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Objective: The objectives of this study were to evaluate the vascularization pattern of uterine myoma (UM) by ultrasonography using Superb Microvascular Imaging (SMI) and tissue stiffness elastography. Method: A prospective and cross‐sectional study was carried out between March 2020 and December 2022 among women with clinical and ultrasound diagnosis of UM who would subsequently undergo radiofrequency ablation. Ultrasound examination was performed using both transvaginal and transabdominal routes. UM vascularization pattern was assessed by power Doppler (PD) and SMI, while elastographic pattern was assessed by shear wave (SWE) and strain (STE). FIGO classification, location, and measurement of the largest UM were also described. Results: A total of 21 women diagnosed with UM were evaluated. There was a predominance of nulliparous women and 20 women (95.2%) reported desire for pregnancy. Of the 18 women with abnormal uterine bleeding, 15 (83.3%) had abdominal cramping. As far as previous treatment, 7 (33.3%) had undergone myomectomy for other UM. The mean uterine and UM volumes were 341.9 cm3 (90–730) and 126.52 cm3 (6.0–430), respectively. There was a predominance of hypoechogenic lesions (90.5%). There was also preponderance of UM in the FIGO 2–5 classification (n = 9; 42.9%). Vascularization patter was mostly moderate (score 2) in 9 cases (42.9%). The majority of UM were considered to have intermediate stiffness (n = 10; 47.6%). Conclusion: The majority of UM showed vascularization and moderate stiffness. A relationship was observed between the stiffness of the UM assessed by elastography and its FIGO classification. [ABSTRACT FROM AUTHOR]

The most frequent benign gynecological tumor in women who are fertile, uterine myoma significantly lowers quality of life. Endoplasmic reticulum stress (ERS) and oxidative stress (OS) play a role in the development of numerous disease states, including gynecological disorders. In order to determine the ERS and OS levels activated in women with uterine myoma, we sought to measure Total Oxidant Status (TOS) level, Glucose regulatory protein 78 (GRP78), C/EBP homologous protein (CHOP) expression, and protein levels. A total of 40 women with uterine myomas and 40 healthy women were included in the study. Serum levels of TOS, GRP78, CHOP, and protein levels were determined using an enzyme-linked immunosorbent assay (ELISA) kit. Reverse transcription polymerase chain reaction (RT-PCR) performed the mRNA levels of endoplasmic reticulum stress-associated molecules GRP78 and CHOP. The TOS levels, GRP78 and CHOP protein levels were significantly higher in women with myomas than in the controls, with values of p = 0.009, p = 0.001, and p = 0.0001, respectively. GRP78 and CHOP expression increased in women with myomas and were significantly higher than the control group used (p < 0.05). ROC curve analysis showed that GRP78 and CHOP are promising biomarkers for uterine myomas (area under the curve (AUC): 0.953, AUC: 0.969, p < 0.001, respectively). Oxidative and ERS may play a vital role in the pathophysiology of the disease due to the increased levels of oxidative and ERS markers in women with uterine myomas. [ABSTRACT FROM AUTHOR]

Background: Uterine myomas, or fibroids, are one of the most common benign tumors that occur in women of reproductive age, with a reasonably high prevalence worldwide. However, rarely, potentially malignant uterine myomas can cause a variety of health problems, including excessive menstruation, pelvic pain, fertility disorders, and pregnancy complications. Objective: This study aims to analyze the relationship between menarche age and parity with the incidence of uterine myoma. Methods: Types and design of research the plan used in this exploration is quantitative exploration with a case control approach. Sampel berjumlah 138 responden masing-masing 102 ibu yang mengalami mioma uteri dan 36 ibu yang tidak mengalami efek buruk mioma uteri. Results: The test results measured using the chi-square test were obtained with p-value menarche age = 0.004 and parity p-value = 0.000, meaning that there was a very large relationship between menarche age and parity with the incidence of uterine myomas. Conclusion: It can be concluded that the earlier the age of menarche increases the risk of uterine myoma later in life. In contrast, slower menarche may be associated with a reduced risk of myomas. Other factors such as genetic, environmental, and lifestyle factors also influence the incidence of uterine myomas, but menarche age is one of the significant hormonal indicators of risk

We present a case of a PTH-related peptide (PTH-rp) producing uterine myoma, leading to hypercalcemia in pregnancy. Our patient presented with dehydration, hypotension, delirium, and malnutrition. Due to a serum calcium level of 17.9 mg/dL (4.48 mmol/L) (reference range 8.8-11.2 mg/dL; 2.20-2.80 mmol/L), prompt treatment with hydration and calcitonin was initiated. The patient went into labor before we could consider other treatment options. Although uncommon in pregnancy, it is of great importance to identify hypercalcemia since it is related to a high risk of maternal and neonatal morbidity and mortality. Because bisphosphonates are contraindicated in pregnancy, hydration and calcitonin are the cornerstones of treatment for PTH-rp-induced hypercalcemia. [ABSTRACT FROM AUTHOR]

AbstractThe major aim of this research hyperthermia and magnetic resonance-high intensity focused ultrasound (MR-HIFU) focused on investigating the potential of aloe vera leaf extract-mediated gold-coated iron oxide nanohybrids (Au-IONPs) as a modern theragnostic material for the treatment of uterine myoma. To assess the cytotoxicity of Au-IONPs, induce hyperthermia, and apply radiotherapy to determine the level of apoptosis in the human ht-UtLM cells. Subsequently, it evaluated the cytotoxicity of the nanoparticles on human ht-UtLM cells by exposing the cells to various concentrations of Au-IONPs for a 4-hour incubation period. Based on the results, concentrations of 10 and 15 µg/mL were selected for further investigation. The MTT assay and flow cytometry results demonstrated that Au-IONPs significantly induce cell apoptosis. It allows the Au-IONPs to turn as an effective development mediator in the ablation of high-intensity focused ultrasound (HIFU) treatment. Finally, it could be suggested to developed material have excellent systemic toxicity, which promises well for treatment of uterine fibroids.HIGHLIGHTSBiosynthesis of gold – iron oxide nanohybrids (Au-IONPs) through a green approach.Physio-chemical properties of Au-IONPs have been characterized through various techniques.Investigating the anti-tumor effects of Au-IONPs in combination with thermo-radiotherapy for uterine myoma.Determine the level of apoptosis in the human myoma cells by inducing hyperthermia and radiotherapy.Observed the correlation behavior between the dose of the cell viability and Au-IONP nanoparticles.Au-IONPs had a significant impact on enhancing the effects of both hyperthermia and radiation therapies.Biosynthesis of gold – iron oxide nanohybrids (Au-IONPs) through a green approach.Physio-chemical properties of Au-IONPs have been characterized through various techniques.Investigating the anti-tumor effects of Au-IONPs in combination with thermo-radiotherapy for uterine myoma.Determine the level of apoptosis in the human myoma cells by inducing hyperthermia and radiotherapy.Observed the correlation behavior between the dose of the cell viability and Au-IONP nanoparticles.Au-IONPs had a significant impact on enhancing the effects of both hyperthermia and radiation therapies. [ABSTRACT FROM AUTHOR]

STUDY QUESTION What is the prevalence of congenital and acquired anomalies of the uterus in women with recurrent pregnancy loss (RPL) of unknown etiology examined using 3D transvaginal ultrasound (US)? SUMMARY ANSWER Depending on the adopted diagnostic criteria, the prevalence of partial septate uterus varies between 7% and 14% and a T-shaped uterus is 3% or 4%, while adenomyosis is 23%, at least one of type 0, type 1 or type 2 myoma is 4%, and at least one endometrial polyp is 4%. WHAT IS KNOWN ALREADY ESHRE and the Royal College of Obstetricians and Gynaecologists guidelines on RPL recommend the adoption of the 3D transvaginal US to evaluate the 'uterine factor'. Nevertheless, there are no published studies reporting the prevalence of both congenital and acquired uterine anomalies as assessed by 3D transvaginal US and diagnosed according to the criteria proposed by the most authoritative panels of experts in a cohort of women with RPL. STUDY DESIGN, SIZE, DURATION This was a retrospective cohort study including 442 women with at least two previous first-trimester spontaneous pregnancy losses (i.e. non-viable intrauterine pregnancies), who referred to the obstetrics and gynecology unit of two university hospitals between July 2020 and July 2023. PARTICIPANTS/MATERIALS, SETTING, METHODS Records of eligible women were reviewed. Women could be included in the study if: they were between 25 and 42 years old; they had no relevant comorbidities; they were not affected by infertility, and they had never undergone ART; they and their partner tested negative to a comprehensive RPL diagnostic work-up; and they had never undergone metroplasty, myomectomy, minimally invasive treatments for uterine fibroids or adenomyomectomy. Expert sonographers independently re-analyzed the stored 2- and 3D transvaginal US images of all included patients. Congenital uterine anomalies (CUAs) were reported according to the American Society for Reproductive Medicine (ASRM) 2021, the ESHRE/European Society for Gynaecological Endoscopy (ESGE) and the Congenital Uterine Malformation by Experts (CUME) criteria. Acquired uterine anomalies were reported according to the International Federation of Gynecology and Obstetrics (FIGO) and the Morphological Uterus Sonographic Assessment (MUSA) criteria. MAIN RESULTS AND THE ROLE OF CHANCE The partial septate uterus was diagnosed in 60 (14%; 95% CI: 11–17%), 29 (7%; 95% CI: 5–9%), and 47 (11%; 95% CI: 8–14%) subjects, according to the ESHRE/ESGE, the ASRM 2021, and the CUME criteria, respectively. The T-shaped uterus was diagnosed in 19 women (4%; 95% CI: 3–7%) according to the ESHRE/ESGE criteria and in 13 women (3%; 95% CI: 2–5%) according to the CUME criteria. The borderline T-shaped uterus (diagnosed when two out of three CUME criteria for T-shaped uterus were met) was observed in 16 women (4%; 95% CI: 2–6%). At least one of FIGO type 0, type 1, or type 2 myoma was detected in 4% of included subjects (95% CI: 3–6%). Adenomyosis was detected in 100 women (23%; 95% CI: 19–27%) and was significantly more prevalent in women with primary RPL and in those with three or more pregnancy losses. At least one endometrial polyp was detected in 4% of enrolled women (95% CI: 3–7%). LIMITATIONS, REASONS FOR CAUTION The absence of a control group prevented us from investigating the presence of an association between both congenital and acquired uterine anomalies and RPL. Second, the presence as well as the absence of both congenital and acquired uterine anomalies detected by 3D US was not confirmed by hysteroscopy. Finally, the results of the present study inevitably suffer from the intrinsic limitations of the adopted classification systems. WIDER IMPLICATIONS OF THE FINDINGS The prevalence of CUAs in women with RPL varies depending on the classification system used. For reasons of clarity, the US reports should always state the name of the uterine anomaly as well as the adopted classification and diagnostic criteria. Adenomyosis seems to be associated with more severe forms of RPL. The prevalence rates estimated by our study as well as the replicability of the adopted diagnostic criteria provide a basis for the design and sample size calculation of prospective studies. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was used. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

Up to 70–80% of women of reproductive age may be affected with the most common uterine tumors, known as fibroids or myomas. These benign tumors are the second most prevalent cause of surgery among premenopausal women. Predictions show that the occurrence of myomas in pregnancy will increase, and that the risk of having myomas during pregnancy increases with advanced maternal age. Although most women with fibroids do not experience any symptoms during pregnancy, up to 30% of women experience problems during pregnancy, childbirth, and the puerperium. The viability of myoma excision during cesarean surgery (CS) is a contentious issue raised by the rising incidence of myomas in pregnancy and CS rates. A new surgical procedure for removing fibroids using a trans-endometrial approach, which involves making an incision through the decidua itself, has put into doubt the long-standing practice of cesarean myomectomy (CM) with a trans-serosal approach. Some authors have recently advocated for this last approach, highlighting its advantages and potential uses in real-world situations. The purpose of this paper is to critique the present approach to cesarean myomectomy by analyzing the clinical and surgical distinctions between the two approaches and providing illustrations of the CM methods. [ABSTRACT FROM AUTHOR]

The study presents the killer functions of circulating neutrophils: myeloperoxidase activity, the ability to generate ROS, phagocytic activity, receptor status, NETosis, as well as the level of cytokines IL-2, IL-4, IL-6, IL-17A, and IL-18, granulocyte CSF, monocyte chemotactic protein 1, and neutrophil elastase in the serum of patients with uterine myoma and endometrial cancer (FIGO stages I-III). The phagocytic ability of neutrophils in uterine myoma was influenced by serum levels of granulocyte CSF and IL-2 in 54% of the total variance. The degranulation ability of neutrophils in endometrial cancer was determined by circulating IL-18 in 50% of the total variance. In uterine myoma, 66% of the total variance in neutrophil myeloperoxidase activity was explained by a model dependent on blood levels of IL-17A, IL-6, and IL-4. The risk of endometrial cancer increases when elevated levels of monocyte chemotactic protein 1 in circulating neutrophils are associated with reduced ability to capture particles via extracellular traps (96% probability). [ABSTRACT FROM AUTHOR]

Myoma of the uterus is a benign neoplasm. The technique of uterine artery embolization (UAE) is used to treat uterine fibroids and is highly effective. The principle of embolization is based on the fact that all blood vessels that supply the uterus end in the endometrium. During UAE small parts are injected – emboli, which are spread along these vessels with the blood flow. In the vessels of the myoma the emboli cannot pass through the capsule of the myoma, so they block the vessels that supply it with blood. This leads to the cessation of blood supply to myomatous nodes, and subsequently there is a decrease in the size of these nodes, on average by 50–60% during the year, with a gradual decrease during the following years of life. This minimally invasive procedure is performed under local anesthesia – after femoral artery puncture, with X-ray control of angiography and intraoperative assessment of blood flow in fibroid nodes using ultrasound (US). Over 15 years of work, 1,400 UAE operations of uterine fibroids have been performed, of which more than 70 cases are UAE of submucosal myomas. Later, when the clinical picture of expulsion of these submucosal nodes appeared, transvaginal myomectomy was performed. Such a combined technique demonstrated high efficiency. The article describes clinical cases of patients who received treatment of large submucosal myoma by the UAE method followed by transvaginal myomectomy of the nascent node. In total, 5 clinical cases are described, the results of ultrasound, macropreparations, and colposcopic images are presented. A clinical case of a uterine myoma, the size of which corresponded to 21 weeks of pregnancy and a volume of 1500 cm3, is presented: after the above complex treatment method the volume of the uterus decreased according to ultrasound examination to 122 cm3 . Also, a clinical case of a patient with uterine myoma, massive bleeding, whose hemoglobin level was 67 g/l is described. The patient was performed by UAE followed by transvaginal myomectomy for expulsion of the submucosal node. So, the described complex method of treatment of submucous uterine fibroids demonstrated high efficiency of clinical results. [ABSTRACT FROM AUTHOR]

Uterine fibroids are the most common benign neoplastic tumor of the uterus, occurring in adolescents with a frequency of less than 1%. According to literature data, 87.5% of young patients, as a rule, have a variety of symptoms, the most frequent of which is abnormal uterine bleeding, anemizing the patient, abdominal pain, abdominal enlargement in volume. Diagnosis in adolescent girls may be difficult, due to the rarity, as well as the presence of some limitations in the echographic examination performed, as a rule, by transabdominal access. Methods of treating leiomyomas in women are well known and are widely described in clinical guidelines ranging from surgical to medicinal, however, they are not standardized for the pediatric population. Currently, no more than 25 clinical observations have been described in the literature, which indicates the importance of accumulating clinical data in order to develop an optimal clinical approach aimed at preserving reproductive function in such patients.

Research objectives: to develop an algorithm for predicting the growth of uterine fibrodis, taking into account the state of epigenetic regulation. Materials and methods. The study was conducted on the basis of clinical divisions of the Department of Obstetrics and Gynecology in 2018–2021. 28 patients with uterine fibroids were examined. Expression of miRNA-29b and miRNA-146a in tumor tissue was determined in all women using real-time PCR. Obtained data were analyzed using the statistical program Statistica 10.0 (StatSoft Inc., USA). Results. The average age of the patients was 39.3 ± 1.0 years. The average number of nodes was 2.7 ± 0.4. The expression levels of microRNA-29b were most frequently determined in the range of 2–7 units and microRNA-146a in the range of 30–67 units in most of the examined tissue samples. The expression of miRNA-29b has the greatest significance for the growth forecast (Wald statistic). According to the logistic regression equation the prognostic factors are patient’s age, estradiol and progesterone level in the I and II phases of the menstrual cycle, diameter of the largest node, expression of miRNA-29b and miRNA-146a. Conclusions. This study shows that the use of miRNA expression profile as an additional marker in the diagnosis and treatment of uterine fibroids is promising and requires more detailed research. Further study of the correlation of clinical and paraclinical parameters can make it possible to predict the course of uterine fibroids, and therefore to apply an effective personalized treatment plan. Theranostics is a new approach to the diagnosis and treatment of patients, based on the uniqueness of each person in order to choose the optimal treatment strategy against the background of the molecular genetic technologies, in particular to determine epigenetic changes in hyperproliferative diseases. The study of miRNA expression may find its place in the theranostics of uterine fibroids in the future.

The presented review summarizes current data on the tactics of accompanying patients with uterine myoma at various stages of their reproductive potential realization: the stage of pregravid preparation, the stage of pregnancy management, the moment of delivery and the postpartum period. Based on the analysis of domestic and foreign special scientific and practical literature, various methods of childbirth are proposed, from more preferable delivery through the natural birth canal, to the necessary caesarean section, performed strictly according to indications. Data are presented on the options for elective and emergency myomectomy during pregnancy, during operative delivery and in the postpartum period. Based on the results of systematization of the information received, the authors raise the question of the need for further research in the field of developing methods for optimal management of patients during pregnancy and childbirth complicated by uterine myoma, due to the relevance of the problems discussed.

Background: Myomas or fibroids are commonly encountered in clinical practice and are present in more than 50% of the reproductive aged women. According to the Global Burden of Disease (2019) data, the global incident cases of uterine myomas has increased. The choice of treatment for reproductive aged women with symptoms needing to preserve their fertility is still myomectomy. There are two main approaches of performing myomectomy i.e., abdominal/open and laparoscopic. There have been recent evidence indicating that laparoscopic myomectomy is associated with shorter recovery time, lower risk of post-operative complications and overall similar clinical outcomes when compared to open myomectomy. Objective: To compare the intra-operative and post-operative clinical outcomes among women undergoing open and laparoscopic myomectomy. Methods: This is a retrospective study done in a tertiary care hospital in Odisha, India. Data from women who undergone either of the two surgical approaches between February 2016 to December 2018 were utilized. The outcomes of interest were estimated blood loss, duration of surgery, need for blood transfusion, duration of hospitalization, indicators of recovery and post-operative complications. Regression analysis was done to document the association of surgery type with the outcomes. Effect sizes were reported either as mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CI). Results: A total of 140 subjects were included in this study (laparoscopic group (LM)=60 and open myomectomy group (OM)=80). Those undergoing LM had lower blood loss (in ml) (MD -21.0; 95% CI: -37.5 to -4.47) and a higher surgical time (in min) (MD 13.0; 95% CI: 3.0 to 23.1), compared to OM. The duration of hospitalization (in days) was comparatively lower in those undergoing LM (MD -2.42; 95% CI: -2.47 to - 2.37). The women undergoing LM had higher odds of being free from analgesic at 2nd post-operative day (OR 5.90; 95% CI :2.82 to 12.3) and discharged by 3rd to 5th post-operative day (OR 4.74; 95% CI :2.27 to 9.91). The risk of need for blood transfusion and post-operative complications were similar in both the groups. Conclusions: The findings suggest that laparoscopic myomectomy offers clear advantage in terms of improved clinical outcomes when compared to conventional open myomectomy. [ABSTRACT FROM AUTHOR]

To investigate the incidence of venous thromboembolism (VTE) in patients undergoing large specimen hysterectomy for benign indications. To evaluate the impact of route of surgery and operative time in the development of VTE in this population. Retrospective cohort study (Canadian Task Force Classification II2) of targeted hysterectomy data prospectively collected from the American College of Surgeons National Surgical Quality Improvement Program involving over 500 hospitals across the United States. National Surgical Quality Improvement Program Database. Women aged 18 years or older undergoing hysterectomy for benign indications between 2014 and 2019. Patients were further classified into 4 groups according to uterine weight: <100 g, 100–249 g, 250 g–499 g, and specimens ≥500 g. Current Procedural Terminology codes were used to identify cases. Variables including age, ethnicity, body mass index, smoking status, diabetes, hypertension, blood transfusion, and American Society of Anesthesiologists classification system scores were collected. Cases were stratified by route of surgery, operative time, and uterine weight. A total of 122,418 hysterectomies occurring between 2014 and 2019 were included in our study, of which 28,407 (23.2%) patients underwent abdominal, 75,490 (61.7%) laparoscopic, and 18,521 (15.1%) vaginal hysterectomy. The overall rate of VTE in patients with large specimen hysterectomies (≥500 g) was 0.64%. After multivariable adjustment, there was no significant difference in the odds of VTE between uterine weight groups. Only 30% of the surgeries with uterine weight above 500 g were performed with minimally invasive surgical routes. Patients who underwent minimally invasive hysterectomy had lower odds of VTE via laparoscopic (adjusted odds ratio [aOR] 0.62; confidence interval [CI]: 0.48–0.81) and vaginal (aOR 0.46; CI: 0.31–0.69) routes compared to laparotomy. Prolonged operative time (>120 min) was associated with increased odds of VTE (aOR 1.86; CI:1.51–2.29). The occurrence of VTE after a benign large specimen hysterectomy is rare. The odds of VTE is higher with longer operative times and lower with minimally invasive approaches, even for markedly enlarged uteri. [ABSTRACT FROM AUTHOR]

Violation of the extracellular matrix components synthesis regulation contributes to the formation and growth of uterine fbroids (MM). Changes of collagen metabolism in connective tissue may be associated with polymorphism of matrix metalloproteinase (MMP) genes. Aim of the study was to analyze of the association of regulatory regions of matrix metalloproteinase genes MMP2 (rs243865), MMP3 (rs3025058), MMP9 (rs3918242) with the development of uterine myoma, its histological form, several concomitant gynecological diseases. Material and methods. The clinical study of 69 patients (23–54 years old) with uterine myoma was conducted. According to the anamnesis, 57.9 % of patients had childbirth, 46.4 % of women had an artifcial termination of pregnancy, and 15.9 % of women had endometriosis. In histological examination, in 48.14 % the nodes corresponded to the phenotype of simple fbroids with a large proportion of fbrous tissue, 51.6 % with the phenotype of proliferating fbroids. The comparison group is represented by a random population sample of women from Western Siberia. 183 women without pronounced gynecological pathologies were examined. MMP2-1306 C/T polymorphism was analyzed by TaqMan, MMP3-1171 5A/6A, MMP9-1562 C/T by restriction fragment length polymorphism method. Results. The genotype frequencies of the analyzed genes did not signifcantly differ between the groups. The complex genotype MMP2-1306CC:MMP3-11715A6A:MMP9-1562CT was decreased in women with uterine myoma relative to the persons of the comparison group. In endometriosis patients MMP9-1562CC genotype was reduced and heterozygosity was increased relative to patients without endometriosis. The frequency of MMP2-1306CC:MMP9-1562CT complex genotype is signifcantly higher in women who gave birth than in women who did not give birth. Complex genotypes differences between histological variants of uterine myoma were revealed. Conclusions. The results of the study show the signifcance of polymorphism effect of the regulatory regions of the MMP genes in the development and nature of the course of uterine myoma.

Up to 70–80% of women of reproductive age may be affected with the most common uterine tumors, known as fibroids or myomas. These benign tumors are the second most prevalent cause of surgery among premenopausal women. Predictions show that the occurrence of myomas in pregnancy will increase, and that the risk of having myomas during pregnancy increases with advanced maternal age. Although most women with fibroids do not experience any symptoms during pregnancy, up to 30% of women experience problems during pregnancy, childbirth, and the puerperium. The viability of myoma excision during cesarean surgery (CS) is a contentious issue raised by the rising incidence of myomas in pregnancy and CS rates. A new surgical procedure for removing fibroids using a trans-endometrial approach, which involves making an incision through the decidua itself, has put into doubt the long-standing practice of cesarean myomectomy (CM) with a trans-serosal approach. Some authors have recently advocated for this last approach, highlighting its advantages and potential uses in real-world situations. The purpose of this paper is to critique the present approach to cesarean myomectomy by analyzing the clinical and surgical distinctions between the two approaches and providing illustrations of the CM methods.

AbstractObjective This study compared the feasibility and efficacy of transabdominal ultrasound (TAU) and combined transabdominal and transvaginal ultrasound (TA/TV US)-guided percutaneous microwave ablation (PMWA) for uterine myoma (UM).Method This study enrolled 73 patients with UM who underwent PMWA via the transabdominal ultrasound-guided (TA group) or the combined transabdominal and transvaginal ultrasound-guided (TA/TV group) approaches. The intraoperative supplementary ablation rates, postoperative immediate ablation rates, lesion reduction rates and other indicators three months postoperatively were compared between the groups. The display of the needle tip, endometrium, uterine serosa, rectum and myoma feeding vessels under the guidance of TAU, transvaginal ultrasound (TVU) and TA/TV US were evaluated in the TA/TV group.Results In the TA/TV group, the real-time position of the needle tip and the endometrium complete display rate of the same lesions with TVU guidance were significantly higher than those using TAU. TA/TV US guidance significantly improved the complete display rate of each indicator. The intraoperative supplementary ablation rate in the TA/TV group was lower than that in the TA group. Similarly, the postoperative immediate ablation and volume reduction rates of the lesions three months postoperatively were higher than those in the TA group, especially for lesions with a maximum diameter ≥6 cm.Conclusion TA/TV US is an effective monitoring method that can be used to improve imaging display. Its use is recommended in patients with obesity, poor transabdominal ultrasound image quality and large myoma volumes.

The objective of present study was to examine endometrial tissue Be, As, Cr, Mo, Sr, Ti, Tl, Cu, Co, Se, Zn, Mn, Fe, Cd, Pb, Mg, P, erythrocytes CAT, SOD, GSH-Px, GSH, MDA, serum retinol, cholecalciferol, phylloquinone, TSA, LSA, TOS, and TAS status and to evaluate the relationships between the variables. The study had 110 participants; of these, 50 were women with uterine myoma (UM), 10 were women with endometrial cancer (EC), and 50 were healthy female subjects. In the study, vitamin analyses by HPLC and element analyses were determined using ICP-OES method. It was observed that EC group was significantly lower than healthy group in terms of levels of cholecalciferol (p < 0.05), phylloquinone (p < 0.01), GSH (p < 0.05), Fe (p < 0.05), and had a significant rise in Mg/Fe (p < 0.01) and Zn/Fe (p < 0.05) in preoperative period. UM group had significantly lower retinol (p < 0.05), phylloquinone (p < 0.001), GSH-Px (p < 0.01), GSH (p < 0.01), Cr (p < 0.01), Cu (p < 0.05), Mg (p < 0.01), and Zn (p < 0.01) levels than control group in preoperative period and significantly higher levels of MDA (p < 0.01), TSA (p < 0.01), and LSA (p < 0.01) than control group. It was found that significant associations were observed between Cu–CA 15–3 (r = 0.558, p = 0.016), Mn–CA 15–3 (r = 0.511, p = 0.030), P–CA 15–3(r = − 0.502, p = 0.034) and with UM, also between GSH–CA-125 (r = − 0.825, p = 0.022) and with EC group. The results of correlation analysis observed that concentrations of Cu, Mn, P, and GSH together with CA 15–3 and CA-125 levels might be important for monitoring patients with UM and EC before surgery. [ABSTRACT FROM AUTHOR]

Uterine fibroids (UF) are common benign tumors in women. The course of UF is associated with troubling symptoms and the development of infertility and pregnancy pathology. Surgical treatment even implies hysterectomy, while pharmacological interventions are modestly effective. Classically, hypoxic metabolism is considered a hallmark of malignant tumor. However, the role of hypoxia-induced factor (HIF) is significant in benign tumors as well. Herein, we briefly review the basic biology of HIF-family proteins, outlining their possible roles in UF. Apart from theoretical justifications, we summarized 15 studies reporting increased expression of HIFs and downstream factors in UF samples. Altogether, data suggest that increased expression of the HIF-protein and altered expression of its dependent genes are presumed to be the factors leading to UF development. Thus, even without being a malignant tumor, UF is characterized by the strong involvement of HIF. This novel insight may give rise to further research in the direction of finding new prognostic markers and effective medicines against UF. [ABSTRACT FROM AUTHOR]

Objectives: to evaluate the benefits of delayed conservative myomectomy with the aim of reducing body weight and correcting hematological and metabolic parameters against the background of the use of gonadotropin-releasing hormone (GnRH) agonists and a combination of myo-inositol and D-chiro-inositol (Inofolic combi) in obese patients with metabolic syndrome by comparing this technique with immediate surgery. Materials and methods. The study included 72 patients with uterine fibroids and obesity who required conservative myomectomy. Patients were offered to postpone surgical intervention in order to correct body weight, metabolic and hematological indicators. As a preoperative preparation, patients were recommended to use GnRH agonists (goserelin), inositols, and iron preparations for anemia. Patients were divided into 2 groups: the first group (n = 31) followed all these recommendations, the second group (n = 41) refused to follow the recommendations and postponed surgical treatment. Group 1 underwent surgical treatment 3 months after the start of treatment, group 2 – after the initial consultation. Results. Patients of the first group lost an average of 7.3 ± 1.4 kg of body weight during preoperative preparation, their hemoglobin level increased by an average of 21.78%, and the volume of the largest myomatous node decreased by an average of 21.82%. The duration of the operation was significantly shorter in group 1 (75 ± 3.84 min) than in group 2 (118 ± 5.33 min). Laparotomy in the first group was not performed in any patient, in the second group it was performed in 9 patients (21.95%) (p < 0.05). There was a decrease in the severity of postoperative pain in group 1, (3.4 В± 1.25 points on the visual analog scale), which was significantly lower than in group 2 (5.1 В± 3.4 points). Conclusions. Body weight reduction against the background of the use of GnRH agonists (goserelin) and inositols (Inofolic combi) due to the improvement of the technical conditions of the operation, metabolic and hematological indicators allow to reduce the duration of surgical intervention and the frequency of laparotomies in patients with uterine fibroids against the background of obesity and metabolic syndrome.

Intrauterine devices (IUDs) are one of the most popular reversible contraception methods. However, if an event related to them is unanticipated, or if they are not located when missing, it can be dangerous. We present a case of chronic lower abdomen pain and recurrent urinary tract infection ongoing for 1.5 years. Despite the patient undergoing laparoscopic uterine myomectomy, her symptoms had not improved. The patient visited a genitourinary clinic for lower urinary tract symptoms and accepted cystoscopy and electrohydraulic lithotomy. Incidentally, a part of an IUD was found in the calculus. This case highlights the need for careful diagnosis and for locating missing IUDs to avoid serious complications.

Abstract Background To investigate the association of clinical characteristics at the time of non-hysteroscopic myomectomy before pregnancy and adverse obstetric outcomes in the next pregnancy. Methods In this retrospective cohort study, we identified 248 women who underwent abdominal or laparoscopic myomectomy for intramural (IM) and/or subserosal (SS) uterine myomas in Bundang CHA Medical Center before pregnancy and delivered at the same hospital between 2010 and 2020. The association between clinical characteristics at the time of myomectomy and subsequent obstetric outcomes was analyzed using the Chi-square test, the Student t-test or one-way ANOVA, and multivariable analysis. Results There was one case of uterine rupture. The gestational age at delivery was 37.7 ± 2.4 weeks. There were 2 (0.8%) cases of fetal loss before 23 weeks, but there were no cases of perinatal death. The risk of transfusion during or after delivery was higher in the group in which multiple myomas were removed compared to the group in which only one was removed (aOR = 2.41, 95% CI [1.20–4.86], p = 0.014). The risk of neonatal composite morbidity was higher in the group in which myomas including the IM type were removed, than in the group in which only SS myomas were removed (aOR = 14.29, 95% CI [1.82–99.57], p = 0.012). Although not statistically significant, the group in which the sum of the diameters of the three largest myomas was greater than 15 cm showed a higher frequency of preterm birth (19.3% vs. 10.1%, p = 0.001) and lower birth weight (2901 ± 625 g vs. 3063 ± 576 g, p = 0.001) compared to the group with diameters less than 15 cm. Placenta accreta/increta (7.9% vs. 3.8%, p = 0.043) and lower placental weight (646 ± 170 g vs. 750 ± 232 g, p = 0.034) were more common in patients with an interval between myomectomy and pregnancy of less than 12 months compared to more than 12 months. Conclusions To our knowledge, this is the first study to investigate the association between clinical features at the time of myomectomy before pregnancy and various adverse obstetric and perinatal outcomes. If the removed myomas are multiple, IM, large, or the interval between myomectomy and pregnancy is short, the risk of obstetric and neonatal complications may increase.

Aim. To analyze the incidence and types of adverse outcomes and complications of laparoscopic myomectomies. Materials and methods. This work is a retrospective study based on data from the Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology. We analyzed 711 case histories of patients diagnosed with uterine myoma who received surgical treatment in the Department of Innovative Oncology and Gynecology from 2015 to 2019. The frequency of malignant neoplasms, verified by pathomorphological examination, and the characteristics of surgical interventions performed in these patients were comparatively evaluated. Results. Surgical interventions for uterine myoma are leading in gynecology due to the high prevalence of such disorders. Conservative myomectomy remains the "gold standard" in organ-sparing surgery. However, during surgeries for suspected benign neoplasms, there is a risk of morcellation of the malignant tumor, significantly worsening patient survival outcomes. In our study, the incidence of uterine leiomyosarcoma in suspected benign neoplasms was 0.98%. The probability of parasitic myomas or disseminated perineal leiomyomatosis after myomatous nodule morcellation is 0.19%. Conclusion. No reliable information about the malignant potential of the tumor and its proliferative activity can be obtained until a definitive pathomorphological examination. The above considerations warrant the routine use of prophylactic measures to prevent tumor cell dissemination.

Purpose: To evaluate the perioperative outcome of laparoendoscopic two-site myomectomy (LETS-M). Methods: The medical records of 204 women receiving LETS-M in a tertiary referral center, including 183 surgeries performed by the experienced surgeon and 21 surgeries performed by 3 well-supervised trainees were retrospectively reviewed. Results: The age of the participants was 39.3 ± 6.4 years. The mean diameter of the largest myoma and the mean number of myomas were 8.5 ± 2.2 cm and 1.7 ± 1.1, respectively. Thirty-one (15%) operations removed more than 2 myomas larger than 5 cm in diameter. The mean weight of the myomas was 281.1 ± 183.1 g. The operation time was 97.6 ± 40.2 min, and the intraoperative blood loss was 99.3 ± 115.2 mL. There were 3 (1%) cases of excessive blood loss (more than 500 mL) and 2 (1%) of postoperative hematoma. The only significant difference between the experienced surgeon and trainees was the operation time (92.3 ± 32.2 min vs. 141.2 ± 54 min, p

Microwave endometrial ablation (MEA) is a minimally invasive treatment for uterine myoma with hypermenorrhea, which can replace conventional hysterectomy. However, cases requiring additional treatment because of postoperative recurrence are often encountered. MEA cauterizes the endometrium and is not recommended for patients who wish to preserve fertility. We present the cases of a patient with myoma-related hypermenorrhea who underwent microwave ablation of the inflowing blood vessels to the uterine myoma under transvaginal ultrasound guidance. A 43-year-old woman was diagnosed with chronic myeloid leukemia and treated with dasatinib 2 years ago. Worsening hypermenorrhea was observed after treatment initiation. Ultrasound and pelvic magnetic resonance imaging revealed a uterine myoma. Therefore, she underwent MEA under transvaginal ultrasound guidance. Visual analog scale evaluation demonstrated considerable improvement in hypermenorrhea and dysmenorrhea; the myoma size showed reduction. The postoperative course was uneventful, and the patient was discharged on the day after surgery. No postoperative complications were observed. This patient is currently undergoing infertility treatment. The microwave ablation of myoma under transvaginal ultrasound guidance can effectively and safely reduce the myoma size. These findings suggest that this method is a novel treatment option for patients with myoma-related hypermenorrhea who wish to preserve their fertility and have children.

The present study aimed to evaluate the clinical and radiological 1-year outcomes of uterine artery embolization (UAE) performed in a selected population of women with symptomatic myomas and who do not wish to conceive. Between January 2004 and January 2018, a total of 62 patients with pre-menopausal status and with no wish to conceive in the future underwent UAE for the treatment of symptomatic fibroids. All the patients underwent magnetic resonance imaging (MRI) and/or transvaginal ultrasonography (TV-US) before and after the procedure at 1-year follow-up. Clinical and radiological parameters were recorded, stratifying the population into 3 groups according to the size of the dominant myoma (group 1: <50 mm; group 2: ≥50 and ≤80 mm; group 3: >80 mm). Mean fibroid diameter was significantly reduced (42.6% ± 21.6%) at 1-year follow-up, with excellent improvements in terms of both symptoms and quality of life. No significant difference was observed regarding baseline dimension and the number of myomas. No major complications were reported (2.5%). The present study confirms the safety and efficacy of UAE in the treatment of symptomatic fibroids in pre-menopausal women with no desire to conceive. [ABSTRACT FROM AUTHOR]

Data on ovarian dysfunction after hysterectomy are found in literary sources, but the nature of changes in the hormonal profile, its chronological sequence, the issue of prognosis and possible preventive measures, even in the case of preservation of ovarian tissue, remain contradictory and fragmentary, which prompted the conduct of this research. The aim of the research is to assess the risk of menopausal disorders after hysterectomy with opportunistic salpingectomy during the menopausal transition. Research materials and methods.A comprehensive assessment of the long-term consequences of hysterectomy in 160 women of reproductive age was carried out. Risk factors were identified during a general clinical examination, based on anamnestic data. Indicators were evaluated in the examined women. Inclusion criteria: age of menopause transition, hysterectomy due to benign uterine pathology, patient's consent to participate in the study. Research results. The data obtained by us after 12 months from the moment of surgical intervention demonstrate neurovegetative and psychoemotional manifestations in 87 patients - 46.25%. Conclusions. 12 months after GE with opportunistic salpingectomy, 46.25% of patients have a gradual formation of components of the menopausal syndrome. age older than 45, hysterectomy, hormonal therapy of benign uterine pathology demonstrate a connection with the development of metabolic disorders in the distant postoperative period, and their combined effect increases the risk of their development.

The purpose: to justify a differentiated approach to the management of patients with hyperplastic uterine diseases complicated by abnormal uterine bleeding (AUB) based on the study of the morpho-functional features of the endo- and myometrium. It has been shown that PgR expression is low in patients with combined lesions of the endometrium and myometrium complicated by AMC. The degree of PgR expression has a strong negative correlation with pathological changes of the endometrial-myometrial junction (r=-0.71), which made it possible to consider these criteria in the creation of a differentiated algorithm for the management of patients taking into account clinical and morphological pathogenetic variants of the disease. The use of differentiated approaches to the treatment of patients with combined hyperplastic processes of the uterus, taking into account the clinical and morphological features of the disease, made it possible to reduce the number of recurrences of AMC and achieve a long-term clinical effect in comparison with traditional treatment.

Iron and cobalt are micronutrients that play an important role in the regulation of cellular processes, being part of the centre of catalases, peroxidases, cytochromes and metalloproteins such as hemoglobin and myoglobin (Fe). Cobalt primarily functions as a component of hydroxycobalamin, which is essential for regulating red blood cell production. Maintaining normal levels of cobalt and iron in the human body is important, as a deficiency can lead to anaemia. These elements are also involved in reactions during which oxidative stress occurs and are therefore considered to be a cause of tumor formation. This paper will discuss aspects of the influence of cobalt and iron on mechanisms that may contribute to the growth of gynecological tumors, as well as other obstetric-gynecological disease entities, by altering the conditions of the microenvironment. In addition, the following review also highlights the role of cobalt and iron in the treatment of gynecological tumors. [ABSTRACT FROM AUTHOR]

This study compared the feasibility and efficacy of transabdominal ultrasound (TAU) and combined transabdominal and transvaginal ultrasound (TA/TV US)-guided percutaneous microwave ablation (PMWA) for uterine myoma (UM). This study enrolled 73 patients with UM who underwent PMWA via the transabdominal ultrasound-guided (TA group) or the combined transabdominal and transvaginal ultrasound-guided (TA/TV group) approaches. The intraoperative supplementary ablation rates, postoperative immediate ablation rates, lesion reduction rates and other indicators three months postoperatively were compared between the groups. The display of the needle tip, endometrium, uterine serosa, rectum and myoma feeding vessels under the guidance of TAU, transvaginal ultrasound (TVU) and TA/TV US were evaluated in the TA/TV group. In the TA/TV group, the real-time position of the needle tip and the endometrium complete display rate of the same lesions with TVU guidance were significantly higher than those using TAU. TA/TV US guidance significantly improved the complete display rate of each indicator. The intraoperative supplementary ablation rate in the TA/TV group was lower than that in the TA group. Similarly, the postoperative immediate ablation and volume reduction rates of the lesions three months postoperatively were higher than those in the TA group, especially for lesions with a maximum diameter ≥6 cm. TA/TV US is an effective monitoring method that can be used to improve imaging display. Its use is recommended in patients with obesity, poor transabdominal ultrasound image quality and large myoma volumes. [ABSTRACT FROM AUTHOR]

The objective: to study the clinical-psychopathological features and psycho-emotional symptoms and borderline mental disorders in women of reproductive age after hysterectomy due to leiomyoma. Materials and methods. An assessment of the psychological state of 160 women after hysterectomy for leiomyoma was carried out. 90 patients of them (average age – 45.9±1.3 years old) had transvaginal hysterectomy, both classic and laparoscopically assisted one with opportunistic salpingectomy (I group) and 70 patients (average age – 47.2±1.6 years old) – abdominal hysterectomy with opportunistic salpingectomy (II group). The control group included 50 women 45.7±1.3 years old with asymptomatic leiomyoma. Clinical psychopathological, anamnestic and experimental psychological methods were used. Pathopsychological methods included methods of visual presentation of the personality profile using the Minnesota Multifaceted Personality Questionnaire. The survey was conducted at the pre-operative period, during the adaptation period and during 12 months. Statistical processing of monitoring data was carried out according to the φ-criterion using the statistical analysis software package STATISTICA v. 10 and Microsoft Office Excel application. Results. The results of the questionnaire determined that 44 (48.89 %) patients of the I group and 33 (47.14 %) women of the II group had disorders related to anxiety, and 6 (6.67 %) and 5 (7 .14 %) of the patients of both groups, respectively, were diagnosed depression before surgical treatment. After hysterectomy the number of patients with an anxiety disorder increased to 52 (57.78 %) in the I group and 41 (52.57 %) – II group, with depression – to 10 (11.11 %) and 8 (11.43 %) women, respectively. However, the psychopathological analysis with psychologists in 12 months after hysterectomy determined affective symptoms in 11 (15.7±7.0 %), and latent depression with a somatopsychic correlation, manifested by a feeling palpitation, cardialgias, vegetative disorders was found in 8 (11.4±6.0 %) cases. The type of personality accentuation influenced the development of psychoemotional manifestations. In this structure, the largest rate consisted of psychoasthenic and hysterical character traits. The age of the patient was important when analyzing additional psychological factors. Women under 44 years old associated hysterectomy with loss of femininity with premature aging of the organism. The patients with successful implementation of their role in the family and society had better postoperative psychological adaptation. Conclusions. There is a trend toward an increased number of anxiety and depressive disorders after hysterectomy in women with leiomyoma. After 12 months, affective symptoms were present in 11 (15.7±7.0 %) cases and in 8 (11.4±6.0 %) cases – hidden depression. Postoperative rehabilitation should include a consultation with a psychologist to identify and treat borderline mental disorders, which will lead to the initiation of compensatory and adaptive reactions of the body and the normalization of the psycho-emotional status. [ABSTRACT FROM AUTHOR]

Background: the most common causes of maternal death in Indonesia are hypertension/pre-eclampsia/eclampsia, bleeding, and infection. Hypertension in pregnancy ranks first as the cause of death in Indonesia at 33% (SRS Litbangkes, 2016). Cervical fibroids can cause complications in both pregnancy and childbirth. The purpose of this case report is to study midwifery care in complex cases. Case report: A 41-year-old woman, second pregnant, 36-37 week’s gestation, primipaternity, secondary primitua with chronic hypertension and uterine myoma (cervical) was referred to the hospital for delivery. Management focuses on support for the mother, involving the family, fulfill the needs of the mother, collaboration with the doctor conducting informed consent regarding the diagnosis, providing counseling and health education on tubectomy contraception, and accompanying the mother until the time of surgery. The mother's response is good, and optimistic about her condition and the baby. Conclusion: midwives in providing midwifery care in cases of delivery with chronic hypertension, superimposed preeclampsia and uterine myoma at an advanced health facility (Type A Hospital). Midwifery care is provided both independently and in collaboration with other professions. Delivery was carried out by caesarean section in accordance with the indications with the output of the mother and baby being healthy. Early detection, recognition of signs and symptoms, diagnosis, referral process and comprehensive management are carried out appropriately.

• Organoids formed from endometrium with an intramural myoma show pathological traits. • Intramural myomas impair the hormonal environment in basal endometrial organoids. • Intramural myomas disrupt the hormonal response in secretory endometrial organoids. • Intramural myomas alter the mechanical environment in endometrial organoids. What influence does an intramural myoma have on the endometrium, and how is this mediated? Endometrium was collected from 13 patients with non-cavity-distorting intramural myomas (diameter ≤4 cm; International Federation of Gynecology and Obstetrics type 4) and 13 patients without myomas undergoing hysterectomy for benign cervical diseases with a similar clinical baseline. Endometrial organoids were established in vitro and induced to reach the secretory phase by oestrogen and progesterone. Transcriptome sequencing was conducted on endometrial organoids in both untreated and secretory stages from three individuals with myomas and three control participants. Immunofluorescence and real-time quantitative PCR (RT-qPCR) were performed on endometrial organoids from another 10 myoma patients and 10 control patients for validation. The data revealed abnormally increased hormone receptor (PGR) levels in the untreated endometrial organoids with myomas, resulting in potentially abnormal glandular and vascular development. The aberrant responses to oestrogen and progestogen prompted further investigation into the secretory phase. The secretory endometrial organoids with myomas exhibited greater changes in acetyl-α-tubulin, ODF2 and TPPP , demonstrating likely decreased cilia, and COL6A1 , used as a marker for increased extracellular matrix (ECM) modelling. Both untreated and secretory endometrial organoids with myoma showed an up-regulation of genes and pathways related to ECM mechanotransduction. The expression pattern of receptivity-related genes was disturbed in endometrial organoids with myoma. This study is the first to reveal that intramural myomas create an abnormal hormonal and mechanical environment in the untreated and secretory endometrial organoids. The intramural myomas negatively impacted gene expression relating to endometrial glands, blood vessels, cilia and ECM, indicating that intramural myomas impair endometrial decidualization and receptivity. [ABSTRACT FROM AUTHOR]

Background: Uterine myoma, which seriously threatens women’s physical and mental health and quality of life, is the most common benign pelvic tumor in gynecology. At present, laparoscopic myomectomy (LM) has become an effective and commonly surgical method in clinical practice. The aim of this study, using meta-analysis method, is to analyze the advantages and disadvantages of baseball suture comparing with traditional one, and provide a theoretical basis for the selection of surgical suture methods. Methods: CNKI, WanFang Data, VIP, PubMed, web of science and the Cochrane Library are searched to collect original data and cases. Two researchers independently screen the literature according to the inclusion and exclusion criteria, extract the data and cross check them. Then RevMan 5.4 and STATA 14 are used for statistical analysis. The difference is statistically significant (p < 0.05). Results: Compared with the traditional suture method, the operation time of LM with baseball suture method is shorter, the amount of intraoperative bleeding is less, the time required for postoperative exhaust, first getting out of bed, hospitalization, and uterine incision suture is shorter, the incidence of needle eye bleeding is lower, the decline of average hemoglobin is lower, and the incidence of pelvic infection is lower, while the difference is statistically significant (p < 0.05). The incidence of postoperative morbidity is lower, while the difference is not statistically significant (p > 0.05). Conclusions: Baseball suture has progressiveness and important value in LM surgical suture. The hemostasis and healing effect is ideal, which can enable patients to recover more quickly, reduce the pain and economic burden caused by the operation, and also enable surgeons to complete the operation more conveniently and efficiently. The protocol of the review was registered on the PROSPERO platform (https://www.crd.york.ac.uk/PROSPERO/) with the registration number CRD42022370262.

Background: To investigate the association of clinical characteristics at the time of non-hysteroscopic myomectomy before pregnancy and adverse obstetric outcomes in the next pregnancy.Methods: In this retrospective cohort study, we identified 248 women who underwent abdominal or laparoscopic myomectomy for intramural (IM) and/or subserosal (SS) uterine myomas in Bundang CHA Medical Center before pregnancy and delivered at the same hospital between 2010 and 2020. The association between clinical characteristics at the time of myomectomy and subsequent obstetric outcomes was analyzed using the Chi-square test, the Student t-test or one-way ANOVA, and multivariable analysis.Results: There was one case of uterine rupture. The gestational age at delivery was 37.7 ± 2.4 weeks. There were 2 (0.8%) cases of fetal loss before 23 weeks, but there were no cases of perinatal death. The risk of transfusion during or after delivery was higher in the group in which multiple myomas were removed compared to the group in which only one was removed (aOR = 2.41, 95% CI [1.20-4.86], p = 0.014). The risk of neonatal composite morbidity was higher in the group in which myomas including the IM type were removed, than in the group in which only SS myomas were removed (aOR = 14.29, 95% CI [1.82-99.57], p = 0.012). Although not statistically significant, the group in which the sum of the diameters of the three largest myomas was greater than 15 cm showed a higher frequency of preterm birth (19.3% vs. 10.1%, p = 0.001) and lower birth weight (2901 ± 625 g vs. 3063 ± 576 g, p = 0.001) compared to the group with diameters less than 15 cm. Placenta accreta/increta (7.9% vs. 3.8%, p = 0.043) and lower placental weight (646 ± 170 g vs. 750 ± 232 g, p = 0.034) were more common in patients with an interval between myomectomy and pregnancy of less than 12 months compared to more than 12 months.Conclusions: To our knowledge, this is the first study to investigate the association between clinical features at the time of myomectomy before pregnancy and various adverse obstetric and perinatal outcomes. If the removed myomas are multiple, IM, large, or the interval between myomectomy and pregnancy is short, the risk of obstetric and neonatal complications may increase. [ABSTRACT FROM AUTHOR]

Objectives: To develop and evaluate magnetic resonance imaging (MRI)-based radiomics models for predicting residual myoma regrowth within 1 year after high-intensity focused ultrasound (HIFU) ablation of uterine myomas.Methods: A retrospective analysis of residual myoma regrowth within 1 year was performed on 428 myomas in 339 patients who were diagnosed with uterine myoma and treated with HIFU ablation in two hospital centers. In total, 851 radiomics features were extracted from T2-weighted images (T2WI) obtained 1 day after HIFU ablation, and the least absolute shrinkage and selection operator in the training cohort (n = 243) was employed to select radiomics features. Support vector machines were adopted to develop radiomics, clinicoradiological and combined radiomics-clinical models to predict residual myoma regrowth, defined as an increase in residual myoma volume of > 10% between that at day 1 post HIFU and that at follow-up MRI within 1 year. These models were validated in both internal (n = 81) and external (n = 104) test cohorts. The predictive performance and clinical application of these models were assessed using receiver-operating-characteristics-curve analysis, the area under the curve (AUC) and decision-curve analysis.Results: The AUCs of the T2WI-based radiomics prediction model in the internal and external test cohorts were 0.834 (95% CI, 0.747-0.920) and 0.801 (95% CI, 0.712-0.889), respectively, and those of the clinicoradiological model were 0.888 (95% CI, 0.816-0.960) and 0.912 (95% CI, 0.851-0.973), respectively. The combined model had better predictive performance than either the radiomics or the clinicoradiological model, with AUC values of 0.922 (95% CI, 0.857-0.987) and 0.930 (95% CI, 0.880-0.980) in the internal and external test cohorts, respectively. Decision-curve analysis also indicated that application of the combined model has clinical value, this model achieving more net benefits than the other two models.Conclusion: T2WI-based radiomics features can predict effectively the occurrence of residual myoma regrowth within 1 year after HIFU ablation of uterine myomas, which serves as an accurate and convenient reference for clinical decision-making. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the perioperative outcome of laparoendoscopic two-site myomectomy (LETS-M).Methods: The medical records of 204 women receiving LETS-M in a tertiary referral center, including 183 surgeries performed by the experienced surgeon and 21 surgeries performed by 3 well-supervised trainees were retrospectively reviewed.Results: The age of the participants was 39.3 ± 6.4 years. The mean diameter of the largest myoma and the mean number of myomas were 8.5 ± 2.2 cm and 1.7 ± 1.1, respectively. Thirty-one (15%) operations removed more than 2 myomas larger than 5 cm in diameter. The mean weight of the myomas was 281.1 ± 183.1 g. The operation time was 97.6 ± 40.2 min, and the intraoperative blood loss was 99.3 ± 115.2 mL. There were 3 (1%) cases of excessive blood loss (more than 500 mL) and 2 (1%) of postoperative hematoma. The only significant difference between the experienced surgeon and trainees was the operation time (92.3 ± 32.2 min vs. 141.2 ± 54 min, p < .001), while the myoma number, myoma diameter, myoma weight, and intraoperative blood loss were not significantly different. The operation time did not differ among different myoma locations. In multivariate analysis, virginity, myoma number, more than 2 large myomas, and myoma size were independent variables for longer operation times. No patient experienced any major complications.Conclusion: LETS-M using conventional laparoscopic equipment is a minimally invasive surgical method that is safe, effective, and easy to learn for managing uterine myoma. It is useful to achieve a favorable perioperative outcome with acceptable operation time. [ABSTRACT FROM AUTHOR]

Introduction and aim Both patients and gynecologists are concerned about how much and how quickly myomas shrink after menopause. This study aimed to elucidate clinical findings that may be associated with postmenopausal shrinkage of uterine myomas. Materials and methods This study included 97 patients who underwent menopause by August 2012, had myoma nodules with the longest diameter between 50 mm and 160 mm, and visited our specialized myoma clinic annually for at least 10 years after menopause. They underwent transabdominal ultrasonography at least once per year. An experienced gynecologist measured the longest diameter of myoma nodules with a maximum diameter between 50 mm and 160 mm. The shrinkage rate of myoma diameters after menopause compared to premenopausal diameters was calculated each year for 10 years. The shrinkage rate of the longest diameter of the largest nodule 10 years after menopause (10-year shrinkage rate) and its relationship with clinical findings (the age at menopause, parity, body mass index {BMI}, number of nodules, MRI findings on T2-weighted image, location of the nodule, and longest diameter of the largest nodule before menopause) were analyzed. Additionally, we examined annual changes in shrinkage rate of myomas over a 10-year period after menopause (annual trend), and the relationship between annual trends and factors such as BMI and the number of nodules. Results In this examination of 10-year shrinkage rate, the group with a BMI of less than 25 showed a significantly greater shrinkage rate compared to the group with a BMI of 25 or more (25.0% vs 15.7%, p=0.023). Additionally, the group with a single nodule showed a significantly greater 10-year shrinkage rate compared to the group with four or more nodules (26.3% vs 15.2%, p=0.036). For annual trends, the rate of change in the first two years after menopause was significantly faster compared to the trend from the third to the 10th year (difference in slope: 3.888 points per year, p<0.001). When divided into two groups based on the number of nodules (one or two nodules group and three or more nodules group), the group with one or two nodules showed a significant difference in the shrinkage rate between up to two years after menopause and from the period from the third to the 10th year (difference in slope: 4.590 points per year, p<0.001). However, for the group with three or more nodules, there was no significant difference in the annual trend between the first two years after menopause and the rate from the third to the 10th year (difference in slope: 1.626 points per year, p=0.107). Conclusion BMI and the number of myoma nodules were significantly related to the 10-year shrinkage rate. Although myomas shrank significantly faster within the first two years after menopause compared to the later period, the early annual trend did not differ significantly from the trend in the later period when there were multiple nodules with a maximum diameter of 50 mm or more., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee of Osaka City University issued approval #2023-004. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Oue et al.)

Objective: To assess the diagnostic value of biomarkers: microbiological, molecular and biological, immunological biomarkers, characteristic of various types of recurrent myoma-associated growth.Materials and Methods: Seventy women of reproductive age with recurrent uterine myoma and its combination with adenomyosis after conservative treatment in the Clinic of Kuban State Medical University were examined. Methods: microbiological examination, sonography, Doppler sonography, histology, immunohistochemistry, morphometry.Results: The type of recurrent myoma-associated growth was proved to be dependent on molecular and biological characteristics of tumors, the presence of infection and blood perfusion. It was indicated that women with recurrence of myoma-associated growth of a “false” type were characterized by high rates of infections (the presence of reproductive losses, chronic inflammatory diseases of the pelvic organs) and significant bacterial contamination of the genital tract biotopes. Blood perfusion features were identified for true and “false” types of recurrent myoma-associated growth based on Doppler sonography data, which were consistent with features of tumor vessel morphometry. Analysis of uterine myoma histological types and their vascularization features showed correlation of forms with a high proliferative potential of a tumor on a molecular and cellular level to moderate and high expression of steroid hormone receptors in combination with Ki67, a significant diameter of the lumen of the vessels with the highest VI and VFI values.Conclusions: A comprehensive study of women with uterine hyperplasia determines the possibility of prediction of pathogenetic variants of recurrent myoma-associated tissue growth and adequate choice of treatment options and rehabilitation course.

Aim. To study the state of the cervical stump after subtotal hysterectomy (STGE) without uterine appendages with and without excision of the endocervix in patients with myoma to justify the choice of a rational volume of surgical operation. Materials and methods. Examination and treatment of 140 women was carried out with the formation of three groups: 1st 40 patients after laparoscopic STGE with excision of the endocervix; 2nd 38 patients after laparoscopic STGE without excision of the endocervix; 3rd (comparison group) 62 patients with uterine myoma that do not require surgical treatment. Results. The study of the state of the cervical stump was carried out 5.10.3 years after surgery. The number of patients with cervical pathology after STGE with excision of the endocervix (in group 1) was 1.8 times less in percentage terms than after STGE without excision of the endocervix (in group 2), and 3.2 times less than in patients with uterine fibroids who do not require surgical treatment (in the 3rd comparison group). Conclusion. Out of 3 (3.8%) patients after surgical treatment with diagnosed HPV type 16.1 (1.3%) in the STGE group without endocervical excision was diagnosed with grade II intraepithelial neoplasia (CIN II). In patients with uterine myoma, STGE can be performed only after a comprehensive preoperative examination, including: diagnosis and treatment of urogenital infections, DNA typing of HPV of high oncogenic types, cytological and colposcopic examination of the cervix, targeted biopsy of the cervix with histological examination of the material. If a subtotal hysterectomy is performed, it must be supplemented with excision of the endocervix. In the future, these women require careful follow-up to improve early diagnosis and treatment of underlying and precancerous diseases and reduce the risk of developing cervical stump cancer.

Introduction. In the cohort prospective comparative study, the investigators examined the effectiveness of intraoperative administration of Antiadgesin and adjuvant therapy with Gynestril after laparoscopic-assisted myomectomy combined with temporary balloon occlusion of the internal iliac arteries and embolization of uterine arteries in the treatment of uterine fibroids.Objective. To achieve stable remission of the disease, improve reproductive outcomes after myomectomy.Materials and methods. 100 women who underwent organ-preserving treatment of uterine fibroids from January 1, 2015 to December 31, 2020 were enrolled in the study. The eligibility criteria were as follows: the age of 28–45 years (the mean age was 34 ± 4.5 years), organ-preserving treatment of uterine fibroids. The exclusion criteria from the study were as follows: the age of over 45 years; allergic reactions to mifepristone, Antiadgesin and contrast media; patients with contraindications for use of drugs, with aggravated medical history, with liver diseases, with endometrial hyperplastic processes (adenomyosis, endometrial hyperplasia).Conclusions. It has been shown that the continuous use of Gynestril at a dose of 50 mg/day for 3 months after surgical treatment due to proliferating uterine fibroids led to the absence of disease-recurrences within two years after discontinuation of the drug, and the occurrence of a relapse in one patient three years after treatment. The use of Gynestril after embolization of the uterine arteries made it possible to statistically reduce the size of the node by 25% within 12 months, 50% after 24 months and 70% – after 36 months. (p

Uterine fibroids (UF) are common benign tumors in women. The course of UF is associated with troubling symptoms and the development of infertility and pregnancy pathology. Surgical treatment even implies hysterectomy, while pharmacological interventions are modestly effective. Classically, hypoxic metabolism is considered a hallmark of malignant tumor. However, the role of hypoxia-induced factor (HIF) is significant in benign tumors as well. Herein, we briefly review the basic biology of HIF-family proteins, outlining their possible roles in UF. Apart from theoretical justifications, we summarized 15 studies reporting increased expression of HIFs and downstream factors in UF samples. Altogether, data suggest that increased expression of the HIF-protein and altered expression of its dependent genes are presumed to be the factors leading to UF development. Thus, even without being a malignant tumor, UF is characterized by the strong involvement of HIF. This novel insight may give rise to further research in the direction of finding new prognostic markers and effective medicines against UF.

Objectives: To investigate the clinicopathological features of patients with uterine myoma and to analyze and summarize factors affecting patient prognosis. Methods: This study retrospectively investigated records of uterine myoma patients treated at Huzhou Central Hospital between June 2018 and May 2020. A total of 149 patients were included in this study, including 121 patients with good prognosis and 28 patients with poor prognosis. Clinical and pathological characteristics, including age, average body mass index (BMI), menopausal status, average lesion diameter, presence of hypertension or diabetes mellitus, operation method, myoma type, location, and quantity, number of fibroids, and presence of pelvic adhesion were analyzed via multivariate analysis. Results: Among the 149 patients with uterine uterine myoma, 92 had anterior wall uterine myoma, 36 had posterior wall uterine myoma, and 21 had uterine fundus uterine myoma. In terms of location, 94 cases were intramural and 55 cases were subserosal. Quantity-wise, 107 had 1-3 myomas while 42 had four or more. Moderate or more severe pelvic adhesions were present in 33 cases. Univariate analysis showed significant differences in age, operation method, myoma type, myoma location, myoma number, and pelvic adhesion severity between patients with good and poor prognosis. Multivariate analysis showed that age, surgical method, uterine myoma type, uterine myoma location, uterine myoma quantity, and pelvic adhesion severity were risk factors affecting the prognosis. Conclusion: Many prognostic factors, including age, operation method, myoma type, myoma location, myoma number, and pelvic adhesion severity are linked to uterine myoma patient prognosis. [ABSTRACT FROM AUTHOR]

Aim: To investigate the efficacy of short‐term administration of relugolix, a novel orally active gonadotropin‐releasing hormone (GnRH) antagonist, before single‐port laparoscopic‐assisted vaginal hysterectomy (LAVH) for symptomatic uterine myomas, retrospectively compared with injection of leuprorelin, a GnRH agonist. Methods: A retrospective comparative study of each 35 women with symptomatic myomas in the relugolix and leuprorelin groups. Results: Before administration of relugolix and leuprorelin, the median uterine volume did not differ significantly between the two groups (p = 0.53). Median uterine volume change from baseline after short‐term administration of relugolix and leuprorelin did not differ significantly (p = 0.17). Surgical duration (p = 0.84) and estimated blood loss (p = 0.48) were not different between the two groups. According to a patient questionnaire, the side effects of the drugs were not different between the two groups (p = 0.27). When patients were was asked if they wanted to have either of these drugs again, some relugolix users preferred leuprorelin due to concern about forgetting daily medication, while some leuprorelin users preferred relugolix to avoid pain at injection. Conclusion: Oral relugolix medication or leuprorelin injection administered before single‐port LAVH for uterine myomas yielded an equivalent reduction of uterine volume and perioperative outcomes with no significant adverse events. Patient preference for either oral daily relugolix or a monthly injection of leuprorelin could be considered when preoperative management is determined. [ABSTRACT FROM AUTHOR]

Background: Preoperative diagnosis of adenomyosis and uterine myoma can be aided by pelvic ultrasonography and cancer antigen 125 (CA125). Objective: This study aimed to evaluate the usefulness of CA125 level and transvaginal ultrasonography in diagnosis of uterine myoma and adenomyosis and to differentiate both lesion. Patients and Methods: One hundred patients complaining of abnormal uterine bleeding were included in this study. They were attending the Obstetrics and Gynecology Departments at Zagazig University Hospitals and AlAhrar Teaching Hospital for hysterectomy. Transvaginal ultrasonography (TVS) was done for all selected cases to examine the pelvis for detecting any pathology. CA 125 level was measured. Hysterectomy specimens were histopathologically examined. Results: The combination of serum CA125 level and TVS showed that it was useful in adenomyosis group as CA125 level increased the accuracy of TVS from 77% to 80.2%, while in myoma group the combination was not useful as CA 125 decreased the accuracy of TVS from 100% to 83.3%. Conclusion: Transvaginal ultrasonography is the most sensitive for myoma (100%) & CA125 level is the most specific (77%) for adenomyosis. CA125 level had the highest sensitivity (87.5%) for adenomyosis than transvaginal ultrasonography (80.1%). Combining both TVS and CA125 level increased the accuracy for detection of adenomyosis to 80.2% but decreased it to 83.3% in detection of uterine myoma. [ABSTRACT FROM AUTHOR]

Aim. To analyze the relationship between bisphenol A levels in the blood of patients with infertility and in vitro fertilization (IVF) outcomes. Materials and methods. Infertility treatment of 301 married couples was performed using IVF. The level of bisphenol A in the blood of patients was determined by gas chromatography-mass spectrometry. The influence of bisphenol A levels on parameters of early embryogenesis and outcomes of IVF programs was assessed. Results. Bisphenol A was detected in 92.9% (277/298) blood samples of women and in 92.7% (141/154) blood samples of men. Bisphenol A levels in women had a statistically significant positive correlation with the level of bisphenol A in their spouses (r=0.533, p0.0001). No differences were found in the main parameters of early embryogenesis and pregnancy rates in quartile bisphenol A subgroups in women and men. There was a trend towards an increase in the miscarriage rate with an increase in the level of bisphenol A. The threshold level of bisphenol A that increased the miscarriage rate was 0.9 ng/ml for women and 0.4 ng/ml for men. With an increase in the threshold level of bisphenol A in both spouses (men 0.4 ng/ml and women 0.9 ng/ml), the odds ratio for miscarriage after IVF 8.8 (95% confidence interval 0.88113.08). Conclusions. Bisphenol A was found in the majority of infertile patients. A significant positive correlation was noted between the level of bisphenol A in patients and their spouses. An increase in the level of bisphenol A in the blood is associated with an increased risk of early reproductive losses after IVF, which requires further research.

Hysteroscopy is the gold standard tool for endoscopic visualization of the uterine cavity and it assesses a simultaneous detection and treatment of intracavitary anomalies with greater accuracy than other methods. The most common uterine abnormalities, including endometrial polyps, submucosal myomas, uterine septum and intrauterine adhesions, are common in infertile women. It is object of debate whether diagnostic and/or operative hysteroscopy should be considered in the basic work-up of infertile couples.