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Introduction: To investigate the in vitro effect of diclofenac on tubal smooth muscle as an alternative to hyoscine‐N‐butyl bromide, which is used for premedication before hysterosalpingography (HSG). Material and Methods: Fallopian tubes were retrieved from seven healthy women after bilateral tubal ligation and in vitro contractility and histological studies were conducted using tissue bath and immunohistochemistry. Results: Diclofenac sodium and hyoscine‐N‐butyl bromide did not significantly change the basal mean tension; however, they decreased the contractions induced by potassium chloride (KCl). The relaxant effect of diclofenac sodium and hyoscine‐N‐butyl bromide was not statistically significantly different. The presence of cyclooxygenase (COX)‐2 enzyme in the fallopian tube was demonstrated by immunohistochemical studies. Conclusions: The in vitro relaxant effect of diclofenac sodium on the fallopian tube is similar to hyoscine‐N‐butyl bromide. Diclofenac may have the potential to be used as an alternative to hyoscine‐N‐butyl bromide in premedication in HSG. [ABSTRACT FROM AUTHOR]

Objective: Tubal ectopic pregnancy (EP) is a leading cause of maternal morbidity and mortality. Studies have suggested that infection‐induced inflammatory responses are major risk factors for EP. The aim of the present study was to find an association between MMP2 and CD63 gene variants and risk of EP during Chlamydia trachomatis infection in an Indian population. Methods: Fallopian tube samples of 120 EP and 120 tubal ligation women were collected. C. trachomatis was detected by PCR. The genotyping of MMP2 (rs17859882 G/T, rs7201A/C) and CD63(rs2231464 C/T, rs376086542 A/G) gene variants was done by qualitative real‐time PCR using allelic discrimination method (VIC‐ and FAM‐labeled). Results: The frequency of GG or GT genotype of MMP2 G/T polymorphism (rs17859882) was 66.6% in infected EP and 36.7% in uninfected EP and 22% in tubal ligation controls (P < 0.0001), while the frequency of AC or CC genotype of MMP2 A/C polymorphism (rs7201) was 66.6% in infected EP and 20.6% in uninfected EP and 13.5% in tubal ligation controls (P < 0.0001). The frequency of CT or TT genotype of CD63 C/T polymorphism (rs2231464) was 74% in infected EP and 21.8% in uninfected EP and 11.8% tubal ligation controls (P < 0.0001), while the frequency of AG or GG genotype of CD63 A/G polymorphism (rs376086542) was 48.1% in infected EP and 41.3% in uninfected EP and 18.6% tubal ligation controls (P < 0.0001). Conclusions: The present study revealed a strong association between the presence of gene variants MMP2 (rs17859882 G/T, rs7201A/C) and CD63 (rs2231464 C/T, rs376086542 A/G) and risk of tubal EP during C. trachomatis infection. Synopsis: MMP2 and CD63 genetic variants are significantly linked with increased susceptibility of tubal ectopic pregnancy during Chlamydia trachomatis infection. [ABSTRACT FROM AUTHOR]

Objectives: To examine the effects of a comprehensive, multiyear (2015–2020) statewide contraceptive access intervention in Delaware on the contraceptive initiation of postpartum Medicaid patients. The program aimed to increase access to all contraceptives, including long‐acting reversible contraceptives (LARC). The program included interventions specifically targeting postpartum patients (Medicaid payment reform and hospital‐based immediate postpartum (IPP) LARC training) and interventions in outpatient settings (provider training and operational supports). Data Sources and Study Setting: We used Medicaid claims data between 2012 and 2019, from Delaware and Maryland (a comparison state), to identify births and postpartum contraceptive methods up to 60 days postpartum among patients aged 15–44 years who were covered in a full‐benefit eligibility category. Study Design: Using difference‐in‐differences, we assessed changes in LARC, tubal ligation, and short‐acting methods (oral contraceptive, injectable, patch/ring). LARC rates were assessed at 60 days after delivery and on an immediate postpartum basis. Other methods were only assessed at 60 days. Analyses were conducted separately for an early‐adopting high‐capacity hospital (that delivers approximately half of all Medicaid financed births) and for all other later‐adopting hospitals in the state. Data Collection/Extraction Methods: Data were extracted from administrative claims. Principal Findings: The program increased postpartum LARC insertions by 60 days after delivery by 11.7 percentage points (95% CI: 10.7, 12.8) in the early‐adopting hospital and 6.9 percentage points (95% CI: 4.8, 5.9) in later‐adopting hospitals. Increases in IPP versus outpatient LARC drove the change, but we did not find evidence that IPP crowded‐out outpatient LARC services. We observed decreases in short‐acting methods, suggesting substitution between methods, but the share of patients with any method increased at the early‐adopting hospital (5.2 percentage points; 95% CI: 3.5, 6.9) and was not statistically significantly different at the later‐adopting hospitals. Conclusions: Direct reimbursement for IPP LARC, in combination with provider training, had a meaningful impact on the share of Medicaid‐enrolled postpartum women with LARC claims. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the imaging features, clinical characteristics and neonatal outcomes of pregnancy luteoma. Material and methods: We retrospectively analyzed patients with pregnancy luteoma admitted to the First Affiliated Hospital of Sun Yat‐sen University between January 2003 and December 2022. We recorded their imaging features, clinical characteristics and neonatal outcomes. Additionally, we reviewed relevant studies in the field. Results: In total, 127 cases were identified, including eight from our hospital and 119 from the literature. Most patients (93/127, 73.23%) were of reproductive age, 20–40 years old, and 66% were parous. Maternal hirsutism or virilization (such as deepening voice, acne, facial hair growth and clitoromegaly) was observed in 29.92% (38/127), whereas 59.06% of patients (75/127) were asymptomatic. Abdominal pain was reported in 13 patients due to compression, torsion or combined ectopic pregnancy. The pregnancy luteomas, primarily discovered during the third trimester (79/106, 74.53%), varied in size ranging from 10 mm to 20 cm in diameter. Seventy‐five cases were incidentally detected during cesarean section or postpartum tubal ligation, and 39 were identified through imaging or physical examination during pregnancy. Approximately 26.61% of patients had bilateral lesions. The majority of pregnancy luteomas were solid and well‐defined (94/107, 87.85%), with 43.06% (31/72) displaying multiple solid and well‐circumscribed nodules. Elevated serum androgen levels (reaching values between 1.24 and 1529 times greater than normal values for term gestation) were observed in patients with hirsutism or virilization, with a larger lesion diameter (P < 0.001) and a higher prevalence of bilateral lesions (P < 0.001). Among the female infants born to masculinized mothers, 68.18% (15/22) were virilized. Information of imaging features was complete in 22 cases. Ultrasonography revealed well‐demarcated hypoechoic solid masses with rich blood supply in 12 of 19 cases (63.16%). Nine patients underwent magnetic resonance imaging (MRI) or computed tomography (CT), and six exhibited solid masses, including three with multi‐nodular solid masses. Conclusions: Pregnancy luteomas mainly manifest as well‐defined, hypoechoic and hypervascular solid masses. MRI and CT are superior to ultrasonography in displaying the imaging features of multiple nodules. Maternal masculinization and solid masses with multiple nodules on imaging may help diagnose this rare disease. [ABSTRACT FROM AUTHOR]

Introduction: Since malignancy during pregnancy is uncommon, information regarding contraception selection or sterilization at delivery is limited. The objective of this study was to examine the type of long‐acting reversible contraception or surgical sterilization procedure chosen by pregnant patients with malignancy at delivery. Material and methods: This cross‐sectional study queried the Healthcare Cost and Utilization Project's National Inpatient Sample in the USA. The study population was vaginal and cesarean deliveries in a hospital setting from January 2017 to December 2020. Pregnant patients with breast cancer (n = 1605), leukemia (n = 1190), lymphoma (n = 1120), thyroid cancer (n = 715), cervical cancer (n = 425) and melanoma (n = 400) were compared with 14 265 319 pregnant patients without malignancy. The main outcome measures were utilization of long‐acting reversible contraception (subdermal implant or intrauterine device) and performance of permanent surgical sterilization (bilateral tubal ligation or bilateral salpingectomy) during the index hospital admission for delivery, assessed with a multinomial regression model controlling for clinical, pregnancy and delivery characteristics. Results: When compared with pregnant patients without malignancy, pregnant patients with breast cancer were more likely to proceed with bilateral salpingectomy (adjusted odds ratio [aOR] 2.30) or intrauterine device (aOR 1.91); none received the subdermal implant. Pregnant patients with leukemia were more likely to choose a subdermal implant (aOR 2.22), whereas those with lymphoma were more likely to proceed with bilateral salpingectomy (aOR 1.93) and bilateral tubal ligation (aOR 1.76). Pregnant patients with thyroid cancer were more likely to proceed with bilateral tubal ligation (aOR 2.21) and none received the subdermal implant. No patients in the cervical cancer group selected long‐acting reversible contraception, and they were more likely to proceed with bilateral salpingectomy (aOR 2.08). None in the melanoma group chose long‐acting reversible contraception. Among pregnant patients aged <30, the odds of proceeding with bilateral salpingectomy were increased in patients with breast cancer (aOR 3.01), cervical cancer (aOR 2.26) or lymphoma (aOR 2.08). The odds of proceeding with bilateral tubal ligation in pregnant patients aged <30 with melanoma (aOR 5.36) was also increased. Conclusions: The results of this nationwide assessment in the United States suggest that among pregnant patients with malignancy, the preferred contraceptive option or method of sterilization at time of hospital delivery differs by malignancy type. [ABSTRACT FROM AUTHOR]

Synopsis: Salpingectomy has a reported theoretical decreased risk of tubal and ovarian cancers. Here we describe a case 29 years after partial salpingectomy. [ABSTRACT FROM AUTHOR]

After several institutions recommended salpingectomy as opposed to tubal ligation, we attempted to perform meta‐analysis to compare operative properties and rates of postoperative wound infections. There are no temporal or linguistic limitations to our search in PubMed, Cochrane Library and Embase. The search was carried out in September 2023. The database search identified 401 potential studies and five studies were included in the meta‐analysis. Our study involved a comparison of salpingectomy with tube ligating in female patients who wanted to be sterilized. Our trial included at least one result of the wound and haemorrhage. The articles that did not qualify for inclusion or did not submit data, and those who did not answer questions were excluded. Abstracts and full‐text articles were assessed independently by two authors using blinding. Conflicting decisions were settled by consensus. The Cochrane‐recommended ROBINS‐I instrument has been applied to evaluate the risk of bias in clinical trials and to establish the quality of inclusion. Two authors separately evaluated the risk of bias for each trial; differences were settled by consensus. There were no statistically significant differences in the rate of postoperative wound infections among those who had received salpingectomy or tubal ligation (OR, 0.46; 95% CI, 0.18–1.20 p = 0.11). In the three trials, the risk of bleeding following the ligation of the fallopian tubes was lower than that of the salpingectomy group (OR, 1.25; 95% CI, 1.21–1.30 p < 0.0001). From this information we have come to the conclusion that it is possible to give preference to tubal ligation for reduction of bleeding in suitable circumstances, and that the findings currently do not provide sufficient evidence for a reduction in the risk of postoperative wound infection. [ABSTRACT FROM AUTHOR]

Between the late 1970s and 1990s, many indigenous Lisu people in the Nu River Valley, an Eastern Himalayan region of China bordering Myanmar and Tibet, underwent what they referred to as "doing medicine"—abortions, vasectomies, and tubal ligations—as part of China's Birth Planning Policy. Lisu, who endured these procedures, struggle with strength loss, nervousness, and pain. Government discourses diminish the Lisu experience, arguing that the policy was lenient toward them. Lisu themselves are reticent to share their experiences but have devised new practices to care for those affected. Drawing on long‐term ethnographic fieldwork, I argue that these chronic illnesses and accompanying care practices constitute everyday forms of remembering through which Lisu give shape to their experiences of cultural loss under Chinese colonization while generating new social relationships. This analysis sheds light on Indigenous experiences of birth planning in China with broader implications for understanding the bureaucratic violence of medicine. [ABSTRACT FROM AUTHOR]

This article examines the trends in tubal sterilization among young women in the United States. The study found that the rate of tubal sterilization has decreased significantly from 2008 to 2020, suggesting potential barriers to access for women who desire the procedure. The decline in tubal sterilization rates may be due to factors such as delayed childbearing and increased use of long-acting reversible contraception. The study also found disparities in access to tubal sterilization, with white patients more likely to undergo the procedure than black individuals. The findings highlight the importance of ensuring patient autonomy and access to tubal sterilization for all women, including young women, who desire this method of contraception. [Extracted from the article]

Background: There is limited knowledge on the effect of scan body (SB) material type, torque value, and sterilization on linear displacements of implant SBs. Purpose: To evaluate the effect of material type, torque value, and sterilization on linear displacements of SBs during screw tightening by using digital image correlation (DIC) analysis. Materials and Methods: One polyetheretherketone (PEEK, Zfx Intraoral Scan Body) and one titanium SB (Ti, MPS Zimmer Scanbody R1410) were tightened with 5 Ncm torque on two implants (Zimmer TSV ⌀4.7 mm) by using a digital torque limiting device. SBs' initial spatial positions relative to the implants were recorded by using 3D DIC technique. Measurements were repeated after initially increasing torque value to 10 Ncm and then to 15 Ncm, and these steps were repeated for a total of 10 PEEK and 10 Ti SBs on both implants (n = 20). All SBs were then sterilized 25 times by using an autoclave (STATIM 5000 S G4) according to manufacturer's recommendations and all measurements were repeated. Linear displacements on three axes were calculated for each SB with increasing torque values (from 5 to 10 Ncm and from 10 to 15 Ncm) before and after sterilization. SB displacements within each torque value–sterilization pair were compared by using Mann–Whitney U test, whereas Wilcoxon signed‐rank test was used to compare SB displacements within each material–torque value pair between conditions and within each material–sterilization pair between torque values (α = 0.05). Results: On x‐axis, PEEK SBs had higher displacements than Ti SBs (p < 0.001), whereas sterilization (p ≤ 0.028) and 15 Ncm torque application (p ≤ 0.006) led to higher displacements of PEEK SBs. On y‐axis, PEEK SBs had higher displacements than Ti SBs with 15 Ncm torque application (p ≤ 0.033). A total of 15 Ncm torque‐applied PEEK SBs and 10 Ncm torque‐applied Ti SBs had higher displacements after sterilization (p ≤ 0.028). Application of 15 Ncm torque led to higher displacements regardless of the material (p ≤ 0.002). On z‐axis, PEEK SBs had higher displacements (p ≤ 0.015), except for 10 Ncm torque‐applied sterilized SBs (p = 0.102). With 10 Ncm torque application, sterilization decreased the displacement values of PEEK SBs (p = 0.044). Greater displacements were observed with 10 Ncm torque‐applied Ti SBs before sterilization and 15 Ncm torque‐applied PEEK SBs after sterilization (p ≤ 0.033). Conclusions: Axial displacement of SBs was affected by material type, torque value, and sterilization. Ti SBs mostly had lower displacements than PEEK SBs. Application of 15 Ncm torque to tested PEEK SBs should be refrained from and a calibrated tightening tool may enable the application of 10 Ncm or lower torque values for lower displacements. Sterilization generally increased PEEK SB displacements. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to verify the association between ovarian cancer (OC) and reproductive‐ and lifestyle‐related risk factors stratified by the subtype of OC. Methods: In this matched case–control study derived from the Korean epithelial ovarian cancer study (Ko‐EVE), we calculated the risk of OC subtypes using odds ratios (ORs) and 95% confidence intervals (95% CIs) in a logistic regression model. Results: As a result of matching, 531 cases and 2,124 controls were selected. Smoking had positive association with high‐grade serous (HGS) OC (OR = 2.69, 95% CI = 1.15–6.30), whereas alcohol consumption had positive association with mucinous type (MUC) (OR = 3.63, 95% CI = 1.39–9.49). Obesity (≥30 kg/m2) was associated with clear cell type (CLC) (OR = 4.57, 95% CI = 1.06–19.77). Spontaneous abortion was negatively associated with CLC (OR = 0.34, 95% CI = 0.13–0.90), in contrast to HGS (OR = 1.43, 95% CI = 0.96–2.15). Tubal ligation, hysterectomy, and oophorectomy were associated with decreased risk of HGS (OR = 0.14, 95% CI = 0.05–0.39; OR = 0.23, 95% CI = 0.07–0.73; OR = 0.28, 95% CI = 0.08–0.97, respectively). Early menarche was strongly associated with increased risk of CLC, but not MUC (OR = 6.11, 95% CI = 1.53–24.42; OR = 3.23, 95% CI = 0.98–10.86). Further, childbirth (≥2 times) was negatively associated with endometrioid type OC and CLC (OR = 0.11, 95% CI = 0.04–0.35; OR = 0.12, 95% CI = 0.02–0.37, respectively). Oral contraceptives and hormone replacement therapy were negatively associated with OC (OR = 0.61, 95% CI = 0.40–0.93; OR = 0.51, 95% CI = 0.32–0.80, respectively), and similar negative associations were also observed in HGS (OR = 0.69; OR = 0.60, respectively). Associations between family history of breast cancer and OC, regular exercise (≥5/week), and artificial abortion and OC were similar across all subtypes (OR = 3.92; OR = 0.41; OR = 0.72, respectively). Conclusion: A heterogeneous association between some risk factors and the incidence of each subtype of epithelial OC was observed, suggesting that the carcinogenic mechanisms of each subtype may be partly different. [ABSTRACT FROM AUTHOR]

Biodegradable shape memory polymers provide unique regenerative medicine approaches in minimally invasive surgeries. Once heated, thermally responsive shape memory polymer devices can be compressed, programmed to fit within a small profile, delivered in the cold programmed state, and expanded when heated to body temperature. We have previously developed a biodegradable shape memory elastomer (SME), poly(glycerol dodecanedioate) (PGD), with transition temperatures near 37°C exhibiting nonlinear elastic properties like numerous soft tissues. Using SMEs in the clinic requires disinfection and sterilization methods that conserve physiochemical, thermomechanical, and shape recovery properties. We evaluated disinfection protocols using 70% ethanol and UV254 nm for research applications and ethylene oxide (EtO) gas sterilization for clinical applications. Samples disinfected with ethanol for 0.5 and 1 min showed no changes in physiochemical material properties, but after 15 min showed slower recovery rates than controls (p <.05). EtO sterilization at 54.4°C decreased transition temperatures and shape recovery rate compared to EtO sterilization at 37.8°C (p <.01) and controls (p <.05). Aging samples for 9 months in a vacuum desiccator significantly reduced shape recovery, and the recovery rate in EtO sterilized samples compared to controls (p <.001). Cytotoxicity testing (ISO‐10993.5C:2012) revealed media extractions from EtO sterilized samples, sterilized at 37.8°C, and high‐density polyethylene negative control samples exhibit lower cytotoxicity (IC50) than Ethanol 1 min, UV 2 h, and EtO 54.4°C. Cell viability of NIH3T3 fibroblasts on sterilized surfaces was equivalent on EtO 37.7°C, EtO 54.4°C and Ethanol sterilized substrates. Finally, chromogenic bacterial endotoxin testing showed endotoxin levels were below the FDA prescribed levels for devices contacting blood and lymphatic tissues for ethanol 1 min, UV 120 min, EtO 37.7°C, EtO 54.4°C. These findings outline various disinfection and sterilization processes for research and pre‐clinical application and provide a pathway for developing custom sterilization cycles for the translation of biomedical devices utilizing PGD shape memory polymers. [ABSTRACT FROM AUTHOR]

Low‐rank tensor optimization can be converted to a convex optimization problem, which minimizes a convex surrogate to the tensor tubal rank. This problem can be solved iteratively by applying a closed‐form proximal operator, called tensor singular value thresholding (t‐SVT). But they suffer from high computational cost of tensor singular value decomposition (t‐SVD) at each iteration. In this article, we propose a fast randomized algorithm for t‐SVT, which is called as FR t‐SVT. The key idea is to extract an approximate basis for the range of each frontal slice of a third‐order tensor in the Fourier domain from its compressed part. Our theoretical analysis shows the relationship between the approximation bounds of t‐SVD and its effect to the problem via t‐SVT. Numerical examples illustrate the effectiveness of our model. [ABSTRACT FROM AUTHOR]

Female sterilization, or tubal ligation, is rural India's most prevalent form of contraception. The paperwork surrounding this procedure provides an interesting lens through which to investigate the state, its institutions and their material conditions. The production and circulation of this paperwork uncover the state as an illegible and unpredictable entity that materializes in people's everyday lives through bureaucratically futile certificates. In this article, the author looks at sterilization paperwork as a tool to tell stories about the state and its institutions as individual women seek and undergo tubal ligation in a government facility in rural India. [ABSTRACT FROM AUTHOR]

In vitro signals indicate that ziritaxestat is a weak cytochrome P450 (CYP) 3A4 inhibitor and inducer. Therefore, potential drug–drug interactions (DDIs) with oral contraceptives were examined at a time when ziritaxestat was under development for treatment of fibrotic diseases. This open‐label, crossover (fixed sequence) DDI study enrolled healthy, nonpregnant women aged 18–65 years (n = 15) who were using highly effective contraception, such as a nonhormonal intrauterine device, bilateral tubal occlusion, or sexual abstinence. A single dose of oral contraceptive (0.03 mg ethinyl estradiol (EE) and 3 mg drospirenone (DRSP)) was administered on days 1, 8, and 18, and ziritaxestat 600 mg once daily was administered from days 8 to 23. Co‐administration resulted in a 2.8‐fold and 2.4‐fold increase in EE maximum plasma concentration (Cmax) and area under the plasma drug concentration–time curve from time zero to infinity (AUC0–inf), respectively (day 18 vs. day 1). DRSP Cmax and AUC0–inf increased by 1.1‐fold and 1.2‐fold, respectively. DRSP is a CYP3A4 substrate, meaning increased EE exposure with ziritaxestat was not due to CYP3A4 inhibition. Ziritaxestat inhibition of EE glucuronidation and sulfation was quantified by liquid chromatography with tandem mass spectrometry in day 1 and day 18 plasma samples after EE conjugate hydrolysis. The ratio of EE AUC from time of administration up to the time of the last quantifiable concentration (AUClast) with/without hydrolysis by arylsulfatase was substantially lower on day 18 vs. day 1, suggesting ziritaxestat is a potent inhibitor of sulfation; EE glucuronidation was largely unaffected by ziritaxestat. In vitro assessment confirmed ziritaxestat is a potent inhibitor of sulfotransferase family 1E member 1 (half‐maximal inhibitory concentration < 0.8 μM). These findings highlight the importance of assessing enzymes other than CYP3A4 when investigating potential DDIs with oral contraceptives. [ABSTRACT FROM AUTHOR]

This article presents a systematic review and diagnostic test accuracy meta-analysis on the use of hysterosalpingography (HSG) and outpatient transvaginal hydrolaparoscopy (THL) for the diagnosis of tubal occlusion. The study included 9 studies on HSG and 3 studies on THL, assessing their sensitivity and specificity for double-sided and at least one-sided tubal occlusion. The results showed that THL is an accurate test for diagnosing tubal occlusion, while HSG is less sensitive but specific. The article provides valuable information for individuals researching infertility and tubal occlusion. [Extracted from the article]

This article presents a systematic review and diagnostic accuracy test meta-analysis on the use of sono-hysterosalpingography (sono-HSG) for the diagnosis of tubal occlusion. The study included 9 studies and found that sono-HSG is an accurate test for diagnosing tubal occlusion. The use of color Doppler was associated with higher specificity. The article provides valuable information for researchers and healthcare professionals working in the field of infertility and reproductive health. [Extracted from the article]

Due to a history of coerced sterilization, a federal Medicaid sterilization policy mandates that a specific consent form be signed by a patient at least thirty days prior to when the patient undergoes sterilization. However, in contemporary obstetrical practice, the Medicaid sterilization policy serves as a policy‐level barrier to autonomously desired care. We review the clinical and ethical implications of the current Medicaid sterilization policy. After discussing the utility and impact of waiting periods for other surgical procedures, we explore the psychology of time required for decision‐making and consider scientific understanding of regret. We argue that the current Medicaid sterilization waiting period is clinically and ethically unjustifiable and that the policy ought to be revised in light of the goals, preferences, and concerns of the people most affected by it. While the need for continued protection against coercion remains, the current mandated waiting period does little to enforce the high‐quality shared decision‐making that is desired for sterilization counseling. [ABSTRACT FROM AUTHOR]

Introduction: Tubal reanastamosis offers hope to conceive again. However, there are many factors that affect the success of this procedure. In our study we aimed to compare the pregnancy rates of the surgical methods used for tubal reanastamosis in pregnancy requested after tubal sterilization. Methods: In our study we compared the rates of pregnancies after reanastamosis retrospectively in female patients under the age of 40 who underwent reanastamosis between 2010 and 2019 with laparotomic, laparoscopic and robotic methods. A single layer of 4 quadrant 6/0 number polydioxanone absorbable sutures were used in all surgical methods. A similar surgical technique was used. Results: In surgical methods (laparotomy, laparoscopy, and robotics), there was a statistical difference between the three groups in terms of operation times of surgical methods used for tubal reanastamosis (p < 0.05). Laparotomy, laparoscopy, and robotics pregnancy rates were 52.6% (n = 41), 67.3% (n = 37), 61.2% (n = 63), respectively. There was no statistical difference between groups in terms of pregnancy rates. However, odds ratio (OR) values of the laparoscopy group and robotics group probability of conception were 1.536 (95% confidence interval [CI], 0.813–2.898), 1.111 (95% CI, 0.656–1.879) higher, respectively. Conclusions: Although there is no statistical difference between the surgical methods used for tubal reanastamosis, we think that the laparoscopic surgical method may be preferable due to the shorter hospital stay. We think that the previous method of bilateral tubaligastion (BTL), the site of reanastasis, and the time between BTL and reanastomosis were effective in pregnancy success. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic permanent contraception was previously accomplished most commonly using tubal occlusion procedures. Bilateral salpingectomy (BS) has recently been introduced as an alternative due to possibly superior contraception and greater protection against ovarian cancer. Aims: The aim of this study is to assess uptake, feasibility and perioperative outcomes of laparoscopic BS as an alternative to tubal occlusion in Australia. Materials and Methods: A retrospective review of permanent female contraception at two Australian hospitals from January 2014 through December 2020 was performed. The primary outcome was the uptake of BS. Secondary outcomes were feasibility, procedure length, number of ports, perioperative complications and admission length. Results: A total of 414 women were included; 92 (22.2%) underwent BS and 322 (77.8%) underwent tubal occlusion. There was a slow uptake of BS from 2014 to 2016 (0–3.2%), with a steep uptake from 2017 to 2020 (30–72%) (P = 0.001). Procedure feasibility was 96.8% (62/64) and 99.3% (282/284) for BS and tubal occlusion group, respectively (P = 0.64). BS procedure time was longer by 23 min (P < 0.001). Three or more surgical ports were used in all cases of BS compared to 4.5% of the tubal occlusion group (P < 0.001). There were no intraoperative complications. There were nine and six postoperative complications in the tubal occlusion versus BS group, respectively (P = 0.10). The median admission length was 7.1 (tubal occlusion) versus 7.3 (BS) h (P = 0.10), with five unintended overnight admissions. Conclusion: BS is an increasing choice for permanent contraception. It appears equally feasible as tubal occlusion but typically requires a longer procedure time and a minimum of three surgical ports. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of laparoscopic tubal anastomosis for tubal occlusions associated with infertility in patients with previous laparoscopic salpingostomy for ectopic pregnancy. Methods: This study is a retrospective analysis of the pregnancy outcomes of 173 infertile patients who underwent hysteroscopy and laparoscopic tubal anastomosis treatment between January 2013 and August 2018 in the Department of Reproductive Endocrinology in West China Second University Hospital of Sichuan University. All patients had a history of laparoscopic salpingostomy for tubal pregnancy. The primary outcomes were intrauterine pregnancy, ectopic pregnancy, and delivery rates. We further studied the associated factors that could influence the change in pregnancy status. Results: The 24‐month cumulative clinical pregnancy rate of all patients was 107/173 (61.8%). The distribution of outcomes for the entire group of pregnancies was as follows: intrauterine pregnancy rate, 76/173 (43.9%); ectopic pregnancy rate, 31/173 (17.9%); delivery rate, 68/173 (39.3%); and miscarriage rate, 8/173 (4.6%). Age, type of anastomosis, hydrosalpinx, and endometrial polyps were significant prognostic factors in the multivariate model. Conclusion: Laparoscopic tubal anastomosis is an effective treatment for tubal‐associated infertility due to previous laparoscopic salpingostomy for ectopic pregnancy, especially for women under 35 years of age. Laparoscopic tubal anastomosis is an effective treatment for tubal‐associated infertility after laparoscopic salpingostomy for tubal pregnancy. [ABSTRACT FROM AUTHOR]

Background: Endometrial ablation (EA) is an alternative to hysterectomy for abnormal uterine bleeding (AUB), with reduced recovery time and fewer operative risks. However, post‐ablation pain may be associated with subsequent surgery, including hysterectomy. It is uncertain what factors affect surgery rates for post‐ablation pain, particularly with respect to timing and technique of tubal interruption. Aim: To evaluate the relationship between tubal interruption and post‐ablation pain and subsequent surgery. Materials and Methods: We conducted a retrospective cohort study involving 324 patients at a Melbourne tertiary hospital from 2009 to 2020. The primary outcome was subsequent pelvic surgery for pain following EA. Results: Pain following EA was reported by 29.7% of patients, with 10.5% of patients undergoing subsequent surgery for pain. Patients with tubal interruption were more likely to undergo subsequent surgery for pain than those with no tubal interruption (odds ratio (OR): 3.49, 95% CI: 1.59–7.66; P = 0.002). Tubal ligation was strongly associated with subsequent surgery for pain (OR: 3.12, 95% CI: 1.48–6.57; P = 0.003). In contrast, those with salpingectomy did not have an increased risk of subsequent surgery for pain, compared to those with no tubal interruption (OR: 1.5; 95% CI 0.32–7.13). Pre‐ablation pain (adjusted OR: 2.98, 95% CI: 1.37–6.48; P = 0.006) and previous caesarean section (OR: 2.66; 95% CI: 1.13–6.25; P = 0.025) were also associated with subsequent surgery for pain. Conclusion: Our results suggest that tubal interruption, pre‐ablation pain and previous caesarean section are associated with subsequent surgery for pain. These results can better inform preoperative counselling regarding the risk of subsequent surgery after EA. [ABSTRACT FROM AUTHOR]

The proposed different origins and pathways to of the dualistic model of epithelial ovarian cancer (EOC) may affect and alter the potential risk reduction related to hysterectomy, salpingectomy and tubal ligation. The aim of our study was to analyze associations between hysterectomy, salpingectomy or tubal ligation and risk reduction of EOC Type I and II. In this nationwide register‐based case‐control study, women diagnosed with EOC, Fallopian tube or primary peritoneal cancer between 2008 and 2014 were included. Cases were classified into Type I and II according to histology and predefined criteria. The exposure variables: hysterectomy, salpingectomy and tubal ligation were identified from national registries. Conditional logistic regression analyses were performed to evaluate associations between Type I and II EOC and the exposure variables. Among 4669 registered cases, 4040 were eligible and assessed for subtyping resulting in 1033 Type I and 3007 Type II. Ten controls were randomly assigned to each case from the register of population. In regression analyses, women with previous salpingectomy had a significantly lower risk of EOC Type II (odds ratio [OR] 0.62; 95% confidence interval [95%CI] 0.45‐0.85) but not Type I (OR 1.16; 95%CI 0.75‐1.78). Hysterectomy was associated with a reduced risk of both EOC Type I (OR 0.71; 95%CI 0.52‐0.99) and Type II (OR 0.81; 95%CI 0.68‐0.96). Similar estimates were obtained for tubal ligation, although without statistical significance. The association between salpingectomy and reduced risk of EOC Type II supports the proposed theory of high‐grade serous cancer originating from the tubal fimbriae. What's new? The dualistic model of epithelial ovarian cancer proposes different tumour origins and pathways, which may be reflected in the potential risk reduction related to hysterectomy, salpingectomy, and tubal ligation. In this nationwide register‐based case control study, salpingectomy had an inverse association with epithelial ovarian cancer Type II but not Type I, supporting the theory of high‐grade serous cancer originating from the fimbriae of the Fallopian tube. These results are valuable in the understanding of the origin of various histological subtypes of epithelial ovarian cancer and strengthen the need for prospective studies to evaluate the clinical net benefit of opportunistic salpingectomy. [ABSTRACT FROM AUTHOR]

This systematic review and meta‐analysis evaluated the diagnostic accuracy of hysterosalpingo‐foam sonography in suspected cases of tubal occlusion. The combined sensitivity and specificity estimates were 0.99 (95% confidence interval [CI], 0.89–0.99) and 0.91 (95% CI, 0.53–0.98), respectively, with positive and negative likelihood ratios of 11.5 (95% CI, 1.5–87.5) and 0.006 (95% CI, 0.0003–0.12), respectively. The diagnostic odds ratio was 1931.008 (95% CI, 69.7–53,460.8). These findings confirm hysterosalpingo‐foam sonography as a highly accurate test for the diagnosis of tubal occlusion and show that it is on a par with standard tests. [ABSTRACT FROM AUTHOR]

Background: Surgical templates are classified as noncritical devices, and they do not need to be sterile. Aim: Primary aim of this study was to assess the microbiological burden present on the surgical templates without metallic sleeves after disinfection. Furthermore, to evaluate trueness after disinfection and steam sterilization at 121°C/15 min, and over a 8‐week storage period. Finally, to assess their accuracy after in vitro implant placement simulation. Materials and methods: Forty surgical templates were printed and divided in five groups of eight templates each. Groups A to C were disinfected with 0.5% Chlorhexidine Gluconate and 70% ethyl alcohol base solution for 15 min. Templates in the group D were steam sterilized at 121°C for 15 min, while, the templates in the group E were used as control. Implant simulation was performed in the group A. Outcome measures were determination of bioburden, trueness assessment using GOM Inspect Professional software, and accuracy evaluated thought the mean angular deviation of simulated implants. Results: Total microbic charge measured as colony forming units (CFU) for sample, was 24.40 in the control group (group E; n = 8), and <4.40 in the test group (group C; n = 8), with a reduction of 84%. Colored representation from GOM inspection showed no differences after disinfection and implant simulation, disinfection alone, and steam sterilization, compared to the control group. A very small difference in the surface and volume dimensions was reported 1 month after templates fabrication. The mean roundness tolerances of the tested templates improved of 0.96 ± 0.56° (95% CI 0.57–1.35). Conclusion: Surgical templates without metallic sleeves can be safely used after disinfection, demonstrating high level of accuracy, even when the surgical procedures should be postponed within a couple of weeks. Further in vivo study are needed to confirm these preliminary results. [ABSTRACT FROM AUTHOR]

Although rare, pregnancy can still occur after both tubal sterilization and endometrial ablation. The resulting pregnancy is often complicated by ectopic pregnancy, miscarriage, and adherent placenta. Endometrial ablation is not a contraceptive. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to explore the need for information about permanent contraception in Japanese women with repeated cesarean sections (CS). Methods: The present, cross‐sectional survey used a self‐administered questionnaire mailed to women with a second or later CS at Tokyo Metropolitan Tama Medical Center between March 2010 and December 2017. Those who were pregnant, had given birth less than 1 year before the survey or had an hysterectomy were excluded. Results: The present study analyzed 284 patients (60 with permanent contraception, 224 without permanent contraception). Forty‐eight (80%) of women with permanent contraception, and 135 (60%) of women without permanent contraception believed that information on permanent contraception was needed before CS. Among women without permanent contraception, significantly fewer women obtained adequate information of permanent contraception from their healthcare workers before a CS compared with women with permanent contraception (8% vs. 71%, p < 0.001). A higher rate of unreliable contraceptive use (41%) and unintended pregnancies (4%) after the latest CS were found among the women without permanent contraception. Conclusions: A large portion of the study cohort wished they had received information on permanent contraception before CS; however, the patients without permanent contraception had limited access to this information. Adequate information about permanent contraception should be provided to women planning a CS to enable them to make an informed decision with respect to the treatment. [ABSTRACT FROM AUTHOR]

Aim: Women who experience menopause before 45 years, have an increased risk for morbidity and mortality. We aimed to identify the factors influencing the age at natural menopause and to investigate whether tubal ligation alter age at natural menopause. Methods: This cross‐sectional study was conducted on total 1660 women with natural menopause. The participants were divided into two groups as the ones having menopause before age of 45 years and after 45 years old. Results: Positive family history, smoking and use of oral contraceptive were found to increase the risk of early menopause by 3.68, 1.34 and 1.04 times, respectively. First pregnancy at older age reduced the risk of early menopause by 0.97 and obesity reduced this risk by 0.65 (95% CI 0.47–0.90). There was no significant difference between menopausal age of patients who underwent BTL (47.46 ± 4.67 years old) and those who did not (47.68 ± 5.18 years old) (P:0.320; P > 0.05). The mean age at menopause of patients who had tubal ligation with laparoscopic cauterization and Pomeroy technique was 46.91 ± 4.07 and 47.55 ± 4.76 years old, respectively (P:0.503; P > 0.05). Besides, there was no significant difference between patients having tubal ligation at the time of cesarean section and those who did not regarding menopausal age (P:0.314; P > 0.05). Conclusion: We recommend identifying modifiable factors and informing women at risk of early menopause. Tubal ligation, when performed correctly, should not compromise ovarian function. If tubal ligation interferes with vascular supply to the ovaries, it may not be substantial enough to result in an earlier onset of menopause. [ABSTRACT FROM AUTHOR]

There are few concordance studies on the Chlamydia trachomatis (infection among infertile couples. The objective of this research was to know the prevalence, concordance and reproductive sequelae that couples may develop when both partners show a C. trachomatis infection. A cross‐sectional study among 688 infertile couples using the C. trachomatis detection by real‐time PCR was performed. The infertility causes were obtained from their medical records. The prevalence of infection was 8.68%. The percentage of concordance was 22.4% (13 couples). A presence of tubal occlusion was only associated with infected‐discordant women [RR = 3.46, 95% CI (1.54–7.74), p <.003]. Seminal values were not associated with discordant men. The concordant couples showed association with the infection and tubal occlusion [RR = 3.19, 95% CI (1.09–9.34), p <.05], and oligozoospermia [RR = 12.17, 95% CI (4.29–34.54), p <.001], hypospermia [RR = 14.13, 95% CI (4.78–41.84), p <.001]. An alteration in semen quality was shown particularly in men whose sexual partners show a tubal pathology. This could occur due to a C. trachomatis infection in the testis, which underlines the need to carry out effective and efficient strategies to identify and treat all sexual partners exposed to C. trachomatis. [ABSTRACT FROM AUTHOR]

Ovarian cancer is the most fatal gynecologic malignancy (50% 5‐year survival) due to a typically advanced stage at diagnosis and a high rate of recurrence. Chemoprevention options are limited, and few interventions have been shown to reduce cancer risk or mortality. Emerging data support the model that fallopian tubes are the site of origin for a proportion of high‐grade serous cancers. This implies that a subset of cancers may be prevented by removing the fallopian tubes while leaving the ovaries intact. Accordingly, there has been shift in clinical practice for average risk women; some now recommend removal of both the fallopian tubes only instead of tubal ligation for sterilization or at the time of benign gynecologic surgery. This has been termed opportunistic salpingectomy and represents a means of decreasing the burden of ovarian cancer by preventing cancers that arise in the fallopian tubes. There have been no detailed, prospective reports that have estimated ovarian cancer risk reduction with opportunistic salpingectomy, neither among women at baseline population risk nor among women at a high risk of developing the disease. The situation is complicated for women with a BRCA mutation—bilateral salpingo‐oophorectomy is a proven means of risk reduction and salpingectomy alone is not the standard of care. Based on the existing data, salpingectomy alone should only be reserved for women with a lifetime risk of ovarian cancer of less than 5%. [ABSTRACT FROM AUTHOR]

Assessment of tubal patency and therapeutic tubal flushing using Lipiodol, an oil-soluble contrast media (OSCM), has been shown to enhance fertility, resulting in increased interest in the use of Lipiodol. A modified hysterosalpingogram (HSG) technique, including a supplementary ultrasound with the contrast in situ, is recommended when using Lipiodol, taking into account both safety issues and technical challenges specific to Lipiodol. [ABSTRACT FROM AUTHOR]

Although menopausal hormone therapy (MHT) seemingly increases the risk of ovarian cancer, evidence is insufficient whether the risk varies between various MHT formulations, regimens and administration modes. With the aim of filling these knowledge gaps, we investigated the effect of different MHT treatment options on the risk of ovarian cancer. This prospective Swedish population‐based matched‐cohort study included all women ≥40 years having used systemic MHT between 2005 and 2012 (288,950 ever‐users), group‐level matched (1:3) to 866,546 nonusers. MHT use was ascertained from the Swedish Prescribed Drug Registry and data was linked to several national health data registries. Multivariable conditional logistic regression provided odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for parity, and comorbidities. Current EP‐MHT use was associated with a modestly increased risk of ovarian cancer (OR = 1.38, 95% CI 1.18–1.62), while no consistent risk was found among past users (OR = 1.00, 95% CI 0.84–1.18). Current continuous testosterone derived (OR = 1.50, 95% CI 1.15–1.96) regimens increased the risk whereas progesterone derived (OR = 1.48, 95% CI 1.00–2.21) regimens increased the risk marginally. Nonsignificant positive associations were observed for sequential regimens (OR = 1.87, 95% CI 0.70–5.08; OR = 1.54, 95% CI 0.96–2.47, respectively). An inverse relationship was observed for all E‐MHT use (OR = 0.25, 95% CI 0.22–0.29), but this association might partly be explained by underreporting of oophorectomies or tubal ligations. Current cutaneous EP‐MHT (OR = 1.28, 95% CI 0.81–2.02) suggested a possibly lower risk than oral MHT (OR = 1.48, 95% CI 1.25–1.75). In conclusion EP‐MHT, notably continuous regimens, were associated with a modestly increased risk of ovarian cancer. The role of E‐MHT requires further clarification. What's new? While menopausal hormone therapy (MHT) appears to influence ovarian cancer risk, whether the risk varies between various MHT treatment options remains unknown. In this Swedish population‐based matched‐cohort study, including all MHT receivers during 2005–2012, we found notable differences between MHT regimens. In addition, cutaneous EP‐MHT suggested for less risk than the most commonly prescribed oral MHT. These findings are important for choosing a MHT treatment option, which involves less excess ovarian cancer risk. [ABSTRACT FROM AUTHOR]

Background: The complications of intraperitoneal onlay mesh repair for ventral hernia has favored sublay mesh placement like open Rives–Stoppa repair (ORS). There was a need for low-cost laparoscopic trans-abdominal repair using a polypropylene mesh (PPM) with sublay, midline closure and addition of posterior component separation (PCS) by transversus abdominis release (TAR). Methods: The techniques used three or six operating ports with triangulation. After adhesiolysis, a transverse incision was made on the peritoneum (P) and posterior rectus sheath (PRS). The retromuscular space was developed by raising a P-PRS flap. Midline closure was performed with No. 1 polydioxanone, and a PPM was placed in sublay, followed by closure of defect and P-PRS incision. For large hernias with divarication; myo-fascial medialization using PCS-TAR aided low-tension midline closure. Results: Eighty-nine patients were operated from 2010 to 2019, 26 primary ventral; 63 incisional; and 22 recurrent hernias. Of the primary, 21 were umbilical, one Spigelian and four epigastric hernias. The incisional group had 57 patients with lower midline scars (C-section 25, open tubal ligation 15, abdominal hysterectomy 17), five lateral (appendicectomy), one post-laparotomy. The mean age, male/female sex ratio and BMI were 41.23 years, 1:10.1 and 29.2 kg/m2, respectively. Mean defect and mesh area were 110 cm2 and 392 cm2. Mean operating time was 192 min. Conversion to open, mesh infection and recurrence rates were 3.4%, 1.1% and 5.62%. Conclusion: Laparoscopic TARM with PPM in sublay avoids mesh–bowel contact. It provides midline closure and PCS-TAR within the same port geometry with results comparable with ORS. [ABSTRACT FROM AUTHOR]

Macrophages play an important role in the inflammatory response. Their various biological functions are induced by different membrane receptors, including Toll‐like receptors, which trigger several intracellular signaling cascades and activate the inflammasomes, which in turn elicit the release of inflammatory mediators such as cytokines. In this study, we present a novel method for the isolation of human mature peritoneal macrophages. This method can be easily implemented by gynecologists who routinely perform laparoscopy for sterilization by tubal ligation or surgically intervene in benign gynecological pathologies. Our method confirms that macrophages are the main peritoneal leukocyte subpopulation isolated from the human peritoneum in homeostasis. We showed that primary human peritoneal macrophages present phagocytic and oxidative activities, and respond to activation of the main proinflammatory pathways such as Toll‐like receptors and inflammasomes, resulting in the secretion of different proinflammatory cytokines. Therefore, this method provides a useful tool for characterizing primary human macrophages as control cells for studies of molecular inflammatory pathways in steady‐state conditions and for comparing them with those obtained from pathologies involving the peritoneal cavity. Furthermore, it will facilitate advances in the screening of anti‐inflammatory compounds in the human system. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of Chlamydia trachomatis infection and the correlates of tubal pathology among Ghanaian women undergoing hysterosalpingography for suspected tubal factor infertility.Methods: A cross-sectional study was conducted among 189 women with infertility who underwent hysterosalpingography at Korle Bu Teaching Hospital, Ghana, from September 1 to November 30, 2016. Demographic data; obstetric and gynecologic history; and hysterosalpingography findings were collected using a structured questionnaire. Endocervical swabs were tested for the presence of Chlamydia trachomatis using a rapid antigen-based diagnostic kit. Associations between the variables were assessed using bivariate analysis.Results: Positive test results for Chlamydia trachomatis were recorded among 15 participants, giving an overall prevalence of 7.9% (95% confidence interval [CI] 4.1%-11.7%). In all, 67 (35.4%) participants had abnormal findings on hysterosalpingography, with 40 (21.2%) displaying bilateral tubal occlusion. The remaining 122 (64.6%) women had normal findings on hysterosalpingography. Eight participants with normal tubal appearance tested positive for Chlamydia trachomatis (prevalence 6.6%, 95% CI 2.2%-11.0%), whereas seven participants with abnormal tubal appearance tested positive (prevalence 10.4%, 95% CI 3.1%-17.7%; P=0.402). No associations were found between participant characteristics and tubal pathology.Conclusion: The prevalence of Chlamydia trachomatis did not differ by hysterosalpingography findings. [ABSTRACT FROM AUTHOR]

Objective: Improvements in success rates of assisted reproduction led to predictions that infertility surgery in both women and men would become extinct in developed countries. We sought to identify the changes in reproductive surgery that occurred between 2001 and 2015 to determine whether these predictions have been accurate. Design: The Australian Institute of Health and Welfare (AIHW) national procedural dataset and the Australian Medicare Benefits Scheme (MBS) claims database were searched for procedure data for male and female reproductive surgery and assisted reproduction from January 2001 to December 2015. The denominators were based on annual point estimates of the total population aged 25–44 years (female) and 25–55 years (male) from the Australian Bureau of Statistics (ABS). This dataset provides procedures undertaken but not their indications. Results: Over the study period the incidence of tubal surgery fell by 66%, vasectomy reversal by 33%, and surgical varicocoelectomy by 50%. In contrast, the rate of hysteroscopic myomectomy increased by 48%, hysteroscopic septoplasty by 125%, and laparoscopy for severe endometriosis increased by 84%. In vitro fertilisation oocyte retrievals increased by 90%. The rate of abdominal myomectomy was unchanged. Conclusion: Fertility surgery is not dead but has evolved. [ABSTRACT FROM AUTHOR]

Bone allografts often undergo γ‐irradiation sterilization to decrease infection risk. However this consequently degrades bone collagen and makes the allograft brittle. Our laboratory has previously found that pre‐treatment with ribose ex vivo protects the bone. However, it remains unclear whether or not ribose‐treated γ‐irradiated allografts are able to unite and remodel in vivo. Using New Zealand White rabbits (NZWr), we aimed to evaluate if ribose‐treated allografts can unite with host bone (compared to untreated (fresh‐frozen) and conventionally‐irradiated allografts). A critically‐sized defect was created in the radii of NZWr and reconstructed with allografts fixed with an intramedullary Kirschner wire. Healing and union were assessed at 2, 6, and 12 weeks post operation, with radiographs, µCT, static and dynamic histomorphometry, backscatter electron microscopy, and torsion testing. Intramedullary fixation achieved stable reconstructions and bony union in all groups and no differences were found in the radiographic and biomechanical parameters tested. Interestingly, γ‐irradiated allografts had significantly less bone volume due to evident resorption of the grafts. In contrast, ribose pre‐treatment protected γ‐irradiated allografts from this bone loss, with results similar to the fresh frozen controls. In conclusion, ribose‐pretreated γ‐irradiated allografts were able to unite in vivo. In addition to achieving bony union with host bone, ribose pre‐treatment may protect against allograft resorption. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res [ABSTRACT FROM AUTHOR]

Background: Lack of time and access to equipment are recognised barriers to simulation training. Aim: To investigate the effect of a take‐home laparoscopic simulator training program on the laparoscopic skills of gynaecology trainees. Method: Participants (n = 17 in 2015, n = 16 in 2016) were supplied with a box trainer, associated equipment and instructions on self‐directed training. A program was designed and implemented in 2015 comprising of ten weekly laparoscopic skills tasks and modified in 2016 to eight monthly tasks. Half of the participants were randomly allocated a supervisor. Participants performed baseline and post‐training assessments of laparoscopic skills in a box trainer task (thread transfer) and virtual reality simulator tasks (laparoscopic tubal ligation and bilateral oophorectomy). Results: Trainees in 2015 demonstrated an improvement in the median time to complete the laparoscopic tubal ligation task (baseline 124 s vs post‐training 91 s, P = 0.041). There was no difference in the number of tubal ligation bleeding incidents, or in the time taken to complete the box trainer thread transfer task. In 2016 trainees demonstrated improvement in tubal ligation time (baseline 251 vs 71 post‐training, P = 0.021) and bilateral oophorectomy time (baseline 891 s vs 504 post‐training, P = 0.025). There was no significant difference in other outcome measures. There was no difference found in performance when groups were compared by supervisor allocation. Conclusion: A take‐home box trainer simulation‐training program was associated with improvement in laparoscopic skills. This type of program may improve trainee access to simulation training. [ABSTRACT FROM AUTHOR]

The current reference standard to check the position of a tubal sterilization microinsert device after its insertion is hysterosalpingography. The objective of this study was to evaluate the accuracy of 2‐dimensional (2D) and 3‐dimensional (3D) ultrasonography (US) in the positioning of the tubal sterilization microinsert for definitive contraception. We searched MEDLINE, Embase, Cochrane, and Scopus databases through October 2017. Selection criteria included studies that analyzed the accuracy of 2D or 3D US, or both, with respect to the positioning of the microinsert. Data were displayed as forest plots and a summary receiver operating characteristic curves. Values for sensitivity, specificity, and positive and negative likelihood ratios (LRs) were calculated. The pooled analysis produced sensitivity and specificity values for 2D US in the positioning of the microinsert of 0.88 (95% confidence interval [CI], 0.47–1.0) and 0.92 (95% CI, 0.88–0.95), respectively, with positive and negative LRs of 8.68 (95% CI, 1.63–46.1) and 0.35 (95% CI, 0.11–1.11), respectively. Three studies analyzed the performance of 3D US, showing sensitivity, specificity, and positive and negative LRs of 0.75 (95% CI, 0.35–0.97), 0.82 (95% CI, 0.77–0.87), 3.65 (95% CI, 2.31–5.75), and 0.46 (95% CI, 0.2–1.09). In conclusion, 2D and 3D US are methods that show good accuracy in tubal sterilization microinsert positioning. [ABSTRACT FROM AUTHOR]

Aim: The aim of this work is to assess the effectiveness of hysteroscopic tubal occlusion using iso‐amyl‐2‐cyanoacrylate, among infertile women with hydrosalpinx prior to in vitro fertilization (IVF). Methods: Hysteroscopic injection of fallopian tubes with hydrosalpinx by 0.5 mL iso‐amyl‐2‐cyanoacrylate was done in 40 infertile women planning for IVF. The patients were then followed‐up after 1 and 3 months, with hysterosalpingography (HSG) to confirm complete tubal occlusion. Reinjection with iso‐amyl‐2‐cyanoacrylate was done in these patients with incomplete tubal occlusion after 1 month of the first injection, followed by HSG 2 months later to confirm complete tubal occlusion. Data were prescribed as range, mean and standard deviation (for parametric variables) and range, number and percentage (for categorical variables). Results: The total number of tubes injected in this study was 54, 42 (77.8%) of which were completely occluded after one injection while 12 (22.2%) were partially occluded. Reinjection of the partially occluded tubes was done, and (HSG) of all patients after 3 months of the primary injection confirmed 48 (88.9%) of the tubes completely occluded while 6 (11.1%) remained partially occluded. Thirty‐two (80%) patients underwent one cycle of IVF/ET (embryo transfer), while 8 (20%) patients did not appear for follow‐up. Among the patients who underwent IVF/ET, 24 (75%) got pregnant, while 8 (25%) failed to conceive. Among the pregnant patients, 8 (33.3%) delivered at term, 3 (12.5%) had first trimester abortion, while the remaining 13 (54.2%) did not deliver yet. Conclusion: Iso‐amyl‐2‐cyanoacrylate used for hysteroscopic tubal occlusion in patients with hydrosalpinx prior to IVF is safe and effective. [ABSTRACT FROM AUTHOR]

Abstract: Women face extraordinary difficulty in seeking sterilization as physicians routinely deny them the procedure. Physicians defend such denials by citing the possibility of future regret, a well‐studied phenomenon in women's sterilization literature. Regret is, however, a problematic emotion upon which to deny reproductive freedom as regret is neither satisfactorily defined and measured, nor is it centered in analogous cases regarding men's decision to undergo sterilization or the decision of women to undergo fertility treatment. Why then is regret such a concern in the voluntary sterilization of women? I argue that regret is centered in women's voluntary sterilization due to pronatalism or expectations that womanhood means motherhood. Women seeking voluntary sterilization are regarded as a deviant identity that rejects what is taken to be their essential role of motherhood and they are thus seen as vulnerable to regret. [ABSTRACT FROM AUTHOR]

Objective: To study the prevalence and pattern of tuboperitoneal pathologies among infertile women in Nigeria, using laparoscopy.Methods: A prospective study was undertaken of infertile women who underwent diagnostic laparoscopy in two fertility clinics in Nigeria between November 2015 and April 2017. The rates of identified tuboperitoneal diseases were examined.Results: The age of the 230 women ranged from 21 to 46 years, and most women had a parity group of 0-1 (87.8%; n=202). Secondary infertility accounted for 124 (53.9%) cases, and the mean duration of infertility was 4.6 ± 2.7 years. Tuboperitoneal pathologies were seen in 171 (74.4%) women and mainly comprised tubal occlusion (56.5%; n=130), hydrosalpinx (41.7%; n=96), pelvic adhesions (39.6%, n=91), and endometriosis (8.8%; n=19). Bilateral tubal occlusion was seen in 46 (20.0%) women, whereas proximal tubal occlusion accounted for 73 (56.2%) of all cases of tubal occlusion.Conclusion: There was a high rate of tuboperitoneal abnormalities in the studied population, which mainly comprised tubal occlusion, hydrosalpinx, pelvic adhesions, and endometriosis. The introduction of laparoscopy is recommended in the initial evaluation of all women with infertility in Nigeria. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To evaluate the difference in tubal ligation use between rural and urban counties in the state of Georgia, USA. Methods: The study population included 2,160 women aged 22‐45. All participants completed a detailed interview on their reproductive histories. County of residence was categorized using the National Center for Health Statistics Urban‐Rural Classification Scheme. We estimated the association between urbanization of county of residence and tubal ligation using Cox regression. Among women with a tubal ligation, we examined factors associated with prior contraception use and the desire for more children. Findings: After adjustment for covariates, women residing in rural counties had twice the incidence rate of tubal ligation compared with women in large metropolitan counties (adjusted hazard ratio [aHR] = 2.0, 95% CI = 1.4‐2.9) and were on average 3 years younger at the time of the procedure. No differences were observed between small metropolitan and large metropolitan counties (aHR = 1.1, CI = 0.9‐1.5). Our data suggest that women from large metropolitan counties are slightly more likely than women from rural counties to use hormonal contraception or long‐acting reversible contraception prior to tubal ligation and to desire more children after tubal ligation. Conclusions: Women from rural counties are more likely to undergo a tubal ligation than their urban counterparts. Our results suggest that circumstances regarding opting for tubal ligation may differ between urban and rural areas, and recommendations of alternative contraceptive options may need to be tailored differently for rural areas. [ABSTRACT FROM AUTHOR]

Objective: To evaluate, in patients who underwent Fallopian-tube sterilization by hysteroscopic insertion of an Essure® device, the feasibility and accuracy of three-dimensional (3D) transvaginal sonography (TVS) to check the position of the device and 3D hysterosalpingo-foam sonography (3D-HyFoSy) using contrast-enhanced gel foam to assess consequent tubal occlusion.Methods: This was a prospective multicenter study conducted from June 2012 to July 2014 in four Italian centers, which included 50 women who underwent hysteroscopic Essure microinsert placement in a total of 95 Fallopian tubes. Placement of the microinserts was performed in an outpatient setting following standard procedure recommendations. All patients underwent transvaginal 3D-HyFoSy and hysterosalpingography (HSG) approximately 12-14 weeks after the procedure. The position of the devices was first checked on 3D-TVS and classified according to specific criteria (Positions A, B, C and D). Then, 3D-HyFoSy with ExEm® gel foam as the ultrasound contrast agent was performed to confirm tubal occlusion by the absence of contrast agent within the tubes and/or around the ovaries. To evaluate the feasibility of 3D-HyFoSy, consecutive volume acquisitions were performed while injecting the gel foam. After sonographic evaluation, women underwent HSG to assess the success of sterilization, as standard methodology. Side effects and pain evoked during and after 3D-HyFoSy and HSG were evaluated using a numeric pain rating scale.Results: On 3D-TVS, 10 devices (10.5%) were in Position A, two (2.1%) in Position B, 59 (62.1%) in Position C and 24 (25.3%) in Position D. During 3D-HyFoSy, tubal occlusion was observed in 89 of 95 tubes (93.7%). In the six cases in which the passage of the contrast was observed, one device (16.7%) was in Position B, one device (16.7%) in Position D and four devices (66.7%) were found to lie in Position C. Tubal patency was confirmed at HSG with a concordance rate of 100%. The mean pain score associated with 3D-HyFoSy was significantly lower than that on HSG.Conclusions: 3D-TVS with HyFoSy allows accurate assessment of the position of Essure microinserts and tubal occlusion. It can be considered a safe, reliable, non-invasive alternative to HSG. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: To determine the safety and effectiveness of female sterilisation in the Finnish population.Design: A national register-based study using record linkage.Setting: National data from Finland.Sample: A total of 16 272 female sterilisations performed in 2009-2014.Methods: The Register of Sterilisations was linked with the Hospital Discharge Register, Termination of Pregnancy Register, and the Medical Birth Register in order to investigate the occurrence of re-sterilisations, other surgical operations, and unwanted pregnancies after sterilisation, per method.Main Outcome Measures: Outcome measures included all pregnancies after sterilisation (births, miscarriages, terminations of pregnancy, and ectopic pregnancies) and operations (repeat sterilisations, other hysteroscopic and laparoscopic procedures, hysterectomies, and re-operations for a complication). The outcomes were presented by method as risk ratio (RR) with 95% confidence intervals (95% CIs).Results: There was no significant difference in all spontaneous pregnancies between the groups. The risk ratio for any pregnancy was 1.27 (95% Cl 0.80-2.02) for Filshie® versus Essure® and 1.35 (95% Cl 0.92-1.96) for Pomeroy versus Essure® . In total, 1394 (8.6%) selected operations were identified after primary sterilisation. Re-sterilisations and hysteroscopies were most frequent among Essure® patients.Conclusions: Patients undergoing hysteroscopic or laparoscopic sterilisation have a similar risk of unintended pregnancy. All sterilisations are safe, and the risk of re-operations because of complications is low. Women with Essure® have a higher risk of undergoing re-sterilisation compared with patients undergoing laparoscopic sterilisation.Tweetable Abstract: Essure® , Filshie® , and Pomeroy sterilisations are equally effective and safe. [ABSTRACT FROM AUTHOR]

Objectives: Essure® has been tested as an alternative treatment for hydrosalpinx before embryo transfer (ET) in women undergoing assisted reproduction techniques. However, the persistence of a foreign body inside the uterine cavity might have a negative impact on the outcome of pregnancy. The present systematic review aimed at identifying, appraising and summarizing the available evidence regarding the effectiveness and safety of using Essure prior to ET for women with hydrosalpinx.Methods: We searched for studies in PubMed, Scopus, CENTRAL, Web of Science and ClinicalTrials.gov and the reference lists of eligible studies. All studies including at least 10 women with hydrosalpinx who received Essure, any other intervention or no treatment prior to ET were considered eligible. Study selection, data extraction and evaluation of the risk of bias were performed independently by two authors. Study outcomes were miscarriage per clinical pregnancy, singleton preterm birth per singleton live birth and live birth/ongoing pregnancy and clinical pregnancy per ET. The pooled results for each outcome and intervention were summarized as proportions with their respective 95% CIs, using a random-effects model.Results: Our electronic search of databases was performed on 7 November 2015, and 26 studies with 43 study arms were considered eligible: eight study arms evaluating Essure; seven assessing tubal aspiration; seven appraising effects of no treatment; 12 evaluating salpingectomy; two assessing tubal division; and seven evaluating tubal occlusion. When compared with women who had no intervention, women with Essure had a higher clinical pregnancy rate per ET (36% (95% CI, 0-43%) vs 13% (95% CI, 9-17%)). When compared with women who had other interventions, women with Essure had a higher miscarriage rate per clinical pregnancy (38% (95% CI, 27-49%) vs 15% (95% CI, 10-19%)).Conclusions: The available evidence suggests that, although Essure prior to ET in women with hydrosalpinx improves the chance of achieving a clinical pregnancy compared with no intervention, it is associated with a higher rate of miscarriage when compared with the other interventions. Although this evidence is based on observational studies, we believe that salpingectomy should be the first option for women who are eligible for videolaparoscopy. However, it is still premature to make recommendations for women who are not eligible for surgery, and randomized controlled trials are needed to clarify which is the best treatment alternative in such a scenario. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: The presence of hydrosalpinx impairs the outcome of in-vitro fertilization embryo transfer (IVF-ET). Surgical methods to either aspirate the fluid or isolate the affected Fallopian tubes have been attempted as a means of improving outcome. The aim of this network meta-analysis was to compare the effectiveness of surgical treatments for hydrosalpinx before IVF-ET.Methods: An electronic search of MEDLINE, Scopus, Cochrane Central Register of Controlled Trials (Central) and the US Registry of clinical trials for articles published from inception to July 2015 was performed. Eligibility criteria included randomized controlled trials of women with hydrosalpinx before IVF-ET comparing ultrasound-guided aspiration of the fluid, tubal occlusion, salpingectomy or no intervention. Ongoing pregnancy was the primary outcome and clinical pregnancy, ectopic pregnancy and miscarriage were secondary outcomes. A random-effects network meta-analysis synthesizing direct and indirect evidence from the included trials was carried out. We estimated the relative effect sizes as risk ratios (RRs) and obtained the relative ranking of the interventions using cumulative ranking curves. The quality of evidence according to GRADE guidelines, adapted for network meta-analysis, was assessed.Results: Proximal tubal occlusion (RR, 3.22 (95% CI, 1.27-8.14)) and salpingectomy (RR, 2.24 (95% CI, 1.27-3.95)) for treatment of hydrosalpinx were superior to no intervention for ongoing pregnancy. For an outcome of clinical pregnancy, all three interventions appeared to be superior to no intervention. No superiority could be ascertained between the three surgical methods for any of the outcomes. In terms of relative ranking, tubal occlusion was the best surgical treatment followed by salpingectomy for ongoing and clinical pregnancy rates. No significant statistical inconsistency was detected; however, the point estimates for some inconsistency factors and their CIs were relatively large. The small study number and sizes were the main limitations. The quality of evidence was commonly low/very low, especially when aspiration was involved, indicating that the results were not conclusive and should be interpreted with caution.Conclusions: Proximal tubal occlusion, salpingectomy and aspiration for treatment of hydrosalpinx scored consistently better than did no intervention for the outcome of IVF-ET. In terms of relative ranking, proximal tubal occlusion appeared to be the most effective intervention, followed by salpingectomy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

CONTEXT Catholic hospitals control a growing share of health care in the United States and prohibit many common reproductive services, including ones related to sterilization, contraception, abortion and fertility. Professional ethics guidelines recommend that clinicians who deny patients reproductive services for moral or religious reasons provide a timely referral to prevent patient harm. Referral practices in Catholic hospitals, however, have not been explored. METHODS Twenty-seven obstetrician-gynecologists who were currently working or had worked in Catholic facilities participated in semistructured interviews in 2011-2012. Interviews explored their experiences with and perspectives on referral practices at Catholic hospitals. The sample was religiously and geographically diverse. Referral-related themes were identified in interview transcripts using qualitative analysis. RESULTS Obstetrician-gynecologists reported a range of practices and attitudes in regard to referrals for prohibited services. In some Catholic hospitals, physicians reported that administrators and ethicists encouraged or tolerated the provision of referrals. In others, hospital authorities actively discouraged referrals, or physicians kept referrals hidden. Patients in need of referrals for abortion were given less support than those seeking referrals for other prohibited services. Physicians received mixed messages when hospital leaders wished to retain services for financial reasons, rather than have staff refer patients elsewhere. Respondents felt referrals were not always sufficient to meet the needs of low-income patients or those with urgent medical conditions. CONCLUSIONS Some Catholic hospitals make it difficult for obstetrician-gynecologists to provide referrals for comprehensive reproductive services. [ABSTRACT FROM AUTHOR]