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Gestational hypertension, often associated with elevated soluble Fms-related receptor tyrosine kinase 1 (sFlt-1), poses significant risks to both maternal and fetal health. Hydrogen sulfide (H2S), a gasotransmitter, has demonstrated blood pressure-lowering effects in hypertensive animals and humans. However, its role in pregnancy-induced hypertension remains unclear. This study investigated the impact of GYY4137, a slow-release H2S donor, on sFlt-1-induced hypertension in pregnant rats . Pregnant rats were administered sFlt-1 (6 μg/kg/day, intravenously) or vehicle from gestation day (GD) 12-20. A subset of these groups received GYY4137 ( 50 mg/kg/day, intraperitoneal) from GD 16-20. Serum H2S levels, mean arterial blood pressure, uterine artery blood flow, and vascular reactivity were assessed. Elevated sFlt-1 reduced both maternal weight gain and serum H2S levels. GYY4137 treatment restored both weight gain and H2S levels in sFlt-1 dams. sFlt-1 increased mean arterial pressure and decreased uterine artery blood flow in pregnant rats. However, treatment with GYY4137 normalized blood pressure and restored uterine blood flow in sFlt-1 dams. sFlt-1 dams exhibited heightened vasoconstriction to phenylephrine and GYY4137 significantly mitigated the exaggerated vascular contraction. Notably, sFlt-1 impaired endothelium-dependent relaxation, while GYY4137 attenuated this impairment by upregulating eNOS protein levels and enhancing vasorelaxation in uterine arteries. GYY4137 mitigated sFlt-1-induced fetal growth restriction. In conclusion, sFlt-1 mediated hypertension is associated with decreased H2S levels. Replenishing H2S with the donor GYY4137 mitigates hypertension and improves vascular function and fetal growth outcomes. This suggests modulation of H2S could offer a novel therapeutic strategy for managing gestational hypertension and adverse fetal effects.

Uterine necrosis is a rare complication of uterine artery embolization for postpartum hemorrhage and most patients end up having a hysterectomy. Here we report a case in which the patient experienced a recurrent fever 28 days after uterine artery embolization as treatment for postpartum hemorrhage and had no response to antibiotics. Magnetic resonance imaging of the pelvis revealed a mass which was approximately 12‐cm in size with air bubbles in the uterus, suggesting necrosis with infection. Transvaginal clamping of the uterine mass was performed and necrotic tissue removed under laparoscopic monitoring, which successfully spared the necessity for a hysterectomy. The patient's subsequent progress was favorable. In the present study we review the high‐risk factors of uterine necrosis following uterine artery embolization and summarize the key points of early diagnosis. In addition, we propose a strategy to successfully spare the necessity for a hysterectomy without the spread of infection or uterine perforation. Synopsis: Uterine necrosis should be considered when consistent fever appears after uterine artery embolization. Earlier diagnosis and timely removal of necrotic tissue could be helpful for hysterectomy sparing. [ABSTRACT FROM AUTHOR]

Objective: To determine the association of first‐trimester uterine artery Doppler with hypertensive disorders of pregnancy in twin pregnancies. Methods: This was a retrospective cohort study of twin pregnancies followed at the University Hospital Center of Central Lisbon, Portugal, between January 2010 and December 2022. First‐trimester uterine artery pulsatility index (UtA‐PI) was determined and compared between twin pregnancies (n = 454) and singleton pregnancies (n = 908), matched to maternal and pregnancy characteristics. Maternal characteristics and mean UtA‐PI were analyzed for gestational age, birth weight, gestational hypertension, early‐ and late‐onset pre‐eclampsia, HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, and preterm birth. Univariable and multivariable logistic regression models were used. Results: The mean first‐trimester UtA‐PI was significantly lower in dichorionic twins than in singletons (P < 0.001). To study hypertensive disorders of pregnancy in twins, 390 pregnancies were included: 311 (79.7%) dichorionic and 79 (20.3%) monochorionic twins. The observed rates of early‐ and late‐onset pre‐eclampsia, gestational hypertension, and HELLP syndrome were 1.0%, 4.4%, 7.4%, and 1.5%, respectively. We achieved a 100% detection rate for early‐onset pre‐eclampsia using the UtA‐PI 90th centile for twins. However, when singleton references were considered, the detection rate decreased to 50%. UtA‐PI at or above the 95th centile was associated with increased odds for preterm birth before 32 weeks (adjusted odds ratio 4.1, 95% confidence interval 1.0–16.7, P = 0.043). Conclusions: Unless other major risk factors for hypertensive disorders are present, women with low UtA‐PI will probably not benefit from aspirin prophylaxis. Close monitoring of all twin pregnancies for hypertensive disorders is still recommended. Synopsis: A first‐trimester uterine artery pulsatility index above the 90th centile, considered for twin pregnancies, detected all cases of early‐onset pre‐eclampsia. [ABSTRACT FROM AUTHOR]

Purpose: The differentiation between conditions such as uterine arteriovenous malformation, pseudoaneurysm, gestational trophoblastic disease, and retained trophoblastic tissue can be challenging. Ultrasound imaging and Doppler interrogation are the primary diagnostic tools to assess cases of enhanced myometrial vascularity and differentiate intrauterine vascular anomalies. However, some cases remain of difficult differentiation. This study aims to analyze suspected cases and describe their diagnostic management and outcomes. Methods: We reviewed post-abortion cases that underwent pelvic transvaginal U/S imaging and Doppler examinations due to suspected uterine vascular anomalies. CT scans were performed in cases in which ultrasound did not reach a diagnosis. Simple follow-up, medical or surgical therapy, or embolization of uterine arteries were performed according to the final diagnosis. Results: From 2015 to 2022, we retrieved from electronic ultrasound records 22 cases of suspected vascular malformations. In eight cases, first-line U/S at admission excluded the suspected anomaly. In Five of the remaining 14 patients, uterine vascular anomalies were excluded upon a second-level U/S based on angio-Doppler imaging and Doppler peak velocity interrogation. Nine cases underwent CT scan, and a digital angiography and embolization were performed in eight of these cases, of whom only two had a documented uterine arteriovenous malformation. Conclusion: Our triage proved that only two out of 22 suspected cases had a uterine arteriovenous malformation. This diagnosis is frequently misused in clinical practice. Our data confirm that enhanced myometrial vascularity should be used to encompass the spectrum of possible differential diagnosis. A precise step-by-step diagnostic method is of paramount importance to prevent unnecessary interventions. [ABSTRACT FROM AUTHOR]

Purpose: To assess the current practices surrounding Uterine Fibroid Embolization (UFE) in Canada. Methods: An online survey was sent to Canadian Association for Interventional Radiology (CAIR) members. It included questions on symptoms prompting UFE, patient awareness, investigation, UFE settings, the number of UFE procedures, and post-UFE care. The findings were discussed at CAIR's 2023 annual meeting by an expert panel. Results: Out of 792 surveys sent, 87 were filled (11%). Menorrhagia is the most common indication for UFE (87%). Women's awareness of UFE as a treatment option for fibroids is viewed as poor or average by 94% of our survey respondents. Most respondents see patients in clinics (92%) before the procedure and evaluate fibroids with MRI pre-UFE (76%). There is variability in care post-UFE, with 33% of procedures being performed as day surgery while 67% lead to overnight stay. For pain management, intravenous analgesia (including patient-controlled analgesia) is used in 76% (63/83) of cases while 19% (16/83) of respondents mentioned using epidural analgesia. Finally, there is an even split between embolic agent used; non-spherical polyvinyl alcohol (50%) and spherical particles (50%). Conclusion: Respondents believe patients in Canada still have limited awareness of UFE. Interventional radiologists are increasingly involved in the entire patient care trajectory, overseeing pre-and post-procedure care and hospitalizing patients. For pain management after UFE, it is observed that while epidural analgesia has been demonstrated more effective than alternatives, it is not widely used as the primary method. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of prior cesarean delivery on second-trimester Uterine Artery (UtA) Doppler and its effect on perinatal outcomes. Materials and Methods: This prospective cohort study was conducted at the Maternal Fetal Medicine unit of Bhumibol Adulyadej hospital, Bangkok, Thailand between June 2023 and January 2024. Healthy pregnant women aged between 18 and 45 years old were recruited and divided into prior (PCD) and non-prior cesarean delivery (non- PCD) groups. Both groups underwent UtA Doppler study from 18 to 24 weeks of gestation. UtA Doppler indices consisted of pulsatility index (UtA-PI), resistance index (UtA-RI) and systolic/diastolic ratio (S/D). Demographics, maternal and neonatal outcomes were collected. Results: Total of 416 participants were recruited and divided equally. The mean age of participants was 30.5 years old. Diabetes mellitus in pregnancy and hypertensive disorder were reported as 18.9 (79/416) and 5.5 (23/416) percent, respectively. From univariate analysis, subjects in the PCD group had higher UtA-PI, UtA-RI and UtA S/D than the non-PCD group with statistical significance. After multiple logistic regressions, only UtA-RI was greater in the PCD group with any statistical significance. The mean gestational age at delivery was 38.41 weeks. Prevalence of small for gestational age deliveries, preeclampsia, and preterm birth were 4.4 (17/376), 3.1 (12/376) and 10 percent (38/376), respectively. Maternal and neonatal outcomes of both groups were comparable. Number of cesarean deliveries, parity, miscarriage, and anterior placentation were not associated with UtA Doppler indices. Conclusion: UtA-RI of prior cesarean delivery participants were higher than non-prior cesarean delivery participants and not associated with maternal and neonatal adverse outcomes. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion This study evaluates the endometrial receptivity of obstetric anticardiolipin syndrome (OAPS) patients using various ultrasound indicators and the efficacy of low‐dose aspirin (LDA) treatment.This retrospective study recruited patients from Shanghai Ren Ji Hospital, China from January 2022 to December 2023. Doppler parameters of the endometrium and uterine artery blood flow were recorded to assess the endometrial receptivity of OAPS patients compared with normal pregnant women and an other immune diseases group. The receiver operating characteristic curve was used to predict the risk of OAPS patients. Doppler parameters of OAPS patients were conducted repeatedly after a 2‐month period of treatment with LDA.Compared with normal pregnant women, the OAPS group showed remarkably increased endometrial perfusion resistance (PI, RI, S/D) and uterine artery perfusion resistance (RI and S/D) (P < 0.001) and had good predictive values (area under the curve = 0.806, 0.976, 0.942, 0.902, and 0.901, respectively). The endometrial thickness of the OAPS group was much thinner than that of the normal group (P < 0.001). Uterine blood flow impedance PI showed no difference in both groups (P = 0.68). In comparison to other autoimmune diseases, the OAPS group also showed an increasing trend in the resistance of endometrium and uterine artery blood flow. After LDA treatment, there was an obvious improvement in the endometrial blood flow perfusion in the OAPS group (P < 0.01).Compared with the normal group and other autoimmune diseases, the resistance of endometrial and uterine artery blood flow in the OAPS group was increased significantly. The Doppler index showed the predictive value of OAPS, and it was confirmed that LDA could enhance blood perfusion among OAPS women. [ABSTRACT FROM AUTHOR]

To investigate the effect of the combination of uterine artery (UtA) Doppler and vitamin D levels on perinatal outcomes in second trimester pregnants was aimed.UtA Dopplers and vitamin D levels of 226 pregnant women in the second trimester were measured. Patients were followed for adverse pregnancy outcomes. The relationship of this combination with these pregnancy outcomes was evaluated.Sensitivity and specificity values ​​are respectively; Left UtA-S/D ratio for preeclampsia was 85.29 and 81.77 %, left UtA-RI was 90.62 and 43.30 % for preterm birth, and 76.19 and 66.34 % for the development of fetal distress had the best predictive effect. Vitamin D values ​​had no predictive value for any parameter (p>0.005).UtA Doppler has a good predictive value for many adverse pregnancy outcomes. However, in order to correlate these results with second trimester vitamin D levels, more homogeneous and specific groups are needed. [ABSTRACT FROM AUTHOR]

Background: Cesarean scar pregnancy (CSP), a distinct form of ectopic pregnancy, presents challenges in effective management. It is categorized into three subtypes according to the location of placental implantation and the thickness of the myometrium at the uterine scar. Nevertheless, the optimal choice of treatment modalities for these subtypes remains largely unexamined. Methods: In this retrospective analysis, we investigated the cases of 130 patients diagnosed with CSP who underwent diverse treatment approaches, namely ultrasound-guided dilation and curettage (D&C), hysteroscopic surgery alone or in combination with laparoscopic surgery (HCoLC), or uterine artery embolization (UAE) followed by curettage. Clinical data were meticulously retrieved from medical records and follow-up data, and a comparative analysis of relevant indicators was carried out across the different CSP subtypes. Results: From January 2017 to December 2021, 35 patients underwent D&C, 85 underwent HCoLC, and 10 received UAE as a pretreatment. In the D&C group, the success rates for Type I and Type II CSP were 64.29% (18/28) and 14.28% (1/7), respectively. Significant differences were observed between the success and failure groups in terms of gestational sac size and clinical classification. Compared to Type I CSP, Type II CSP exhibited significantly longer surgical durations and higher hospitalization costs (P < 0.05). Three patients classified as Type III underwent simultaneous hysteroscopic evacuation of cesarean scar pregnancy and laparoscopic repair of the cesarean scar defect, achieving a 100% success rate in their initial treatment. HCoLC showed no significant differences in surgical duration and hospitalization costs but had higher success rates and shorter hospital stays compared to the D&C and UAE groups (P < 0.05). The UAE group had significantly longer surgical durations, higher hospitalization costs, and a higher incidence of postoperative complications (P < 0.05). However, these factors did not result in improved surgical success rates. Conclusion: The classification of CSP and the measurement of gestational sac are of crucial importance in determining the most appropriate surgical intervention strategy. For patients diagnosed with Type I CSP, D&C and hysteroscopy are reliable treatment choices. In cases with larger gestational sacs or Type II CSP, hysteroscopy, either alone or in combination with laparoscopy, is regarded as a reliable and effective treatment approach. In patients with type III CSP, lesion excision with uterine repair is the recommended treatment. [ABSTRACT FROM AUTHOR]

Objectives: This study evaluates the association of novel inflammatory markers and Doppler parameters in late‐onset FGR (fetal growth restriction), utilizing a machine‐learning approach to enhance predictive accuracy. Materials and Methods: A retrospective case–control study was conducted at the Department of Perinatology, Ministry of Health Etlik City Hospital, Ankara, from 2023 to 2024. The study included 240 patients between 32 and 37 weeks of gestation, divided equally between patients diagnosed with late‐onset FGR and a control group. We focused on novel inflammatory markers—systemic immune‐inflammation index (SII), systemic inflammatory response index (SIRI), and neutrophil‐percentage‐to‐albumin ratio (NPAR)—and their correlation with Doppler parameters of umbilical and uterine arteries. Machine‐learning algorithms were employed to analyze the data collected, including demographic, neonatal, and clinical parameters, to develop a predictive model for FGR. Results: The machine‐learning model, specifically the Random Forest algorithm, effectively integrated the inflammatory markers with Doppler parameters to predict FGR. NPAR showed a significant correlation with FGR presence, providing a robust tool in the predictive model (Accuracy 77%, area under the curve [AUC] 0.851). In contrast, SII and SIRI, while useful, did not achieve the same level of predictive accuracy (Accuracy 75% AUC 0.818 and Accuracy 73% AUC 0.793, respectively). The model highlighted the potential of combining ultrasound measurements with inflammatory markers to improve diagnostic accuracy for late‐onset FGR. Conclusions: This study illustrates the efficacy of integrating machines with traditional diagnostic methods to enhance the prediction of late‐onset FGR. Further research with a larger cohort is recommended to validate these findings and refine the predictive model, which could lead to improved clinical outcomes for affected pregnancies. Trial Registration: ClinicalTrials.gov identifier: NCT06372938 [ABSTRACT FROM AUTHOR]

Background: Complications during pregnancy frequently result in adverse events impacting both the mother and the fetus. Hemodynamic changes characteristic of pregnancy typically involve a decline in uterine artery flow resistance, accompanied by increased blood flow as gestational age progresses. While these changes are a natural part of pregnancy, pathological alterations marked by high-resistant circulation can pose significant risks for adverse pregnancy outcomes. The uterine artery Doppler has been utilized largely in the first and second trimesters to screen high risk pregnancies in relation to the development of subsequent complications. Second trimester screening can be still of value for late scheduled and those with unplanned pregnancies who require closer antenatal monitoring. The aim of this study was to determine the sensitivity, specificity, positive and negative predictive value of the uterine artery Doppler parameters in the prediction of adverse pregnancy outcomes in our population. Methods: This was a hospital-based, time-bound and prospective study, conducted in the Department of Radiodiagnosis of Mahatma Gandhi Memorial Medical College & M.Y. Hospital, Indore, Madhya Pradesh, India, after getting approval by the Institutional Scientific and Ethical Committee. The duration of this study was from Sept. 2022 to Sept. 2023. A total of 150 pregnant women in 2rd trimester (22-24 weeks), referred to the Department of Radiodiagnosis were included in the study according to the inclusion and exclusion criteria, after enrolling PCPNDT registration and after obtaining written informed consent. Results: In our study, 20.7% women delivered babies before gestational age of 37 weeks, also 15.3% underwent LSCS and 6% had assisted delivery. 28 out of 63 women with high mean PI gave birth to babies with adverse perinatal outcomes, while rest 35 women gave birth to babies with no adverse perinatal outcomes, giving sensitivity of 44.4% and specificity of 81.6%. 23 out of 53 women with high mean RI gave birth to babies with adverse perinatal outcomes, while rest 30 women gave birth to babies with no adverse perinatal outcomes, giving sensitivity of 43.4% and specificity of 77.3%. Conclusion: In second trimester, high mean uterine artery PI has higher specificity for adverse perinatal outcomes than high mean uterine artery RI. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To quantify the association between prophylactic radiologic interventions and perioperative blood loss during cesarean delivery in women with placenta accreta spectrum disorder through a systematic review and network meta-analysis. DATA SOURCES: On January 3, 2023, a literature search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science. We also checked ClinicalTrials.gov retrospectively. Prophylactic radiologic interventions to reduce bleeding during cesarean delivery involved preoperative placement of balloon catheters, distal (internal or common iliac arteries) or proximal (abdominal aorta), or sheaths (uterine arteries). The primary outcome was volume of blood loss; secondary outcomes were the number of red blood cell units transfused and adverse events. Studies including women who received an emergency cesarean delivery were excluded. METHODS OF STUDY SELECTION: Two authors independently screened citations for relevance, extracted data, and assessed the risk of bias of individual studies with the Cochrane Risk of Bias in Non-randomized Studies of Interventions tool. TABULTATION, INTEGRATION, AND RESULTS: From a total of 1,332 screened studies, 50 were included in the final analysis, comprising 5,962 women. These studies consisted of two randomized controlled trials and 48 observational studies. Thirty studies compared distal balloon occlusion with a control group, with a mean difference in blood loss of 2406 mL (95% CI, 2645 to 2167). Fourteen studies compared proximal balloon occlusion with a control group, with a mean difference of 21,041 mL (95% CI, 21,371 to 2710). Sensitivity analysis excluding studies with serious or critical risk of bias provided similar results. Five studies compared uterine artery embolization with a control group, all with serious or critical risk of bias; the mean difference was 2936 mL (95% CI, 21,522 to 2350). Reported information on adverse events was limited. CONCLUSION: Although the predominance of observational studies in the included literature warrants caution in interpreting the findings of this metaanalysis, our findings suggest that prophylactic placement of balloon catheters or sheaths before planned cesarean delivery in women with placenta accreta spectrum disorder may, in some cases, substantially reduce perioperative blood loss. Further study is required to quantify the efficacy according to various severities of placenta accreta spectrum disorder and the associated safety of these radiologic interventions. [ABSTRACT FROM AUTHOR]

Objective To explore the relationship between the serum level of placental growth factor (PLGF) and ultrasonic blood flow parameters and pregnancy outcome in patients with late-onset preeclampsia (LOPE). Methods A total of 152 patients with LOPE were selected and divided into the P1 (＜ 12.00 ng/L) group, the P2 (12.00-56.73 ng/L) group, the P3 (＞56.73-89.41 ng/L) group and the P4 (＞ 89.41 ng/L) group according to serum level of PLGF. There were 38 cases in each group. The clinical data, uterine artery pulsatility index (PI), resistance index (RI), peak systolic velocity (S)/ end-diastolic velocity (D) and adverse pregnancy outcome were compared between the four groups. The relationship between PLGF level and clinical characteristics was analyzed by linear regression analysis. The influence of LOPE severity on the relationship between PLGF and ultrasonic blood flow parameters was analyzed by stratified interactive analysis. Multivariate generalized linear mixed effect model was used to analyze the relationship between PLGF level and adverse pregnancy outcome in patients with LOPE. Results The diastolic blood pressure, 24 h urinary protein, PI, RI and S/D decreased significantly with the increase of PLGF level (P＜0.05). The proportion of severe LOPE and systolic blood pressure were significantly higher in the P1 group than those of the other groups (P＜0.05), and the above indexes were influencing factors of the level of PLGF (P＜0.05). The results of stratified interactive test showed that the LOPE severity did not affect the relationship between PLGF and ultrasonic blood flow parameters. There were significant differences in the incidence of HELLP syndrome, fetal growth restriction, fetal distress, premature delivery and neonatal asphyxia between patients with different PLGF levels (P＜0.05). The incidence of preterm delivery was higher in the P1 group than that in the other groups, and the other adverse pregnancy outcomes were higher in the P3 group and P4 group. Conclusion Serum PLGF levels affect uterine artery blood flow parameters and adverse pregnancy outcome in patients with LOPE. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Could the risk of subsequent pregnancy loss be predicted based on the risk factors of recurrent pregnancy loss (RPL) patients? SUMMARY ANSWER A nomogram, constructed from independent risk factors identified through multivariate logistic regression, serves as a reliable tool for predicting the likelihood of subsequent pregnancy loss in RPL patients. WHAT IS KNOWN ALREADY Approximately 1–3% of fertile couples experience RPL, with over half lacking a clear etiological factor. Assessing the subsequent pregnancy loss rate in RPL patients and identifying high-risk groups for early intervention is essential for pregnancy counseling. Previous prediction models have mainly focused on unexplained RPL, incorporating baseline characteristics such as age and the number of previous pregnancy losses, with limited inclusion of laboratory and ultrasound indicators. STUDY DESIGN, SIZE, DURATION The retrospective study involved 3387 RPL patients who initially sought treatment at the Reproductive Immunology Clinic of Renji Hospital, Shanghai Jiao Tong University School of Medicine, between 1 January 2020 and 31 December 2022. Of these, 1153 RPL patients met the inclusion criteria and were included in the analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS RPL was defined as two or more pregnancy losses (including biochemical pregnancy loss) with the same partner before 28 weeks of gestation. Data encompassing basic demographics, laboratory indicators (autoantibodies, peripheral immunity coagulation, and endocrine factors), uterine and endometrial ultrasound results, and subsequent pregnancy outcomes were collected from enrolled patients through initial questionnaires, post-pregnancy visits fortnightly, medical data retrieval, and telephone follow-up for lost patients. R software was utilized for data cleaning, dividing the data into a training cohort (n = 808) and a validation cohort (n = 345) in a 7:3 ratio according to pregnancy success and pregnancy loss. Independent predictors were identified through multivariate logistic regression. A nomogram was developed, evaluated by 10-fold cross-validation, and compared with the model incorporating solely age and the number of previous pregnancy losses. The constructed nomogram was evaluated using the AUC, calibration curve, decision curve analysis (DCA), and clinical impact curve analysis (CICA). Patients were then categorized into low- and high-risk subgroups. MAIN RESULTS AND THE ROLE OF CHANCE We included age, number of previous pregnancy losses, lupus anticoagulant, anticardiolipin IgM, anti-phosphatidylserine/prothrombin complex IgM, anti-double-stranded DNA antibody, arachidonic acid-induced platelet aggregation, thrombin time and the sum of bilateral uterine artery systolic/diastolic ratios in the nomogram. The AUCs of the nomogram were 0.808 (95% CI: 0.770–0.846) in the training cohort and 0.731 (95% CI: 0.660–0.802) in the validation cohort, respectively. The 10-fold cross-validated AUC ranged from 0.714 to 0.925, with a mean AUC of 0.795 (95% CI: 0.750–0.839). The AUC of the nomogram was superior compared to the model incorporating solely age and the number of previous pregnancy losses. Calibration curves, DCAs, and CICAs showed good concordance and clinical applicability. Significant differences in pregnancy loss rates were observed between the low- and high-risk groups (P  <   0.001). LIMITATIONS, REASONS FOR CAUTION This study was retrospective and focused on patients from a single reproductive immunology clinic, lacking external validation data. The potential impact of embryonic chromosomal abnormalities on pregnancy loss could not be excluded, and the administration of medication to all cases impacted the investigation of risk factors for pregnancy loss and the model's predictive efficacy. WIDER IMPLICATIONS OF THE FINDINGS This study signifies a pioneering effort in developing and validating a risk prediction nomogram for subsequent pregnancy loss in RPL patients to effectively stratify their risk. We have integrated the nomogram into an online web tool for clinical applications. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the National Natural Science Foundation of China (82071725). All authors have no competing interests to declare. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between varying degrees of abnormality in the Doppler uterine artery pulsatility index (UtA‐PI) and adverse perinatal outcome. Methods: This was a prospective study of women with a singleton, non‐anomalous pregnancy in whom UtA‐PI was measured universally in midpregnancy and who gave birth in Oxford University Hospitals, Oxford, UK, between 2016 and 2023. Relative risk ratios (RRR) for the primary outcomes of extended perinatal mortality and live birth with a severe small‐for‐gestational‐age (SGA) neonate were calculated using multinomial logistic regression, for early preterm birth (before 34 + 0 weeks' gestation) and late preterm/term birth (at or after 34 + 0 weeks). Risks were also investigated for iatrogenic preterm birth and a composite adverse outcome before 34 + 0 weeks. Results: Overall, 33 364 pregnancies were included in the analysis. Compared to those with a normal UtA‐PI, the risk of extended perinatal mortality with delivery before 34 + 0 weeks was higher in women with UtA‐PI ≥ 90th percentile (RRR, 4.7 (95% CI, 2.7–8.0); P < 0.001), but this was not demonstrated in births at or after 34 + 0 weeks. The risk of live birth with severe SGA was associated strongly with abnormal UtA‐PI for early births (RRR, 26.0 (95% CI, 11.6–58.2); P < 0.001) and later births (RRR, 2.3 (95% CI, 1.8–2.9); P < 0.001). Women with raised UtA‐PI were more likely to have an early iatrogenic birth (RRR, 7.8 (95% CI, 5.5–11.2); P < 0.001). For each outcome before 34 + 0 weeks and the composite outcome, the risk increased significantly in association with the degree of abnormality in the UtA‐PI (from < 90th, 90–94th, 95–98th to ≥ 99th percentile) (Ptrend < 0.001). When using the 90th percentile as opposed to the 95th, there was a significant improvement in the overall predictive accuracy (as determined by the area under the receiver‐operating‐characteristics curve) for the composite adverse outcome (χ2 = 6.64, P = 0.01) and iatrogenic preterm birth (χ2 = 4.10, P = 0.04). Conclusions: Elevated UtA‐PI is a key predictor of iatrogenic preterm birth, severe SGA and perinatal loss up to 34 + 0 weeks' gestation. The 90th percentile for UtA‐PI should be used, and management should be tailored according to the degree of abnormality, as pregnancies with very raised UtA‐PI measurement constitute a group at extreme risk of adverse outcome. © 2024 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]

Objective: To exploit the combination diagnostic performance of serum microRNA-134-5p (miR-134-5p) and color Doppler ultrasound in patients with endometriosis patients. Methods: Quantitative real time polymerase chain reaction (qRT-PCR) analysis was applied to measure relative abundance of miR-134-5p in serum of patients with endometriosis and gynecological benign diseases. Calculation of uterine artery blood flow parameters was conducted using Color Doppler ultrasound. Receiver operating characteristic (ROC) curve was established to evaluate the diagnostic capacity of miR-134-5p and Doppler parameters. Kaplan-Meier method was used for the analysis of recurrence-free survival rate. Results: Compared with the control group, serum miR-134-5p expression was remarkably diminished in endometriosis patients (P < 0.001). End-diastolic velocity (EDV) and peak systolic velocity (PSV) were notably decreased in endometriosis patients compared with the control group (P < 0.001), while pulsatility index (PI) and resistance index (RI) were distinctly increased (P < 0.001). Serum miR-134-5p expression was positively correlated with EDV (r = 0.5777, P < 0.0001) and PSV (r = 0.6945, P < 0.0001), but negatively correlated with PI (r=-0.6382, P < 0.0001) and RI (r=-0.6247, P < 0.0001). The area under the ROC curve (AUC) of serum miR-134-5p combined with Doppler parameters was 0.905, with the sensitivity of 87.40%, and the specificity of 82.29%. The recurrence-free survival time was shorter in patients with low miR-134-5p expression than those with high miR-134-5p expression (P = 0.013). Conclusion: A better diagnostic value of endometriosis detection could be obtained when serum miR-134-5p was combined with Doppler parameters. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the performance of an artificial intelligence (AI) and machine learning (ML) model for first‐trimester screening for pre‐eclampsia in a large Asian population. Methods: This was a secondary analysis of a multicenter prospective cohort study in 10 935 participants with singleton pregnancies attending for routine pregnancy care at 11–13+6 weeks of gestation in seven regions in Asia between December 2016 and June 2018. We applied the AI+ML model for the first‐trimester prediction of preterm pre‐eclampsia (<37 weeks), term pre‐eclampsia (≥37 weeks), and any pre‐eclampsia, which was derived and tested in a cohort of pregnant participants in the UK (Model 1). This model comprises maternal factors with measurements of mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor (PlGF). The model was further retrained with adjustments for analyzers used for biochemical testing (Model 2). Discrimination was assessed by area under the receiver operating characteristic curve (AUC). The Delong test was used to compare the AUC of Model 1, Model 2, and the Fetal Medicine Foundation (FMF) competing risk model. Results: The predictive performance of Model 1 was significantly lower than that of the FMF competing risk model in the prediction of preterm pre‐eclampsia (0.82, 95% confidence interval [CI] 0.77–0.87 vs. 0.86, 95% CI 0.811–0.91, P = 0.019), term pre‐eclampsia (0.75, 95% CI 0.71–0.80 vs. 0.79, 95% CI 0.75–0.83, P = 0.006), and any pre‐eclampsia (0.78, 95% CI 0.74–0.81 vs. 0.82, 95% CI 0.79–0.84, P < 0.001). Following the retraining of the data with adjustments for the PlGF analyzers, the performance of Model 2 for predicting preterm pre‐eclampsia, term pre‐eclampsia, and any pre‐eclampsia was improved with the AUC values increased to 0.84 (95% CI 0.80–0.89), 0.77 (95% CI 0.73–0.81), and 0.80 (95% CI 0.76–0.83), respectively. There were no differences in AUCs between Model 2 and the FMF competing risk model in the prediction of preterm pre‐eclampsia (P = 0.135) and term pre‐eclampsia (P = 0.084). However, Model 2 was inferior to the FMF competing risk model in predicting any pre‐eclampsia (P = 0.024). Conclusion: This study has demonstrated that following adjustment for the biochemical marker analyzers, the predictive performance of the AI+ML prediction model for pre‐eclampsia in the first trimester was comparable to that of the FMF competing risk model in an Asian population. Synopsis: Machine learning model achieved comparable predictive performance to that of the FMF competing risk model in predicting preterm and term pre‐eclampsia in an Asian population. [ABSTRACT FROM AUTHOR]

Preeclampsia (PE) is a prevalent obstetric complication affecting approximately 3–5% of pregnancies worldwide and is a major cause of maternal and perinatal morbidity and mortality. Preeclampsia is considered a disease of the endothelial system that can progress to eclampsia, characterized by seizures. Early diagnosis and appropriate management are crucial to improving maternal and fetal outcomes, as preeclampsia can lead to severe complications such as placental abruption, fetal growth restriction, and stroke. The pathophysiology of PE is complex, involving a combination of genetic, acquired, and immunological factors. A central feature of the condition is inadequate placentation and impaired uteroplacental perfusion, leading to local hypoxia, endothelial dysfunction, vasoconstriction, and immunological dysregulation. Recent evidence suggests that dysregulation of ion transporters may play a significant role in the adaptation of uterine circulation during placentation. These transporters are essential for maintaining maternal-fetal homeostasis, influencing processes such as nutrient exchange, hormone synthesis, trophoblast cell migration, and the function of smooth muscle cells in blood vessels. In preeclampsia, adverse conditions like hypoxia and oxidative stress result in the downregulation of ion, solute, and water transporters, impairing their function. This review focuses on membrane transporters involved in PE, discussing functional alterations and their physiological implications. The goal of this investigation is to enhance understanding of how dysregulation of ion and small molecule transporters contributes to the development and progression of preeclampsia, underscoring the importance of exploring these signaling pathways for potential therapeutic interventions. Visual representation of the location of the main ion, solute, and water transporters in placental tissue and their functions related to placentation. Alterations in the expression and/or function of these components affect the regulation of vascular tone, trophoblast invasion, cell proliferation, and water balance, contributing to PE development and progression. [Display omitted] • Changes in ion and small molecule transporters can impair normal placental function. • Ion transporters are crucial for placental function; dysfunction may contribute to PE. • Potassium transporters impact vascular tone and angiogenesis, playing a role in PE. • Sodium transporter ENaC is vital for placentation; reduced expression links to PE. • Targeting ion transporters like nAChRs may offer PE treatment options. [ABSTRACT FROM AUTHOR]

In 2020, approximately 287,000 mothers died during pregnancy or childbirth, with one of the leading causes of maternal mortality being peripartum hemorrhage. It can be treated both pharmacologically and procedurally, for example, through uterine artery ligation, embolization, or hysterectomy. In case of procedural treatment, it is essential for the medical team to familiarize themselves with the anatomical structure of the patient's uterine arteries. Various variations in the course of this vessel are distinguished, such as the uterine artery branching as a bifurcation with the inferior gluteal artery, a common trunk of the uterine artery with another vessel, or even its duplication. Using radiological techniques such as angiography, it is possible to visualize vessels and their variations, which can allow for better patient care. Unfamiliarity with the departure and trajectory of the uterine artery may be associated with an increased risk of postoperative complications, especially after hysterectomy, where the uterine arteries close at the level of the uterus or at the beginning of their departure from the internal iliac artery. Ligating them in other place may result in ischemia of an area that should be continuously supplied with blood. Also, during surgery, special attention should be paid to possible anatomical variations of the patient's uterine artery, which, although rare, can cause intraoperative complications. A thorough analysis of the departure and trajectory of the uterine artery by physicians can prevent postoperative complications and also allow for the safe conduct of embolization procedures. The following article presents a literature review on the departure and course of the uterine artery and its variations, as well as procedural interventions related to this vessel. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of different drug treatments on uterine artery blood flow parameters, serum placental growth factor (PLGF), soluble fms-like tyrosine kinase-1 (sFlt-1), and sFlt-1/PLGF in patients with recurrent spontaneous abortion and to explore the predictive value of uterine artery blood flow parameters, serum PLGF, sFlt-1, and sFlt-1/PLGF for pregnancy outcomes. Methods: This retrospective cohort study included 173 patients who experienced recurrent spontaneous abortion and 100 control patients. Patients with recurrent spontaneous abortion were divided into an aspirin group (75 patients), aspirin combined with low molecular weight heparin (LMWH) group (68 patients), and non-drug group (30 patients) based on different drug treatments. Uterine artery blood flow parameters at gestational weeks 30-31+6 were monitored for the four groups, and serum samples were collected at gestational weeks 30-31+6 to measure the levels of serum PLGF and sFlt-1 and calculate the sFlt-1/PLGF ratio. Results: 1. Uterine artery blood flow parameters at gestational weeks 30-31+6 were significantly greater in the non-drug group than in the aspirin group, combined drug group, and control group (p<0.05). 2. Serum PLGF levels and the sFlt-1/PLGF ratio at gestational weeks 30-31+6 were significantly lower in the non-drug group than in the aspirin group, combined drug group, and control group, while serum sFlt-1 levels were significantly greater in the non-drug group than in the aspirin group, combined drug group, and control group (p<0.05). 3. Serum PLGF, sFlt-1, and sFlt-1/PLGF had lower diagnostic efficiency for predicting hypertensive disorders during pregnancy than the combined diagnostic efficiency of serum PLGF, sFlt-1, and sFlt-1/PLGF with uterine artery blood flow parameters at gestational weeks 30-31+6. Conclusion: Aspirin and aspirin combined with LMWH can upregulate serum PLGF and decrease serum sFlt-1 levels in patients with recurrent spontaneous abortion, reduce the miscarriage rate, and significantly improve pregnancy outcomes. The combination of serum PLGF, sFlt-1, sFlt-1/PLGF, and uterine artery blood flow parameters can effectively predict hypertensive disorders during pregnancy. [ABSTRACT FROM AUTHOR]

Uterine arteriovenous malformation (UAM) is a rare medical condition. Even though UAM can cause abnormal and life-threatening uterine hemorrhage, there is no consensus on the clinical guideline on its treatments, most likely due to its low incidence, unknown etiology, and distinct fertility demands by different patients. Here, we present one elderly woman with uncommon UAM. We first discuss our experience regarding the diagnoses and treatments of UAM and then propose a hypothesis for the pathogenesis of UAM. [ABSTRACT FROM AUTHOR]

Background: Cesarean sections are the most common abdominal surgical interventions worldwide, with increasing rates in both developed and developing countries. Postpartum (hemorrhage PPH) during cesarean sections can lead to maternal morbidity, prolonged hospital stays, and increased mortality rates. Although various non-surgical measures have been recommended for PPH prevention, surgical techniques such as uterine artery ligation and embolization have been used to manage PPH effectively. Objective: This study aimed to evaluate the effectiveness of a surgical technique based on the temporary bilateral clamping of uterine arteries to reduce blood loss during cesarean sections. Methods: A longitudinal prospective, randomized, controlled study was conducted with a preliminary population group of 180 patients at the University Hospital Regional de Málaga from November 2023 to January 2024. The study protocol was approved by the Ethics Committee of the Regional University Hospital of Malaga (protocol 1729-N-23 and registred with ISRCTN15307819|| http://www.isrctn.org/, Date submitted 12 June 2023 ISRCTN 15307819). The patients were divided into two groups based on whether the clamping technique was applied during their cesarean sections. The study assessed hemoglobin levels before and after surgery, hospitalization durations, and the prevalence of anemia at discharge as the primary outcomes. Results: The patients who underwent the clamping technique demonstrated significant reductions in hemoglobin differences (0.80 g/dL) compared to the control group (1.42 g/dL). The technique also resulted in shorter hospital stays (3.02 days vs. 3.90 days) and a lower prevalence of anemia at discharge (76.2% vs. 60%). Conclusion: Temporary clamping of uterine arteries during cesarean sections appears to be an effective measure for preventing postpartum hemorrhaging, reducing hospital stays, and decreasing the prevalence of anemia at discharge. Further research with larger sample sizes and standardized indications is warranted to confirm the benefits and potential broader applications of this technique. Trial registration: ISRCTN 15,307,819. [ABSTRACT FROM AUTHOR]

Background: Fetal growth restriction (FGR) occurs in 10% of pregnancies worldwide. Placenta dysfunction, as one of the most common causes of FGR, is associated with various poor perinatal outcomes. The main objectives of this study were to screen potential diagnostic biomarkers for FGR and to evaluate the function of immune cell infiltration in the process of FGR. Methods: Firstly, differential expression genes (DEGs) were identified in two Gene Expression Omnibus (GEO) datasets, and gene set enrichment analysis was performed. Diagnosis-related key genes were identified by using three machine learning algorithms (least absolute shrinkage and selection operator, random forest, and support vector machine model), and the nomogram was then developed. The receiver operating characteristic curve, calibration curve, and decision curve analysis curve were used to verify the validity of the diagnostic model. Using cell-type identification by estimating relative subsets of RNA transcripts (CIBERSORT), the characteristics of immune cell infiltration in placental tissue of FGR were evaluated and the candidate key immune cells of FGR were screened. In addition, this study also validated the diagnostic efficacy of TREM1 in the real world and explored associations between TREM1 and various clinical features. Results: By overlapping the genes selected by three machine learning algorithms, four key genes were identified from 290 DEGs, and the diagnostic model based on the key genes showed good predictive performance (AUC = 0.971). The analysis of immune cell infiltration indicated that a variety of immune cells may be involved in the development of FGR, and nine candidate key immune cells of FGR were screened. Results from real-world data further validated TREM1 as an effective diagnostic biomarker (AUC = 0.894) and TREM1 expression was associated with increased uterine artery PI (UtA-PI) (pvalue = 0.029). Conclusion: Four candidate hub genes (SCD, SPINK1, TREM1, and HIST1H2BB) were identified, and the nomogram was constructed for FGR diagnosis. TREM1 was not only associated with a variety of key immune cells but also correlated with increased UtA-PI. The results of this study could provide some new clues for future research on the prediction and treatment of FGR. [ABSTRACT FROM AUTHOR]

Aim: To document the outcomes of second‐trimester induction of labor with laminaria cervical dilation followed by gemeprost vaginal tablets, with a particular emphasis on its complications. Methods: This was a single‐center retrospective cohort study of women who experienced medical abortions between 12 and 21 weeks of gestation from January 2016 to July 2021. Procedures were performed with three laminaria cervical dilation for 2 days followed by the administration of gemeprost (1 mg, vaginal tablet) every 3 h with a maximum of five tablets per day. Epidural anesthesia was provided upon request. The primary outcome was successful labor induction, which was defined as fetal expulsion without assisted surgical procedures. Other maternal outcomes, complications and related interventions during and after the procedure were assessed. Results: Among 319 women, 313 (98.1%) experienced successful labor induction with a median of one gemeprost tablet. The median blood loss during the abortion was 145 mL, and three women (0.9%) required blood transfusion. Fever was observed in 19 women (6.0%) during hospitalization, although most cases were drug fever. Thirteen women (4.1%) had abnormal uterine bleeding ~24 days after the abortion. Eleven cases (3.4%) were associated with retained products of conception, of which three cases required uterine artery embolization and three needed surgical curettage. Conclusions: Second‐trimester induction of labor with laminaria cervical dilation and subsequent gemeprost vaginal tablets is a reliable method for completing medical abortions. Abnormal uterine bleeding several weeks after abortion is suspected to be a retained product of conception that could require invasive treatment. [ABSTRACT FROM AUTHOR]

Introduction: Postpartum Haemorrhage (PPH) is one of the main causes of maternal morbidity and mortality globally, accounting for about 25% of maternal deaths. Uterine Artery Embolisation (UAE) has gained recognition as a valuable non surgical treatment option for managing PPH, providing effective haemorrhage control while maintaining fertility. Aim: To assess the effectiveness and safety of UAE in the treatment of PPH. Materials and Methods: A thorough investigation was performed using PubMed, Scopus, Science Direct and the Cochrane Library to locate studies released between 2000 and 2024. The included studies comprised Randomised Controlled Trials (RCTs), casecontrol studies, and cohort studies that assessed the efficacy of UAE for PPH. The primary outcomes assessed were clinical success rates, technical success rates, and complication rates. Secondary outcomes included fertility preservation, postpartum recovery time, and the impact on future pregnancies. Data analysis was undertaken using Review Manager 5.3, with Mean Differences (MD) and Risk Ratios (RR) calculated for continuous and dichotomous outcomes, respectively. Results: Out of 437 identified studies, 13 met the inclusion criteria for evaluating the effectiveness of UAE as a treatment for PPH. These comprised five RCTs with 1,200 participants, four case-control studies with 800 participants, and four cohort studies with 1,000 participants. The RCTs were conducted in North America, Europe, and Asia, involving women who had experienced PPH. Case-control studies compared UAE recipients to those receiving alternative treatments, considering factors like age, severity of PPH, and obstetric history. Cohort studies followed UAE recipients over time to assess long-term outcomes. The pooled technical success rate was 96% (95% CI, 94.0-98.0; I2=20.0%; p-value=0.143), and the clinical success rate was 92% (95% CI, 88.0-96.0; I2=35.6%; p-value=0.012). The complication rate was 8% (95% CI, 5.0-11.0; I2=40.1%; p-value=0.021). These findings indicate a high effectiveness and reliability of UAE for PPH treatment. The diverse study types and participant populations enhance the generalisability of these results, underscoring UAE's potential to improve outcomes for women experiencing PPH globally. Conclusion: UAE demonstrates high clinical and technical success rates with a relatively low complication rate, establishing it as a safe and effective intervention for PPH. Future studies need to look into lasting outcomes, including fertility preservation and impacts on subsequent pregnancies, to further substantiate UAE's role in PPH management. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Uterine artery embolization demonstrated significant efficacy in the treatment of utero‐cervical cancer. This minimally invasive procedure holds promise as a valuable adjunct therapy, potentially offering improved outcomes and reduced morbidity in select cases. Further research is warranted to validate its broader clinical utility. Vaginal bleeding is a common complication of Cervical cancer that can be considered a critical emergency. Conventional hemostatic treatments may occasionally help reduce the bleeding but are not an effective long‐term solution. Uterine Artery Embolization, a minimally invasive intervention, can halt the bleeding, achieving hemostasis, while removing many of the complications that alternative interventions carry. We outline a case study of a patient with extensive vaginal bleeding who had uterocervical malignancy and talk about the benefits of uterine artery embolisation for therapeutic management. [ABSTRACT FROM AUTHOR]

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality. Routine treatment of PPH includes uterotonics, tranexamic acid, curettage, uterine (balloon) tamponade, compression sutures, uterine artery ligation, and, if available, transcatheter arterial embolization (TAE). In cases of severe PPH refractory to standard medical and surgical management, hysterectomy is usually the ultima ratio, and is equally associated with a higher rate of complications. In addition, this sudden loss of fertility, especially in young women, can be devastating. Here, we report a case of a 29-year-old woman who suffered from severe PPH with a blood loss > 1500 mL and hemodynamic instability after delivery of her first baby at a smaller hospital. She was consequently successfully treated with resuscitative endovascular balloon occlusion of the aorta (REBOA) by first placing a balloon catheter into the infra-renal aorta and subsequent TAE after failure of all other available treatment options prior to hysterectomy. TAE has been suggested in PPH treatment to avoid hysterectomies and thus to preserve patients' reproductive function. If hemodynamic stabilization cannot be achieved with mass transfusion, REBOA seems to be an effective rescue strategy with which to achieve hemodynamic stabilization and gain additional time for embolization. Although REBOA is already recommended in several PPH guidelines, this approach seems relatively unknown in German-speaking countries. [ABSTRACT FROM AUTHOR]

Objective: To determine and compare pregnancy outcomes after bilateral uterine artery ligation (BUAL) or bilateral hypogastric artery ligation (BHAL) for postpartum hemorrhage (PPH). Material and Methods: This retrospective cross-sectional study was conducted from January 2010 to June 2018 at a tertiary referral hospital. Patients who had undergone arterial ligation for PPH were included in the study. Patients who had undergone BUAL and BHAL were compared with a control group in terms of fertility and pregnancy outcomes. Results: A total of 156 patients were included, of whom 47 underwent BUAl, 59 underwent BHAL and 50 were in the control group. There was no significant difference between the groups in subsequent pregnancies in terms of the incidence of miscarriage, fetal growth restriction, preeclampsia, primary cesarean deliveries, and infertility (p>0.05). There was a significant difference between all groups in gestational age at birth and birthweight. Preterm birth was observed in 32.2% of patients in the BHAL group, and this rate was significantly higher than in the BUAL (12.8%) and control (6%) groups (p=0.001). Conclusion: PPH is a life-threatening obstetric problem. The effects of interventions performed to reduce pelvic blood flow in patients may lead to persistent problems, such as preterm birth and low birth weight in the next pregnancy. However, these interventions do not appear to affect the risk of miscarriage. In subsequent pregnancies of patients who received BHAL, special attention should be paid to preterm birth. [ABSTRACT FROM AUTHOR]

Objectives: During human pregnancy, placental extravillous trophoblasts replace vascular smooth muscle and elastic tissue within the walls of the uterine spiral arteries, thereby remodeling them into distensible low‐resistance vessels to promote placental perfusion. The present study determined whether B‐flow/spatiotemporal image correlation (STIC) M‐mode ultrasonography provides an in‐vivo imaging method able to digitally quantify spiral artery luminal distensibility as a physiological index of spiral artery remodeling during the advancing stages of normal human pregnancy. Methods: A prospective, longitudinal, observational study was conducted to quantify spiral artery distensibility (i.e. vessel luminal diameter at systole minus diameter at diastole) by B‐flow/STIC M‐mode ultrasonography during the first, second and third trimesters in 290 women exhibiting a normal pregnancy. Maternal serum levels of placental growth factor (PlGF) and soluble fms‐like tyrosine kinase‐1 (sFlt‐1), growth factors that modulate important events in spiral artery remodeling, were quantified in a subset of the women in the first, second and third trimesters of pregnancy. Results: Median (interquartile range (IQR)) spiral artery distensibility increased progressively between the first (0.17 (0.14–0.21) cm), second (0.23 (0.18–0.28) cm) and third (0.26 (0.21–0.35) cm) trimesters of pregnancy (P < 0.0001 for all). Median (IQR) spiral artery volume flow increased progressively between the first (2.49 (1.38–4.99) mL/cardiac cycle), second (3.86 (2.06–6.91) mL/cardiac cycle) and third (7.79 (3.83–14.98) mL/cardiac cycle) trimesters (P < 0.001 for all). In accordance with the elevation in spiral artery distensibility, the median (IQR) ratio of serum PlGF/sFlt‐1 × 103 levels increased between the first (7.2 (4.5–10.0)), second (22.7 (18.6–42.2)) and third (56.2 (41.9–92.5)) trimesters (P < 0.001 for all). Conclusions: The present study shows that B‐flow/STIC M‐mode ultrasonography provides an in‐vivo imaging technology to quantify digitally the structural and physiological expansion of the walls of the spiral arteries during the cardiac cycle as a consequence of their transformation into compliant vessels during advancing stages of normal human pregnancy. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

The article focuses on evaluating the effectiveness of various treatment strategies for managing cesarean scar ectopic pregnancies, highlighting the high success rates of surgical options compared to medical treatments. Topics include a comparative analysis of surgical and medical treatment outcomes, the safety and success rates of different methods, and recommendations for patient counseling and shared decision-making.

This study aimed to evaluate the safety and efficacy of emergency and prophylactic uterine artery embolization (UAE) in our clinical practice, including technical success, clinical success, and associated complications. In this retrospective study, we analyzed 64 women who underwent emergency (n =18) and prophylactic (n = 46) UAE. Indications for emergency UAE included postpartum hemorrhage or severe hemorrhage during pregnancy termination, while prophylactic UAE was performed prior to surgical removal of retained products of conception (RPOC), delivery with abnormal placental implantation, or pregnancy termination (cervical pregnancy or fetal anomalies accompanied by abnormal placental implantation). Technical success of UAE was defined as complete exclusion of the vascular lesion and contrast stasis on the final angiogram, while clinical success was defined as cessation of bleeding after UAE Termination without a hysterectomy. The overall clinical success of UAE in our study was 97% (62/64). All embolization procedures were technically and clinically successful in the prophylactic group without life-threatening hemorrhages or hysterectomies (100% success rate, 46/46). However, while 100% technical success was similarly attained in the emergency group, bleeding was successfully controlled in 89% of cases (16/18). In two patients with significant blood loss (over 2000 mL), embolization failed to achieve hemostasis, resulting in persistent bleeding and subsequent hysterectomy. UAE is a safe and effective procedure for managing primary postpartum hemorrhage or severe hemorrhage during pregnancy termination and for decreasing the risk of severe hemorrhage during surgical removal of RPOC, delivery with abnormal placental implantation, or pregnancy [ABSTRACT FROM AUTHOR]

Yanyu Zhong,1,&ast; Nan Wang,1,&ast; Sihui Lu,2 Yaqian Lu,2 Xin Pan,3 Ying Zhou1 1Reproductive Medicine Centre, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China; 2Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China; 3Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ying Zhou, Reproductive Medicine Centre, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Gusu District, Suzhou, Jiangsu Province, 215008, People’s Republic of China, Tel +86-0512-67973182, Email zhouyingzzzyyy@163.com Xin Pan, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Gusu District, Suzhou, Jiangsu Province, 215008, People’s Republic of China, Tel +86-0512-67973182, Email panxinxin9@outlook.comObjective: This study aimed to analyze uterine artery and spiral artery hemodynamics in patients with unexplained recurrent pregnancy loss (URPL) with varying pregnancy outcomes.Methods: 174 pregnant women with URPL and 144 pregnant women without adverse pregnancy histories were enrolled in this retrospective study. Based on pregnancy outcomes, these patients were divided into two groups: normal pregnancy outcomes (URPL-N, n=138) and adverse pregnancy outcomes (URPL-A, n=36). Control group participants were categorized into normal pregnancy outcomes (CON-N, n=129) and adverse pregnancy outcomes (CON-A, n=15). We compared uterine artery and spiral artery hemodynamics during different stages of gestation and the predictive value of these parameters for pregnancy outcomes.Results: URPL-N group had fewer pregnancy losses and lower BMI compared to URPL-A group (P< 0.05). Spiral artery hemodynamics in URPL-N and CON-N groups were lower than those in URPL-A and CON-A groups during the mid-luteal phase, 11– 13 weeks, 15– 17 weeks, and 19– 21 weeks of gestation, respectively. Uterine artery hemodynamics ((Pulsatility index (mPI), resistive index (mRI), and systolic-to-diastolic ratio (mS/D)) in the mid-luteal period were lower in URPL-N group than URPL-A group. Similarly, in CON-N group were lower than CON-A group. The URPL-A and CON-A groups had higher uterine artery and spiral artery hemodynamics when compared to the URPL-N and CON-N groups. Spiral artery hemodynamics exhibited larger areas under the ROC curve compared to uterine artery parameters.Conclusion: Abnormal hemodynamics in these arteries may contribute to URPL and adverse pregnancy outcomes. Spiral artery hemodynamics are more reliable predictors of pregnancy outcomes than uterine artery parameters.Keywords: unexplained recurrent pregnancy loss, spiral artery, uterine artery, blood flow, pregnancy outcome

Endogenous hydrogen sulfide (H2S) produced by cystathionine β-synthase (CBS) and cystathionine-γ lyase (CSE) has emerged as a novel uterine vasodilator contributing to pregnancy-associated increases in uterine blood flow, which safeguard pregnancy health. Uterine artery (UA) H2S production is stimulated via exogenous estrogen replacement and is associated with elevated endogenous estrogens during pregnancy through the selective upregulation of CBS without altering CSE. However, how endogenous estrogens regulate uterine artery CBS expression in pregnancy is unknown. This study was conducted to test a hypothesis that endogenous estrogens selectively stimulate UA CBS expression via specific estrogen receptors (ER). Treatment with E2β (0.01 to 100 nM) stimulated CBS but not CSE mRNA in organ cultures of fresh UA rings from both NP and P (gestational day 20, GD20) rats, with greater responses to all doses of E2β tested in P vs. NP UA. ER antagonist ICI 182,780 (ICI, 1 µM) completely attenuated E2β-stimulated CBS mRNA in both NP and P rat UA. Subcutaneous injection with ICI 182,780 (0.3 mg/rat) of GD19 P rats for 24 h significantly inhibited UA CBS but not mRNA expression, consistent with reduced endothelial and smooth muscle cell CBS (but not CSE) protein. ICI did not alter mesenteric and renal artery CBS and CSE mRNA. In addition, ICI decreased endothelial nitric oxide synthase mRNA in UA but not in mesenteric or renal arteries. Thus, pregnancy-augmented UA CBS/H2S production is mediated by the actions of endogenous estrogens via specific ER in pregnant rats.

Uterine leiomyomas are one of the most common smooth muscle tumors in women. Cervical leiomyomas, in contrast, are a relatively rare entity with limited available information, presenting a challenge for determining optimal treatment. Uterine artery embolization of cervical leiomyomas has been previously explored and met with some success. However, it has been associated with complications such as expulsion or incomplete embolization. This case, however, describes a patient who presented with a large cervical fibroid and was successfully treated with bilateral ovarian artery embolization, resulting in decreased fibroid burden and resolution of the patient's symptoms. Previous reports have demonstrated successful ovarian artery embolization for uterine leiomyomas, but this approach has yet to be shown for a cervical leiomyoma. Given the challenge presented by cervical leiomyomas, this case emphasizes a unique anatomical variant and the embolization method, providing an alternative, less-invasive option for reducing patient disease burden.

We aimed to evaluate the physiological variation in common pulsed-wave Doppler (PWD) indices of impedance to determine the number of waveforms to be averaged to minimise variability to 5%. A single-centre, prospective, cross-sectional cohort study of uncomplicated singleton pregnancies at 20–37 week's gestation. From each patient 100 PWD waveforms were acquired including the umbilical artery (UA), middle cerebral artery (MCA) and uterine arteries (UtAs), with 30 waveforms acquired from the ductus venosus. Each waveform was individually measured using the machine's in-built software in automated mode. The variability was assessed using coefficient of variation. The number of waveforms to be averaged was calculated using the moving average and standard error of mean. From a cohort of 200 pregnancies, a total of 189 were analysed. The pulsatility index (PI) demonstrated greater variability compared with the resistance index (RI) in all vessels studied. A minimum of 14 UA and MCA, and 13 UtA PWD waveforms were required to reduce PI variability to 5%, while only 2 RI waveforms were required for UA, 1 for MCA and 8 for UtAs. The variability shown across all PWD indices and between vessels means that PWD indices results should be interpreted cautiously and averaged over multiple waveforms. Consideration should be given to adoption of RI, as it showed greater stability than PI for maternal-fetal Doppler. [ABSTRACT FROM AUTHOR]

Background: This study examined the improvement of dysmenorrhoea and menorrhagia after uterine artery embolisation (UAE) in women with symptomatic adenomyosis and identified factors that could predict the improvement of dysmenorrhoea and menorrhagia. Methods: This retrospective study included women with adenomyosis who underwent bilateral UAE between December 2014 and December 2016. The percentage of the volume of the absence of contrast enhancement on T1-weighted images was evaluated 5-7 days after UAE. A receiver operating characteristic (ROC) analysis was used to determine a cut-off point and predict the improvement of dysmenorrhoea and menorrhagia. Results: Forty-eight patients were included. At 24 and 36 months after UAE, the improvement rates for dysmenorrhoea and menorrhagia were 60.4% (29/48) and 85.7% (30/35), and the recurrence rates were 19.4% (7/36) and 9.1% (3/33), respectively. Only the percentage of the volume of the absence of contrast enhancement on T1-weighted images was associated with the improvement of dysmenorrhoea (p = 0.001, OR = 1.051; 95% CI: 1.02-1.08) and menorrhagia (p = 0.006, OR = 1.077; 95% CI: 1.021-1.136). When the cut-off value of the ROC analysis was 73.1%, sensitivity, specificity, positive predictive value, and negative predictive value for the improvement of dysmenorrhoea were 58.6%, 94.7%, 94.4%, and 60%, while they were 58.9%, 80%, 100%, 100%, and 45.5% for the improvement of dysmenorrhoea. Conclusion: Bilateral UAE for symptomatic adenomyosis led to good improvement of dysmenorrhoea and menorrhagia. The percentage of the volume of the absence of contrast enhancement on T1-weighted images of the uterus in postoperative magnetic resonance imaging might be associated with the improvement of dysmenorrhoea and menorrhagia. [ABSTRACT FROM AUTHOR]

Objective: To investigate the influence of different measurement conditions and ultrasound training level on uterine artery pulsatility index (UtA‐PI) measurements as required for combined first trimester preeclampsia (PE) screening. Methods: This was a prospective study of consecutive patients with singleton pregnancies presenting for an ultrasound examination between 11 and 14 weeks' gestation. UtA‐PI measurements were conducted by residents in training and repeated by experienced sonographers thereafter. UtA‐PI measurements were conducted under different examination conditions. First, the trainee sonographers performed transabdominal sagittal and transverse UtA‐PI measurements without bladder filling. These measurements were then repeated by the expert sonographers. Additionally, the expert sonographers also performed transvaginal UtA‐PI measurements and transabdominal measurements with bladder filling. Statistical analysis was conducted with the statistical software R and included descriptive statistics as well as 2‐sided paired t tests. Results: A total of 100 women were included in the study. Mean age was 31.7 ± 4.92 years and mean gestational week was 12.5 ± 0.53 weeks. A total of 56% were nulliparous and 44% were parous. UtA‐PI was significantly lower if performed by a sonographer in training versus an experienced sonographer (P =.031). No significant difference was observed in comparing transverse and sagittal techniques (P =.241). There was also no significant difference in transabominal versus transvaginal measurements (P =.806) and with an empty versus full bladder (P =.444). Conclusion: Experience of sonographer has a significant impact on UtA‐PI. Supervised onsite training is necessary to improve reliability and consistency of UtA‐PI measurements and make PE screening reliable for implementation in a universal screening setting. [ABSTRACT FROM AUTHOR]

Kun-Kun Qiang,1,2 Qing-Yun Song1,2 1Department of Diagnostic Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China; 2Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Chengdu, People’s Republic of ChinaCorrespondence: Qing-Yun Song, Department of Diagnostic Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of China, Email huaxi2chaoshengsqy@163.comIntroduction: Uterine artery pseudoaneurysm (UAP) is a rare cause of late postpartum hemorrhage. Insufficient understanding of this condition among clinicians may result in delayed diagnosis and treatment, potentially leading to incorrect interventions and poor prognosis, including fatal hemorrhage and even necessitating hysterectomy in severe cases.Case Report: The patient, a 41-year-old woman with a history of three pregnancies and two deliveries, underwent cesarean section and subsequently experienced persistent small amounts of vaginal bleeding for a duration of two months. Transvaginal ultrasonography revealed a hypoechoic mass in the cervix that was initially misdiagnosed as a cervical fibroid. Approximately 12 h prior to admission, she experienced an episode of acute vaginal bleeding of significant intensity. Emergency transvaginal ultrasound demonstrated an intrauterine mass located in the posterior wall of the cervix with swirling blood flow, exhibiting a to-and-fro pattern. The mass was connected to the left uterine artery adjacent to the cervix through a tear measuring approximately 0.5 cm in diameter. Emergency bilateral uterine artery embolization was performed. After a follow-up period of ten months, there was no recurrence of abnormal vaginal bleeding, and subsequent ultrasound examination confirmed the complete resolution of the cervical lesions.Conclusion: The findings of this case suggest that the UAP undergoes a dynamic process. In the early stages, the lesion may manifest as a small hypoechoic or anechoic area within the myometrium. Color Doppler imaging might not reveal blood flow signals within the lesion, potentially leading to misdiagnosis as other common uterine lesions such as fibroids or cysts. However, considering the close association between UAP and the uterine artery, meticulous observation of the relationship between the uterine artery and its branches is crucial for identifying myometrial lesions to facilitate early detection of UAP and minimize misdiagnosis.Keywords: uterine artery, pseudoaneurysm, postpartum hemorrhage, ultrasound, uterine artery embolization

ObjectiveTo explore the application value of uterine artery blood flow associated with multiple parameters in the diagnosis of placenta accreta spectrum disorders.MethodsThis study was a retrospective cohort study. Pregnant women diagnosed with placenta previa were selected from Beijing Obstetrics and Gynecology Hospital, Capital Medical University, from January 2017 to December 2021. The general information, past history, antenatal information[including pulsatility index(PI) of uterine artery, ultrasonic signs, etc.] and operation information of the pregnant women were obtained through the hospital electronic medical record system. According to the results of operation, the patients were divided into accreta group and non-accreta group. The diagnostic value of uterine artery PI associated with multiple parameters in the placenta accreta spectrum disorders was analysed.ResultsA total of 80 pregnant women were divided into accreta group(34 cases) and non-accreta group(46 cases) according to the inclusion and exclusion criteria. Compared with the non-accreta group, the age of pregnant women in the accreta group(P=0.017) and history of cesarean section(P < 0.001) significantly increased, and the mean PI of uterine artery significantly decreased(P=0.006). There were significant differences in ultrasonic signs such as local interruption or disappearance of the posterior placental lower vocal cords(P < 0.001), abundant blood flow after placenta(P < 0.001), and interruption or disappearance or irregularity of the boundary of the uterus and bladder(P=0.003). The area under the ROC curve of uterine artery PI, cesarean section history and ultrasonic signs in the diagnosis of placenta accreta spectrum disorders was 0.96(95% CI: 0.93-0.99), the sensitivity was 97.06%(95% CI: 91%-100%), and the specificity was 65.22%(95% CI: 51%-79%).ConclusionsUterine artery blood flow PI associated with multiple parameters has high sensitivity in the prediction of placenta accreta spectrum disorders, which is helpful in the early detection of this disease.

Abstract Aim The present study was performed to characterize and compare the perfusion of vaginal and uterine arteries after challenging the reproductive tract of dairy cows via natural mating, artificial insemination (AI), or intravaginal deposition (vaginal fundus) of different biological fluids or a placebo. Materials and methods In a double-blind study, six German Holstein cows were administered PGF2α during dioestrus and 48 h later treated with GnRH. Intravaginal or intrauterine treatments were carried out 12 h after GnRH was administered. Animals served as their controls, using a cross-over design with an interval of 14 days between experiments. The experimental animals were allocated to receive the following treatments: natural mating (N), intrauterine artificial insemination (A), intravaginal deposition (vaginal fundus) of 6 mL raw semen (R) or 6 mL seminal plasma (S), and compared to their controls [control 1: 6 mL placebo (P: physiological saline); control 2: no treatment (C)). Corresponding time intervals were chosen for the untreated control oestrus. Blood flow volume (BFV) in the uterine (u) and vaginal (v) arteries ipsilateral to the ovary bearing the preovulatory follicle was determined using transrectal Doppler sonography. Results All animals exhibited oestrus and ovulated between 30 and 36 h after GnRH. Transient increases (P 0.05). Only mating and deposition of either raw semen, seminal plasma or AI increased uBFV (P

After menstruation the uterine spiral arteries are repaired through angiogenesis. This process is tightly regulated by the paracrine communication between endometrial stromal cells (EnSCs) and endothelial cells. Any molecular aberration in these processes can lead to complications in pregnancy including miscarriage or preeclampsia (PE). Placental growth factor (PlGF) is a known contributing factor for pathological angiogenesis but the mechanisms remain poorly understood. In this study, we investigated whether PlGF contributes to pathological uterine angiogenesis by disrupting EnSCs and endothelial paracrine communication. We observed that PlGF mediates a tonicity-independent activation of nuclear factor of activated T cells 5 (NFAT5) in EnSCs. NFAT5 activated downstream targets including SGK1, HIF-1α and VEGF-A. In depth characterization of PlGF - conditioned medium (CM) from EnSCs using mass spectrometry and ELISA methods revealed low VEGF-A and an abundance of extracellular matrix organization associated proteins. Secreted factors in PlGF-CM impeded normal angiogenic cues in endothelial cells (HUVECs) by downregulating Notch-VEGF signaling. Interestingly, PlGF-CM failed to support human placental (BeWo) cell invasion through HUVEC monolayer. Inhibition of SGK1 in EnSCs improved angiogenic effects in HUVECs and promoted BeWo invasion, revealing SGK1 as a key intermediate player modulating PlGF mediated anti-angiogenic signaling. Taken together, perturbed PlGF-NFAT5-SGK1 signaling in the endometrium can contribute to pathological uterine angiogenesis by negatively regulating EnSCs-endothelial crosstalk resulting in poor quality vessels in the uterine microenvironment. Taken together the signaling may impact on normal trophoblast invasion and thus placentation and, may be associated with an increased risk of complications such as PE. [ABSTRACT FROM AUTHOR]

Objective: Analysis of serum three acyl glycerin (TAG), oxidized modified low density lipoprotein (OX-LDL) and placental growth factor (PLGF) with preeclampsia disease progression and the relationship between the risk of spontaneous abortion. Methods: A total of 120 pregnant women with preeclampsia (observation group) and 120 pregnant women with normal pregnancy test results (control group) admitted to our hospital from February 2022 to February 2023 were selected as research objects. The expression levels of serum TAG, OX-LDL and PLGF in all pregnant women were detected, and the progress of preeclampsia was recorded. More progress with stable condition group TAG,OX-LDL, serum PLGF expression level indicators and uterine artery blood flow mechanics. Using multiariable Logistic regression analysis of serum TAG, OX-LDL, PLGF and preeclampsia progression, the relationship between the receiver-operating characteristic curve (ROC) analysis of serum TAG, OX-LDL and PLGF to preeclampsia prediction to miscarry. Results: Observation group TAG, OX-LDL is higher than the control group, serum PLGF level lower than the control group, (P＜0.05). Progression group serum TAG, OX-LDL level group were higher than in a stable condition and PLGF level under stable condition group (P＜0.05). The multi-factor Logistic regression analysis, TAG, OX-LDL, serum PLGF were preeclampsia is an independent predictor of disease progression (P＜0.05). Progression group of uterine artery pulsation index (PI), resistance index (RI), systolic and diastolic blood flow velocity ratio (S/D) were greater than in a stable condition group (P＜0.05). The Pearson correlation analysis, preeclampsia pregnant uterine artery PI, RI and S/D and serum TAG, OX-LDL expression levels were positively correlated (P＜0.05), and negatively correlated to the level of PLGF (P＜0.05). According to ROC curve analysis, the AUC of serum TAG, OX-LDL combined with PLGF in predicting abortion of preeclampsia pregnant women was 0.908, which was greater than 0.648 of TAG, 0.660 of OX-LDL and 0.673 of PLGF (P＜0.05). Conclusion: Serum TAG, OX-LDL and PLGF are closely related to the progression of preeclampsia. The combined application has a certain predictive value for abortion and is worthy of clinical attention. [ABSTRACT FROM AUTHOR]

In this prospective cohort study, the effectiveness of combining second trimester maternal serum β-HCG levels with Colour Doppler ultrasound measurements is assessed. The study aims to predict pre-eclampsia and intrauterine growth restriction (IUGR) in 88 primigravidae women. Significant associations were found between elevated β-HCG levels and abnormal Doppler indices, including increased Pulsatility Index (PI) and Resistance Index (RI), with the development of pre-eclampsia and IUGR. The combined utilisation of these biomarkers greatly enhanced the accuracy of predictions, resulting in a high level of sensitivity and specificity. This indicates their potential value in regular prenatal screening. This approach has the potential to facilitate earlier interventions, which could lead to a decrease in the negative outcomes linked to these conditions. [ABSTRACT FROM AUTHOR]

Introduction- Doppler ultrasonography is used to evaluate uteroplacental circulation by analysing the systolic and diastolic waveforms. Given the ethnic and geographical differences in PIH and IUGR, it is crucial to comprehend the methods used to predict it in different populations. The aim of present study was to assess the role of level 2 doppler waveforms (at the time of anomaly scan) in assessing abnormal trophoblastic invasion and predicting adverse pregnancy outcomes in the form of PIH and IUGR. Material and methods- The present prospective study was conducted in department of obstetrics and gynaecology at SMGS Hospital among 100 pregnant females visiting the OPD during the study period of one year. As detailed level 2 anomaly scan is mandatory in our settings at 18-22 weeks, the required data on doppler study at 18-22 weeks could easily be extracted from the study patients, thus being economical on the part of patients in low resource settings.The doppler study was performed on all cases throughout the 18-22 weeks period of pregnancy and the two Indices like Pulsatility Index and Diastolic notch of uterine artery were recorded. The patients were followed up for the development of PIH and IUGR. Results- Out of 100 cases, pregnancy induced hypertension was found in 20 cases while 80 cases did not show pregnancy induced hypertension.30 cases developed IUGR and 70 remained non IUGR cases. Diastolic notch was found in 16 of PIH and 22 of nonPIH patients. 8 of PIH cases had a pulsatility index (PI) of greater than 1.71, compared to 10 of non PIH cases, which had a PI of greater than 1.71 (p=0.01). The sensitivity of diastolic notch in diagnosis of PIH was 65.3% whereas, that of PI was 53.48%. Similarly, diastolic notch was present in 19 of IUGR cases and 10 of non IUGR cases.8 of IUGR patients had PI of >1.7 and 20 of non IUGR cases had PI of > 1.7 giving the statistically significant results. Thus, second trimester doppler changes in the uterine artery has a role in prediction of IUGR too. Conclusion– Uterine artery doppler is a potentially effective method for predicting the occurrence of PIH and IUGR by examining both the pulsatility index (PI) and the presence of a diastolic notch in the uterine artery. The Doppler technique demonstrated a high level of diagnostic accuracy in detecting preeclampsia. [ABSTRACT FROM AUTHOR]

Objective: To evaluate ureteral involvement using transvaginal sonography (TVS) regarding the distortion of the course of the ureters caused by deep endometriosis (DE), which can facilitate predicting the need for ureterolysis during surgery, even in the absence of ureteral stenosis or dilatation. Methods: This is a single‐center, observational, retrospective pilot study of 88 consecutive patients who later underwent surgery for DE that used ultrasound preoperative diagnosis of ureteral medial deviation of one or both ureters between January 2019 and January 2022. At TVS, the course of the ureter was considered medialized if, in longitudinal and transversal section, any distance was detectable between the ureter and the cervix at the point where the ureter crosses the uterine artery. The primary end point was to determine sensitivity, specificity, and positive and negative predictive values of "ureteral medial deviation" diagnosed using TVS, in order to predict the need for ureterolysis. Results: Our series included 88 women with a median age of 39 (interquartile range 33–43) years. Ureteral medialization showed a relatively low false‐positive rate (10.9%), with a specificity of 89.1% (95% confidence interval [CI] 81.4%–96.7%) and a sensitivity of 86.6% (95% CI 80.3%–92.9%), along with a high positive predictive value of 93.3% (95% CI 88.4%–98.1%), and a lower negative predictive value of 79.1% (95% CI 69.8%–88.5%), respectively. Conclusions: This study introduced a new ultrasound sign with a high degree of accuracy to predict ureterolysis and this may have positive implications in the management and surgical planning of patients with ureteral endometriosis. Synopsis: Evaluation of ureteral involvement regarding the distortion of the course of the ureters by deep endometriosis, which can facilitate predicting the need for ureterolysis. [ABSTRACT FROM AUTHOR]

Background: The Doppler technique is a noninvasive method for evaluating the blood flow in the fetus and placenta. It is a potential screening tool for identifying pregnancies at higher risk of developing preeclampsia. This study aimed to identify any abnormalities in uterine artery Doppler among pregnant females between 19 and 26 weeks of gestation that may indicate potential complications like preeclampsia. Methods: The study was conducted at Zagazig University Hospital and El-Galaa Teaching Hospital, involving 150 pregnant women attending the antenatal care clinic. The participants had a gestational age between 19 and 26 weeks and were assessed and monitored using Doppler. Results: Out of the 150 pregnant patients enrolled in the study, 20 cases (13.3%) developed preeclampsia. Among these cases, 12 (8%) experienced perinatal complications, including Intrauterine fetal death (IUFD), intrauterine growth restriction (IUGR), antepartum hemorrhage, and postpartum hemorrhage. IUFD and IUGR were reported in 4 (2.7%) cases each, antepartum hemorrhage in 3 (2%) cases, and postpartum hemorrhage in 1 case (0.667%). We observed a significant increase in the mean uterine artery Resistance index (RI) and Pulsatility index (PI) in women who developed preeclampsia compared to those who did not (p<0.001). Conclusions: Uterine artery Doppler is an easy, fast, and non-invasive screening test that may add help in preeclampsia prediction. RI was a significant predictor for Uterine artery Doppler at a cutoff value of >0.58 with AUC 0.951 with 95% Sensitivity and 93.8% Specificity. PI was a significant predictor for Uterine artery Doppler at a cutoff value of >1.1 with AUC. [ABSTRACT FROM AUTHOR]

Objective: This study investigates the effects of previous vaginal deliveries and cesarean sections, as well as their repetitions, on uterine artery (UtA) Doppler parameters in subsequent pregnancies. Methods: The study included 300 healthy pregnant women between 20 and 24 weeks of gestation. Pregnant women were compared in terms of UtA Doppler parameters according to previous delivery type and number Results: Once compared according to delivery methods, UtA pulsatility index (PI), PI percentile, PI multiple of median (MoM), and systole/ diastole (S/D) values were similar in nulliparous, vaginal delivery (VD) group and cesarean delivery (CD) group (p values 0.191, 0.374, 0.284, and 0.152, respectively). UtA resistance index (RI) was significantly higher in the CD group (p=0.010). Once UtA Doppler parameters were compared according to the delivery method and repetitions, it was determined that all indices were significantly different between the groups (p=0.013 for UtA PI, p=0.041 for UtA PI percentile, p=0.016 for UtA PI MoM, p=0.001 for UtA RI, p=0.019 for UtA S/D). Regression analysis showed a statistically significant effect of parity on the UtA RI variable (p=0.007). Conclusion: Cesarean deliveries may alter UtA Doppler parameters in subsequent pregnancies, and furthermore, increasing numbers of cesarean and vaginal deliveries may impact all UtA Doppler parameters. [ABSTRACT FROM AUTHOR]

Cervical pregnancy, being the second rarest form of ectopic pregnancy after abdominal pregnancy, is a difficult clinical entity to diagnose and manage in a young primigravida with no identifiable risk factors or associated symptoms. Further, early intervention is of utmost importance owing to the deleterious complications and high mortality associated with it if not addressed to. It is also difficult to choose a particular management approach for this out of the available options. We report a case of 23-year-old primigravida with 8 weeks of gestation, asymptomatic and with no underlying risk factors, diagnosed with cervical pregnancy during a routine antenatal scan. She was successfully managed with bilateral uterine artery embolization in conjunction with systemic methotrexate followed by suction and evacuation. [ABSTRACT FROM AUTHOR]

To describe the management of uterine artery (pseudo)aneurysm, ruptured or unruptured, during pregnancy. After reporting a case about this rare pathology, a review of the literature was performed. The search was applied to PubMed databases. A total of eighteen articles met the inclusion criteria. Eighteen patients were reported. Eight (44.4 %) patients didn't have prior medical or surgical history. Fifteen (83.3 %) beneficed interventional radiology method during pregnancy including two cases (13.3 %) with repeated embolization because of recanalization of the (pseudo)aneurysm. Nine patients (50 %) beneficed a planned cesarean between 34 and 39 weeks of gestation. One (15.8 %) patient was diagnosed with fetal death before treatment of the uterine artery (pseudo)aneurysm. The decision to proceed to the treatment of the (pseudo)aneurysm must consider several factors, associated or not with a good fetal vitality and a hemodynamically stable patient. Embolization appears to be the method of choice. Mode of delivery and term remain not clear and contraindication of expulsive efforts in case of a uterine artery (pseudo)aneurysm merit further investigations. [ABSTRACT FROM AUTHOR]

Pyometra is a reproductive disease that most often affects cats which is caused by bacterial infection of the uterus. This study aims to determine the risk factors that could influence the occurrence of pyometra in cats. The study was conducted at the Four Leg Pet Care, Asa Animal Clinic, and K-5 Animal Care in Kediri regency in December 2021 to February 2022. This retrospective cohort study took secondary data for the period 2020 to 2021 as research material and found 35 cats diagnosed with pyometra. The odds ratio was calculated to analyze the associations to some factors including age, body weight, use of hormonal contraception, frequency of administration of hormonal contraception, hormonal contraceptive drugs used, dose of hormonal contraception given. Analysis of the relationship between risk factors for pyometra showed that the factors age, use of hormonal contraception, and frequency of giving hormonal contraceptives each have p values of 2.17, 2.13, and 2.13, respectively. It could be concluded that age, use of hormonal contraception, and frequency of administration of hormonal contraception influenced or had an association with the risk of pyometra in cats. [ABSTRACT FROM AUTHOR]