvendiran. Obesity-associated endometrial cancer: Identifying the contributions of TMEM205 expression to the pathogenesis of disease. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4236.

Pelvic pain and venous congestion revisited: examining relationship between chronic pelvic pain and uterine venous size and blood flow.

To investigate the relationship between increased uterine venous plexus diameter and chronic pelvic pain in women attending a gynecology clinic. This was a retrospective study of patients attending a tertiary university hospital in London, UK. Women presenting to the gynecology clinic undergoing transvaginal ultrasound examination were recruited into the study. The largest trunk of the uterine venous plexus was measured on each side. Blood flow within the uterine veins was categorized into continuous or interrupted flow and evaluated using color and spectral Doppler ultrasound during normal respiration and on Valsalva maneuver to demonstrate the presence of venous reflux. The largest uterine vein diameter and its blood flow were used for the analysis. The main variables of interest were chronic pelvic pain, uterine vein diameter and type of blood flow. We included 1500 women in the study, of whom 584 (38.9% (95% CI, 36.5-41.5%)) reported chronic pelvic pain. Dysmenorrhea was the most common type of pelvic pain. Age (P < 0.001), menopausal status (P = 0.02), varicose veins (P = 0.01), adenomyosis (P < 0.001) and endometriosis (P < 0.001) were found to be independently associated with the occurrence of pain on multiple logistic regression analysis. There was no difference in uterine vein diameter between women with and those without pain (P = 0.10). Neither uterine vein diameter (P = 0.47) nor type of blood flow (P = 0.07) was significantly associated with the occurrence of pelvic pain on multiple logistic regression. Our findings show that uterine vein diameter is not associated with pelvic pain. However, we found other important clinical and demographic factors that are associated with chronic pelvic pain. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Comparison of perioperative outcomes of different routes of hysterectomies- total abdominal, vaginal and laparoscopic, in a tertiary care hospital in Karachi, Pakistan

Background: This study was conducted to compare the perioperative findings among women undergoing hysterectomy by abdominal (TAH), vaginal (VH) and laparoscopic (TLH) routes. Methods: A 5-year cross-sectional survey was conducted at the Aga Khan University Hospital from January 2015-December 2020 to compare perioperative outcomes of the different routes of hysterectomies. Medical record review of 385 patients who underwent hysterectomy for benign conditions were reviewed and analysed, out of which 195 (50.6%) underwent TAH, 96 (24.9%) VH and 94 (24.4%) were operated laparoscopically. Patients with uncontrolled medical comorbid, history of 2 or more abdominal surgeries and uterine size of more than 14 weeks were excluded from the study. Results: revealed significant difference between the mean hospital stay of patients with TAH having the highest mean stay in days (TAH=4.8±1.01, VH=4.4±0.7 and TLH=3.9±0.82 in days; p&lt;0.01) TLH took comparatively significantly longer operating time than TAH (p=0.0005) and VH groups (p=0.004) however, median estimated blood loss was significantly lower in women who underwent TLH as compare to TAH [median (25th-75th percentile); 100 (50-200)] versus 300 (200-500); p&lt;0.01] and VH [100 (50-200)] versus 250 (100-400); p&lt;0.01]. The incidence of post-operative complications was less than 3% and these were observed in women underwent TAH. Conclusions: VH and TLH have lesser complications and hospitalization days as compared to TAH, making these 2 methods superior. Informed decision making by patient and surgeon’s training together can account for choosing the best method of hysterectomy suitable to the patient.

Comparative Study of Vaginal Hysterectomy and Total Abdominal Hysterectomy in Non-descent Uterus in a Rural Tertiary Care Center.

Aim To study the role of vaginal hysterectomy in non-descent uterus and to compare it with abdominal hysterectomy with respect to operative time, intraoperative blood loss and complications, ambulation, and postoperative complications. Materials and methods A prospective non-randomized study was carried out on 200 cases at a rural tertiary care center in B.G. Nagara, Karnataka, India for a period of 18 months after obtaining institutional ethical committee approval. One hundred patients underwent a vaginal hysterectomy, and there other 100 underwent an abdominal hysterectomy for similar indications. Results Mean age, parity, mode of delivery, BMI, uterine size, and anesthesia were similar between the groups. The most common indication was fibroid uterus (50%). It was found that the vaginal hysterectomy group was associated with significantly reduced mean operative durationand a decline in postoperative Hemoglobin when compared to the abdominal hysterectomy group. Patients who underwent vaginal hysterectomy had less postoperative pain and were ambulated earlier and discharged earlier. Also, postoperative complications were more common in those who underwent abdominal hysterectomy. Conclusion Vaginal hysterectomy is a safe and the least invasive route and is associated with lesser complications and should be chosen as the preferred method of hysterectomy, whenever feasible.

Extreme plasticity of reproductive state in a female rodent

Successful sexual reproduction relies on the coordination of multiple biological systems, yet traditional concepts of biological sex often ignore the natural plasticity in morphology and physiology underlying sex. Most female mammals develop a patent (i.e., opened) vaginal entrance (introitus) prenatally or postnatally before or during puberty, usually under the influence of estrogens, and remain patent for the remainder of their lifespan1. An exception is the southern African giant pouched rat (Cricetomys ansorgei), whose vaginal introitus remains sealed well into adulthood2. Here, we explore this phenomenon and report that the reproductive organs and the vaginal introitus can undergo astounding and reversible transformation. Non-patency is characterized by reduced uterine size and the presence of a sealed vaginal introitus. Furthermore, the female urine metabolome shows that patent and non-patent females profoundly differ in their urine content, a reflection of differences in physiology and metabolism. Surprisingly, patency state did not predict fecal estradiol or progesterone metabolite concentrations. Exploring the plasticity that exists in reproductive anatomy and physiology can uncover that traits long considered 'fixed' in adulthood can become plastic under specific evolutionary pressures. Moreover, the barriers to reproduction that such plasticity creates present unique challenges to maximizing reproductive potential.

Introducing misoprostol for treatment of incomplete abortion: A feasibility and acceptability study in secondary-level health facilities in Myanmar

ObjectiveTo assess the feasibility and acceptability of misoprostol as a treatment option for incomplete abortion in secondary hospitals in Yangon and Mandalay, Myanmar. MethodsAn explanatory sequential mixed methods study was conducted. Women seeking treatment for an incomplete abortion with a uterine size <12 weeks were eligible to participate in the prospective cohort including sublingual administration of 400 μg misoprostol, clinical assessment 7–10 days after administration, and patient interview. Treatment efficacy was assessed, defined as proportion of participants with complete uterine evacuation with misoprostol alone. After the cohort, provider interviews were conducted to understand how their experiences with misoprostol may have influenced cohort findings. Study sites included seventeen secondary health facilities in four townships in Yangon and Mandalay, Myanmar. ResultsA total of 110 women were enrolled from July 2018 to January 2019; 96 completed follow-up. In 75 % of cases, incomplete abortion was successfully treated with misoprostol. Treatment efficacy varied significantly by region (Yangon 85 %, Mandalay 67 %; p = 0.048), driven by providers’ variable comfort with misoprostol and proclivity to intervene with additional treatment. With experience, all were willing to incorporate the protocol into practice by study end. Patient acceptability and satisfaction were high. ConclusionMisoprostol is an acceptable and feasible treatment option for women seeking postabortion care at secondary facilities in Myanmar. Extensive health provider training and support systems and continued implementation experience are crucial to effectively translate clinical PAC guidelines into practice in Myanmar.