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In order to study the anatomical variability of the uterus induced by pregnancy, a parametrization of gravid uterine geometry based on principal component analysis (PCA) is proposed. Corresponding meshes used for PCA are created by a ray description technique applied to a reference mesh. A smoothed voxel-based methodology is applied to determine the reference mesh from a database of 11 real shapes produced by the FEMONUM project. The ray-based correspondence technique is compared to two existing methods (He, Giessen) as well as a proposed mixed method. Principal component analysis results are based on a database of 11 existing shapes. Results of the parametrization show that 90% of the total variance of the database can be represented with four new shape parameters and that a wide spectrum of shapes can be generated. [ABSTRACT FROM AUTHOR]

This research applied discursive psychological analysis to discussions about cervical screening on Facebook and Twitter. The analysis focused on how people justify not attending cervical screening. Previous research has identified barriers to attending cervical screening such as embarrassment, fear of pain, and the procedure being too triggering for survivors of sexual assault. Findings identified three discourses around how social media users positioned attendance and non-attendance: (i) practical barriers such as the length of time waiting for results; (ii) psychological barriers such as cervical screenings being triggering for survivors of sexual assault; (iii) taking accountability for non-attendance. Findings are discussed in light of how non-attendance to cervical screenings is accounted for, which campaigners could consider when promoting the importance of attending cervical screening. [ABSTRACT FROM AUTHOR]

Background: The European Society of Human Reproduction and Embryology-European Society for Gynaecological Endoscopy (ESHRE-ESGE) system is designed mainly for clinical orientation; its overdiagnosis of septate uteri was confirmed in a general population in comparison to the American Society of Reproductive Medicine (ASRM) supplemental classification proposed by Ludwin. However, the agreement among septate uterus recognition using the ESHRE-ESGE and the supplemental ASRM classifications and the rate of overdiagnosis of septate uterus by ESHRE-ESGE in infertile women remain unclear.Methods: We conducted a retrospective study of 53,540 infertile patients in our reproductive centre from June 2013 to December 2016, to compare septate uterus recognition using three systems. The data were analysed by the ESHRE-ESGE system, the ASRM by Salim and the ASRM by Ludwin separately. The concordance of diagnoses of septate uteri using these three systems was compared.Results: ESHRE-ESGE classification significantly increased the frequency of septate uteri (11.31%, 6056 vs. 7.20%, 3854 vs. 3.80%, 2034). Good agreement was observed between the ESHRE-ESGE and the ASRM by Salim (k = 0.686, p < 0.001) and between the ASRM by Salim and that by Ludwin (k = 0.671, p < 0.001), while moderate agreement was found between the ESHRE-ESGE and ASRM by Ludwin systems (k = 0.444, p < 0.001). These results suggest that Ludwin's criteria are the strictest, while the ESHRE-ESGE system is much more relaxed for septate uterus diagnosis.Conclusion: A risk of overtreatment may also exist in infertile patients when using the ESHRE-ESGE system. Therefore, the ESHRE-ESGE system should be used with caution when guiding hysteroscopic metroplasty in infertile patients. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to compare uterine sonographic characteristics in early puerperium, following vaginal versus cesarean deliveries; and in women with abnormal third stage of labor, compared to uncomplicated vaginal delivery.Materials and Methods: This is a prospective study of women after delivery of singleton, appropriate-for-gestational-age weight, term neonates; 66 women delivered vaginally and 33 delivered by cesarean section. Sonographic uterine dimensions (height, length, and width), intracavitary thickness and its echogenicity (at level of fundus, midcavity and cervix) were recorded at less than and after 24 h from delivery, and compared between women delivered vaginally and by cesarean section. Among women delivered vaginally, data were further analyzed according to whether women underwent manual revision of the uterine cavity.Results: Sonographic evaluations were taken at 15.4 (4.3-24.0) and 39.5 (28.8-108.8) hours after delivery (median, range). We found no clinically significant differences in uterine characteristics according to mode of delivery or according to manual revision of the uterine cavity. The sonographic appearance of the uterus was similar when performed at less than or after 24 h from delivery.Conclusions: Postpartum sonographic evaluation of the uterus appears similar after vaginal and cesarean deliveries. [ABSTRACT FROM AUTHOR]

Background: the study was performed in a prospective randomized fashion in order to compare the value of tansvaginal ultrasound, and the value of combined colour Doppler imaging of uterine, ovarian blood flow and transvaginal folliculometry in assessment of ovulation induction of infertile women. Objectives: Ovulation rate was taken as the gold standard for assessment of ovulation induction result. Patients and Methods: Analysis of the results provided the following information: A) Better sensitivity & specificity of colour Doppler indices in detection of ovulation. B) Better timing of human chorionic gonadotrophin administration & better ovulation rate when colour Doppler was used in cycle monitoring. Results: It can be concluded from the results of this study that combined use of transvaginal sonography & colour Doppler imaging is more reliable in assessment of ovulation & is more useful in monitoring of follicular growth and vascularity in clomiphene citrate induced cycles than the use of transvaginal ultrasound alone. Conclusion: combined use of transvaginal sonography & colour Doppler imaging is more reliable in assessment of ovulation & is more useful in monitoring of follicular growth and vascularity in clomiphene citrate induced cycles than the use of transvaginal ultrasound alone. The study opens a new field of ongoing research on the valuable application of colour Doppler studies in the management of gynecologic infertility due to ovarian cause. [ABSTRACT FROM AUTHOR]

Cesarean section is the most commonly performed surgical procedure in women. The surgical incision line in the uterus is generally located in the lower segment of the anterior uterine wall. Acquaintance with the normal and abnormal findings of the anterior uterine wall is of critical importance for imagers in this era of ever increasing cesarean sections performed worldwide. [ABSTRACT FROM AUTHOR]

Objective: This study aims at evaluating the endometrial receptivity in uterus of pregnant rats exposed to nicotine via examination of integrin expression by immunohistochemical effect.Methods: In this study, 16 healthy pregnant rats were divided into two groups of control and study groups each comprising eight rats. The rats randomised to study group were given a certain amount of nicotine before and during the pregnancy. Integrin expression was detected in uterus of all rats by immunohistochemical staining. The effect of nicotine exposure on embryo implantation and the endometrial receptivity were immunohistochemically and pathologically evaluated.Results: Comparison of both groups revealed no difference in living, viable foetuses. Intensity and universality of immunohistochemical staining of Integrin β3 for endometrial epithelium and endometrial stroma were detected to be identical between the groups.Conclusion: No immunochemical effect was observed on integrin expression, which is a very important part of receptivity in an animal model created with pregnant rats that were transdermally exposed to nicotine. Our study demonstrated that the harmful effect of nicotine use before and pregnancy on implantation is limited at the level of integrin expression, in a dose-dependent manner and also by considering the method of administration. [ABSTRACT FROM AUTHOR]

Introduction: Abnormal Uterine Bleeding is one of the most common complaints of the women attending gynec OPD which requires proper endometrial cavity evaluation. Hysteroscopy has been shown to be highly accurate in diagnosing abnormalities of the endometrial cavity, tubal ostia, and endocervical canal .The aim of the study is to evaluate the feasibility of hysteroscopy in abnormal uterine bleeding and Correlate the findings of hysteroscopy with histological findings. Methods: The present study "Hysteroscopy for Abnormal Uterine Bleeding" is a prospective study, carried out at our institute from July 2015 to June 2016. 60 cases were taken up for the study. The results of hysteroscopy and endometrial histology were studied and analyzed. Results: The most common complaint was menorrhagia (17 cases, 28.33%) followed by menometrorrhagia. Abnormal findings were seen in 49 patients (81.66%). The most common abnormality was hyperplasia of endometrium (31.66%). Out of 60 patients of our study who underwent Hysteroscopy and subsequent curettage, 96.66% histopathological findings correlating with hysteroscopy. Conclusions: Hysteroscopy is a safe, reliable and quick procedure to evaluate the endometrial cavity in patients presented with abnormal uterine bleeding. As Hysteroscopy provides direct visualization of cervix, uterine cavity and cornual openings, it is much better than biopsy and curettage. [ABSTRACT FROM AUTHOR]

Laparoscopic supracervical hysterectomy (LASH) is a safe and fast minimally invasive approach in hysterectomy. In order to extract the uterine body from the abdominal cavity, one condition for LASH is the morcellation of the tissue. The intra-abdominal dissemination of benign and occult malignant uterine cells is a possible risk of this method, which can be avoided by the use of special bags for laparoscopic in-bag morcellation. We present a case of laparoscopic supracervical hysterectomy with in-bag morcellation in a uterus of more than 1400 g. and describe that this minimal-access surgery is safe and feasible even in very large uteri. This case report is registered in Research Registry under the UIN researchregistry1810. [ABSTRACT FROM AUTHOR]

Objective: To report our initial experience with and the short-term outcomes of two-phase laparoendoscopic single-site cervical ligament-sparing hysterectomy (LESS-CLSH). Materials and Methods: A retrospective case study included 40 women who underwent LESS-CLSH from January 2014 to December 2016 at Buddhist Tzu Chi General Hospital. Uterine specimens were extracted through contained manual morcellation with a tissue pouch. The first phase was LESS supracervical hysterectomy and conization of the internal orifice of the cervix. The second phase was transvaginal cervical conization and cylinderization. Women with a uterus diameter of >12 cm, a broad ligament myoma, or severe pelvic adhesion were categorized into a difficult group, and others were categorized into a nondifficult group. Results: The difficult group required more time and had more blood loss than the nondifficult group. The mean surgical time was 187.2 ± 33.9 and 139.1 ± 20.7 min, and the mean blood loss was 533.3 ± 333.3 and 225.3 ± 168.2 mL in the difficult and nondifficult groups, respectively. The overall visual analog scale (VAS) pain scores at 0-4, 24, and 48 h after surgery were 7.1 ± 1.9, 4.2 ± 1.6, and 2.3 ± 1.5, respectively; no difference in the VAS pain scores, pain relief score, and hospitalization duration was observed between the two groups. Minor surgical complications or adverse events on follow-up were noted. Three months after surgery, the diameter and thickness of the cervix were decreased by approximately 0.5 and 1.0 cm, respectively. Conclusion: LESS-CLSH is a minimally invasive, safe, and feasible approach, even for difficult laparoscopic hysterectomy. Contained manual morcellation enables more controlled specimen removal than morcellation only. [ABSTRACT FROM AUTHOR]

Introduction: We evaluated a new digital single-use flexible ureteroscope, LithoVue™ with respect to deflection, image quality and maneuverability. Methods: A prospective cohort study was conducted in eight tertiary reference centers in Europe in December 2015 and January 2016. All consecutive patients included underwent flexible ureteroscopy and were 18 years or older. Deflection and image quality pre- and post-use and maneuverability were rated with a Likert scale. Results: A total of 40 procedures were performed (five per institution). The indication for FURS was treatment of renal stones in 92.5 % of the cases. Before LithoVue™ usage, the median measured upward and downward deflections were both 270°. Image quality was rated as 'very good' in 65 % of cases and 'good' in 30 %. Maneuverability was 'very good' in 77.5 % and 'good' in 17.5 %. At the final evaluation, median upward and downward deflections were both 270°. Image quality was still 'very good' in 65 % of cases and 'good' in 30 % with no significant difference compared with preoperative data ( p = 1). Maneuverability was 'very good' in 72.5 % and 'good' in 17.5 %, with no significant difference compared with preoperative data ( p = 0.92). Two LithoVue™ broke during surgery (5 %): one occurring in extreme deflection with acute infundibulopelvic angle and spontaneous loss of vision for the second one. Conclusion: The LithoVue™ displayed good image quality, active deflection and maneuverability. Further evaluation of surgical outcomes and cost analysis will help to present the best utility of this single-use FURS in current practice. [ABSTRACT FROM AUTHOR]

Epidemiologic studies have shown the relationship of maternal hemoglobin level and abnormal findings in uterine Doppler sonography with pregnancy- related complications. In this study, we evaluated the relationship of uterine artery Doppler velocimetry findings and hemoglobin level with the outcomes of pregnancy in women with preeclampsia and healthy women. In this prospective study performed from September 2013 to September 2014, 50 patients with Preeclampsia in the third trimester (more than 28 weeks) referred to Afzalipour Hospital, Kerman/ Iran and 50 healthy pregnant women who attended the perinatology clinic for prenatal care, were randomly selected. The results of uterine artery Doppler, hemoglobin concentration and outcome of pregnancy were compared between the two groups. Twenty nine patients (51%) with preeclampsia and 17 patients (34%) in the control group had abnormal Doppler findings. In both groups, birth weight was lower in women with abnormal Dopller findings compared to the women who had normal sonography findings (p=0.024 and p=0.008, respectively); furthermore, in both groups, gestational age at birth time was lower in women with abnormal sonography findings (p=0.044 and p=0.012, respectively). The average hemoglobin concentration was not statistically different between the two groups and abnormal Doppler findings showed no significant relationship with the mean concentration of hemoglobin in none of the two groups. This study showed that abnormal findings in Doppler of the uterine artery are associated with adverse pregnancy outcomes such as low birth weight and premature births and the coexistence of preeclampsia is associated with worse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

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This study examined effect of mycotoxin binder administered to female mice exposed to zearalenon on apoptosis incidence by observe at MDA, Caspase 9 and 3 levels in mice uterus. Negative control group (K−) was not exposed to zearalenon and without the administration of mycotoxin binders, positive control group (K+) exposed to zearalenon of 0.1 mg/head/day and without the provision of mycotoxin binders; and treatment groups (P1, P2, P3) were exposed to zearalenon 0.1 mg/head/day by providing mycotoxin binders each 0.5; 1; 2 mg/head/day. Zearalenon and mycotoxinbinders administration was conducted for 10 days. Results on MDA level were as follows 15.48 ± 0.50 (K−), 45.59 ± 0.50 (K+), 34.92 ± 3.38 (P1), 27.72 ± 1.25 and 23.89 ± 3.74. Caspase 9 levels showed the following results: 0.3 ± 0.60 (K), 8.3 ± 0.90 (K+), 3.6 ± 0.41 (P1), 3.3 ± 0.34 (P2) and 2.8 ± 0.28 (P3), while the levels of Caspase3 were as follows: 3.35 ± 0.44 (K−),12.5 ± 0.66 (K+), 3.6 ± 0.41 (P1), 4.80 ± 0.43 (P2) and 3.85 ± 0.50 (P3). In conclusion, mycotoxin binders may lower malondialdehyde (MDA) level and the expression of caspase 9 and caspase3 in the uterus of mice exposed to zearalenon. [ABSTRACT FROM AUTHOR]

The recently introduced multivariate multiscale entropy (MMSE) has been successfully used to quantify structural complexity in terms of nonlinear within- and cross-channel correlations as well as to reveal complex dynamical couplings and various degrees of synchronization over multiple scales in real-world multichannel data. However, the applicability of MMSE is limited by the coarse-graining process which defines scales, as it successively reduces the data length for each scale and thus yields inaccurate and undefined entropy estimates at higher scales and for short length data. To that cause, we propose the multivariate multiscale fuzzy entropy (MMFE) algorithm and demonstrate its superiority over the MMSE on both synthetic as well as real-world uterine electromyography (EMG) short duration signals. Based on MMFE features, an improvement in the classification accuracy of term-preterm deliveries was achieved, with a maximum area under the curve (AUC) value of 0.99. [ABSTRACT FROM AUTHOR]

Introduction: Fetal cells in maternal blood may be used for noninvasive prenatal diagnostics, although their low number is a challenge. This study's objectives were to evaluate whether physical activity, transabdominal and transvaginal ultrasound scans of the uterus, as well as overnight or day-to-day variation affect the number of isolated fetal cells, more specifically the presumed endovascular trophoblast (pEVT).Material and Methods: In each of 3 different experiments, 10 normal singleton pregnant women (gestational age 10+4-14+4 weeks) participated. The number of pEVTs was assessed in 30-36 ml blood using specific markers for enrichment and identification.Results: The number of pEVTs increased overnight (p = 0.001) from a median of 1.5 to 3.5 and even further to a median of 6.0 after 30 min of physical activity (p = 0.04) but was not affected by transabdominal and transvaginal ultrasound scans. Repeated sampling showed that the interindividual variation of pEVTs was higher than the intraindividual variation (p < 0.001). However, even in pregnant women with a consistently low number of pEVTs, isolation of the pEVTs for prenatal diagnoses was possible in all cases by doing 2 separate blood samplings a few days apart.Discussion: The number of pEVTs identified in maternal blood can be increased by presampling conditions or repeated sampling. [ABSTRACT FROM AUTHOR]

Ascending infection of the uterus with Gram-negative bacteria is responsible for postpartum endometritis in cattle and buffalo and can adversely affect fertility. Development of a laboratory animal model for bovine endometritis would facilitate the understanding of the pathogenesis as it is difficult to conduct controlled experimentation in the native host. In the present study, 30 virgin Swiss Albino mice (5-8 weeks old) were used to evaluate the pathogenic potential of Escherichia coli, isolated from the normally calved postpartum buffalo to induce endometritis. Mice in the diestrus phase of the estrous cycle were randomly allotted to one of the following four intravaginal inoculation (100 µL) treatments: EG (experimental group)-1: sterile normal saline; EG-2, -3 and -4: E. coli@ 1.5 × 104, 105 and 106 CFU/ml, respectively. The animals were then scarified 36 h post-inoculation to study gross and microscopical lesions. Gross changes were confined to EG-4. Acute endometritis was recorded in 50% of the EG-3 and 66.7% of the EG-4. The rate of acute endometritis development was significantly higher in EG-4 (P<0.05) as compared to the other groups. The present study demonstrated that the animal model for bubaline endometritis can be developed in mice by intravaginal inoculation of E. coli@ 1.5 × 106 CFU/ml at diestrus. Ease of intravaginal inoculation, apparent absence of systemic involvement and high infective rate are the advantages of the model over other studies. [ABSTRACT FROM AUTHOR]

Purpose: To correlate preoperative ultrasound examination with intraoperative and anatomo-pathological findings, including estimation of number, localization and size of uterine myomas, uterine diameters and volume.Methods: A prospective study on 126 women undergoing surgery for uterine myomatosis at Campus Bio-medico between May 2013 and April 2014. The patients were divided into two groups: one submitted to hysterectomy and the other submitted to open myomectomy. Ultrasound scans were performed 1 day before surgery by the same expert sonographer. The number of myomas at ultrasound was compared to intraoperative visualization and anatomo-pathological findings. Wilcoxon Test was applied to compare data registered with each technique.Results: There was no significant difference between the number of myomas recorded at visualization and at ultrasound, while there was a significant difference between visualization and anatomo-pathology (p = 0.0006). The analysis showed a non-significant difference between myoma number at ultrasound and at anatomo-pathology in the two groups, if the number of myomas was less than or equal to six. Contrarily, we observed a significant difference if the number of myomas was more than six (p = 0.003).Conclusions: Our data show that ultrasound has limits in identifying the exact number of uterine myomas. This mapping is particularly needed in a minority of patients with usually desiring fertility who need a debulking procedure due to the large size and/or number of myomas or myoma location causing symptomatology. In patients with more than six myomas, voluminous uterus, a second-level examination such as Magnetic Resonance may be helpful. [ABSTRACT FROM AUTHOR]

In order to ensure safe magnetic resonance-guided, high-intensity focused, ultrasound ablation of uterine leiomyomas, the ultrasound beam path should be free of intervening scar and bowel. Pre-treatment MRI of a 9-cm long and 7.7-cm wide leiomyomatous uterus in a 39-year-old woman with menorrhagia and abdominopelvic pain initially demonstrated a focused ultrasound treatment path without a bowel between the uterus and the abdominal wall. On the day of ablation, however, multiple loops of bowel were observed in the ultrasound beam path by MRI. Uterine repositioning was accomplished with a 76-mm donut vaginal pessary, which anteverted the fundus and successfully displaced the bowel. A vaginal pessary may aid in repositioning an axial or retroverted uterus to enable ablation of uterine leiomyomas. [ABSTRACT FROM AUTHOR]

Backgrounds/aims: The aim of this study was to investigate the effect of rectal and intrauterine anesthesia during vaginoscopic hysteroscopy.Methods: This was a randomized, double-blind, placebo-controlled study. Patients were randomized to rectal indomethacin, intrauterine lidocaine and placebo groups. Patients with conditions that could cause or contribute to pelvic pain were excluded. Pain was evaluated with Visual Analog Scale, when the cervical canal was passed, while within the cavity and at 10 min after procedure. The Analog Pain Scale scores of the 3 groups were compared with the Kruskal-Wallis 1-way analysis of variance test. A value of p < 0.05 was accepted as statistically significant.Results: The study included a total of 206 patients. No difference was seen between the groups in respect of indication, age, gravid and duration of procedure. While the anesthesia was determined as superior to the placebo in reducing pain at all 3 stages (p < 0.05), intrauterine lidocaine was determined to be more effective than rectal indomethacin in reducing pain within the cavity and 10 min after the procedure (p < 0.05).Conclusion: Rectal or intrauterine anesthesia applied with the vaginoscopic technique is useful in hysteroscopy. However, intrauterine anesthesia is more effective in reducing pain. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate whether confirmation of suitability for service by traditional methods, observation and transrectal palpation, is improved in cattle by additional ultrasonographic examination of the uterus and ovaries. The data from 600 lactating cows from Southern Germany submitted for the first service and alternately assigned to manual (group M, n = 301) and manual and sonographic examination (group S, n = 299) were evaluated. Cows of group M with a large, soft follicle with an estimated diameter of 12.0 to 22.5 mm, without a palpable CL (>10 mm), and with a contractile uterus without palpable content were considered suitable for service and inseminated. Cows of group S with a soft follicle measuring 12.0 to 22.5 mm, without a CL (>10 mm), and with a contractile uterus and no echoic content were inseminated. Pregnancy was determined by ultrasonography at 28 to 35 days after the first service. In group S, 10.9% fewer cows (P = 0.003) were considered suitable for service than in group M. The main reason (29.6%) for exclusion from service in group S was the presence of a CL greater than 10 mm in addition to a preovulatory follicle (12.0–22.5 mm), which was diagnosed less frequently in group M (4.5%; P < 0.0001). The first-service conception rate tended to be higher in group S than in group M (62.7% vs. 54.9%; P = 0.10), and the percentage of open cows, based on all cows submitted for service, was higher in group M than in group S (35.2% vs. 25.1%; P = 0.007). We concluded that sonographic examination of cows submitted for service facilitates the exclusion from service of proestrous and diestrous cows and reduces the number of pointless services. [ABSTRACT FROM AUTHOR]

Objective: To demonstrate sequential changes of the postpartum uterus using two- and three-dimensional (2D and 3D) ultrasounds and Doppler studies.Methods: Eighty-one women who delivered a singleton at term were recruited for this prospective longitudinal study. Manual and ultrasound examinations of the uterus were performed for seven consecutive weeks. Sequential changes in size of the uterus, endometrial thickness and appearances and Doppler indices of the uterine and arcuate arteries were analyzed.Results: Complete follow ups were achieved in 71 women who had an uncomplicated postpartum course. 2D and 3D ultrasound estimations of uterine volume are highly correlated with each other (r > 0.7), but not manual estimations (r < 0.3). Data generated from 497 3D observations demonstrated rapid involution of the uterus in the first two weeks after delivery. Breastfeeding and parity did not affect uterine involution (r < 0.2). Resistance index (RI) of the uterine artery started to elevate at four weeks after delivery (r > 0.7). RI of the arcuate artery was not significantly changed during the study period (r < 0.2). Uterine involution was independent from progressive thinning of the endometrium and elevation of uterine artery RI. (r < 0.1 and 0.2, respectively).Conclusion: Longitudinal sonographic study showed independent physiologic reversals of uterine volume, endometrium and vascular supply in the first seven weeks following vaginal delivery. Standardization of measurement techniques is essential to apply this information for an early detection of postpartum uterine complications. [ABSTRACT FROM AUTHOR]

Background: Many women suffer from some degree of intrauterine adhesions (IUAs) presenting with various clinical symptoms and signs. Hysteroscopy is the mainstay of diagnosis, classification, and treatment of the IUA. Aim: This study was undertaken to review the clinical features and treatment outcome in patients diagnosed with Asherman's syndrome at the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, over a 10 years period, 1997-2006. Subjects and Methods: This is a retrospective study of cases of Asherman's syndrome managed at the UMTH over a 10-year period, from January 1, 1997 to December 31, 2006. Case records of the patients were retrieved from medical records' Department. Sociodemographic and clinical information relating to clinical presentations, treatment modalities, and outcomes were collated. The data were analyzed using SPSS 16.0 Statistical Computer Package (SPSS Inc., IL, USA 2006). Chi-square and binary logistic regression were used for inferential statistics. Results: Asherman's syndrome constituted 8.1% (81/996) of all gynecological operations in UMTH during the study period. The case records retrieval rate was 96.3% (78/81 folders). Most of the patients, 59% (46/78) were in their third decade and majority 85.9% (67/78) were married. The most common risk factor was pregnancy-associated, accounting for 61.5% (48/78). Infertility and hypomenorrhea were the most common mode of presentations in 55.1% (43/78) and 32.1% (25/78) of cases, respectively. Most of the patients 85.9% (67/78) were treated by blind dilatation and curettage (D/C), Foley's catheter insertion and estrogen-progesterone combination. Correction of menses was seen in 37.2% (29/78) of the patients while the pregnancy rate was 32.1% (25/78). On binary logistic regression age of the respondents, multigravidity, and previous pelvic surgeries for pregnancy (C/S and D/C for abortion) emerged as the only respondent's related risk factors associated with the development of Asherman's syndrome. Conclusion: Asherman's syndrome is relatively common due to complications of pregnancy and delivery, and blind D/C has a relatively poor outcome. Age of the respondents, multigravidity, and previous pelvic surgeries for pregnancy (C/S and D/C for abortion) were associated with the development of Asherman's syndrome. Therefore, other methods of adhesiolysis such as hysteroscopic adhesiolysis should be explored. [ABSTRACT FROM AUTHOR]

Background: Adenomyosis is a proliferative uterine dysfunction with unknown aetiology. One possible mechanism of its development involves disturbances in stem cell differentiation in uterine tissue. Previously, we identified pluripotent/multipotent cells in the bovine uterus, therefore our present study focused on determining expression of pluripotency markers, NANOG, OCT4 and SOX2, in bovine adenomyotic tissues and cells. Findings: Immunolocalisation revealed protein expression of NANOG, OCT4 and SOX2 in both normal and adenomyotic uteri. mRNA expression for NANOG and OCT4 was increased in tissues obtained from uteri with adenomyosis compared to controls, but at the protein level there were no significant differences. mRNA expression for all three pluripotency markers was higher in myometrial cells isolated from uteri with adenomyotic lesions than in those isolated from normal uteri. The protein level of NANOG and SOX2 was decreased in stromal cells from adenomyotic tissues, whereas the level of OCT4 and SOX2 was increased in myometrial cells obtained from dysfunctional uteri. Conclusions: The results indicate significant changes in expression of pluripotency markers in adenomyotic compared to normal uteri, which suggest the involvement of uterine stem cells in adenomyosis. [ABSTRACT FROM AUTHOR]

Background and Purpose Hydrogen sulphide reduces uterine contractility and is of potential interest as a treatment for uterine disorders. The aim of this study was to explore the mechanism of sodium sulphide ( Na2S)-induced relaxation of rat uterus, investigate the importance of redox effects and ion channel-mediated mechanisms, and any interactions between these two mechanisms. Experimental Approach Organ bath studies were employed to assess the pharmacological effects of Na2S in uterine strips by exposing them to Na2S with or without Cl− channel blockers ( DIDS, NFA, IAA-94, T16 Ainh- A01, TA), raised KCl (15 and 75 mM), K+ channel inhibitors (glibenclamide, TEA, 4- AP), L-type Ca2+ channel activator ( S- Bay K 8644), propranolol and methylene blue. The activities of antioxidant enzymes were measured in homogenates of treated uteri. The expression of bestrophin channel 1 ( BEST-1) was determined by Western blotting and RT- PCR. Key Results Na2S caused concentration-dependent reversible relaxation of spontaneously active and calcium-treated uteri, affecting both amplitude and frequency of contractions. Uteri exposed to 75 mM KCl were less sensitive to Na2S compared with uteri in 15 mM KCl. Na2S-induced relaxations were abolished by DIDS, but unaffected by other modulators or by the absence of extracellular HCO3−, suggesting the involvement of chloride ion channels. Na2S in combination with different modulators provoked specific changes in the anti-oxidant profiles of uteri. The expression of BEST-1, both mRNA and protein, was demonstrated in rat uteri. Conclusions and Implications The relaxant effects of Na2S in rat uteri are mediated mainly via a DIDS-sensitive Cl−-pathway. Components of the relaxation are redox- and Ca2+-dependent. [ABSTRACT FROM AUTHOR]

Objective: Conservative management of cases detected with placental invasion anomaly. Material and Method: Analysis of the clinical characteristics of the cases, diagnosed with placental invasion anomalies, treated in our hospital. Results: A total of ten patients diagnosed with placental invasion anomaly during two years period. Seven cases were placenta accreta and three cases were placenta percreta. The mean estimated blood loss and blood transfusion amount were 1950 (±646) mL and 5.7 (±3.8) units respectively. While in seven cases, Bakri balloon application controlled postpartum hemorrhage (PPH); but one case needed uterine artery ligation and the other one case needed B-lynch suturation + uterine artery ligation in addition to Bakri balloon application. In the remaining one case, hemorrhage was controlled by application of square sutures+ condom combined foley catheter tamponade + Affronti sutures. While none of the cases, where only uterine balloon tamponade (UBT) is applied, required hysterectomy, but the case received B-lynch suturation + uterine artery ligation required urgent hysterectomy due to coagulopathy. None of our cases experienced postpartum infection, mortality and pelvic organ injury. Conclusion: In conservative management of the patients diagnosed with placental invasion anomaly, use of UBT is effective for providing hemorrhage control and protection of fertility. [ABSTRACT FROM AUTHOR]

Objectives Human conception cohorts in gestation during stressful times reportedly yield lower ratios of male to female live births than do other conception cohorts. Much literature attributes this phenomenon to spontaneous abortion of less fit male fetuses. Controversy remains, however, as to whether stressful times make males fetuses less fit ('Shifting Distribution' of fitness) or whether male fetuses need greater fitness to avoid spontaneous abortion during stressful times ('Shifting Criterion' for survival). Methods Although research using gestational hCG as a signal of fetal fitness reports support for the latter mechanism, we believe an analytic error casts doubt on those findings. Here we offered an alternative test that corrects the error. Conclusion This more accurate test found similar results to those originally reported. Am. J. Hum. Biol. 27:426-431, 2015. © 2014 The Authors American Journal of Human Biology Published by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Purpose: To assess the concordance between the presumed diagnosis obtained with the 3D sonohysterography (SHG) and with the diagnostic hysteroscopy (HYS); to determine whether the 3D SHG has the accuracy needed to be considered as a diagnostic screening standard in cases of suspected endouterine pathology. Methods: We selected 224 patients who voluntarily decided to undergo 3D SHG from a population with suspected presence of endouterine disease at TVS. The patients underwent first 3D SHG and then diagnostic HYS. We recorded each patient's discomfort/pain during the two techniques. We used the 'Bayes Theorem' to calculate the sensitivity and specificity of the 3D SHG as compared to HYS. Results: Overall the 3D SHG diagnosis was confirmed in 156/224 cases (69.64 %). Concordance for endometrial thickening was 0 %; for Asherman's syndrome was 50.00 %; for polyp was 77.78 %; and for myoma, mucus accumulation and Müllerian anomalies (arcuate uterus, septate and subseptate uterus) was 100.00 %. Furthermore, 3D SHG was better tolerated than HYS. Conclusion: Despite the diagnostic accuracy and mini-invasiveness of 3D SHG, we suggest that it cannot be a substitute of HYS in endouterine disease diagnosis, but it could be considered as a good method of screening to address patients to hysteroscopic confirmation. [ABSTRACT FROM AUTHOR]

The article offers information on the use of three-dimensional ultrasound for gynecological imaging. Topics discussed include reproductive problems of women, treatment of 30-year-old women suffering from three consecutive first-trimester miscarriages by intrauterine adhesions, and use of virtual hysteroscopy for examining the uterine cavity.

Purpose: To study the consistency of hysteroscopy findings and histological chronic endometritis (CE) in recurrent implantation failure (RIF) cases, and to compare their values in indicating antibiotic treatment. Methods: Sixty RIF cases (January 2009-January 2010) and 202 consecutive RIF cases (May 2010-April 2012) in Peking University Third Hospital reproductive medical center were studied. 60 RIF patients' endometrial samples redid section and CD38/CD138 immunohistochemical stain for CE screening. In 202 RIF cases, the presence of hyperemia, mucosal edema, and micropolyps under hysteroscopy were considered CE diagnostic parameters. Antibiotic was offered to part of the patients. The patients' clinical outcomes were analyzed by statistical methods. Results: In 202 RIF cases, the hysteroscopy CE rate was 66.3 %, while histological CE rate was 43.6 %. The sensitivity and specificity of hysteroscopy were 35.2 and 67.5 %. In histological CE patients, 68 cases underwent regular antibiotic treatment and 20 did not. Two groups had similar clinical pregnancy rates (35.3 vs. 30.0 %), embryo implantation rates (18.9 vs. 20.4 %) and ongoing pregnancy rates (29.4 vs. 25.0 %). In hysteroscopy CE patients, the implantation rate (18.6 vs. 4.9 %) and ongoing pregnancy rate (29.3 vs. 7.4 %) significantly increased ( P < 0.05) with antibiotic treatment, and higher intrauterine pregnancy rate in treatment group (29.3 vs. 11.1 %). In reviewing the chosen 60 RIF cases, the histological CE rates were similar in both pregnancy and non-pregnancy group after subsequent embryo transfer. Conclusions: CE occurs frequently in RIF patients; hysteroscopy has more diagnostic and treatment value for them. [ABSTRACT FROM AUTHOR]

Direct selection for uterine capacity (UC) increased the number of live pigs born. A method to indirectly estimate UC in developing gilts is needed for this trait to be incorporated into commercial selection strategies. We tested the hypothesis that selection for UC alters phenotypic characteristics of the reproductive tract of prepubertal gilts and that these changes could be estimated in live animals using transrectal ultrasound (TRU). Gilts from lines selected for UC and a randomly selected control (CO) line were submitted for TRU at 130, 150, or 170 d of age and harvested 24 h later (n = 10 gilts/line per age). Diameter of the uterine horn was measured (2 to 4 measurements per animal) at TRU. At harvest, measurements of the ovary (height, width, length, weight, and number of visible follicles >1 mm) and uterine horn (weight, length, diameter, and endometrial diameter) were taken. There was no line × age interaction for any of the traits. All ovarian traits increased (P < 0.03) with age. Weight and length of the uterine horn was not different at 130 or 150 d but were increased (P < 0.01) at 170 d of age. Diameter of the uterine horn tended (P = 0.06) to be increased at 170 d compared with 130 or 150 d, but age did not affect (P = 0.38) endometrial diameter. Ovarian weight and width were increased (P < 0.01) and ovarian length and height tended (P = 0.07) to be greater for UC than CO gilts, but the number of visible follicles did not differ. The UC gilts had increased (P < 0.02) weight of uterine horns, which tended (P = 0.09) to be longer than in the CO gilts. Diameter of the uterine horn and the endometrium were greater (P < 0.01) for UC gilts than for CO gilts. Uterine horn diameter measured with TRU was not affected by age or line and was not highly correlated with any of the measured traits. Selection for increased UC results in larger ovaries and uterine horns, but TRU was not useful for estimating these traits in gilts of the age studied. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the successful rate and patient acceptance of different-sized hysteroscope in office hysteroscopy. Methods: We retrospectively evaluated 900 office hysteroscopy performed in ambulatory setting using three different hysteroscopes: 5 mm Hamou II ( n = 300), 5 mm Bettocchi ( n = 300) and 4 mm Bettocchi ( n = 300). Endpoints of our study were the successful rate of hysteroscopy, the eventual side effects/complication and the pain intensity experience from the patients using visual analog scale (VAS). Results: Use of 4 mm Bettocchi leads to a higher rate of successfully performed hysteroscopy (99 %, n  = 297) and statistically significant when compared to the 5 mm Hamou (95 %, n  = 285) and to the 5 mm Bettocchi (96 %, n  = 288) (4 mm Bettocchi vs. 5 mm Bettocchi p < 0.05; 4 mm Bettocchi vs. 5 mm Hamou II p < 0,001; 5 mm Bettocchi vs. 5 mm Hamou II ns). Moreover, the VAS score was higher using 5 mm Hamou II (5.72 ± 1.99) and statistically significant when compared to the 4 mm Bettocchi (3.06 ± 2.14) and to the 5 mm Bettocchi (4.27 ± 1.88) (A vs. B p < 0.05; A vs. C p < 0.001; B vs. C p < 0.001). Conclusions: Our result suggests that the hysteroscope size plays a pivotal role in the acceptance and for the success of office hysteroscopy. [ABSTRACT FROM AUTHOR]

Aim: To describe our experience with various interventions for caesarean scar pregnancies (CSPs) based on the myometrial thickness between the gestational mass and the bladder. Methods: All patients were initially administered methotrexate. Then, the appropriate therapies hysteroscopy alone or combined with uterine artery embolization (group A) and direct laparoscopy alone or combined with laparoscopic uterine artery occlusion (group B) was selected based on the myometrial thickness between the gestational mass and the bladder. Results: The uteri of all 53 patients with CSPs were conserved; no conversion to laparotomy or blood transfusion was required. Uterine rupture occurred in one case during surgery in group A. The operative time in group B was longer than group A (42 ± 18 vs. 80 ± 33 min; p = 0.022). The two groups were also similar with respect to other characteristics (p > 0.05). Conclusion: Myometrial thickness should be considered during the management of CSPs. Surgical approaches in the treatment of CSPs using 2-mm boundaries may yield an optimal clinical outcome. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

To determine the role, timing and indications for endometrial hysteroscopic investigation in relation to the clinical, ultrasound and histological features of the endometrium during tamoxifen (TAM) use. We performed an observational longitudinal cohort study (years 2007-2012) that investigated the endometria of 151 TAMusers with hysteroscopy and histology. For all patients, gynaecological history, years of adjuvant treatment, ultrasound endometrial thickness measurement and indications for hysteroscopy were recorded. Hysteroscopic findings showed that 100% of patients referred for simple follow-up had no evidence of endometrial disease. We found a strong correlation between previous history of abnormal uterine bleeding (with or without endometrial thickening) and hysteroscopic suspicion of endometrial atypia that was confirmed by histology. Hysteroscopy had 83.3% sensitivity, 99% specificity, 83.3% positive predictive value (PPV) and 99% negative predictive value (NPV) in detecting endometrial atypia. No significant correlation was found between endometrial thickening to O5 mm without bleeding and histological atypia. Similarly, the duration of treatment was not related to endometrial thickening and histological atypia. Endometrial stromal hyperplasia was detected by histology in 70.5% of patients with endometrial thickness measurements ranging from 5 to 10 mm. In contrast, no atypia was detected when endometrial thickness was !5 mm. Ultrasound performed using a 5-mm cut-off threshold for endometrial thickness resulted in 100% sensitivity, 15% specificity, 4% PPV and 100% NPV in detecting endometrial atypia, while a 10-mm cut-off threshold resulted in 84% sensitivity, 69% specificity, 10% PPV and 99% NPV. Low-risk TAM users do not require different endometrial surveillance than the general population. Hysteroscopy could play a fundamental role in determining the endometrial status of patients before the initiation of TAM treatment and in assessing the endometrial status of patients when bleeding occurs. [ABSTRACT FROM AUTHOR]

Abstract: Endometritis constitutes a major problem in managing broodmares. The histological occurrence of polymorphonuclear neutrophils (PMNs) in the stratum compactum of the endometrium is accepted as the reference standard to diagnose endometritis in mares. The objective of this study was to determine the distribution of PMNs within different sampling locations of the uterus by cytological examinations and to compare it with PMN numbers in endometrial biopsies of the corresponding location. Cytological and endometrial samples were obtained from 37 uteri within 2 ± 1 hours after slaughter through small incisions from five different, predefined locations of each uterus. The cytological samples were smeared on microscopic slides, stained, and classified as negative (<2% PMNs) or positive (≥2% PMNs) for endometritis. Histologically, the numbers of PMNs were counted in three high power fields by an experienced pathologist and classified as positive for this type of endometritis if ≥5 PMNs occurred in three high power fields (×40 magnification). The biopsies were also evaluated for lymphoplasmacellular endometritis, periglandular fibrosis (endometrosis), and angiosclerosis. The prevalence of positive cytological and histological samples was 14.6% and 17.8%, respectively. A fair agreement between the two diagnostic methods could be detected (k = 0.29; P < 0.01). The numbers of PMNs differed between the sampling locations, resulting in positive and negative locations within a positive scored uterus, in both cytologically positive scored uteri (8/10) and histologically positive scored uteri (13/14). No significant differences were found in PMN numbers in the different locations, either the cytological (P = 0.78) or histological (P = 0.79) examination. Additionally, no significant differences were observed in the assessment of endometrosis (P = 0.96) and angiosclerosis (P = 0.67) within the locations. In conclusion, PMN numbers of a cytological examination of the endometrium showed fair agreement to the occurrence of PMN in the stratum compactum of the histological examination at the same sampling location. Although variations were found in the number of PMN using both methods (cytology and histology), statistically significant differences were not detected within the different locations (P = 0.78; P = 0.79), implyingies that the decision to take more than one sample should be critically considered. Additional research is warranted to determine the number of sampling locations necessary for reliable examination results. [Copyright &y& Elsevier]

Objective: The objective of this study was to determine the indications, success, and complications of operative hysteroscopy performed at a teaching hospital Materials and Methods: A two-year retrospective cohort study was done of women undergoing operative hysteroscopy at Bakırkoy Dr Sadi Konuk Teaching and Research Hospital from January 2010 to January 2012. Results: 120 patients were included in the study. The mean age of patients undergoing operative hysteroscopy was 44.33 years. The most common indication for operative hysteroscopy was endometrial polyp. There were four procedure-related complications. Conclusion: Hysteroscopy is a safe and effective minimally invasive procedure with a low rate of complications. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study was conducted to describe the experiences of residents who opt out of some components of a dedicated abortion rotation. Study Design: Eligible residents at programs receiving funding from the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning were invited to complete a cross-sectional, online survey. Results: The majority of residents who opted out of some portion of the family planning training reported that the rotation positively affected skills in pregnancy options counseling, cervical dilation, first-trimester ultrasound, techniques of first-trimester uterine evacuation and other skills. Twenty-one of the 65 (31%) did an elective abortion, and 56 (84%) completed aspirations for at least one non-elective indication including therapeutic abortion and miscarriage. While no resident desired additional elective abortion training, 11 (16%) wanted additional uterine aspiration and 14 (21%) wanted additional second-trimester uterine aspiration training for non-elective indications. Conclusion: Providing access to an abortion rotation for residents who do not plan to do elective abortions gives them the opportunity to improve their skills in family planning, therapeutic abortion and miscarriage management. [Copyright &y& Elsevier]

The manual inspection of the uterine cavity (MIUC) is a procedure that has become, in some public institutions, in a routine procedure during health in the third stage of labor, this without the existence of scientific evidence or the official standards to conduct it without a precise indication, as retention of these placenta and membrane remains, uterine hypotonia, suspicion of uterine rupture or labor with c-section and instrumented labor background. This has generated interest in conducting a search in scientific literature to determine which are the main indications, contraindications and complications of this procedure, with the purpose of proposing actions that help to improve the quality of health care provided to women during labor. Specific ongoing evidence was found that the MIUC must only be conducted under specific indications, since it does not provide any improvement regarding the decrease of mortality during puerperium when routinely conducted. But this procedure was found to cause pain without analgesia measures commonly recommended. The acknowledgment of the scientific evidence by the physicians can help improve obstetric practices, preventing procedures that, without correct indications, can cause adverse events. [ABSTRACT FROM AUTHOR]

Objective: To identify and analyze the abnormal hysteroscopic findings in women with failed IVF, and their effect on pregnancy outcome. Methods and Materials: A simple, descriptive, non-randomized study of 245 patients was conducted at King Hussein medical center. All patients with failed IVF were referred to routine hysteroscopy in our hysteroscopic unit. The hysteroscopic finding was identified and recorded. The patients' ages ranged from 20 to 38 years and duration of infertility ranged from 5-10 years. Results: Uterine cavity was normal in 75% of the cases, while sixty one (25%) patients showed abnormal hysteroscopic findings of the cervical canal and uterine cavity (endometrium). The abnormal hysteroscopic findings seen were: intramural myoma: 26 cases, endometrial polyp: 19 cases, isthmic abnormalities were present in 8% (5 cases), endometrial hyperplasia in 3 cases, intrauterine adhesion (synechiae): 4 cases, and septate uterus in 4 cases. Conclusion: Patients with recurrent IVF embryo transfer failures should be reevaluated using hysteroscopy prior to further commencing IVF-embryo transfer cycles. Hysteroscopy is part of first-line exams in infertile woman regardless of age. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the technical success of total fibroid clearance at open myomectomy for massive and/or multiple symptomatic fibroids using MR imaging (MRI) as the imaging modality. Methods: The study group comprised 27 women [mean age 37.4 ± 6.9 years (range 27-53)] who underwent open myomectomy for the treatment of massive/multiple symptomatic fibroids at our institution between January 2009 and April 2010. Myomectomy was performed with the intention of achieving complete fibroid clearance. Pre- and postmyomectomy MRI was performed to assess changes in uterine volume and fibroid burden. Periprocedural data (including blood loss and complications) and relief of clinical symptoms at follow-up were also recorded. Results: The mean time to MRI and clinical follow-up was 10 months (range 6-15 months). The mean uterine volume premyomectomy was 795 ± 580 cc and postmyomectomy was 123 ± 70 cc ( p < 0.001). The mean percentage reduction in uterine volume was 80.3 % (range 43.0-98.1 %). Of the 10/27 (37.0 %) women with residual fibroids at follow-up: 7 patients had fibroids measuring up to 1 cc in volume, 3 patients had fibroids measuring up to 6 cc. Postoperative adnexal seromas were observed in 6/27 (22.2 %) patients. The clinical success rates of myomectomy amongst the 22/27 (81 %) responders were: 73 % for menorrhagia, 64 % for pain, and 36-64 % for mass-related symptoms. Conclusions: Using MRI, we have confirmed that open myomectomy can achieve total or near-total fibroid clearance in the majority of patients with massive and/or multiple fibroids. [ABSTRACT FROM AUTHOR]

Purpose: Our aim is to study the feasibility and effect of bilateral laparoscopic temporary occlusion of uterine arteries by special vascular clamps on blood loss during laparoscopic myomectomy. Methods: Of 166 women with symptomatic uterine myomas necessitating surgical intervention who wished to retain their uteri, 80 underwent laparoscopic uterine artery clipping and myomectomy (experimental group) and 86 received laparoscopic myomectomy only (control group). Main outcome measures were operating time, number and weight of leiomyomas, blood loss, Doppler examination of the uterine arteries and complications of procedure. Results: In the experimental group the median hemoglobin drop measured on day 3 postoperatively was 1.2 g/dl. In the control group the mean hemoglobin drop measured on day 3 postoperatively was 1.45 g/dl. The time needed to put the clips in place (the time from the opening of the retroperitoneum and the positioning of the clips) varied between 6 and 40 min. No patient required blood transfusion. There were no conspicuous complications. Conclusion: The use of the clips has proved to be statistically effective in reducing hemoglobin loss during laparoscopic myomectomy. [ABSTRACT FROM AUTHOR]

Objective: The purpose of our study is to highlight the essential role of hysteroscopy in the evaluation and treatment of women presenting with recurrent implantation failure after in-vitro fertilization, recurrent pregnancy loss, unexplained infertility and abnormal uterine bleeding. Methods: This prospective study was carried out in the Gynecology Department at Queen Alia Hospital, Jordan. Patients who underwent diagnostic or therapeutic hysteroscopy between May 2011 and April 2012 were included in the study. Hysteroscopic findings and the procedures performed were collected and analyzed using SPSS. Numbers and percentages were calculated and analyzed to describe the results. Results: Of the 379 patients studied, 171 women (45.1%) had intrauterine pathologic findings. In patients with history of recurrent implantation failure after in-vitro fertilization, 17 (54.8%) out of 31 patients had abnormal hysteroscopic findings. Out of 49 patients with a history of recurrent pregnancy loss, 22 patients (44.9%) had intra uterine abnormalities. Of 54 patients with unexplained infertility, 24 patients (44.4%) had uterine cavity pathology and out of 245 patients with abnormal uterine bleeding, 137 patients (55.9%) had normal and 108 patients (44.1%) had abnormal hysteroscopic findings. One hundred and twenty two operative hysteroscopic procedures were performed. The most common procedure was hysteroscopic endometrial polypectomy (38.5%). Conclusion: Because of the high rate of intrauterine pathology in women with recurrent implantation failure after in-vitro fertilization, recurrent pregnancy loss, unexplained infertility and abnormal uterine bleeding, hysteroscopy should be considered as early as possible in the diagnostic work-up of these patients. [ABSTRACT FROM AUTHOR]

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Background/Aims: To investigate the reproductive outcome after hysteroscopic resection of uterine septum in women with septate uterus and otherwise idiopathic primary infertility. Methods: Sixty-eight patients with septate uterus and idiopathic primary infertility were included in this prospective observational study. All patients underwent hysteroscopic metroplasty with scissors under general anesthesia. Main outcome measures were clinical pregnancy rate, live birth and abortion rate at 12 months' follow-up and at mean follow-up time. Results: At 12 months' follow-up, the clinical pregnancy rate, the live birth rate and the abortion rate were 44% (30/68), 36.8% (25/68) and 16.6% (5/30), respectively. At total follow-up time, the overall pregnancy rate, the live birth rate and the abortion rate were 53.8% (35/65), 41.5% and 14.2% (7/35), respectively, while the stillbirth rate was 2.8% (1/35). Conclusion: Hysteroscopic metroplasty in women with septate uterus and unexplained infertility could improve clinical pregnancy rate and live birth rate in patients with otherwise unexplained infertility. If such a patient is looking for a spontaneous pregnancy, this is more likely to occur during the first 15 months following the procedure. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The endometrium is one of the most fascinating tissues in the human body. Its sole purpose is to enable implantation of an embryo during a relatively short window of opportunity in the menstrual cycle. It is becoming clear that overcoming the current bottleneck in improvements to assisted reproductive techniques will require a closer look at the interface between uterus and embryo. Indeed, embryo implantation requires a cross talk with a receptive endometrium. Using sonography, hysteroscopy and endometrial biopsy we can learn about anatomical and functional markers of endometrial receptivity. This article reviews the factors which might cause defective endometrial receptivity. These include uterine polyps, septa, leiomyomata and adhesions. The effect of thin endometrium, endometriosis and hydrosalpinx is also described. Finally contemporary investigation of molecular markers of endometrial receptivity is described. Improving embryo implantation by a closer look inside the uterus is the key to increasing pregnancy rates in IVF. [Copyright &y& Elsevier]

The article comments on a short cervical length that was incidentally detected during lower uterine segment transabdominal scanning. It discusses the risk for preterm birth, cervical length and patient risk factors, other high-risk groups and short cervical length in singleton gestation with prior spontaneous preterm birth. It also notes cervical length screening as safe through transvaginal ultrasound examination and recommends cerclage for women and use of progesterone supplementation.

Objective: To identify uterine hysteroscopic findings among patients with prior cesarean section and whom had post-menstrual bleeding spotting type. Methods: We conducted a descriptive and prospective study between June 2008 and December 2009 involving women admitted to our clinic in Ji-Paraná (RO), Brazil, and who complained of prolonged genital bleeding after menstrual period. A total of 20 women with the simultaneous following characteristics were selected: at least one prior cesarean section, aged between 18 and 45 years, no use of hormonal contraceptives, and no history of uterine surgery that could change the cavity anatomy. All participants underwent a hysteroscopic examination. Results: During hysteroscopy, in 90% of the patients, the presence of a cesarean section scar was observed in the last third of the cervix. This scarring causes an anomaly in the uterine cavity anatomy, characterized by the viewing of an enlargement followed by a retraction of the anterior wall, which affords the presence of a pseudocavity with depth and lumen narrowing in variable degrees. Two patients did not present the pseudocavity. Conclusion: Pseudocavities in cesarean section scar are usually found in hysteroscopic examination of patients with prior cesarean section and abnormal uterine spotting. [ABSTRACT FROM AUTHOR]

Hysteroscopy is an effective diagnostic and therapeutic methods of intrauterine pathology that has all of the available diagnostic methodologies highest sensitivity and specificity. Diagnostic hysteroscopy is gradually replacing curettage, which compared with hysteroscopy does not provide adequate diagnosis of organic findings in uterine cavity, and solution of intrauterine pathology diagnostic curettage is rather random. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether placenta previa is associated with ultrasonographic findings during the first trimester. Methods: A case-control study with 1:5 (34 and 170 cases with placenta previa and normal placenta) matched pairs was conducted to compare ultrasonographic findings, including the position of the gestational sac (GS), that of the embryo in the GS, and placental cord insertion from 5-11 weeks of gestation. Results: Embryos located in the lower part of the GS at 6-7 weeks of gestation were observed in 83.3 and 17.1% of the cases and the controls, respectively. Placental cord insertion in the lower third of the uterus at 9-11 weeks of gestation was observed in 38.3 and 6.7% of the cases and the controls, respectively. Conclusion: Low embryo localization and low placental cord insertion during the first trimester was associated with placenta previa. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Uterine arteriovenous malformations (AVM) may be responsible for vaginal bleeding potentially life-threatening. They are most often acquired following uterine trauma (curettage, cesarean section, artificial delivery/uterus examination) in association with pregnancy or gestational trophoblastic disease. We report three cases of patients having uterine AVM after curettage. The diagnostic management is important to avoid differential diagnoses (intra-uterine retention, hemangioma, gestational trophoblastic disease). It is based on serum hCG measurement and Doppler ultrasound, then confirmed on dynamic angio-MRI, which tends to replace angiography as first-line. The therapeutic management in cases of symptomatic AVMs is mostly embolization which offers the possibility for childbearing. Current data on subsequent pregnancies is reassuring even if they remain limited. [Copyright &y& Elsevier]