Search

Embryo migration is defined as the movement of embryos to implant at the exact site in the endometrial cavity during assisted reproductive technology (ART). We aimed to evaluate the impact of embryo migration on clinical pregnancy (CPR) and live birth rates (LBR) in fresh oocyte donation (OD) cycles. A total of 611 fresh OD cycles was recruited in this prospective cohort study. All embryos were expulsed to upper-middle uterus between 10 and 20 mm from the fundus. Air bubble-fundus distance was measured using ultrasound (USG) at the time of embryo transfer (ET) and then 60 minutes after ET. Patients were divided into 3 groups; first group consisted of patients whose embryos migrated towards fundus, second group whose embryos remained between 10 and 20 mm from fundus and the third group including embryos which migrated towards cervix. There was no significant difference between the groups regarding CPR and LBR (p = 0.359 and p = 0.865, respectively). Our study revealed that embryo migration was a fact and almost 22% of embryos migrated towards the fundus or the cervix. On the other hand, whether the embryo stayed static or migrated, CPR and LBR did not differ significantly in fresh OD cycles. [ABSTRACT FROM AUTHOR]

In the case of placenta previa‐accreta when the placenta covers the entire anterior uterine wall, it is difficult to avoid transecting the placenta by traditional low‐transverse cesarean section (CS), resulting in catastrophic hemorrhage and fetal anemia. To prevent this critical risk, we developed the CS with transverse uterine fundal incision (TUFI) and this technique has been widely used as a beneficial surgical method in clinical practice owing to its safety advantages for the mother and neonate since our first report. However, the risk of uterine rupture during a subsequent pregnancy remains unclear. Based on our 17 years of experience, patients who require TUFI do not need to avoid this beneficial operative method simply because of their desire to conceive again, as long as certain conditions can be met. To approve a post‐TUFI pregnancy, an appropriate suture method, delay in conception for at least 12 months with evaluation of the TUFI scar, and cautious postoperative management are at a minimum essential. In this article, we showed our recommendation for operative procedure and discuss the current status of the management of post‐TUFI pregnancies based on the evaluation of the TUFI wound scar and experience with postoperative pregnancies. [ABSTRACT FROM AUTHOR]

Levonorgestrel-releasing intrauterine device is widely used in the treatment of adenomyosis and heavy menstrual bleeding. For patients with large uterine cavity or abnormal uterine cavity, they might encounter the problem of downward displacement and expulsion of the device during treatment. Herein, this study reported an easy minimally invasive method using GyneFix intrauterine device system to fix levonorgestrel-releasing intrauterine device into the uterine fundal muscle layer. The two ends of the intrauterine devices were firstly bundled together tightly. The suction sheath was inserted into the uterine cavity until reaching the fundus. Then, the bundled intrauterine devices were inserted into the sheath and fixed the GyneFix knot at the uterine fundus following the GyneFix IUD installation method. In this way, the LNG-IUD could be fixed well in the uterine cavity. This outpatient procedure does not require any special preparation or training. [ABSTRACT FROM AUTHOR]

Background: Endometrial scratching (ES) remains controversial regarding its potential effectiveness in improving pregnancy rates. The objective of the present study was to assess the impact of endometrial fundal incision (EFI) during hysteroscopy on reproductive outcomes in a population of oocyte recipients. Materials and Methods: A randomized controlled trial was conducted between 2020 and 2023 at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki and "Assisting Nature Centre of Reproduction and Genetics". The study population consisted of women who underwent hysteroscopy randomly assigned in a 1:1 ratio to either EFI (one to three months before embryotransfer with donor oocytes) or no intervention throughout office hysteroscopy. Clinical pregnancy and live birth rates were the primary outcomes. Results: After the exclusion of patients with intraoperative diagnosed endometrial pathology, a total of 124 women underwent randomization. The pregnancy test was positive in 79% (n=49/62) of the women in the EFI compared to 59.7% (n=37/62) in the hysteroscopy-only group (P=0.019), while the live birth rates did not differ between the two groups (58.1%, n=36/62 vs. 51.6%, n=32/62, P=0.470). Conclusion: EFI during hysteroscopy seems to improve pregnancy rates in oocyte recipients without intrauterine pathology, while live birth rates are not affected by the EFI. These results should be interpreted with caution before the implementation of EFI in the routine in vitro fertilization (IVF) practice (registration number: NCT04580056). [ABSTRACT FROM AUTHOR]

Objective: This study determined the effect of herbal drinks (Moringa, turmeric, and lemongrass) on uterine involution in post-partum women at the Tuminting Regional Health Center, Manado City. Materials and methods: This experiment used a "posttest control group design." The experimental group was given special treatment, including Moringa, Turmeric, and Lemongrass herbal drinks or Saraba Keke in sachet powder drinks by pouring hot water 150 ml/cc twice daily for 14 days. Meanwhile, the control group was given treatment as usual (conventional). After being given treatment, both groups had their uterine fundus height measured on day 3, day 7, and day 14, and then compared. For data analysis in this work, the paired t-test used. Results: The age of respondents in the intervention group was 20-35 years, which was 95%. Most respondents were parity 2, about 46% in the control group. The average uterine fundus height of post-partum mothers on day 7 in the intervention group was 5.1940, while in the control group, it was 6.019; and on day 14 in the intervention group, the height of the uterine fundus was no longer palpable, while in the control group, it was still 0.4460. Conclusion: A mixed herbal drink of Moringa, Turmeric, and Lemongrass was effective in accelerating uterine involution in post-partum women and no side effects were reported during the study. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of hypotension in cesarean section operations performed with spinal anesthesia varies between 55-90%. In this study, the relationship between the patient's abdominal circumference, symphyseal fundal height, and vertebral column length with the incidence of hypotension and the level of block in cesarean section operations performed under spinal anesthesia was investigated. Methods: The prospective, single-center study was conducted with patients who had undergone cesarean section with spinal anesthesia at the Training and Research Hospital. Pregnant and ASA II group patients older than 37 weeks who were to undergo cesarean section with spinal anesthesia were included in the study. Patients with multiple pregnancies, patients with premature rupture of membranes, preterm patients, and patients in active labor were excluded from the study. Those with diagnoses of abnormal presentation, polyhydramnios, oligohydramnios, macrosomic babies, and intrauterine growth retardation were also excluded from the study. Abdominal circumference was measured at the umbilicus level at the end of expiration in the supine position. Vertebral column length was measured and recorded from the C7 vertebra to the sacral hiatus. The distance of the patient from the symphysis pubis to the highest point of the uterine fundus in the supine position was measured and recorded. Spinal anesthesia was performed in the sitting position with a 26G Quincke spinal needle for the first time through the L4-5 interval and 2 mL of 0.5% hyperbaric bupivacaine was administered. When the block reached T6, the operation was started. Electrocardiogram (ECG), SpO2, and arterial blood pressure were monitored, and the first values were recorded. Results: A total of 98 parturient patients were included in this study. Overall, the incidence of hypotension was 87.78% (87 out of 98 parturients). Symphyseal fundal height correlated positively with spinal blockade levels at each different time point except for "Min. 4". Discussion and Conclusion: Symphyseal fundal height is a sensitive marker to determine the risk of hypotension after spinal anesthesia. We found that the symphyseal fundal height is a more sensitive marker for hypotension that will develop after spinal anesthesia compared to the other two parameters. [ABSTRACT FROM AUTHOR]

Background: Induced endometrial injury is a technique described that have positive impact on implantation. The aim of this study was to investigate whether hysteroscopic endometrial fundal incision (EFI) in oocyte recipients before embryo transfer increases pregnancy and live birth rates or not. Materials and Methods: A prospective study was conducted between 2014 and 2019 at an in vitro fertilization (IVF) unit in Greece. As part of the protocol, hysteroscopy and EFI were offered to all the egg recipients and the outcomes compared with those from an older cohort from the same Unit not undergoing hysteroscopy. Results: In total, 332 egg recipients participated in the study; 114 of them underwent EFI prior to embryo transfer. Both groups were similar in terms of age, years of infertility, duration of hormone replacement treatment (HRT) and number of blastocysts transferred. In the EFI group, minor anomalies were detected and treated in 6.1% (n=7) of the participants. Moreover, pregnancy test was positive in 73.7% of the women in the hysteroscopy group compared to 57.8% in the nonhysteroscopy group (P=0.004). Live birth rate was also higher (56.1 vs. 42.2%, P=0.016) in the EFI group compared to the non-hysteroscopy one. Conclusion: Apart from the obvious benefit of recognizing obscured anomalies, requiring surgical correction, it appears that in oocyte recipients prior to embryo transfer, EFI might improve uterine receptivity and reproductive outcomes. [ABSTRACT FROM AUTHOR]

This study aimed to analyze the therapeutic effect of thunder-fire moxibustion plus Shenghua Decoction on uterine involution after cesarean section and its influence on lactation. One hundred and twenty parturients with post-cesarean section uterine involution were recruited from our hospital between October 2021 to July 2022. Participants were grouped into A, B, C, and D groups and treated with conventional therapy, Shenghua Decoction, thunder-fire moxibustion, and Shenghua Decoction+thunder-fire moxibustion, respectively. Groups B, C and D, especially group D, had shorter duration of lochia and faster descending speed of uterine fundus height than group A. All the four groups showed decreased uterine cavity volume after treatment, with the lowest volume found in group D. In terms of clinical efficacy, group D also had better treatment outcomes than the other three groups. Furthermore, the breast fullness degree and lactation yield scores were higher in group D than other groups, whilst the four groups were not statistically different in the incidence of adverse reactions. Shorter length of maternal hospital stays, and uterus recovery time were found in group D. In summary, thunder)fire moxibustion plus Shenghua Decoction should be treatment of choice for post-cesarean section uterine involution that can promote maternal breast milk secretion. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Postpartum haemorrhage is a preventable cause of maternal mortality that commonly occurs during the third stage of labour. Skin-to-skin contact is an intervention that can support the physiological processes of labour by increasing oxytocin levels, which can accelerate placental expulsion and enhance uterine contractions, thereby contributing to the prevention of postpartum haemorrhage. This systematic review aims to evaluate the impact of skin-to-skin contact on key maternal variables during the third stage of labour, including the duration of this stage, placental integrity, the need for manual placental extraction, the administration of therapeutic uterotonics, and the position of the uterine fundus. A systematic review with meta-analysis of randomised controlled trials and prospective quasi-experimental studies was conducted. Studies were searched in PubMed, Scopus, Cochrane, CINAHL, Google Scholar, and Web of Science. Statistical analysis was performed using STATA version 18. The results of the meta-analysis were reported using relative risk (RR) for dichotomous data and mean difference (MD) for continuous data, both with 95 % confidence intervals (CI). A random-effects model was employed due to the anticipated heterogeneity among the included studies. Sensitivity analyses were performed to assess the robustness of the findings, and a subgroup analysis was conducted based on the type of birth, study design, and country economic level. Twenty-five trials were included. Skin-to-skin contact significantly reduced the duration of the third stage of labour (MD: − 4.26; 95 %; CI: − 5.70, − 2.81), increased the likelihood of complete placental integrity (RR: 1.09; 95 % CI: 1.02, 1.16), and significantly reduced both the likelihood of a supraumbilical position of the uterine fundus (RR: 0.39; 95 % CI: 0.20, 0.76) and the need for uterotonic administration (RR: 0.24; 95 % CI: 0.12, 0.48). Skin-to-skin contact is a simple practice that can favourably influence the physiological processes of labour and improve various maternal outcomes. These benefits include reducing the duration of the third stage of labour, ensuring complete birth of the placenta, decreasing the need for uterotonic administration, and increasing the likelihood of a proper uterine fundal position. Therefore, it is recommended to include this practice in labour care protocols. [ABSTRACT FROM AUTHOR]

Background: Intrapartum care is of paramount importance in overall respectful maternity care (RMC). Uterine fundal pressure maneuver (UFPM) is the most controversial obstetric maneuver considered obsolete in many countries. UFPM is associated with adverse life threatening maternal and fetal effects. The baseline prevalence of UFPM in our tertiary care teaching hospital with a heavy patient load was 78.4% which was quite high. Our aim was to reduce the prevalence of UFPM by 75% from baseline over a period of 10 months. Methods: After root cause analysis, we formulated the departmental Standard Operating Procedures on safe vaginal delivery and birth practices and initiated the Labour Room Quality Improvement Initiative. We sensitized and created awareness among the resident doctors and nursing staff regarding the high prevalence of UFPM through dedicated lectures, intercommunication via WhatsApp groups and strict vigilance in the labor wards. The point of care quality improvement (QI) methodology was used. The primary outcome was decrease in the prevalence of UFPM. Results: The prevalence of UFPM reduced from the baseline value of 78.4%–4% over the period of 7 months. Post intervention it gradually increased and sustained at 21.2% over a follow‐up period of 3 months. Conclusion: QI methods can effectively and rapidly improve the acceptance and adherence to newer initiatives in a busy tertiary care health facility to reduce the prevalence of UFPM and eventually improve the overall RMC. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To examine the effect of fundal pressure applied in the second stage of labor on birth outcomes and neonatal O2 saturation. Methods: The study is of a descriptive and comparative type. Research data were collected in the obstetrics clinic of a Maternity Hospital between August 15, 2019 and February 15, 2020. The study sample consisted of 160 pregnant women who met the research criteria (80 pregnant women who received fundal pressure, 80 pregnant women who did not receive fundal pressure). Results: The duration of the second and third stages of labor was found to be shorter in the nonfundal pressure group (t = −3.422, p = 0.001; t = 2.195, p = 0.030). When the groups were compared, the formation of perineal trauma and second‐degree laceration, episiotomy requirement, elongation of the episiotomy incision and cervical laceration rate were found to be significantly higher in the fundal pressure group χ2 = 10.794 p = 0.001; χ2 = 8.403 p = 0.004; χ2 = 10.014, p = 0.002; χ2 = 16.579 p = 0.000; χ2 = 16.276 p = 0.000). The 1st and 5th min Apgar scores of the newborns were lower in the fundal pressure group (t = −6.377, p = 0.000; t = −3.581, p = 0.001). The 1st, 5th, 10th, and 15th min oxygen saturation of the newborns were determined to be significantly lower in the fundal pressure group (t = −4.753, p = 0.000; t = −2.427, p = 0.016; t = −2.604, p = 0.010; t = −2.492, p = 0.014). Conclusion: According to the study results, it was determined that the uterine fundal pressure has a negative effect on birth outcomes and neonatal oxygen saturation. Adverse effects of fundal pressure application should be revealed in different aspects. [ABSTRACT FROM AUTHOR]

Copyright of Reproductive Health of Woman is the property of Professional-Event Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Uterine fundal pressure involves a birth attendant pushing on the woman's uterine fundus to assist vaginal birth. It is used in some clinical settings, though guidelines recommend against it. This systematic review aimed to determine the prevalence of uterine fundal pressure during the second stage of labour for women giving birth vaginally at health facilities. Methods: The population of interest were women who experienced labour in a health facility and in whom vaginal birth was anticipated. The primary outcome was the use of fundal pressure during second stage of labour. MEDLINE, EMBASE, CINAHL and Global Index Medicus databases were searched for eligible studies published from 1 January 2000 onwards. Meta-analysis was conducted to determine a pooled prevalence, with subgroup analyses to explore heterogeneity. Results: Eighty data sets from 76 studies (n = 898,544 women) were included, reporting data from 22 countries. The prevalence of fundal pressure ranged from 0.6% to 69.2% between studies, with a pooled prevalence of 23.2% (95% CI 19.4–27.0, I2 = 99.97%). There were significant differences in prevalence between country income level (p < 0.001, prevalence highest in lower-middle income countries) and method of measuring use of fundal pressure (p = 0.001, prevalence highest in studies that measured fundal pressure based on women's self-report). Conclusions: The use of uterine fundal pressure on women during vaginal birth in health facilities is widespread. Efforts to prevent this potentially unnecessary and harmful practice are needed. Plain Language Summary: Uterine fundal pressure involves a health worker pushing on the uppermost part of a woman's abdomen during the pushing phase of labour, with the aim of assisting or accelerating vaginal birth. The World Health Organization and other bodies specifically recommend against the use of fundal pressure, as it is not beneficial and is potentially harmful to women. This study undertook a review to determine how often fundal pressure is used on women giving birth in hospitals around the world. We searched five databases and found 76 studies from 22 countries. We determined that 23.2% of women experience some form of fundal pressure during the pushing phase of labour. Results between studies varied widely, ranging from 0.6% to 69.2% of women experiencing some form of fundal pressure. This may be due to different study populations, or different methods of assessing or documenting fundal pressure use. It may also reflect differences in clinical practice or guidelines. Despite these differences, our findings indicate uterine fundal pressure is still widespread and efforts to prevent this potentially unnecessary and harmful practice are needed. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of congenital uterine anomalies and the differentiation between different subtypes is based on various sets of measurements that are difficult to implement during daily workflow.Purpose: To describe the shape and range of measurements of the normal uterus at the fundus in women of reproductive age.Material and Methods: This retrospective study was conducted on 200 pelvic magnetic resonance imaging (MRI) examinations of female patients of reproductive age with normal uteri divided into three age groups (15-24 years, 25-34 years, 35-45 years). The shape of the endometrium and serosa were documented. The thickness from the external to the internal fundic contour and the intercornual distance were measured.Results: The shape of endometrium is most commonly concave or flat but is not uncommonly convex. The shape of the serosa is convex in most cases but can be flat or concave. There is a progressive increase in thickness at the fundus with increased age with mean values of 10.8, 12.3, and 13.6 mm and ranges of 5.6-15.8 mm, 7-18.7 mm, and 7.3-19.8 mm, respectively, in the first, second, and third age groups. There is a progressive increase in intercornual distance with age with mean values of 41.4, 44.5, 47.2 mm and ranges of 30.6-50.7 mm, 31.5-57.3 mm, and 35.2-61 mm, respectively, in the first, second, and third age groups.Conclusion: Our study reports the range of normality in shape and measurement of the uterine fundus to aid in the detection of congenital uterine abnormalities. [ABSTRACT FROM AUTHOR]

Aim: To clarify whether the incidence of uterine fundal pressure (UFP) maneuver at delivery and consequent uterine rupture were declined. Methods: Population‐based postal questionnaire study was conducted. A questionnaire was sent to obstetric institutions across Japan. Questions were included the total number of deliveries, UFP and uterine ruptures associated with UFP in 2012 and 2017. As the primary outcome, frequencies of the UFP and uterine rupture were compared between 2012 and 2017. The secondary outcomes were included improved managements of delivery regarding UFP. Results: A number of vaginal deliveries were significantly declined from 80.4% in 2012 to 78.1% in 2017 (P < 0.001). Frequencies of UFP per vaginal deliveries were also significantly declined 11.2% (38 973/347771) in 2012 to 9.5% (35 205/404444) in 2017 (<0.001). Number of uterine ruptures were 6 cases in 2012 (1:6496) and 11 cases in 2017 (1:3473) (P = 0.210). Compared to situation in 2012, informed consent was more frequently obtained for UFP in 2017. Written informed consent for UFP became to be obtained in 12% of institutions in 2017 from only 3% in 2012. More than 80% of institutions are performing UFP within 3 times. Regarding to uterine rupture, try of labor after the cesarean section, UFP and augmentation were improved in more than 10% of institutions. Most impact vehicle changing behavior was OBGY clinical guideline. Conclusion: Although significant declined incidence of uterine rupture after UFP could not be demonstrated, frequency of UFP was decreased recent 5 years. This is due to improvement of obstetric management by obstetric caregivers throughout Japan. [ABSTRACT FROM AUTHOR]

Aim: Although the procedure of abdominal trachelectomy has been remarkably improved, preventing subsequent cervical stenosis remains challenging. In this study, we analyzed the clinicopathological risk factors for cervical stenosis to explore the appropriate surgical procedures for the prevention of cervical stenosis following trachelectomy. Methods: Thirty‐two patients who underwent abdominal extended and radical trachelectomy were assessed retrospectively (median follow‐up period = 33 months). To evaluate the risk factors, the clinicopathological factors were analyzed by univariate and multivariate analyses. The reconstructed uterine length (UtL), that is, the length between the vaginal end of the neo‐cervix and the uterine fundus, was measured by transvaginal ultrasound after surgery. The cut‐off value for the UtL was assessed by a receiver operating characteristic (ROC) curve analysis. Results: Cervical stenosis of any grade was observed in 12 patients (grade 1 = 9, grade 3b = 3). Among the various clinicopathological factors, the UtL and cervical length (CL) were significantly related to cervical stenosis following trachelectomy. The multivariate analysis revealed that the UtL, but not CL, is an independent risk factor for stenosis. The ROC curve analysis revealed that stenosis was significantly more likely to occur in patients with a UtL shorter than 53 mm (area under the ROC curve = 0.902). UtL in the patients who became pregnant was longer than that in the patients who did not. No evidence of recurrent cancer was observed during the follow‐up period. Conclusion: Our proposed method may provide a functional reconstructed uterus with preserving fertility by remaining UtL more than 53 mm. [ABSTRACT FROM AUTHOR]

Introduction: Uterine fundal pressure, or the Kristeller maneuver (KM), is a non–evidence‐based procedure used in the second stage of labor to physically force the fetus to delivery. Even though officially banned, the KM is practiced in 25% of vaginal deliveries in Spain. Methods: Using semi‐structured interviews (N = 10 women, N = 15 midwives, N = 3 obstetricians), we sought to understand how providers justify using the KM, and to describe the current circumstances in which the KM is practiced. Women described their preexisting knowledge of and experiences with the KM; providers described how they learned and practiced the KM. We used framework analysis to analyze the transcripts, and we consensus‐coded across three independent investigators. Results: Providers reported practicing a new, gentler Kristeller to which official policy did not apply. Providers knew the KM posed risks, but they assumed the risks resulted from poor technical training. Providers did not learn the KM through standard means, and they practiced it in secret. Women knew about the KM before delivery, and many had planned to refuse the procedure. Providers made women's refusal more difficult by offering the KM in coded terms as "just a little help." Women did not experience the KM as gentle, and the force of the procedure made their refusal nearly impossible. Conclusions: The normal birth policy has failed to achieve its objectives due to maternity care providers' unique logic surrounding a new KM technique. Women's ability to refuse the Kristeller is limited. [ABSTRACT FROM AUTHOR]

Background: Osseous metaplasia of the nonteratomatous ovary is extremely rare. This condition has been reported in association with endometriosis and certain ovarian neoplasms. Case: A 35-year-old nulliparous patient presented with new-onset severe abdominal pain associated with abdominal fullness, nausea, and vomiting. She had a large, tender pelvic mass anterior to the cervix. Computed tomography showed a midline pelvic mass, measuring 13.1 × 12.3 × 9.3 cm, located anteriorly and superiorly to the uterine fundus, with partially calcified septations as well as an eccentric soft-tissue nodule The uterus was enlarged and lobulated, containing multiple fibroids. There was a complex cystic mass superior to the uterus producing low-level internal echoes and having a few septations with areas of calcification. The patient underwent an exploratory laparotomy during which the pelvic mass was identified as an endometrioma arising from the left ovary. The cyst was densely adherent to the superior aspect of a leiomyomatous uterus with a large fundal fibroid measuring ∼7 cm. Intraoperative pathologic evaluation revealed that this cyst was benign. Lysis of adhesions, followed by myomectomy, was performed, removing 19 fibroids weighing 235 g in aggregate. Results: The patient had an uncomplicated postoperative course and was referred for infertility evaluation. Pathologically, this lesion was consistent with an endometriotic cyst (endometrioma) with focal osseous metaplasia. Conclusions: It has been theorized that chronic inflammation might be a driving force in the formation of bone within these lesions. [ABSTRACT FROM AUTHOR]

Mesonephric adenocarcinoma is a rare tumor that is considered to develop from mesonephric remnants of the female genital tract. This tumor usually occurs in the lateral wall of the uterine cervix. Herein, we present an exceptionally rare case of mesonephric adenocarcinoma located in the uterine fundus. The tumor exhibited intense hypermetabolism on 18F-FDG PET/CT. Based on the characteristic histologic features and immunohistochemical phenotypes, the diagnosis of mesonephric adenocarcinoma was confirmed. The patient underwent hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection, and no lymph node or distant metastasis was identified. After 20 months of surveillance without adjuvant therapy, she remains free of relapse.

Background: Uterine synechia are bands of fibrous tissue that when seen on prenatal ultrasound are not felt to pose significant risk to a fetus outside of early pregnancy loss. On the contrary, amniotic bands are diagnosed when bands of amniotic tissue are found to entrap and possible amputate involved fetal parts. Case presentation: Ultrasound imaging demonstrated a twin pregnancy affected by entrapment of twin B's head in a uterine synechium versus an amniotic band at 11 weeks + 0 days. The entrapment persisted until the second trimester. After a review of still images and video clips with a fetal surgeon, the patient was scheduled for possible fetal surgery. Upon arrival at 16 weeks + 0 days, the entrapment was observed to have spontaneously resolved. The patient experienced preterm premature rupture of membranes at 17 weeks + 6 days, and developed chorioamnionitis at 18 weeks + 5 days. Shortly after diagnosis with chorioamnionitis, she delivered spontaneously at 18 weeks + 5 days. Postnatal hysteroscopy demonstrated uterine synechium at the uterine fundus, which was resected. Conclusions: This is the first case of fetal head entrapment by a uterine synechium. [ABSTRACT FROM AUTHOR]

Abstract: We report a case of cesarean scar pregnancy at 16 weeks. Magnetic resonance imaging confirmed the isthmic ectopic location with an empty fundus and a high suspicion of placental invasion to the anterior myometrium. Because of pelvic pain, bleeding and the major risks of hysterectomy, a decision was made to terminate the pregnancy. After a preventive pelvic artery embolization, we performed an unusual posterior isthmic hysterotomy for the extraction of the fetus, followed by conservative management of the placenta. Bleeding loss was 300 mL, and no complication was reported. Successive magnetic resonance imaging was planned and 6 months later, there were no placental remnants. At 7 months, an office hysteroscopy revealed a normal uterine cavity. In case of cesarean scar pregnancy in the second trimester with an emergency need to interrupt pregnancy, posterior hysterotomy with conservative treatment of placenta may be an option to avoid massive bleeding and hysterectomy. [ABSTRACT FROM AUTHOR]

Abstract: Transverse uterine fundal cesarean section in cases of total placenta previa reduces blood loss, but its influence on subsequent pregnancies, including the uterine rupture risk, remains unclear. We report a case of uterine rupture due to placenta percreta in the first trimester in a 43‐year‐old woman who underwent transverse uterine fundal incision in a previous pregnancy (at 40 years old). The patient did not undergo assessment of the uterine scare after the previous operation. Oocyte donation and in vitro fertilization at another institution resulted in the current pregnancy. At 11 weeks 3 days, she was admitted to the emergency department because of sudden severe abdominal pain. Ultrasound showed massive accumulation of free fluid in the peritoneal cavity and the fetus was outside the uterine cavity; uterine rupture was diagnosed. During emergency laparotomy, the uterine rupture was detected at exactly the previous incision site; a total hysterectomy was performed. Pregnancy after a transverse uterine fundal cesarean section is at high risk. As uterine scar dehiscence might have caused the uterine rupture, wounds should be evaluated before allowing subsequent pregnancies. [ABSTRACT FROM AUTHOR]

We examine the prevalence of the practice of applying fundal pressure in the second stage of labour, the technique used, and its impact on mother and infant health. This analytical cross-sectional study was conducted in a state hospital in the city of Bursa, Turkey with 350 women giving vaginal birth in gestational weeks 37–42. We found that fundal pressure is commonly applied but that this is done without a specific indication, that it is more associated with the performance of an episiotomy, and at the same time, the use of the technique does not have an adverse impact on maternal satisfaction or the health of the mother and infant. [ABSTRACT FROM AUTHOR]

The study was designed to test the hypothesis that the inhibition of acetylcholinesterase (AChE) activity at the periphery by Neostigmine (0.5 mg/animal) will be sufficient to prevent inflammatory dependent suppression of the gonadotropin-releasing hormone (GnRH)/luteinising hormone (LH) secretion in ewes in the follicular phase of the estrous cycle, and this effect will be comparable with the systemic AChE inhibitor, Donepezil (2.5 mg/animal). An immune/inflammatory challenge was induced by peripheral administration of lipopolysaccharide (LPS; 400 ng/kg). Peripheral treatment with Donepezil and Neostigmine prevented the LPS-induced decrease (P<0.05) in LHβ gene expression in the anterior pituitary gland (AP) and in LH release. Moreover, Donepezil completely abolished (P<0.05) the suppressory effect of inflammation on GnRH synthesis in the preoptic area, when pretreatment with Neostigmine reduced (P<0.05) the decrease in GnRH content in this hypothalamic structure. Moreover, administration of both AChE inhibitors diminished (P<0.05) the inhibitory effect of LPS treatment on the expression of GnRH receptor in the AP. Our study shows that inflammatory dependent changes in the GnRH/LH secretion may be eliminated or reduced by AChE inhibitors suppressing inflammatory reaction only at the periphery such as Neostigmine, without the need for interfering in the central nervous system. [ABSTRACT FROM AUTHOR]

Background: Naltrexone may provide a suitable alternative to methadone and buprenorphine in the treatment of pregnant opioid-dependent women; however, little is known about its effects on neonatal morbidity and mortality. Objective: The aim was to evaluate the health of neonates exposed to naltrexone in utero, and compare it with outcomes in neonates exposed to methadone or buprenorphine and a non-exposed control group. Methods: Sequential cohorts of Western Australian (WA) opioid-dependent women treated with implant naltrexone, oral methadone or sublingual buprenorphine were identified via records from a drug and alcohol clinic (Subiaco, WA) for naltrexone and state prescribing records for methadone and buprenorphine. A control cohort of non-opioid-dependent women was obtained from the WA electoral roll. Identifying information and treatment records for these women were linked against the Midwife Notification System records to identify exposed offspring born between 2001 and 2011. Birth characteristics, congenital anomalies and perinatal mortality for all neonates were extracted from state records. Results: The birth characteristics of naltrexone-exposed neonates ( n = 68) were superior to methadone-exposed neonates ( n = 199) in terms of birth size (birth weight, head circumference and length), hospital length of stay (5.5 vs. 11.3 days), and rates of neonatal abstinence syndrome (NAS) (7.5 vs. 51.5%). Naltrexone-exposed neonates were generally not significantly different to buprenorphine-exposed neonates ( n = 124), with the exception of significantly lower rates of NAS (7.5 vs. 41.8%) and shorter hospital length of stay (5.5 vs. 8.0 days) in naltrexone-exposed neonates. Compared with the control group of neonates ( n = 569), naltrexone-exposed neonates were not significantly different in terms of overall rates of congenital anomalies, stillbirths and neonatal mortality; however, they were significantly smaller (3137.1 vs. 3378.0 g), spent more time in hospital following birth (5.5 vs. 4.3 days) and had higher rates of NAS (7.5 vs. 0.2%). Exposure of neonates to prenatal methadone was associated with a high incidence of neonatal mortality (2.0 vs. 0.2 per 100 live births) and congenital anomalies (10.6 vs. 4.4 per 100 births) compared with the control group. Rates of neonatal mortality and congenital abnormalities in buprenorphine-exposed neonates were not significantly different to the control group. Conclusions: The use of implant naltrexone during pregnancy was not associated with higher rates of negative birth outcomes compared with methadone- and buprenorphine-exposed neonates. Significantly, naltrexone and buprenorphine were not associated with the high rates of neonatal mortality or congenital anomalies seen in methadone-exposed neonates. [ABSTRACT FROM AUTHOR]

Purpose: Uterine rupture is a rare but serious event with a median incidence of 0.09%. Previous uterine surgery is the most common risk factor. The aim of our study was to analyze retrospectively women with uterine rupture during labor and to evaluate postulated risk factors such as uterine fundal pressure (UFP). Methods: Twenty thousand one hundred and fifty-two deliveries were analyzed retrospectively. Inclusion criteria were 22 weeks and 0 days-42 weeks and 0 days of gestation, singleton pregnancy and cephalic presentation. Women with primary cesarean section were excluded. A logistic regression analysis adjusting for possible risk factors was conducted and a subgroup analysis of women with unscarred uterus was performed. Results: Twenty-eight cases of uterine rupture were identified (incidence: 0.14%). Uterine rupture was noticed in multipara patients only. In the multivariate analysis among all study patients, only previous cesarean section remained a statistically significant risk factor [adjusted odds ration (adj. OR) 12.52 confidence interval (CI) 95% 5.21-30.09]. In the subgroup analysis among women with unscarred uterus (n = 19,415) three risk factors were associated with uterine rupture: UFP (adj. OR 5.22 CI 95% 1.07-25.55), abnormal placentation (adj. OR 20.82 CI 95% 2.48-175.16) and age at delivery > 40 years (adj. OR 4.77 CI 95% 1.44-15.85). Conclusions: The main risk factor for uterine rupture in the whole study population is previous uterine surgery. Risk factors in women with unscarred uterus were UFP, abnormal placentation, and age at delivery > 40 years. The only factor which can be modified is UFP. We suggest that UFP should be used with caution at least in presence of other supposed risk factors. [ABSTRACT FROM AUTHOR]

Background: In the selection of an appropriate IUD little consideration is placed on device size or adequacy of fit. Properly fitting IUDs will likely lead to less adverse effects or patient discomfort resulting in enhanced continuation of use.Methods: A multicenter study conducted at 7 centers in 410 nulliparous women, to measure the width of the uterine cavity using 2D and 3D ultrasound.Results: Measurements of maximal fundal cavity width was performed by either 2D or 3D ultrasound by experienced sonographists. The mean width of the uterine cavity in the fundus was 22.2mm (range 6.0-41.1mm). There was no statistical difference in the values whether determined by 2D (n=258) or 3D (n=152) measurements having a median value of 22.5mm and 21.6mm, respectively, 79% of women had a uterine cavity width between 15mm and 28mm, 32%<20mm and 6.8%<15mm, respectively.Discussion: Uterine cavities in nulliparous women are narrow and rarely wide enough to fit conventional IUDs. Gross discrepancy between the IUD and the uterine cavity leads to side effect (e.g., expulsion, embedment, bleeding, pain) and early discontinuation. Historically, devices too large for the uterine cavity have been routinely inserted which may account for their 5-year continuation rates being only 40 to 50%. Our study suggests that preprocedural 2D or 3D sonography to measure the width of the uterine cavity may result in the selection of a suitable IUD to maximize continuation of use. Measurement of the cavity width is not necessary with a frameless IUD. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Japan Academy of Midwifery is the property of Japan Academy of Midwifery and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To determine inter- and intraobserver agreement, diagnostic accuracy and the learning curve required for interpreting the 'sliding sign' and predicting pouch of Douglas (POD) obliteration.Methods: This was an inter-/intraobserver, diagnostic-accuracy and learning-curve study involving six observers with different medical backgrounds, clinical skill sets and prior gynecological ultrasound experience: five non-specialist observers who had performed 0-750 previous gynecological scans and an expert sonologist who had performed  > 15 000. Following a formal theoretical and practical training session, they each viewed 64 offline transvaginal ultrasound (TVS) 'sliding-sign' videos from two anatomical locations (retrocervix and posterior uterine fundus (PUF)) in 32 women presenting with chronic pelvic pain, interpreting the videos as positive or negative for sliding sign and predicting, on that basis, the POD status. For intraobserver agreement analysis they re-analyzed the same video sets, in a different order, at least 7 days later. The expert sonologist was the reference standard for interpreting the sliding sign and the gold standard, laparoscopy, was used for the POD analysis. Learning-curve cumulative summation (LC-CUSUM) tests were conducted to assess if observer performance reached acceptable levels, using LC-CUSUM score < -2.45 as a cut-off.Results: With respect to interpretation of the sliding sign, the overall multiple-rater agreement was moderate (Fleiss' kappa, K = 0.499). Observers were more consistent in their interpretation of the second compared with the first observation set (K = 0.547 vs 0.453) and for the retrocervical compared with the PUF region (K = 0.556 vs 0.346). Regarding prediction of POD status, the accuracy, sensitivity, specificity and positive and negative predictive values for individual observers ranged from 65.4 to 96.2%, 80.0 to 100%, 64.7 to 100%, 50.0 to 100% and 94.7 to 100%, respectively. Using LC-CUSUM score < -2.45, the observer with experience of 200 previous gynecological scans reached acceptable levels for predicting POD obliteration and interpreting the sliding sign at each region (retrocervix and PUF) at 39, 54 and 28 videos and the observer with experience of 750 scans at 56, 53 and 53 videos.Conclusions: Performance of a minimum number of gynecological ultrasound examinations is necessary for interpreting offline videos of the real-time dynamic sliding sign and predicting POD obliteration. Non-specialist observers with prior experience of 200 or more gynecological scans were more consistent in interpreting the sliding sign at the retrocervix vs PUF. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Background: Incarceration of the pregnant uterus is a rare condition and can lead to bladder obstruction, renal failure, or uterine rupture. We present a novel, noninvasive technique to reduce an incarcerated uterus.Method: With conscious sedation, the patient was placed in all-fours position. The physician's hands were placed on the patient's abdomen and pressure applied until the uterine fundus was palpated. Gentle, steady fundal pressure on both sides was directed toward the maternal chest (bilateral mediocephalad pressure) elevating the uterus out of the pelvis. This approach successfully reduced the gravid incarcerated uterus and was well tolerated by the patient and fetus.Experience: The author's experience with this method is limited to this case. Prior experience with reduction of the incarcerated uterus has been with methods previously described in the literature.Conclusion: In conjunction with conscious sedation and all-fours positioning, transabdominal manipulation of the uterine fundus with bilateral mediocephalad pressure may facilitate reduction of an incarcerated uterus. This method may obviate the need for more invasive procedures. [ABSTRACT FROM AUTHOR]

Rupture of a gravid uterus is a surgical emergency. Predisposing factors include a scarred uterus. Spontaneous rupture of an unscarred uterus during pregnancy is a rare occurrence. We hereby present the case of a spontaneous complete uterine rupture at a gestational age of 35 weeks 01 day in a 25 years old patient. The case was managed at the Civil Hospital Bahawalpur. She had past history of one uterine curettage for endometrial polyp one year back. She presented with mild abdominal pains of sudden onset. After conservative management for 10 hours in hospital she suddenly developed severe abdominal pains with P/V bleeding. On ultrasound scan, uterine rupture was diagnosed and an emergency laparotomy was done. The ruptured amniotic sac with baby and placenta were found in the peritoneal cavity with rupture of the uterine funds. Spontaneous uterine fundus rupture usually occurs when there is an upper segment uterine scar. This case report shows that past history of curettage is a risk factor for the presence of uterine scar. [ABSTRACT FROM AUTHOR]

Background: Fundal pressure (pushing on the upper part of the uterus in the direction of the birth canal) is often performed in routine practice, however the benefit and indications for its use are unclear and vigorous pressure is potentially harmful. There is some evidence that it may be applied routinely or to expedite delivery in some situations (e.g. fetal distress or maternal exhaustion), particularly in settings where other methods of achieving delivery (forceps, vacuum) are not available. Gentle assisted pushing (GAP) is an innovative method of applying gentle but steady pressure to the uterine fundus with the woman in an upright posture. This trial aims to evaluate the use of GAP in an upright posture, or upright posture alone, on reducing the mean time of delivery and the associated maternal and neonatal complications in women not having delivered following 15-30 min in the second stage of labour. Methods/Design: We will conduct a multicentre, randomized, unblinded, controlled trial with three parallel arms (1:1:1). 1,145 women will be randomized at three hospitals in South Africa. Women will be eligible for inclusion if they are ≥18 years old, nulliparous, gestational age ≥ 35 weeks, have a singleton pregnancy in cephalic presentation and vaginal delivery anticipated. Women with chronic medical conditions or obstetric complications are not eligible. If eligible women are undelivered following 15-30 min in the second stage of labour, they will be randomly assigned to: 1) GAP in the upright posture, 2) upright posture only and 3) routine practice (recumbent/supine posture). The primary outcome is the mean time from randomization to complete delivery. Secondary outcomes include operative delivery, adverse neonatal outcomes, maternal adverse events and discomfort. Discussion: This trial will establish whether upright posture and/or a controlled method of applying fundal pressure (GAP) can improve labour outcomes for women and their babies. If fundal pressure is found to have a measurable beneficial effect, this gentle approach can be promoted as a replacement for the uncontrolled methods currently in use. If it is not found to be useful, fundal pressure can be discouraged. [ABSTRACT FROM AUTHOR]

Objective: To clarify the incidence of uterine fundal pressure at delivery and its effect on uterine rupture. Study design: A questionnaire was sent to 2518 institutions in Japan. We received a response from 1430. Results: Of reporting institutions, 89.4% used fundal pressure in at least some of their deliveries. Among the 347,771 women who delivered vaginally in this study, 38,973 (11.2%) were delivered with the assistance of fundal pressure. There were six cases of uterine rupture associated with uterine fundal pressure, with one case resulting in maternal death secondary to amniotic fluid embolism. Conclusion: Since uterine fundal pressure may potentially cause serious injury to either the mother and/or neonates, the indications for application need to be clearly elucidated, and obstetric care providers also need comprehensive education and training. [ABSTRACT FROM AUTHOR]

Key Clinical Message Placenta percreta (with bladder invasion) is a rare obstetric condition with the risk of massive intraoperative hemorrhage. In these cases, the combination of a transverse uterine fundal incision and retrograde cesarean hysterectomy could be useful to minimize maternal hemorrhage and avoid severe bladder injury. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the correct position of the anchor at insertion and follow-up and assess if migration of the anchor occurs over time. Materials and methods: This was an insertion-related, prospective, postmarketing study in 309 women. Following insertion, women were followed up at 4-6 weeks, 6 months, and yearly thereafter. The position of the visualized anchor in the fundus of the uterus was evaluated using ultrasound by measuring its distance from the serosal surface of the uterus (SA-distance). Results: A total of 309 parous (n=115) and nulliparous (n=194) women were fitted with the frameless GyneFix 200 or the GyneFix 330 intrauterine device for contraception. The mean SA-distance in 306 parous and nulliparous women was 6.0 mm (range 2.0-24.0 mm) at insertion in the parous group and 5.4 mm (range 1.3-11.0 mm) in the nulliparous group. At the first followup in 281 women, the SA-distance was 6.0 mm (range 2.0-12.0 mm) in the parous group and 5.5 mm (range 1.1-11.0 mm) in the nulliparous group. The SA-distance was not significantly different. One patient had an exceptionally large SA-distance of 24 mm, probably due to insertion in the posterior wall. No follow-up could be done in this patient. In 77 women, the SA-distance was measured up to 42 months. The mean SA-distance at insertion in the parous group was 5.2 mm (range 3.0-8.5 mm) and 4.8 mm (range 1.3-7.0 mm) in the nulliparous group. At the last follow-up up to 36 months or longer, the SA-distance was 5.1 mm (range 3.0-8.5 mm) in the parous group and 4.9 mm (range 1.3-7.0 mm) in the nulliparous group. The SA-distance was not significantly different. The visualized anchor was highly visible on ultrasound in all cases. Conclusion: The visualized anchor is a key element in the optimization of frameless technology, with the aim of allowing the provider to check its placement at insertion and at follow-up, which enhances provider confidence and assurance. The authors recommend measuring the thickness of the fundus prior to inserting the frameless intrauterine device and to measure the distance between the serosa and the visualized anchor following insertion and at the first follow-up examination. [ABSTRACT FROM AUTHOR]

Globally, as well as in South Africa, postpartum haemorrhage (PPH) due to uterine atony is the number one direct cause of maternal mortality associated with the postpartum period. Active management of the third stage of labour has been thought to prevent PPH in women. This study assesses uterine fundal massage in the postpartum period as part of active management of the third stage of labour (AMTSL) and its outcome on the number of PPH cases at a level 2 maternity hospital. A quasi-experimental approach was used to determine the effect of continuous uterine fundal massage, every 15 minutes for the first 2 hours after birth, on the number of PPH cases at a level 2 maternity hospital in the Western Cape. It was found that the number of PPH cases reduced from 33/426 cases in the comparison group to 23/431 cases in the experimental group, although this was not statistically significant (Chi-square test, p=0.14). There was also a reduction in the mean postpartum blood loss (not statistically significant). Potential risk factors were considered in a logistic regression model but did not change the final conclusion that the effect of the intervention did not result in a statistically significant decrease in occurrence of PPH (p=0.1039).There was insufficient evidence to reject the null hypothesis of the study. It was concluded that more studies may be necessary to add to the outcome of AMTSL intervention in the maternity setting. A number of other recommendations were made for later implementation within the clinical setting for this study. [ABSTRACT FROM AUTHOR]

We are reporting a case of Mullerianosis, which presented as a multiloculated cystic mass on the serosal surface of the fundus of the uterus. Clinically and radiologically, this was interpreted as an ovarian tumor. Mullerianosis is a very rare benign tumor-like lesion. Awareness of this lesion is necessary to avoid misdiagnosis by clinicians, radiologists, and pathologists. [ABSTRACT FROM AUTHOR]

Background. Uterine inversion is a rare, but life threatening, obstetrical emergency which occurs when the uterine fundus collapses into the endometrial cavity. Various conservative and surgical therapies have been outlined in the literature for the management of uterine inversions. Case. We present a case of a chronic, recurrent uterine inversion, which was diagnosed following spontaneous vaginal delivery and recurred seven weeks later. The uterine inversion was likely due to a leiomyoma. This late-presenting, chronic, recurring uterine inversion was treated with a vaginal hysterectomy. Conclusion. Uterine inversions can occur in both acute and chronic phases. Persistent vaginal bleeding with the appearance of a prolapsing fibroid should prompt further investigation for uterine inversion and may require surgical therapy. A vaginal hysterectomy may be an appropriate management option in select populations and may be considered in women who do not desire to maintain reproductive function. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the effect of inflatable obstetric belts on uterine fundal pressure in the management of the second stage of labor. Method: Between July 2009 and December 2010, 188 nulliparous women with a singleton pregnancy at term were enrolled and only one dropped. The participants were randomized to receive either standard care (control group, n = 91) or uterine fundal pressure by the Labor Assister™ (Baidy M-520/Curexo, Inc., Seoul, Korea; active group, n = 97) during the second stage of labor in addition to standard care. The Labor Assister is an inflatable obstetric belt that is synchronized to apply constant fundal pressure during a uterine contraction. The primary endpoint was duration of the second stage of labor in women who delivered vaginally (control, n = 80 versus active, n = 93). It was not analyzed in women who delivered by cesarean section ( n = 14) and delivered precipitously ( n = 1). The secondary outcomes are perinatal outcomes and perineal laceration. Participants received patient-controlled epidural analgesia. Results: The 93 women in the active group spent less time in the second stage of labor when compared to the 80 women in the control group (46.51 ± 28.01 min versus 75.02 ± 37.48 min, p < 0.001). There was no significant difference in perinatal outcomes and perineal laceration between the two groups. Conclusion: The uterine fundal pressure exerted by the inflatable obstetric belt reduces the duration of the second stage of labor without complications in nulliparous women who receive patient-controlled epidural analgesia. [ABSTRACT FROM AUTHOR]

Abstract: The distribution of intrauterine embryo implantation site(s) in most mammalian species shows remarkably constant patterns: in monotocous species such as humans, an embryo tends to implant in the uterine fundus; in polytocous species such as rodents, embryos implant evenly along the uterine horns. These long-time evolved patterns bear great biological significance because disruption of these patterns can have adverse effects on pregnancies. However, lack of suitable models and in vivo monitoring techniques has impeded the progress in understanding the mechanisms of intrauterine embryo distribution. These obstacles are being overcome by genetically engineered mouse models and newly developed high-resolution ultrasound. It has been revealed that intrauterine embryo distribution involves multiple events including uterine sensing of an embryo, fine-tuned uterine peristaltic movements, time-controlled uterine fluid reabsorption and uterine luminal closure, as well as embryo orientation. Diverse molecular factors, such as steroid hormone signaling, lipid signaling, adrenergic signaling, developmental genes, ion/water channels, and potentially embryonic signaling are actively involved in intrauterine embryo distribution. This review covers the biomechanical and molecular aspects of intrauterine embryo distribution (embryo spacing at the longitudinal axis and embryo orientation at the vertical axis), as well as its pathophysiological roles in human reproductive medicine. Future progress requires multi-disciplinary research efforts that will integrate in vivo animal models, clinical cases, physiologically relevant in vitro models, and biomechanical/computational modeling. Understanding the mechanisms for intrauterine embryo distribution could potentially lead to development of therapeutics for treating related conditions in reproductive medicine. [Copyright &y& Elsevier]

This article reviews the changes in patient selection for intrauterine devices (IUDs) and evidence-based practices regarding counseling and management of common IUD issues. Where evidence-based research is lacking, expert opinion and common standards of practice are reviewed, and current clinical resources are identified. [ABSTRACT FROM AUTHOR]

Objective To determine the feasibility and safety of transverse fundal incision with manual placental removal in women with placenta praevia and possible placenta accreta. Design Case series. Setting Four level-three Japanese obstetric centres. Population Thirty-four women with prior caesarean section and placenta praevia that widely covers the anterior uterine wall, in whom placenta accreta cannot be ruled out. Methods A transverse fundal incision was performed at the time of caesarean section and manual placental removal was attempted under direct observation. Main outcome measure Operative fluid loss. Results The total volume of fluid lost during our operative procedure compares favourably with the volume lost during our routine transverse lower-segment caesarean sections performed in patients without placenta praevia or accreta. The average fluid loss was 1370 g. No patients required transfer to intensive care, and there were no cases of fetal anaemia. Conclusions This procedure has the potential to reduce the heavy bleeding that arises from caesarean deliveries in women with placenta praevia and placenta accreta. [ABSTRACT FROM AUTHOR]

The article provides insights on how to optimise the management of patients with infertility in Great Britain. The National Institute for Health and Clinical Excellence (NICE) published a guideline on the assessment and treatment of fertility problems in February 2013. Investigations should be carried out in primary care for suspected ovarian disorder, suspected tubal and uterine abnormalities and semen analysis. INSET: key points.