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ObjectiveEvaluate reduction in progressively motile sperm per high power field (HPF) in midcycle cervical mucus after intercourse with Ovaprene: an investigational monthly non-hormonal vaginal contraceptive consisting of a vaginal ring and mechanical barrier, releasing spermiostatic ferrous gluconate.Study designOpen-label, multicenter study enrolling heterosexually-active women with previous permanent contraception. Participants underwent a baseline postcoital test cycle with no device to confirm the presence of sperm, followed by one diaphragm postcoital test cycle, one Ovaprene safety cycle, and two Ovaprene postcoital test cycles. In each postcoital test cycle, participants underwent a midcycle cervical mucus evaluation to confirm an Insler score ≥10 and absence of sperm, and then returned two to four hours after vaginal intercourse for repeat cervical mucus evaluation. We considered

Prenatal and postpartum depression may be influenced by the composition of host associated microbiomes. As such, the objective of this study was to elucidate the relationship between the human gut or vaginal microbiomes in pregnancy with prenatal or postpartum depression. 140 female participants were recruited at their first prenatal visit and completed the Edinburgh Postnatal Depression Scale (EPDS) to screen for depression and anxiety, in addition the EPDS was completed one month postpartum. Vaginal and stool biospecimens were collected in the third trimester, analyzed using 16S rRNA gene sequencing, and assessed for alpha and beta diversity. Individual taxa differences and clustering using the k-medoids algorithm enabled community state type classification. Participants with higher postpartum EPDS scores had higher species richness and lower abundance of L. crispatus in the vaginal microbiota compared to those with lower EPDS scores. Participants with a higher prenatal EPDS score had lower species richness of the gut microbiome. Participants with a vaginal community state type dominated by L. iners had the highest mean prenatal EPDS scores, whereas postpartum EPDS scores were similar regardless of prenatal vaginal state type. Our small sample size and participant's self-report bias limits generalizability of results. Depression in the prenatal and postpartum period is associated with the composition and diversity of the gut and vaginal microbiomes in the third trimester of pregnancy. These results provide a foundational understanding of the microbial relationships between maternal health and depression for identifying potential therapeutic treatments. • High postpartum depression scores associated with a vaginal microbiome with less L. crispatus. • High postpartum depression scores associated with a vaginal microbiome dominated by L. iners. • High prenatal depression scores were associated with a dysbiotic gut microbiome. • Supports importance of the microbiota-gut-brain axis for mental health. • Supports emerging importance of the microbiota-vaginal-brain axis for mental health. [ABSTRACT FROM AUTHOR]

ObjectiveEvaluate safety of Ovaprene, an investigational non-hormonal vaginal contraceptive designed for monthly use.Study designOpen-label, multicenter study enrolling heterosexually-active women with previous permanent contraception who underwent assessments during five menstrual cycles: baseline postcoital test cycle, diaphragm postcoital test cycle, Ovaprene safety cycle, and two Ovaprene postcoital test cycles. Safety outcomes included treatment emergent adverse events (TEAEs), systemic laboratory findings, pelvic examinations, colposcopies, Nugent scores, determination of community state types of vaginal microbiota, and anti-Escherichia coli activity and inflammatory markers in cervicovaginal fluids.ResultsWe enrolled 38 participants. Of these, 33 used Ovaprene and completed 77 Ovaprene cycles. The most common product-related urogenital TEAEs were bacterial vaginosis (BV) and vaginal odor. The frequency of transitioning from Lactobacillus-dominated community state type to community state type IV (not Lactobacillus-dominated) was similar before Ovaprene use and afterwards. Mean Nugent scores were

Abstract Abnormal female reproductive tract microbiota are associated with gynecological disorders such as endometriosis or chronic endometritis and may affect reproductive outcomes. However, the differential diagnostic utility of the vaginal or the endometrial microbiome and the impact of important technical covariates such as the choice of hypervariable regions for 16 S rRNA sequencing remain to be characterized. The aim of this retrospective study was to compare vaginal and endometrial microbiomes in IVF patients diagnosed with implantation failure (IF) and/or recurrent pregnancy loss (RPL) and to investigate the overlap between established vaginal and endometrial microbiome classification schemes. An additional aim was to characterize to which extent the choice of V1-V2 or V2-V3 16 S rRNA sequencing schemes influences the characterization of genital microbiomes. We compared microbiome composition based on V1-V2 rRNA sequencing between matched vaginal smear and endometrial pipelle-obtained biopsy samples (n = 71); in a sub-group (n = 61), we carried out a comparison between V1-V2 and V2-V3 rRNA sequencing. Vaginal and endometrial microbiomes were found to be Lactobacillus-dominated in the majority of patients, with the most abundant Lactobacillus species typically shared between sample types of same patient. Endometrial microbiomes were found to be more diverse than vaginal microbiomes (average Shannon entropy = 1.89 v/s 0.75, p = 10−5) and bacterial species such as Corynebacterium sp., Staphylococcus sp., Prevotella sp. and Propionibacterium sp. were found to be enriched in the endometrial samples. The use of two widely used clinical classification schemes to detect microbiome dysbiosis in the reproductive tract often led to inconsistent results vaginal community state type (CST) IV, which is associated with bacterial vaginosis, was detected in 9.8% of patients; however, 31,0% of study participants had a non-Lactobacillus-dominated (NLD) endometrial microbiome associated with unfavorable reproductive outcomes. Results based on V2-V3 rRNA sequencing were generally consistent with V1-V2-based; differences were observed for a small number of species, e.g. Bifidobacterium sp., Propionibacterium sp. and Staphylococcus sp. and with respect to slightly increased detection rates of CST IV and NLD. Our study showed that endometrial microbiomes differ substantially from their vaginal counterparts, the application of a trans-cervical sampling method notwithstanding. Characterization of endometrial microbiomes may contribute to the improved detection of women with an unfavorable reproductive outcome prognosis in IVF patients..

Abstract Many species use chemical messengers to communicate a remarkable range of information. Mice appear to make particular use of chemical messengers, including effects on estrous cycling and initiation, pregnancy, aggression, stress and of course attraction. Behavioral studies have helped identify several candidate messengers, or pheromones, that mediate attraction in mice. One question is whether attractive chemical messengers induced a physical vaginal secretory response. The preparation hypothesis posits that increased vaginal secretion would lubricate and protect the vagina in response to the prospect of imminent coitus, but this has been difficult to assess experimentally, particularly in mice. We developed a rapid, sensitive, minimally invasive method of quantifying vaginal moisture in mice and used this model to test vaginal secretory responses to male bedding. We report that female mice experience an increase in vaginal moisture after exposure to male, but not female, bedding. This response is induced by either physical or airborne exposure to male urine, to preputial gland extract, and to the preputial gland-derived pheromone alpha/beta farnesenes. This vaginal response is diurnally regulated, seen only during their active phase. The response is sensitive to the estrous phase, with a clear response during estrus but not during metestrus. We conclude that mice may serve as a model for aspects of vaginal function and that this assay will be readily applicable to other small animals. The identification of a pheromone-mediated vaginal secretory response offers a window into the regulation of the vaginal environment and the neurobiology of sexual responses in mice.

Abstract Background Cervical cancer is the 2nd most common female cancer among Sri Lankan females and is almost associated with sexually transmitted cervicovaginal human papillomavirus (HPV) infection. The study objectives were to determine the prevalence of vaginal and cervical HPV infection among 35year old ever-married women and assess the validity of primary healthcare provider-collected vaginal HPV/DNA specimens as a cervical cancer screening tool to improve the coverage of the programme. Method A descriptive cross-sectional study was carried out from the 1st of September 2018 to the 31st of January 2019. Ever-married women 35 years of age in Kalutara district were the study population. Two women from each Public Health Midwife area (n = 413) were selected randomly from the relevant area eligible families register/s. HPV/DNA cervical specimen and vaginal specimen collection (n = 621) were carried out. Specimens were screened by the Cobas 4800 HPV/DNA automated Polymerase Chain Reaction (PCR) machine. Participants’ profiles were recorded by the research assistants using an interviewer-administered questionnaire. Results The overall prevalence of vaginal and cervical HPV infection was 7.08% (95% CI; 5.2-9.4%) and 6.12% (95% CI; 4.26-8.3%) respectively. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, and the kappa coefficient of the vaginal HPV/DNA screening method vs. cervical HPV/DNA screening method were 100%, 98.9%, 86.4%, 100%, 99% and 0.92 respectively. Conclusions Vaginal HPV/DNA specimen screening method can be used as a cervical cancer screening tool due to its high validity. Pilots of the feasibility should be set up before the regional or national rollout of vaginal sampling strategies.

Background & Methods: The aim of the study is to study Ultrasound evaluation of vaginal bleeding in first trimester pregnancy. All ages of the study's patients participated in a prospective, duration-based study. 306 patients admitted to our hospital with history of bleeding in the first trimester of pregnancy in whom ultrasound evaluation was done were studied. Results: In the present study, the most common transvaginal ultrasound finding was RPOC (43.46%) followed by blighted ovum (18.95%). Conclusion: USG played a very important role in the diagnosis of cause of first trimester bleeding. It can diagnose threatened abortion positively. Ectopic, threatened abortion, inevitable abortion and complete molar pregnancy are reliably diagnosed. Patient with complete abortions were accurately identified, so that unnecessary curettage was avoided with a consequent reduction in morbidity. In the present study, 18.95% had Blighted Ovum, 0.98% had Complete Mole, 3.27% had Ectopic, 10.13% had inevitable abortion, 1.96% had Mole, 10.46% had Embryonic demise, 0.65% had Fibroid, 11.11% had Missed abortion, 0.65% had Partial Mole, 0.98% had complete mole, 43.46% had RPOC, 11.76% had Threatened Abortion, 0.98% had USG Inconclusive and 0.33% had Uterine Anomaly. [ABSTRACT FROM AUTHOR]

Abnormal female reproductive tract microbiota are associated with gynecological disorders such as endometriosis or chronic endometritis and may affect reproductive outcomes. However, the differential diagnostic utility of the vaginal or the endometrial microbiome and the impact of important technical covariates such as the choice of hypervariable regions for 16 S rRNA sequencing remain to be characterized. The aim of this retrospective study was to compare vaginal and endometrial microbiomes in IVF patients diagnosed with implantation failure (IF) and/or recurrent pregnancy loss (RPL) and to investigate the overlap between established vaginal and endometrial microbiome classification schemes. An additional aim was to characterize to which extent the choice of V1-V2 or V2-V3 16 S rRNA sequencing schemes influences the characterization of genital microbiomes. We compared microbiome composition based on V1-V2 rRNA sequencing between matched vaginal smear and endometrial pipelle-obtained biopsy samples (n = 71); in a sub-group (n = 61), we carried out a comparison between V1-V2 and V2-V3 rRNA sequencing. Vaginal and endometrial microbiomes were found to be Lactobacillus-dominated in the majority of patients, with the most abundant Lactobacillus species typically shared between sample types of same patient. Endometrial microbiomes were found to be more diverse than vaginal microbiomes (average Shannon entropy = 1.89 v/s 0.75, p = 10−5) and bacterial species such as Corynebacterium sp., Staphylococcus sp., Prevotella sp. and Propionibacterium sp. were found to be enriched in the endometrial samples. The use of two widely used clinical classification schemes to detect microbiome dysbiosis in the reproductive tract often led to inconsistent results vaginal community state type (CST) IV, which is associated with bacterial vaginosis, was detected in 9.8% of patients; however, 31,0% of study participants had a non-Lactobacillus-dominated (NLD) endometrial microbiome associated with unfavorable reproductive outcomes. Results based on V2-V3 rRNA sequencing were generally consistent with V1-V2-based; differences were observed for a small number of species, e.g. Bifidobacterium sp., Propionibacterium sp. and Staphylococcus sp. and with respect to slightly increased detection rates of CST IV and NLD. Our study showed that endometrial microbiomes differ substantially from their vaginal counterparts, the application of a trans-cervical sampling method notwithstanding. Characterization of endometrial microbiomes may contribute to the improved detection of women with an unfavorable reproductive outcome prognosis in IVF patients.. [ABSTRACT FROM AUTHOR]

Introduction: Depletion of Lactobacillus species and an overgrowth of anaerobes in the vaginal tract bacterial vaginosis (BV)], is associated with non-optimal reproductive health outcomes, and increased susceptibility to sexually transmitted infections (STIs). BV is currently treated with antibiotics, although these provide suboptimal cure levels and high recurrence rates. Vaginal microbiota transplantation (VMT), the transfer of vaginal fluid from healthy donors with an optimal vaginal microbiota to a recipient with BV, has been proposed as an alternative treatment strategy. Methods: Here, we investigated knowledge and perceptions of blood donors to the concept of an optimal vaginal microbiome and VMT via the Western Cape Blood Service (WCBS) clinics in Cape Town, South Africa, by a self-administered questionnaire. Results & discussion: Analysis of responses from 106 eligible women showed that 86% (91/106) would consider donating samples. Responses significantly associated with willingness to donate vaginal samples included: (1) belief that helping others outweighs the inconvenience of donating vaginal sample (p = 1.093e−05) and (2) prior knowledge of the concept of a healthy vaginal microbiome (p = 0.001). Most potential donors (59/91; 65%) were willing to receive a VMT themselves if needed. Participants who were unwilling to donate vaginal samples (15/106; 14%) indicated that vaginal sample collection would be unpleasant and/or embarrassing. The benefits of a collaboration with WCBS for this project include the naturally altruistic nature of blood donors, the constant in-flow of donors to WCBS clinics, and the infrastructure and logistical aspects in place. Data from this observational study highlight factors affecting the willingness of blood donors to become vaginal sample donors. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions Cesarean delivery is the most common mode of delivery among extremely preterm infants but there are insufficient data regarding the best mode of delivery among extremely preterm singletons. The objective of this study was to compare the rate of death or severe neurodevelopmental impairment among extremely preterm singletons by actual mode of delivery.Observational study using prospectively collected data from 25 US medical centers. We included postnatally‐treated singletons with birth weight 401–1000 g, gestational age 22 + 0/7–26 + 6/7 weeks, without a major birth defect, born 2006–2016. Death or severe neurodevelopmental impairment (Bayley Scales of Infant Development‐3rd edition cognitive composite score<70, cerebral palsy (Gross Motor Function Classification Scale >3), bilateral blindness, or bilateral hearing loss) at 18–26 month follow‐up were compared by mode of delivery (cesarean, vaginal including vertex or breech) using propensity score analysis to adjust for baseline characteristics.There was no difference in death or severe neurodevelopmental impairment between cesarean and vaginal (vertex or breech) births (42.4% cesarean vs. 47.2% vaginal; adjusted odds ratio (aOR), 95% confidence intervals (CI); 1.03, 0.91–1.17). Both cesarean delivery (26.8% cesarean vs. 51.5% breech vaginal; aOR: 0.71; 95% CI: 0.55–0.92) and vertex vaginal delivery (28.5% vertex vaginal vs. 51.5% breech vaginal; aOR: 0.59; 95% CI: 0.45–0.76) were associated with lower mortality compared with breech vaginal delivery.Among postnatally‐treated extremely preterm singletons, there was no difference in death or severe neurodevelopmental impairment between cesarean or vaginal delivery. Both vertex vaginal and cesarean delivery were associated with lower mortality compared with breech vaginal delivery. [ABSTRACT FROM AUTHOR]

Plumbagin is a naphthoquinone from the roots of the Plumbago species and exhibits anticancer activity. Translational usage of plumbagin in biomedical sciences is restricted due to its poor solubility and bioavailability. Therefore, pH-responsive plumbagin-loaded vaginal nanoformulations with polylactic acid (PLA)–chitosan polymeric coat were fabricated by inotropic gelation technique. Among the four (F1, F2, F3, F4) nanoformulations prepared, F3 exhibited good interaction of polymers with plumbagin as evidenced by FTIR, XRD, and thermal analysis. The positive zeta potential (48.4 ± 5.57 mV), optimal size (694 ± 65.76 nm), low PDI (0.157), and good encapsulation efficiency (77.8 ± 3.62%) of F3 were significant. The indirect method of drug loading (58.35 ± 5.00%) confirmed the drug content of about 495.44 ± 5.00 µg of plumbagin in 1 mg of F3. The drug loading pattern was confirmed by TEM analysis, and the spherical morphology of the nanocomposite was confirmed by SEM analysis. F3 formulation showed 46% and 25.2% of drug release in 24 h in simulated vaginal fluid at pH 4.5 and 7 respectively with sustained release and hydrolyses of lactic acid from PLA. Among all the nanoformulations evaluated, nanoformulation F3 with promising physicochemical properties showed good antifungal and antibacterial activity against various fungal and bacterial strains. F3 exhibited potent cytotoxicity with an IC50 of 3.6 ± 0.12 µg/ml for HeLa and an IC50 of 0.81 ± 0.01 µg/ml for SiHa cells. Altogether, the nanoformulation F3 exhibited potent antimicrobial activity against vaginal infections and cytotoxicity against cervical cancer cell lines. pH-responsive vaginal nanoformulations and their biological activities [ABSTRACT FROM AUTHOR]

Many species use chemical messengers to communicate a remarkable range of information. Mice appear to make particular use of chemical messengers, including effects on estrous cycling and initiation, pregnancy, aggression, stress and of course attraction. Behavioral studies have helped identify several candidate messengers, or pheromones, that mediate attraction in mice. One question is whether attractive chemical messengers induced a physical vaginal secretory response. The preparation hypothesis posits that increased vaginal secretion would lubricate and protect the vagina in response to the prospect of imminent coitus, but this has been difficult to assess experimentally, particularly in mice. We developed a rapid, sensitive, minimally invasive method of quantifying vaginal moisture in mice and used this model to test vaginal secretory responses to male bedding. We report that female mice experience an increase in vaginal moisture after exposure to male, but not female, bedding. This response is induced by either physical or airborne exposure to male urine, to preputial gland extract, and to the preputial gland-derived pheromone alpha/beta farnesenes. This vaginal response is diurnally regulated, seen only during their active phase. The response is sensitive to the estrous phase, with a clear response during estrus but not during metestrus. We conclude that mice may serve as a model for aspects of vaginal function and that this assay will be readily applicable to other small animals. The identification of a pheromone-mediated vaginal secretory response offers a window into the regulation of the vaginal environment and the neurobiology of sexual responses in mice. [ABSTRACT FROM AUTHOR]

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Objective Combining pharmacologic agents with mechanical ripening achieves the shortest labor duration, yet there is no clear evidence on route of drug administration in obese individuals. The use of buccal misoprostol has shown greater patient acceptance but remains understudied. Our objective was to evaluate the difference in time to delivery of buccal compared with vaginal misoprostol in combination with a Foley catheter (FC) for induction of labor (IOL) in the obese population. Study Design This was a secondary analysis of a randomized controlled trial comparing identical dosages (25 μg) of buccal and vaginal misoprostol in combination with a FC. The parent trial was an institutional review board-approved, randomized clinical trial conducted from June 2019 through January 2020. Labor management was standardized among participants. Women undergoing IOL at ≥37 weeks with a singleton gestation and cervical dilation ≤2 cm were included. Body mass index (BMI, kg/m 2) was stratified. The primary outcome was time to delivery. Results A total of 215 participants were included. Demographic characteristics were similar between the three groups. Vaginal drug administration achieved a faster median time to delivery than the buccal route among patients with a body mass index greater than or equal to 30 kg/m 2 (vaginal misoprostol–FC: 21.3 hours vs. buccal misoprostol–FC: 25.2 hours, p = 0.006). There was no difference in the cesarean delivery rate between the two groups. Furthermore, patients with a BMI greater than or equal to 30 kg/m 2 receiving vaginal misoprostol delivered 1.2 times faster than women who received buccal misoprostol after censoring for cesarean delivery and adjusting for parity (hazard ratio: 1.2, 95% confidence interval: 1.1–1.7). There were no significant differences in maternal and neonatal outcomes. Conclusion We found that vaginal misoprostol was superior to buccal misoprostol when combined with a FC among individuals with a BMI greater than or equal to 30 kg/m 2. Vaginal misoprostol should be the preferred route of drug administration for term IOL in this population. Key Points Vaginal misoprostol was superior to buccal route among patients with obesity. There was no difference in the cesarean delivery rate between the two groups. Vaginal misoprostol should be the preferred route of administration among patients with obesity. [ABSTRACT FROM AUTHOR]

To provide available evidence comparing surgical outcomes of different vaginal hysterectomy (VH) techniques and devices. PubMed, Embase, and ClinicalTrials.gov databases were searched from inception to December 1, 2023, using relevant keywords. Studies comparing at least 2 surgical techniques and devices for VH were included. An arm-based random effect frequentist network meta-analysis was performed. All available surgical outcomes were evaluated. Ten randomized controlled trials and 7 observational studies were eligible reporting on 1577 women undergoing VH with different techniques and devices (50% conventional, 22.5% Ligasure, 17.3% BiClamp, and 9.2% transvaginal natural orifice transluminal endoscopic surgery [vNOTES]). All surgical techniques/devices had a comparable risk ratio (RR) in terms of intraoperative complications, but Clavien-Dindo grade III postoperative complications were significantly reduced in the vNOTES group (RR, 0.15; 95% confidence interval [CI], 0.03–0.82; I2 = 0%) compared with conventional VH. The pooled network analysis showed a lower standard mean deviation for blood loss when comparing energy-based vessel sealing technologies (Ligasure: standard mean deviation, −0.92; 95% CI, −1.47 to −0.37; BiClamp: standard mean deviation, −1.66; 95% CI, −2.77 to −0.55) with conventional VH. Total operative time, postoperative hemoglobin variation, and pain were significantly reduced only in the Ligasure group compared with conventional VH. Bilateral salpingectomy or bilateral salpingo-oophorectomy was most commonly performed in the vNOTES group (RR, 1.9; 95% CI, 1.17–3.10) compared with the conventional VH group. Modern surgical techniques/devices have the potential to improve anatomic exposure and to reduce morbidity of VH. This may drive resurgence of vaginal approach to hysterectomy. [ABSTRACT FROM AUTHOR]

The gut, urine, and vaginal microbiomes play significant roles in the pathogenesis of recurrent urinary tract infections (rUTIs). Analysis of these microbiota has shown distinct associations with urinary tract infections. Encouraging data indicate that rUTIs may be responsive to microbiome treatments such as fecal microbiota transplantation, expanding potential treatments beyond antibiotics, hydration, and behavioral interventions. If successful, these nonantibiotic therapies have the potential to increase time between rUTI episodes and reduce the prevalence of multidrug-resistant organisms. In this review, we discuss the role of the 3 microbiomes in the pathogenesis of rUTI and utilization of live biotherapeutic products as therapy for rUTI. [ABSTRACT FROM AUTHOR]

Background: Despite the rising rates of opportunistic salpingectomy at the time of surgery for non‐malignant conditions, salpingectomy is not widely adopted during vaginal hysterectomy (VH) and has not been extensively investigated. Objectives: The aim of the primary study was to determine the feasibility of bilateral opportunistic salpingectomy at the time of VH. Secondary aims included surgical outcomes, factors associated with patient selection, and the prevalence of incidental tubal malignancies. Search Strategy: In this systematic review and meta‐analysis we searched Pubmed, Embase and ClinicalTrials.gov databases from inception to September 1, 2023, using relevant keywords. Selection Criteria: Original articles with no language restriction reporting outcomes of women undergoing planned VH with opportunistic salpingectomy, were considered eligible. Studies including patients undergoing VH with and without opportunistic salpingectomy were also included. Data Collection and Analysis: The Newcastle‐Ottawa scale was used to assess quality of observational studies. DerSimonian–Laird random effects meta‐analysis was performed and pooled effect estimates and proportions with corresponding 95% confidence intervals were computed. Heterogeneity was assessed using the I2 statistic. Results: Seven observational cohort studies including 4808 women undergoing opportunistic salpingectomy at the time of VH and 10 295 patients undergoing VH alone were selected. The pooled proportion of success was 81.83 per 100 observations (95% CI: 75.35–87.54). Opportunistic salpingectomy at the time of VH, when feasible, was associated with a significant reduction in intraoperative complications (OR 0.06, 95% CI: 0.01, −0.37, P = 0.03) and total operative time (95% CI: −17.80, −1.07, P = 0.03) compared to those where it failed. Successful salpingectomy was significantly hindered by nulliparity (OR 0.12, 95% CI: −17.69, −1.21, P < 0.001) and favored by pelvic organ prolapse (OR 3.20, 95% CI: 1.35, 7.55, P = 0.008). Immunohistochemical tubal abnormalities were found in 13/579 (2.1%) patients. The overall quality of the evidence, according to the GRADE assessment, was low. Conclusion: Opportunistic salpingectomy is safe, effective, and feasible at the time of VH. Nulliparity and pelvic organ prolapse are factors potentially influencing surgical outcomes. Synopsis: Opportunistic salpingectomy is safe, effective, and feasible at the time of VH. Nulliparity and pelvic organ prolapse are factors potentially influencing surgical outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: Simple Summary: The female reproductive tract has a complex mix of microorganisms that are important for keeping the reproductive system healthy. When the balance of these microorganisms is disrupted, it may predispose to diseases. One such disease, endometritis, commonly causes fertility problems in mares and is difficult to diagnose and treat using standard tests. Although advanced DNA sequencing provides useful information about the microorganisms in the reproductive tract of mares, it is still challenging to define what a "normal" microbiota looks like. This review aims to summarize current knowledge about the microorganisms in the reproductive tract of mares, including the vagina, cervix, and uterus. It also explores factors that can affect these microorganisms, such as the stage of the estrous cycle, the types of bacteria, the season, and geographic location. The female reproductive tract microbiota is a complex community of microorganisms that might be crucial in maintaining a healthy reproductive environment. Imbalances in the bacterial community (dysbiosis) and the reduction of beneficial organisms and pathogen proliferation are associated with disease. Endometritis is a common cause of fertility problems in mares, and it is still challenging to diagnose and treat based on routine culture results of certain microorganisms. Although high-throughput sequencing studies provide helpful information regarding the composition of the reproductive tract microbiota in mares, there are still challenges in defining a "normal" microbiota. The primary objective of this literature review is to summarize the current knowledge regarding the microbiota present in the reproductive tract of mares, including the vagina, cervix, and uterus. The second objective is to describe the relevant factors that can impact the reproductive microbiota of mares, including the estrous cycle stage, the type of species (genera) investigated, season, and geographic location. The rationality of identifying the normal microbiota in the reproductive tract of a mare will likely aid in understanding the impact of the microbiota on the host's reproductive health and contribute to the treatment and prevention of equine sub and infertility issues. [ABSTRACT FROM AUTHOR]

IntroductionDepletion of Lactobacillus species and an overgrowth of anaerobes in the vaginal tract bacterial vaginosis (BV)], is associated with non-optimal reproductive health outcomes, and increased susceptibility to sexually transmitted infections (STIs). BV is currently treated with antibiotics, although these provide suboptimal cure levels and high recurrence rates. Vaginal microbiota transplantation (VMT), the transfer of vaginal fluid from healthy donors with an optimal vaginal microbiota to a recipient with BV, has been proposed as an alternative treatment strategy.MethodsHere, we investigated knowledge and perceptions of blood donors to the concept of an optimal vaginal microbiome and VMT via the Western Cape Blood Service (WCBS) clinics in Cape Town, South Africa, by a self-administered questionnaire.Results & discussionAnalysis of responses from 106 eligible women showed that 86% (91/106) would consider donating samples. Responses significantly associated with willingness to donate vaginal samples included: (1) belief that helping others outweighs the inconvenience of donating vaginal sample (p = 1.093e−05) and (2) prior knowledge of the concept of a healthy vaginal microbiome (p = 0.001). Most potential donors (59/91; 65%) were willing to receive a VMT themselves if needed. Participants who were unwilling to donate vaginal samples (15/106; 14%) indicated that vaginal sample collection would be unpleasant and/or embarrassing. The benefits of a collaboration with WCBS for this project include the naturally altruistic nature of blood donors, the constant in-flow of donors to WCBS clinics, and the infrastructure and logistical aspects in place. Data from this observational study highlight factors affecting the willingness of blood donors to become vaginal sample donors.

Background: Pelvic organ prolapse (POP) is a public health problem that influences millions of women around the globe, and it has a significant impact on the quality of life. From the FDA statement regarding the complications of using mesh implants in POP surgery to studies that have shown the benefits and side effects, we conducted a systematic review investigating the complications associated with surgical mesh implantation for POP repair. Methods: Relevant studies were identified through a comprehensive search of scientific databases. Studies evaluating the use of mesh in POP surgery and reporting on associated complications were included. Results: Among 2816 studies, 28 studies met the research criteria, with a total number of 8958 patients, revealing that in laparoscopic mesh surgery, the rate of mesh exposure was lower compared to vaginal mesh surgery, among other complications. Conclusions: Laparoscopic mesh surgery is superior as a long-term approach for POP repair compared to vaginal mesh surgery, offering lower complication rates and potentially better anatomical success. However, vaginal mesh surgery remains a valuable option for patients who are unsuitable for laparoscopy due to specific factors. Future research should explore alternative techniques, like pectopexy with or without mesh, to further improve surgical outcomes and patient experience. [ABSTRACT FROM AUTHOR]

• In this work, we suggested a computerized decision-making process for deciding on the best birthing style. • A deep neural network model (DNN) was developed by using train set with h2o package. The model was selected on the basis of AUC (Area Under the Curve) & KS (Kolmogorov-Smirnov) score. The AUC, KS score for train set were 0.99, 0.98 respectively. • The prediction error rates for caeseraen & vaginal classes in train data are 0.02 & 0.00 respectively. • The results support the use of these algorithms in the creation of a clinical decision system to help gynecologists choose the most appropriate delivery method. One of the factors that worry obstetricians the most is the method of delivery. In recent years, the rate of caesarean sections has steadily climbed and now exceeds the threshold advised by medical organizations. Obstetricians typically lack the tools they need to assess whether vaginal delivery or a caesarean delivery is more appropriate. In this work, we suggested a computerized decision-making process for deciding on the best birthing style. The data was collected from 101 pregnant subjects who were admitted to hospital in eastern India for delivery from January 2021 to September 2021.The data set had 101 instances & 11 variables. The response was a binary variable with "caesarean" & "vaginal" as the outputs. A deep neural network model (DNN) was developed by using train set with h2o package. The model was selected on the basis of AUC (Area under the Curve) & KS (Kolmogorov-Smirnov) score. The AUC, KS score for train set were 0.99, 0.98 respectively. The prediction error rates for caeseraen & vaginal classes in train data are 0.02 & 0.00 respectively. The results support the use of these algorithms in the creation of a clinical decision system to help gynaecologists choose the most appropriate delivery method. [ABSTRACT FROM AUTHOR]

Vaginal lactobacilli protect against bacterial vaginosis and vaginal candidiasis. They may have probiotic properties and help maintain the balance and health of the vaginal ecosystem while the loss of these bacteria predisposes females to urinary and genital infections. The aim of this study was to investigate the probiotic potential of vaginal Lactobacillus among healthy females in northern Iran. The Lactobacillus strains were isolated from vaginal samples and were identified by sequencing of the 16S rRNA fragment. Functional properties such as tolerance to low pH, H2O2 production, adherence ability to Hela cells and antagonistic activity against Candida albicans was examined. A total of 38 vaginal lactobacilli strains from five species, including Lactobacillus crispatus (n = 13), Lactobacillus gasseri (n = 10), Lactobacillus acidophilus (n = 6), Lactobacillus jensenii (n = 5) and Lactobacillus johnsonii (n = 4), were identified. All of the species showed significant tolerance to low pH over 24 h (p < 0.001). The best adherence ability to Hela cells was seen in Lactobacillus gasseri strains. Nearly 17 of the strains had higher anti-candida activity compared to the other strains. According to the findings, four lactobacilli strains isolated in the vaginal samples of healthy Iranian women had the best probiotic potential. [ABSTRACT FROM AUTHOR]

Aims: Women of advanced age may choose between restorative or obliterative surgery for surgical management of pelvic organ prolapse. Obliterative surgery is traditionally reserved for a subset of older women with more severe medical comorbidities, since obliterative approaches are generally considered to be less morbid and older individuals have higher rates of perioperative complications than younger cohorts. This study compared perioperative complications amongst octogenarians undergoing obliterative versus reconstructive approaches. This data will help to inform perioperative counselling as previous studies have not been powered to evaluate complications in this population. Methods: The National Surgical Quality Improvement Program database was used to identify patients that had Pelvic organ prolapse surgery between 2012 and 2021, aged 80 years or older. Single‐compartment procedures, vaginal mesh procedures, and oncologic surgery were excluded. The primary outcome was any complication within the first 30 days excluding urinary tract infection (UTI). UTI, readmission, and severe complications were secondary outcomes. Results: Of the 4149 patients identified, 2514 (60.6%) underwent reconstructive surgery and 1635 (39.4%) underwent obliterative surgery. Patients undergoing reconstructive surgery were more likely to have an American Society of Anesthesiologists (ASA) class of 1 or 2 (46.1% vs. 31.3%, p = 0.002) and were less likely to be on antihypertensive medication (72.0% vs. 75.8%, p = 0.006). Further, there was an increased length of stay (1.47 ± 1.84 vs. 1.03 ± 1.31 days, p < 0.001) in hospital for reconstructive surgery which was more often performed as an inpatient (45.7% vs. 37.9%, p < 0.001). There was no difference in the primary outcome: any complication excluding UTIs. However, UTI was more common in the reconstructive group (aOR 0.48; 95% confidence interval 0.34−0.0). The rate of serious complications (Clavien‐Dindo Class IV) was low overall and not different between reconstructive and obliterative approaches (1.3% vs. 1.0%, respectively). Conclusions: Both vaginal reconstructive and obliterative approaches have low complication rates in octogenarians, with only UTI rate being different between cohorts. When choosing surgical approach, we suggest a case‐based, patient center discussion on the anatomic outcomes, durability and patient satisfaction. [ABSTRACT FROM AUTHOR]

Introduction: Brucella abortus is the causative agent of brucellosis in cattle and in humans, resulting in economic losses in the agricultural sector and representing a major threat to public health. Elk populations in the American Northwest are reservoirs for this bacterium and transmit the agent to domestic cattle herds. One potential strategy to mitigate the transmission of brucellosis by elk is vaccination of elk populations against B. abortus; however, elk appear to be immunologically distinct from cattle in their responses to current vaccination strategies. The differences in host response to B. abortus between cattle and elk could be attributed to differences between the cattle and elk innate and adaptive immune responses. Because species-specific interactions between the host microbiome and the immune system are also known to affect immunity, we sought to investigate interactions between the elk microbiome and B. abortus infection and vaccination. Methods: We analyzed the fecal and vaginal microbial communities of B. abortus-vaccinated and unvaccinated elk which were challenged with B. abortus during the periparturient period. Results: We observed that the elk fecal and vaginal microbiota are similar to those of other ruminants, and these microbial communities were affected both by time of sampling and by vaccination status. Notably, we observed that taxa representing ruminant reproductive tract pathogens tended to increase in abundance in the elk vaginal microbiome following parturition. Furthermore, many of these taxa differed significantly in abundance depending on vaccination status, indicating that vaccination against B. abortus affects the elk vaginal microbiota with potential implications for animal reproductive health. Discussion: This study is the first to analyze the vaginal microbiota of any species of the genus Cervus and is also the first to assess the effects of B. abortus vaccination and challenge on the vaginal microbiome. [ABSTRACT FROM AUTHOR]

Objectives: The changes of the extracellular matrix of the connective tissue have significantly contributed to the incidence of pelvic organ prolapse (POP). It seems reasonable that sonoelastography could be a useful tool to evaluate the elasticity of pelvic floor tissue in patients with POP and compare it to those without POP. The main aim of this pilot study was to determine if there are differences in the elasticity of the levator ani muscle (LAM) and vaginal tissue between patients with and without POP. Methods: Prospective observation study, including 60 patients (30 with POP and 30 without POP). Sonoelastography was performed to evaluate the elasticity (in kilopascals, kPa) of the following regions of interest: vagina at the level of middle third of the urethra; vagina at the level of the bladder trigone; vagina in the anterior and posterior fornix; vagina at the level of middle third of the anorectal canal; posterior third of the LAM. Results: A total of 60 patients completed the study (30 with POP, 30 without POP). In the POP group, 18/30 (60%) had an anterior vaginal wall prolapse, 3/30 (10%) a uterine prolapse, 15/30 (50%) a rectocele, and 6/30 (20%) a enterocele. Patients with POP had higher elasticity in all anatomical study areas, with statistically significant differences in the anterior fornix (13.6 vs 11.2 kPa; P:.012). A multiple regression (controlling age, menopausal stage, and parity) allowed to detect statistically significant differences in the elasticity of the middle third of the urethra (P:.03) and the middle third of the anorectal canal (P:.019). Conclusion: It is possible to evaluate the elasticity of the LAM and vaginal tissue using sonoelastography, detecting a higher elasticity in patients with POP than in those without POP. [ABSTRACT FROM AUTHOR]

Objective: This article provides a systematic approach to performing a vaginal natural-orifice transluminal endoscopic surgery (vNOTES) sacrocolpopexy (SCP) to create an anatomically aligned vaginal axis, an intraoperatively adjustable apical suspension, and variable compartment tensioning. Methods: The technique presented for vNOTES SCP focuses on: (1) retroperitoneal tunneling; (2) direct sacrum access below the S-1 level, using uterosacral-ligament guidance; (3) transvaginal tensioning of the mesh to ensure both adequate vaginal length and cuff elevation using the DZOH apical-suspension technique; (4) circumvention of intrapelvic laparoscopic suturing; and (5) near-total peritoneal coverage of the mesh arms. Results: This detailed description of a successful novel technique to perform vNOTES SCP was based on cadaveric experience as well as in live patients that is reproducible on living patients. Conclusions: This apical suspension technique for vNOTES SCP may be a viable, reproducible, safe, and efficient transvaginal alternative to the commonly practiced minimally invasive approaches that involve abdominal-port placements. (J GYNECOL SURG 40:116) [ABSTRACT FROM AUTHOR]

Objective: To study the guiding significance of medical history on laparoscopic and vaginal cervical cerclage in the treatment of cervical incompetence and its influence on pregnancy outcome. Methods: A total of 53 cases by laparoscopic abdominal cervical cerclage (LAC group) before pregnancy and 73 cases by transvaginal cervix cerclage (TVC group) at 12–14 weeks of pregnancy were collected. Multivariate logistic regression analysis was performed on the influencing factors of delivery gestational weeks. Furthermore, the gestational weeks after cervical cerclage were compared between the two groups with high- and low-risk grades. Results: The number of previous uterine cavity operations in LAC group was more than that TVC group, and the costs of operation were more than TVC group. At the same time, the hospitalization days and operation time were longer than those in TVC group, and the delivery rate of cesarean section was higher than TVC group, but the total hospitalization times were less than TVC group (P < 0.05). The rate of delivery before 34 weeks of pregnancy and the incidence of premature rupture of membranes or premature labor in LAC group were lower than those in TVC group (P < 0.05). In TVC group, the increased number of prior PTB or STL and the history of cervical cerclage failure would increase the risk of premature delivery before 34 weeks of pregnancy. There was no increased risk of preterm delivery before 34 weeks of pregnancy in LAC group (P > 0.05). According to the risk level, in the high-risk group, the delivery rate of LAC group at gestational weeks < 37 weeks, < 34 weeks and < 28 weeks was lower than that of TVC group. Conclusion: Laparoscopic cervical cerclage might be more effective in preventing premature delivery before 34 weeks of gestation, and its influence on delivery gestational weeks was not affected by related medical history. For high-risk patients with the history of prior PTB or STL and failed cerclage, laparoscopic cervical cerclage might be more effective than vaginal cervical cerclage in preventing extremely preterm before 28 weeks, premature delivery before 34 weeks and premature delivery before 37 weeks. Therefore, our limited experience suggested that LAC can be a recommended option for patients with high-risk history. [ABSTRACT FROM AUTHOR]

Maternal asthma status, prenatal exposures, and infant gut microbiota perturbation are associated with heightened risk of atopy and asthma risk in childhood, observations hypothetically linked by intergenerational microbial transmission. Using maternal vaginal (n = 184) and paired infant stool (n = 172) samples, we identify four compositionally and functionally distinct Lactobacillus-dominated vaginal microbiota clusters (VCs) that relate to prenatal maternal health and exposures and infant serum immunoglobulin E (IgE) status at 1 year. Variance in bacteria shared between mother and infant pairs relate to VCs, maternal allergy/asthma status, and infant IgE levels. Heritable bacterial gene pathways associated with infant IgE include fatty acid synthesis and histamine and tryptophan degradation. In vitro, vertically transmitted Lactobacillus jensenii strains induce immunosuppressive phenotypes on human antigen-presenting cells. Murine supplementation with L. jensenii reduces lung eosinophils, neutrophilic expansion, and the proportion of interleukin-4 (IL-4)+ CD4+ T cells. Thus, bacterial and atopy heritability are intimately linked, suggesting a microbial component of intergenerational disease transmission.

Introduction: Endometritis and wound infection after caesarean section is the most common complication of caesarean section and is associated with many problems and complications. The present study was conducted with aim to determining the effect of vaginal washing with chlorhexidine before cesarean section on endometritis and wound infection after cesarean section. Methods: This randomized clinical trial study with a control group was conducted in 2021-2022 on 320 patients with indications for cesarean section referred to the Kowsar Hospital in Qazvin, Iran. Before cesarean section, the patients were divided into two groups of test (vaginal prep with chlorhexidine) and control (vaginal prep with normal saline serum). During the first 10 days after cesarean section, the patients were examined for symptoms of endometritis and abdominal incision site infection. Data analysis was done using SPSS statistical software (version 25) and independent t-tests, Mann-Whitney, Chi-square and Fisher's exact test. P0.05). Conclusion: The vaginal preparation with chlorhexidine had positive effects in reducing the incidence of infection and endometritis. Therefore, it is recommended to do the vaginal preparation with chlorhexidine in addition to routine abdominal washing to prevent infections after cesarean section.

One in three women will experience pelvic floor disorders in her lifetime and nearly 60 percent of postmenopausal women are affected by vaginal dryness. Conservative management is recommended as first line treatment for pelvic organ prolapse and stress urinary incontinence. Also, vaginal estrogens are often prescribed for symptomatic vaginal atrophy. Lasers have been used in cosmetic industry for connective tissue remodeling and repair of skin. Their use in the last decade for treating genitourinary symptoms of menopause, pelvic organ prolapse and stress urinary incontinence has gained popularity but there is lack of robust evidence to support its use in routine practice. The European Board and College of Obstetrics and Gynaecology calls for high quality evidence with patient related outcome measures before adopting to routine clinical practice. [ABSTRACT FROM AUTHOR]

Abstract Objective To evaluate the clinical effectiveness and pregnancy rate after hysteroscopic resection (HR) and/or vaginal repair (VR) in patients with cesarean scar defect (CSD). Methods This prospective observational study enrolled 191 patients who received CSD surgery in the First affiliated hospital of Sun Yat-sen University between September 2019 to February 2022 (96 in HR and 95 in VR, respectively). Patient follow-up were performed three months after surgery in both groups by transvaginal ultrasound to confirm the presence of fluid in the niche, along with the resolution of prolonged menses at the same time. The primary outcome was the clinical effectiveness between HR and VR, identified by the resolution of prolonged menses. Results The rates of niche-fluid disappearance (70.1% vs 60.2%, P = 0.176) and prolonged menses resolution (74.8% vs 80.0%, P = 0.341) were comparable for HR and VR. A subgroup analysis for niche size revealed that HR provides patients with small niche a more favorable rate of menstrual resolution compared to VR (size of niche ≤ 15 mm2, aOR = 3.423, 95% confidence interval [CI] 1.073–10.918), but patients with large niche experience a lower rate of resolution compared to VR (size of niche > 25 mm2, aOR = 0.286, 95% CI 0.087- 0.938). During follow-up, 41 patients who wanted to conceive became pregnant. Kaplan–Meier estimates of the cumulative probability of pregnancy at 12 months and 24 months were 47.1% (95% CI: 34.5%, 58.8%) and 63.8% (95% CI: 52.5%, 72.9%), respectively. The median pregnancy time was 22 months (95% CI: 14.2, 29.8) after VR and 12 months (95% CI: 8.3, 15.7, Gehan-Breslow-Wilcoxon P = 0.021) after HR. Among patients with subsequent infertility, 31.6% achieved pregnancy by unassisted mode and 29.8% by IVF/ICSI. Moreover, among patients with previously failed IVF/ICSI treatment, 60% (12/20) obtained pregnancy, including 71.4% (10/14) after HR and 33.3% (2/6) after VR. Conclusions Hysteroscopic resection is as effective as vaginal repair at relieving symptoms of CSD-associated prolonged menses. Hysteroscopic resection is the modality of choice with an improvement in prolonged menses for small niche, while vaginal might be considered for a large niche. Furthermore, surgical intervention could improve the clinical pregnancy rate of CSD patients. All of these provide evidence for the individualized management of CSD.

Objective: To investigate the vaginal and gut microbes changes during the carcinogenesis of cervical and the auxiliary diagnostic value. To investigate the effect of microbiome-specific metabolites butyric on cervical cancer cells. Methods: We studied 416 vaginal 16S rRNA sequencing data and 116 gut sequencing data. Reads were processed using VSEARCH. We used Shannon index, Chao1 index, Simpson diversity index, β diversity index, Linear discriminant analysis Effect Size (LEfSe), co-abundance network and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis to explore microbiome differences between groups. We constructed random forest models based on genus and verified its discriminant effect. Finally, we used the cell counting kit-8 (CCK-8) method to detect cell proliferation capacity and flow cytometry to detect apoptosis and induction of cell cycle progression. Results: Compared to the non-cancerous population, patients with cervical cancer had unique microbial community characteristics in both vaginal and gut ecological niches. Our predictive model based on genus in two ecological regions achieved high accuracy in the diagnosis of cervical cancer (vaginal model AUC=91.58 %; gut model AUC=99.95 %). Butyric inhibited cervical cancer cell proliferation in a concentration-dependent manner and promoted apoptosis of cancer cells. Conclusion: Significant differences were found in vaginal and gut microbes in patients with cervical cancer compared to the non-cancerous population. The prediction models constructed at the genus level in both ecological sites have good diagnostic value. Microorganisms may be involved in cervical cancer progression in a metabolite-dependent way, and targeting butyric may provide therapeutic options for cervical cancer.

Hydrogels are hydrophilic, three-dimensional, cross-linked polymers that absorb significant amounts of biological fluids or water. Hydrogels possess several favorable properties, including flexibility, stimulus-responsiveness, versatility, and structural composition. They can be categorized according to their sources, synthesis route, response to stimulus, and application. Controlling the cross-link density matrix and the hydrogels' attraction to water while they're swelling makes it easy to change their porous structure, which makes them ideal for drug delivery. Hydrogel in drug delivery can be achieved by various routes involving injectable, oral, buccal, vaginal, ocular, and transdermal administration routes. The hydrogel market is expected to grow from its 2019 valuation of USD 22.1 billion to USD 31.4 billion by 2027. Commercial hydrogels are helpful for various drug delivery applications, such as transdermal patches with controlled release characteristics, stimuli-responsive hydrogels for oral administration, and localized delivery via parenteral means. Here, we are mainly focused on the commercial hydrogel products used for drug delivery based on the described route of administration. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of non‐ablative vaginal Er:YAG laser device in stress urinary incontinence (SUI) treatment. Methods: We conducted a multicenter blinded randomized sham‐controlled trial in which women with urodynamic SUI were randomization to active arm using Er:YAG laser therapy, and sham arm using sham handpiece. Patients received two treatments 1 month apart. The primary outcomes measure was 1 h pad weight test measured at 6 months. Secondary outcomes were durability of treatment success at 12 months, and questionnaires for assessment of SUI severity (ICIQ‐UI SF), sexual function (PISQ‐12) and HRQoL (KHQ), and incidence and severity of device related adverse events and pain (VAS). Results: A total of 110 participants with SUI were recruited; 73 in the active arm and 37 in the sham arm. Two participants were excluded; one was assigned the wrong treatment and one withdrew their consent. Treatment success was observed in 36% of the sham arm and 59% of the active arm; in the latter, odds of achieving treatment success were more than three‐fold higher (OR 3.63, 95% CI: 1.3–11.2, P = 0.02). HRQoL by KHQ showed significant improvement in the active versus the sham arm (OR 0.36, 95% CI: 0.15–0.87, P = 0.003). Similarly, subjective patient assessment of general and sexual function improvement with PISQ‐12 and PGI‐I showed superior effect over sham (OR 2.8, 95% CI: 1.2–7.0, P = 0.02 and OR 0.13, 95% CI: 0.05–0.36, P < 0.001, respectively). Conclusion: Non‐ablative vaginal Er:YAG laser therapy significantly improves SUI symptoms versus sham treatment. Er:YAG laser therapy should be considered as a non‐surgical treatment option for SUI patients. Non‐ablative vaginal Er:YAG laser therapy significantly improves SUI symptoms versus sham treatment. [ABSTRACT FROM AUTHOR]

This study aimed to assess the prevalence of Staphylococcus aureus and Enterococcus sp. among pregnant women who visit the General Hospital in Delta Central Senatorial District, Nigeria. Samples were collected from the vaginal and rectum areas of pregnant women attending the General Hospitals of Abraka, Oghara, Udu, Ughelli North and Ughelli South. Bacteriological and biochemical analyses were conducted to isolate, characterize, and identify the bacteria. Two types of bacteria were found; Enterococcus sp. and Staphylococcus sp. The study result showed that Staphylococcus aureus (13.7%) was more prevalent than other isolates and was found in samples obtained from Udu General Hospital. In comparison, Ughelli South General Hospital had the lowest prevalence for S. aureus (7.9%). Samples from Oghara General Hospital had the highest prevalence for Enterococcus sp. (3.7%) while the lowest prevalence for Enterococcus sp. (1.1%) was obtained from Ughelli South General Hospital. S. aureus (51.6%) was found to be the most prevalent bacterium, while Enterococcus sp. (11.1%) was the least prevalent. The bacterial load from the vaginal swab samples was higher than that of rectum swab samples, which suggests that pregnant women attending these hospitals may have infections. The total bacterial count among pregnant women was highest in samples obtained from Udu General Hospital (5.4±0.5), followed by Abraka (5.0±0.6), Oghara (4.8±0.2), and Ughelli North (4.5±0.15), and while the least count was recorded from samples obtained from Ughelli South General Hospital (3.0±0.2). This study helps manage and plan future medical treatments. Pregnant women should be screened early in their pregnancies, between the 12th and 16th weeks, which is the second trimester, and treated appropriately to avoid complications that arise from untreated infections. [ABSTRACT FROM AUTHOR]

Background & Objective: The purpose of this study was to compare the effectiveness of Buccal, Vaginal, and Sublingual misoprostol for induction of labor in term pregnancy. Materials & Methods: The research was done as an RCT from 2017 to 2018. About 300 participants were randomly allocated to obtain 50 µg Buccal, 25 µg Vaginal, and 50 µg Sublingual misoprostol in Kosar Hospital, Qazvin, Iran. The maternal and fetal complications, Bishop score hour 1, and hour 6 were observed. Results: There were no differences between fetal complications (P>0.05) and maternal complications (P>0.05) among the three groups. Bishop score hour 1 (P = 0.146), Bishop Score hour 6 (P = 0.704), and total dose (P = 0.15) also were no differences among these groups. Our study found a difference between the three groups (P = 0.015) in achieving standard vaginal delivery within 24 hours, as Buccal, Sublingual and Vaginal groups were performed respectively. The use of Oxytocin in the Buccal group was higher than that of other groups (P = 0.022). Conclusion: This study found that there is no difference in terms of fetal complications and maternal complications in the three groups, but there was a significant difference in Oxytocin use and vaginal delivery within 24 h from the start of induction. [ABSTRACT FROM AUTHOR]

Objective: Vaginal douching is practiced by women for various reasons. Studies have shown that this practice can upset the normal vaginal flora, increasing susceptibility to certain sexually transmitted diseases (STIs). This study aimed to assess the health risks associated with this practice among women aged 15–54 years in a densely populated community in Kumasi, the second capital city of Ghana. Methods: A cross‐sectional survey was conducted to gather data on the prevalence of vaginal douching among young women and their beliefs, motivations, and knowledge about the practice. A structured questionnaire was used in recruiting participants. One‐hundred and fifteen structured questionnaires were administered to women aged between 15 and 54 after their consent was sought. Results: The study established that more than half of the participants (69.6%) engaged in douching with a midpoint of 19.5. The study indicated no significant difference between the age of participants and douching (p < 0.93). However, there was an indication of a significant association between educational status, marital status, and perception in relation to douching (p < 0.003, 0.0015, and 0.00, respectively), which also influenced the frequency of douching and contraction of STIs. Conclusion: Most women in the study community recruited, regardless of their educational and marital status, believed that douching is necessary and considered part of feminine hygiene practices. Practicing douching may lead to most health complications including pelvic inflammatory disease and infertility which must be given serious attention by researchers, health personnel, and various women's groups. [ABSTRACT FROM AUTHOR]

This study aimed to design a new Benzydamine HCl (BNZ) suppo-sponge for controlled, mucoadhesive dosage form for vaginal candidiasis treatment, offering advantages over traditional creams, ointments, or gels. BNZ-loaded suppo-sponges were fabricated by simple casting / freeze-drying technique utilizing the cross-linking of chitosan (Cs) with vanillin (V). Vaginal suppo-sponges were prepared based on different vanillin cross-linking ratios (V).n), from 0 to 2%w/w. To best of our knowledge, this is the first study that uses Schiff's base between chitosan and vanillin as a drug delivery system to treat fungal vaginal infections. Schiff's base formation was confirmed by FT-IR. In-vitro appraisal showed acceptable physical and mechanical characteristics. Formulations based on cross-linking of Cs with V showed a more pronounced in-vitro antifungal activity. In-vitro drug release revealed a prolonged release pattern, becoming more noticeable with the higher cross-linked suppo-sponges (22.34% after 8 h). In-vivo testing of CsV2 suppo-sponge indicated a more pronounced reduction in fungal count than both CsV0 and Tantum® Rosa in the first week, with a peak reduction on day 7 and the 10th and 11th days of the second week. Conclusively, Chitosan/vanillin suppo-sponges represent a promising delivery system for drugs intended for local treatment of vaginal candidiasis. than both CsV0 and Tantum® Rosa in the first week, with a peak reduction on day 7 and the 10th and 11th days of the second week. Conclusively, Chitosan/vanillin suppo-sponges represent a promising delivery system for drugs intended for local treatment of vaginal candidiasis. [ABSTRACT FROM AUTHOR]

Introduction: Endometritis and wound infection after caesarean section is the most common complication of caesarean section and is associated with many problems and complications. The present study was conducted with aim to determining the effect of vaginal washing with chlorhexidine before cesarean section on endometritis and wound infection after cesarean section. Methods: This randomized clinical trial study with a control group was conducted in 2021-2022 on 320 patients with indications for cesarean section referred to the Kowsar Hospital in Qazvin, Iran. Before cesarean section, the patients were divided into two groups of test (vaginal prep with chlorhexidine) and control (vaginal prep with normal saline serum). During the first 10 days after cesarean section, the patients were examined for symptoms of endometritis and abdominal incision site infection. Data analysis was done using SPSS statistical software (version 25) and independent t-tests, Mann-Whitney, Chi-square and Fisher's exact test. P<0.05 was considered significant. Results: Vaginal preparation with chlorhexidine has reduced the incidence of infection in the test group (P<0.05). Although the vaginal preparation with chlorhexidine in the case group decreased the incidence of endometritis compared to the control group, this difference was not significant (P>0.05). Conclusion: The vaginal preparation with chlorhexidine had positive effects in reducing the incidence of infection and endometritis. Therefore, it is recommended to do the vaginal preparation with chlorhexidine in addition to routine abdominal washing to prevent infections after cesarean section. [ABSTRACT FROM AUTHOR]

To evaluate the use, outcomes and toxicities of high dose rate brachytherapy (HDRB) to the vulvovaginal region in previously irradiated and radiotherapy-naïve patients for primary or recurrent gynaecological malignancies. From January 2010 to December 2020, 94 women with a median age of 64 years (range 31–88 years) were treated with interstitial HDRB for vulvovaginal disease. Treatment details, including cumulative radiotherapy doses, were recorded together with reported toxicity, using Common Terminology Criteria for Adverse Events (CTCAE) grading. Dosimetric parameters, including D90, V100 and V150 together with treatment response at 3 months, overall survival, relapse-free survival and long-term toxicity data, were collated from referring centres. The median follow-up was 78 months (range 2–301). Primary sites of disease included vagina (37), endometrium (29), vulva (16), ovary (7) and cervix (5). Eighty-six (91.5%) patients were treated with curative intent, eight (8.5%) were palliative treatments. Fifty patients received HDRB for recurrent disease, 39 patients for primary disease and five as part of adjuvant treatment. The anatomical site of disease treated with HDRB ranged from vagina (76), vulva (14) and peri-urethral sites (four). The 2- and 5-year local relapse-free survival rates were 76% and 72%, respectively; 15 patients experienced local failure only, whereas six patients had local and nodal/distant failure. The median time to local recurrence was 8 months (range 2–88 months). The 2- and 5-year overall survival rates for all patients were 67% and 47%, respectively; the median overall survival was 59 months. Seventy-nine (84%) patients had a complete response measured with imaging at 3 months. Grade 3 toxicity was reported in 14 patients (14.8%). This retrospective series suggests the use of interstitial brachytherapy for vulvovaginal gynaecological malignancy to be an effective and safe treatment option. Good local control was achieved with a tolerable toxicity profile; it is a valuable treatment modality. • High dose rate interstitial brachytherapy is used in the treatment of gynaecological tumours affecting the vulvovaginal region. • Good locoregional control and tolerable toxicities are achievable with interstitial brachytherapy. • A complete treatment response at 3 months will often be sustained. [ABSTRACT FROM AUTHOR]

Background and Objectives: Preterm birth is a significant concern in obstetrics and neonatology since preterm neonates are at higher risk of various health complications and may require specialized care. The optimal mode of delivery in preterm birth is a matter of debate. This study aimed to evaluate the mode of delivery in preterm neonates and the associated neonatal outcomes. Material and Methods: This was a retrospective cohort study including all preterm neonates born between January 2010 and December 2020 at the 3rd Department of Obstetrics & Gynecology of Aristotle University of Thessaloniki, Greece. The mode of delivery in relation to gestational age groups and the cause of preterm birth were analyzed. Neonatal outcomes were also evaluated according to gestational age, indication and mode of delivery. Results: A total of 1167 preterm neonates were included in the study; the majority of them were delivered via cesarean section (76.1%). Most of the preterm neonates (n = 715; 61.3%) were delivered at 32+0–36+6 weeks, while cesarean section was the most common mode of delivery after 28+0 weeks. Furthermore, spontaneous onset of labor (OR: 6.038; 95% CI: 3.163–11.527; p < 0.001), multiple gestation (OR: 1.782; 95% CI: 1.165–2.227; p = 0.008) and fetal distress (OR: 5.326; 95% CI: 2.796–10.144; p < 0.001) were the main causes of preterm delivery at 32+0–36+6 weeks. The overall mortality rate was 8.1% among premature neonates. Regarding morbidity, 919 (78.7%) neonates were diagnosed with respiratory disorders, 129 (11.1%) with intraventricular hemorrhage and 30 (2.6%) with necrotizing enterocolitis. Early gestational age at delivery was the main risk factor of neonatal morbidity and mortality. Notably, the mode of delivery did not have any impact on neonatal survival (OR: 1.317; 95% CI: 0.759–2.284; p = 0.328), but preterm neonates born via cesarean section were at higher risk of respiratory disorders, compared to those born via vaginal delivery (OR: 2.208; 95% CI: 1.574–3.097; p < 0.001). Conclusions: Most preterm deliveries occurred in the moderate-to-late preterm period via cesarean section. Early gestational age at delivery was the main prognostic factor of neonatal morbidity and mortality, while the mode of delivery did not have any impact on neonatal survival. Future research on the mode of delivery of the preterm neonates is warranted to establish definitive answers for each particular gestational age. [ABSTRACT FROM AUTHOR]

BackgroundProlapse recurrence after transvaginal surgical repair is common; however, its mechanisms are ill-defined. A thorough understanding of how and why prolapse repairs fail is needed to address their high rate of anatomic recurrence and to develop novel therapies to overcome defined deficiencies.ObjectiveThis study aimed to identify mechanisms and contributors of anatomic recurrence after vaginal hysterectomy with uterosacral ligament suspension (native tissue repair) vs transvaginal mesh (VM) hysteropexy surgery for uterovaginal prolapse.Study designThis multicenter study was conducted in a subset of participants in a randomized clinical trial by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network. Overall, 94 women with uterovaginal prolapse treated via native tissue repair (n=48) or VM hysteropexy (n=46) underwent pelvic magnetic resonance imaging at rest, maximal strain, and poststrain rest (recovery) 30 to 42 months after surgery. Participants who desired reoperation before 30 to 42 months were imaged earlier to assess the impact of the index surgery. Using a novel 3-dimensional pelvic coordinate system, coregistered midsagittal images were obtained to assess study outcomes. Magnetic resonance imaging-based anatomic recurrence (failure) was defined as prolapse beyond the hymen. The primary outcome was the mechanism of failure (apical descent vs anterior vaginal wall elongation), including the frequency and site of failure. Secondary outcomes included displacement of the vaginal apex and perineal body and change in the length of the anterior wall, posterior wall, vaginal perimeter, and introitus of the vagina from rest to strain and rest to recovery. Group differences in the mechanism, frequency, and site of failure were assessed using the Fisher exact tests, and secondary outcomes were compared using Wilcoxon rank-sum tests.ResultsOf the 88 participants analyzed, 37 (42%) had recurrent prolapse (VM hysteropexy, 13 of 45 [29%]; native tissue repair, 24 of 43 [56%]). The most common site of failure was the anterior compartment (VM hysteropexy, 38%; native tissue repair, 92%). The primary mechanism of recurrence was apical descent (VM hysteropexy, 85%; native tissue repair, 67%). From rest to strain, failures (vs successes) had greater inferior displacement of the vaginal apex (difference, -12 mm; 95% confidence interval, -19 to -6) and perineal body (difference, -7 mm; 95% confidence interval, -11 to -4) and elongation of the anterior vaginal wall (difference, 12 mm; 95% confidence interval, 8-16) and vaginal introitus (difference, 11 mm; 95% confidence interval, 7-15).ConclusionThe primary mechanism of prolapse recurrence following vaginal hysterectomy with uterosacral ligament suspension or VM hysteropexy was apical descent. In addition, greater inferior descent of the vaginal apex and perineal body, lengthening of the anterior vaginal wall, and increased size of the vaginal introitus with strain were associated with anatomic failure. Further studies are needed to provide additional insight into the mechanism by which these factors contribute to anatomic failure.