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A 40-year-old woman who had obstetric history of one vaginal delivery and two surgical abortions to terminate early pregnancy received regular prenatal care without any systemic maternal diseases. During the detailed second trimester ultrasound, a homogenous adhesion-induced pseudocystic lesion of 8.6 × 7.4 cm was found between the inlet of the endocervix and the uterine cavity in the lower segment of the uterus. There was a clear septum with an inlet of about 2.6 cm near the right lower segment of the uterus. Transvaginal sonography showed a cervical length of 3.29 cm without dilatation. No gross fetal anomalies were found. Sometimes, the fetal head or limbs moved into this cystic space. At 36 3/7 weeks of gestation, a cesarean section was arranged for fetal breech presentation and pre-labor rupture of the membrane. After the delivery of the baby and its placenta, there was no obvious septum in the uterine cavity but only a very short fibrous tissue from the posterior wall of uterus, which could be destroyed when the baby was delivered. No adverse outcomes for the mother or the neonate were observed. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has substantially impacted healthcare systems and obstetric practices worldwide. Labor induction is a common procedure for preventing obstetric complications in high-risk populations. This study evaluated perinatal outcomes of labor induction using a modified management protocol in a tertiary care center during the COVID-19 pandemic. Methods: We conducted a retrospective study by reviewing electronic structured delivery records of women who underwent elective labor induction between June 2020 and October 2022. We analyzed maternal characteristics, maternal outcomes, and neonatal outcomes during the pre-pandemic (June 2020 to May 2021) and pandemic periods (May 2021 to October 2022). Results: The study included 976 cases: 325 pregnancies in the pre-pandemic group and 651 in the pandemic group. The pandemic group showed earlier gestational age at delivery (39 vs. 40 weeks, p < 0.01) and lower body mass index (27.1 vs. 27.5 kg/m2, p = 0.03). During the pandemic period, we observed a significant increase in labor induction cases and a decrease in cesarean sections. Neonatal outcomes, including Apgar scores and intensive care admissions, showed no significant differences between groups. Subgroup analysis identified advanced maternal age (OR = 1.08; 95% CI = 1.03–1.14; p < 0.01) and primiparity (OR = 5.24; 95% CI = 2.75–9.99; p < 0.01) as independent risk factors for cesarean delivery. Conclusions: Even under modified protocols for labor induction during the COVID-19 pandemic, more pregnancies underwent labor induction while achieving a significant reduction in cesarean sections. Advanced maternal age and primiparity were identified as independent risk factors associated with cesarean delivery. [ABSTRACT FROM AUTHOR]

We hypothesized and investigated whether prenatal exposure to preeclampsia (PE) would simultaneously affect perinatal cardiovascular features and angiotensin system expressions. This prospective study was composed of mother-neonate dyads with (n = 49) and without maternal preeclampsia (n = 48) in a single tertiary medical center. The neonates exposed to PE had significantly larger relative sizes for the left and right coronary arteries and a higher cord plasma level of aminopeptidase-N, which positively correlated with the maternal diastolic blood pressures and determined the relative sizes of the left and right coronary arteries, whereas the encoding aminopeptidase-N (ANPEP) mRNA level in the PE cord blood leukocytes was significantly decreased, positively correlated with the neonatal systolic blood pressures (SBPs), and negatively correlated with the cord plasma-induced endothelial vascular cell adhesion molecule-1 mRNA levels. The PE cord plasma significantly induced higher endothelial mRNA levels of angiotensin II type 1 receptor (AT1R) and AT4R, whereas in the umbilical arteries, the protein expressions of AT2R and AT4R were significantly decreased in the PE group. The endothelial AT1R mRNA level positively determined the maternal SBPs, and the AT4R mRNA level positively determined the neonatal chamber size and cardiac output. In conclusion, PE may influence perinatal angiotensin system and cardiovascular manifestations of neonates across placentae. Intriguing correlations between these two warrant further mechanistic investigation. [ABSTRACT FROM AUTHOR]

Aim: To compare and evaluate the efficacy of the levonorgestrel‐releasing intrauterine system (LNG‐IUD) and resectoscopy remodeling procedure for intermenstrual bleeding associated with previous cesarean delivery scar defect (PCDS). Methods: A retrospective comparative study was conducted on patients with PCDS receiving LNG‐IUD (levonorgestrel 20 μg/24 h, N = 33) or resectoscopy remodeling (N = 27). Treatment outcomes were compared over 1, 6, and 12 months. Outcomes in patients with a retroverted or large uterus size, defect size, and local vascularization also were evaluated. Results: At 12 months post‐treatment, there were no significant differences between groups in efficacy rate; however, the reduction of intermenstrual bleeding days was higher in the LNG‐IUD group than in the resectoscopy group (13.6 vs. 8.5 days, p = 0.015). Within the first year, both groups experienced a reduction in bleeding days, but the decrease was greater in the LNG‐IUD group. Individuals exhibiting increased local vascularization at the defect site experienced more favorable outcomes in the LNG‐IUD group than the resectoscopy group (p = 0.016), and who responded poorly tended to have a significantly larger uterus in the LNG‐IUD group (p = 0.019). No significant differences were observed in treatment outcomes for patients with a retroverted uterus or large defect in either group. Conclusions: Our findings support that the LNG‐IUD is as effective as resectoscopy in reducing intermenstrual bleeding days associated with PCDS and can be safely applied to patients without recent fertility aspirations. Patients with increased local vascularization observed during hysteroscopy may benefit more from LNG‐IUD intervention than resectoscopy. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy of levonorgestrel 52 mg intrauterine system for intermenstrual bleeding in patients with previous cesarean delivery scar defects (PCDSs). Methods: The medical records of 28 consecutive patients with previous cesarean delivery scar defect and intermenstrual bleeding who had undergone conservative treatment with levonorgestrel 52 mg intrauterine system were reviewed. The efficacy of treatment and frequency of adverse events were measured retrospectively. Results: After 1 year of treatment, 22 patients (78.6%) reported an improvement in symptoms. The mean duration of menstruation were 18 and 5 days before and after treatment, respectively. No uterine perforations or pelvic inflammatory diseases occurred during or after the insertion procedures. Eighteen (64.3%) patients did not experience any adverse events, and the patients with adverse events reported that they could be managed by adjusting their medications or observation. Conclusion: Levonorgestrel intrauterine system may have a role in the safe and effective management of intermenstrual spotting in patients with PCDSs. [ABSTRACT FROM AUTHOR]