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Study Objective: To identify factors that affect reproductive outcomes after hysteroscopic adhesiolysis in patients with severe intrauterine adhesions (IUAs, scored between 9 and 12 according to the American Fertility Society classification) and amenorrhea.Design: A retrospective cohort study.Setting: A university-affiliated hospital.Patients: One hundred fifty-one patients with severe IUAs and amenorrhea.Intervention: Patients were diagnosed via hysteroscopy and underwent at least 1 hysteroscopic adhesiolysis between May 2012 and January 2016.Measurements and Main Results: Of 151 patients, 12 were lost to follow-up, and 139 were included in the study with a follow-up period ranging from 2 to 6 years. Of the 139 evaluable patients, 107 (77%) recovered with a normal uterine cavity (free of IUAs), 28 (20.1%) had improved uterine cavity (fewer IUAs), and 4 (2.9%) showed no improvement. Moreover, 79 patients (56.8%) recovered with normal menstruation, 54 (38.9%) showed increased frequency of menstruation, and 6 (4.3%) had persistent amenorrhea. Seventy-seven (55.4%) became pregnant, of whom 13 had a spontaneous miscarriage, 11 birthed prematurely (at 31-36 gestational weeks), 44 experienced term delivery, and 9 were still pregnant at the end of the study. Age >32 years (p = .002, odds ratio [OR] = 3.442), >2 surgeries (p = .027, OR = 2.969), cervical canal adhesions (p = .047, OR = 2.112), and disease course >6 months (p = .037, OR = 2.335) were risk factors for infertility in patients with severe IUAs and amenorrhea.Conclusion: Younger age, earlier treatment within the disease course, fewer cervical canal adhesions, and fewer surgical procedures improve the reproductive outcome in patients with severe IUAs and amenorrhea. [ABSTRACT FROM AUTHOR]

Study Objective: To investigate risk factors for infertility and recurrent cesarean scar pregnancy (CSP) after previous CSP.Design: A retrospective cohort study (Canadian Task Force classification II-1).Setting: University hospital.Patients: Between January 2007 and April 2016, a total of 650 patients were included, all diagnosed with CSP and treated by high-intensity focused ultrasound (HIFU) and uterine artery embolization (UAE), followed by suction curettage under hysteroscopic guidance.Intervention: None.Measurements and Main Results: Follow-up of the reproductive outcomes ended in June 2017. A total of 135 of the 650 patients with CSP were involved in the study, among whom 32 became infertile, 78 had an intrauterine pregnancy, and 25 had recurrent CSP after previous CSP. Age (≥35 years; odds ratio [OR], 4.252; p = .002), β-human chorionic gonadotropin (≤5000 mIU/mL; OR, 3.778; p = .011), and longer duration of amenorrhea (>56 days; OR, 2.507; p = .05) were risk factors for infertility. Treatment with UAE (OR, 5.796; p = .003), more abortions (≥4; OR, 2.851; p = .022), and being asymptomatic (OR, 4.175; p = .039) were risk factors for recurrent CSP. There was no statistically significant difference in the subsequent outcomes of pregnant women in the HIFU and UAE groups (p >.05).Conclusion: More attention should be given to subsequent reproductive outcomes after CSP, not only for intrauterine pregnancy, but also for infertility and recurrent CSP. Early diagnosis and treatment of CSP could reduce the risk of infertility and recurrent CSP. HIFU seemed to be superior to UAE in reducing the risk of recurrent CSP. Patients with CSP should adhere to strict contraception if they do not desire more children. [ABSTRACT FROM AUTHOR]

Study Objective: Removal of retained adherent placental remnants (RAPRs) may be challenging using traditional 5Fr or 7Fr hysteroscopic grasping forceps because they are very small. This is particularly true when the retained placental remnant is large. This video demonstrates the advantages of using the Hysteroscopy Endo-Operative System (HEOS), a specially designed operative hysteroscope with a 13Fr working channel, to remove retained placental remnants.Design: Step-by-step explanation of the technique using videos and pictures (educative video) (Canadian Task Force Classification III).Setting: Third Xiangya Hospital of Central South University, Hunan, China.Patient: A 32-year-old woman was diagnosed with RAPRs 5 weeks after the evacuation of retained placenta after a spontaneous abortion at 16 weeks' gestation. Gynecologic examination revealed an anterior 8-week uterus and no tenderness. Serum β-human chorionic gonadotropin was 150 mIU/L. Sonography revealed an irregular intrauterine mass, 3.5 cm × 3.5 cm × 3 cm in size.Intervention: Removal of RAPRs using HEOS (Sopro-comeg Company, Bordeaux, France).Measurement and Main Results: The operation time was only 12 minutes. The RAPRs were removed completely and quickly in 1 procedure with no complications. The serum β-human chorionic gonadotropin titer normalized 1 week after the procedure. This study was approved by the institutional review board of the Third Xiangya Hospital of Central South University.Conclusions: When indicated, removal of RAPRs using HEOS is safe and simple because of its large and strong cold forceps. Additionally, it avoids electrical and thermal injury to the endometrium, which is particularly important in a population that wants to preserve fertility. [ABSTRACT FROM AUTHOR]

Study Objective: The majority of the current published literature describes hysteroscopic adhesiolysis (HA) for patients with intrauterine adhesions (IUA) using electrical instruments which may cause thermal injury to the endometrium. This video shows the procedure for HA using the "ploughing" technique with cold scissors.Design: Step-by-step explanation of the technique using videos and pictures (educative video) (Canadian Task Force Classification III).Setting: Third Xiangya Hospital of Central South University, Changsha, China.Patient: A 39-year-old woman diagnosed with IUA.Intervention: HA using the ploughing technique with cold scissors, followed by adjunct postoperative treatment with a follow up hysteroscopy 2 months later.Measurement and Main Results: The uterine cavity was successfully reopened, and the scars covering the inner uterine walls were ploughed longitudinally to release the contraction imposed by the scars, as well as to provide a fresh and rich blood-supplied surface for endometrium to grow and cover after the surgery. There were no complications. The follow-up hysteroscopy 2 months later revealed a normal uterine cavity and much improved endometrium, along with restoration of almost normal menses.Conclusion: HA using the ploughing technique with cold scissors is effective for rebuilding the uterine cavity even for patients with severe IUA. Its advantages merit further study. [ABSTRACT FROM AUTHOR]

Objective: To present a rare case of retroperitoneal ectopic pregnancy with lymphatic migration after in vitro fertilization-embryo transfer (IVF-ET) and propose the possible explanation for embryonic migration.Design: Illustrative video presentation. Images, videos (educational videos), and title slides were used to introduce the case of a patient with retroperitoneal ectopic pregnancy with lymphatic migration after IVF-ET and provide a potential explanation for embryo distant migration in the patient. This work was approved by the institutional review board.Setting: University hospital.Patient(s): A 32-year-old woman (gravida 2, para 0) with a history of right salpingectomy was admitted to the hospital 40 days after IVF-ET because of ectopic pregnancy for 1 day; the patient had secondary infertility for 6 years. Gynecologic examination indicated anterior 40-day uterus with no tenderness. A preoperative B-mode ultrasound scan showed that the endometrium was 23 mm, and there was no acoustic image of the pregnant sac in the uterine cavity. Magnetic resonance imaging showed that 1 oval signal measuring approximately 30 × 28 × 35 mm was detected at the gap between the aorta anterior to the third lumbar vertebra and inferior vena cava. The inferior vena cava could be seen on the rear right of the gestational sac, and the abdominal aorta could be seen on the rear left.Intervention(s): Retroperitoneal ectopic pregnancy with lymphatic migration after IVF-ET was diagnosed using B-mode ultrasound, MRI, and pathology analysis and was removed laparoscopically.Main Outcome Measure(s): Mechanism analysis of distant ectopic migration in a patient receiving IVF-ET with a history of tubal surgery.Result(s): The patient was diagnosed using B-mode ultrasound and MRI and underwent laparoscopic surgery to diagnose and remove the retroperitoneal ectopic pregnancy tissue. Further, the pregnancy lesion was completely removed using an ultrasonic knife. The pathological examination showed that the pregnancy tissue was located inside an enlarged lymph node surrounded by lymphoid tissue, and lymphocyte infiltration was also seen in the endometrial tissue, suggesting that the implanted embryo migrated to the retroperitoneum through the lymphatic channels. The patient successfully conceived through IVF-ET 1 year after the operation, and a full-term neonate was delivered by cesarean section.Conclusion(s): This case reinforces that in patients with a history of tubal surgery, whether unilateral or bilateral, clinicians should pay more attention to the possibility of retroperitoneal pregnancy after IVF-ET and to the follow-up of such patients. The pathological examination report provided evidence that lymphatic migration may be the possible mechanism of retroperitoneal ectopic pregnancy or embryonic migration after intrauterine placement. [ABSTRACT FROM AUTHOR]

Background Previous studies have revealed the important role of miR-200b in cancer biology, including its upregulation in cervical cancer. However, miR-200b function in cervical cancer progression remains unclear. Thus, this study aims to explore the functional role of miR-200b in cervical cancer development, involving its potential regulation on FoxG1, one transcriptional repressor. Methods Thirty paired cervical cancer samples were used to analyze the expression of miR-200b and FoxG1 by real time PCR and western blot analysis. Further gain- and loss-of-function studies were performed to validate FoxG1 as one miR-200b target, in line with luciferase report assays. MiR-200b silence was also conducted to observe its regulation on cell viability, migration and invasion in vitro , while tumor growth in vivo was tracked through the delivery of miR-200b inhibitor. Results MiR-200b upregulation was confirmed in cancer tissues or cells as compared to normal controls, while FoxG1 downregulation was observed and then FoxG1 was definitely validated as one miR-200b target. Further in vitro studies showed that enforced miR-200b downregulation induced the decrease of cell ability, with increased cell apoptosis, and attenuated ability of cell migration and invasion in both HeLa and C33A cells, while further inhibition of FoxG1 expression could reverse all these changes. In addition, miR-200b silence in vivo strongly inhibited tumor growth. Conclusion Upregulated miR-200b in cervical cancer was proven to show positive regulation on cervical cancer development by directly targeting FoxG1. Moreover, miR-200b silence was proposed to inhibit tumor growth in vivo , implying its therapeutic value in cervical cancer treatment. [ABSTRACT FROM AUTHOR]