Guideline No. 446: Hysteroscopic Surgery in Fertility Therapy.

OBJECTIVE: To evaluate the indications, benefits, and risks of hysteroscopy in the management of patients with infertility and provide guidance to gynaecologists who manage common conditions in these patients. TARGET POPULATION: Patients with infertility (inability to conceive after 12 months of unprotected intercourse) undergoing investigation and treatment. BENEFITS, HARMS, AND COSTS: Hysteroscopic surgery can be used to diagnose the etiology of infertility and improve fertility treatment outcomes. All surgery has risks and associated complications. Hysteroscopic surgery may not always improve fertility outcomes. All procedures have costs, which are borne either by the patient or their health insurance provider. EVIDENCE: We searched English-language articles from January 2010 to May 2021 in PubMed/MEDLINE, Embase, Science Direct, Scopus, and Cochrane Library (see Appendix B for MeSH search terms). VALIDATION METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional recommendations). INTENDED AUDIENCE: Gynaecologists who manage common conditions in patients with infertility. TWEETABLE ABSTRACT: When offering hysteroscopic surgery to patients with infertility, ensure it improves the live birth rate. SUMMARY STATEMENTS: RECOMMENDATIONS.

Técnicas de radiología intervencionista para el manejo del sangrado uterino anormal (SUA) / Interventional radiology techniques for the management of abnormal uterine bleeding (AUB)

El sangrado uterino anormal (SUA) es una de las patologías ginecológicas más comunes en mujeres en edad reproductiva. El sistema de clasificación de la Federación Internacional de Ginecología y Obstetricia (PALM-COEIN) armoniza las definiciones de los síntomas de hemorragia normal y anormal y clasifica las posibles causas subyacentes en causas estructurales y no estructurales. El objetivo de este manuscrito es revisar el diagnóstico radiológico de cada una de las causas estructurales de sangrado uterino anormal, examinar las indicaciones de las técnicas de radiología vascular intervencionista en el manejo del SUA y conocer el procedimiento de embolización de arterias uterinas, así como sus posibles complicaciones y contraindicaciones.(AU)

Abnormal uterine bleeding is one of the most common gynaecological pathologies in women of reproductive age. The classification system of the International Federation of Gynaecology and Obstetrics (PALM-COEIN) harmonizes the definitions of normal and abnormal bleeding symptoms and classifies possible underlying causes as structural and non-structural. The aim of this manuscript is to review the radiological diagnosis of each of the structural causes of abnormal uterine bleeding, to examine the indications for interventional vascular radiology techniques in the treatment of abnormal uterine bleeding, and to learn about the uterine artery embolization procedure, as well as its possible complications and contraindications.(AU)

Leiomioma uterino gigante en adolescente mexicana de 14 años, un caso raro de sangrado uterino anormal. Reporte de caso / Giant uterine leiomyoma in a 14-year-old Mexican adolescent, a rare case of abnormal uterine bleeding. Case Report

Resumen ANTECEDENTES: Los leiomiomas son neoplasias benignas comunes durante la edad reproductiva. Su aparición en adolescentes es excepcional y un reto diagnóstico en menores de 18 años de edad. El caso aquí reportado se integra a los 26 casos asentados en la bibliografía y se trata del tumor más grande en la paciente más joven hasta ahora comunicado. CASO CLÍNICO: Paciente de 14 años, con inicio de sangrado uterino anormal, aumento del perímetro abdominal y tres semanas con hipermenorrea. El reporte inicial de la química sanguínea informó: anemia severa y el ultrasonido pélvico: un gran tumor anexial sólido. Luego de mejorar las condiciones hemodinámicas de la paciente por medio de transfusiones de concentrados eritrocitarios se practicó una laparotomía exploradora y se extirpó un leiomioma gigante, dependiente del útero. El informe histopatológico fue de: leiomioma de 16 cm de diámetro, con degeneración roja. La paciente cursó sin complicaciones posquirúrgicas y hasta la actualidad no ha experimentado datos de recurrencia ni sangrado uterino anormal. CONCLUSIÓN: La fisiopatología de la miomatosis uterina sigue aún sin comprenderse del todo. El tratamiento quirúrgico a una edad temprana debe tomar en consideración el deseo de embarazo y llevar a cabo un seguimiento estrecho para valorar: la fertilidad, recurrencia, atipia celular y trastornos menstruales.

Abstract BACKGROUND: Leiomyomas are common benign neoplasms during reproductive age. Its appearance in adolescents is exceptional and a diagnostic challenge in children under 18 years of age. The case reported here is one of the 26 cases reported in the bibliography and it is the largest tumor reported in the youngest patient to date. CLINICAL CASE: A 14-year-old patient with onset of abnormal uterine bleeding, increased abdominal circumference and three weeks with hypermenorrhea. Initial blood chemistry report: severe anemia and pelvic ultrasound: a large solid adnexal tumor. After improving the patient's hemodynamic conditions through transfusions of erythrocyte concentrates, an exploratory laparotomy was performed and a giant leiomyoma, dependent on the uterus, was removed. The histopathological report was: leiomyoma of 16 cm in diameter, with red degeneration. The patient had no postoperative complications and to date she has not experienced recurrence or abnormal uterine bleeding. CONCLUSION: The pathophysiology of uterine fibroids remains poorly understood. Surgical treatment at an early age should take into account the desire for pregnancy and carry out a close follow-up to assess: fertility, recurrence, cellular atypia and menstrual disorders.

Risk factors for the development of endometrial lesions in breast cancer patients using tamoxyphen: a retrospective cohort study / Estudo de coorte retrospectivo para avaliação de fatores de risco para desenvolvimento de lesão endometrial em pacientes com câncer da mama em uso de tamoxifeno

ABSTRACT Introduction: breast cancer is the cancer with the highest incidence in women in Brazil, representing 29.7% of all cancers. More than two thirds of women with breast cancer show expression for hormone receptors, and in these cases, hormone therapy with tamoxifen is indicated, which may represent a risk factor for the development of endometrial cancer (four-fold greater relative risk). Objective: this study aimed to evaluate the association of tamoxifen and the development of endometrial disturbances and to assess possible other associated risk factors. Patients and method: a total of 364 breast cancer patients were evaluated, 286 who used tamoxifen and 78 who did not use this hormone therapy. Results: patients who used tamoxifen had a mean follow-up time of 51.42 months similar to those without hormone therapy (p=0.081). A total of 21 (7.3%) women who used tamofixen and no cases among women without hormone therapy presented endometrial changes during follow-up (p=0.01). Despite information regarding obesity was available for only 270 women, obesity was also significantly associated with the development of endometrial changes (p=0.008). Conclusion: furthermore, the association between tamofixen and endometrial changes remained significant (p=0.039) after adjusting for obesity.

RESUMO Introdução: o câncer da mama é o câncer de maior incidência no sexo feminino no Brasil, representando 29,7% de todos os cânceres. Mais de dois terços das mulheres com câncer da mama apresentam expressão para receptores hormonais, estando, nestes casos, indicada a terapia hormonal com tamoxifeno, que pode representar fator de risco para o desenvolvimento do câncer do endométrio (risco relativo quatro vezes maior). Objetivo: este trabalho teve como objetivo avaliar a associação entre o uso de tamoxifeno e o desenvolvimento de distúrbios endometriais bem como eventuais outros fatores associados. Pacientes e método: Estudo de coorte retrospectivo de 364 pacientes com câncer da mama, das quais 286 utilizaram tamoxifeno e 78 não utilizaram esta hormonioterapia. Resultados: pacientes que usaram tamoxifeno tiveram um seguimento médio de 51,42 meses, semelhante àquelas sem terapia hormonal (p=0,081). Um total de 21 (7,3%) mulheres que usaram tamofixeno e nenhuma mulher sem terapia hormonal apresentaram alterações endometriais durante o seguimento (p=0,01). Nas 270 mulheres que tinham informação sobre obesidade, esta se associou significantemente com o desenvolvimento de alterações endometriais (p=0,008). A associação entre tamofixeno e alterações endometriais permaneceu significante (p=0,039) após ajustar para interação com obesidade. Conclusão: o uso de tamoxifeno no tratamento do câncer da mama esteve associado ao maior risco para desenvolvimento de alterações endometriais especialmente quando associado à obesidade.

Mesenchymal stem cells to treat female infertility; future perspective and challenges: A review.

Infertility negatively impacts the overall health and social life of affected individuals and couples. Female infertility is their inability to perceive pregnancy. To date, polycystic ovary syndrome, primary ovarian insufficiency, fallopian tube obstruction, endometriosis, and intrauterine synechiae have been identified as the primary causes of infertility in women. However, despite the mutual efforts of clinicians and research scientists, the development of an effective treatment modality has met little success in combating female infertility. Intriguingly, significant research has demonstrated mesenchymal stem cells as an optimal source for treating infertility disorders. Therefore, here we attempted to capsulize to date available studies to summarize the therapeutic potential of mesenchymal stem cells in combating infertility in women by focusing on the underlying mechanism through which stem cells can reduce the effects of ovarian disorders. Furthermore, we also discussed the preclinical and clinical application of stem cell therapy, their limitation, and the future perspective to minimize these limitations.

Androgen Signaling in Uterine Diseases: New Insights and New Targets.

Common uterine diseases include endometriosis, uterine fibroids, endometrial polyps, endometrial hyperplasia, endometrial cancer, and endometrial dysfunction causing infertility. Patients with uterine diseases often suffer from abdominal pain, menorrhagia, infertility and other symptoms, which seriously impair their health and disturb their lives. Androgens play important roles in the normal physiological functions of the uterus and pathological progress of uterine diseases. Androgens in women are synthesized in the ovaries and adrenal glands. The action of androgens in the uterus is mainly mediated by its ligand androgen receptor (AR) that regulates transcription of the target genes. However, much less is known about the signaling pathways through which androgen functions in uterine diseases, and contradictory findings have been reported. This review summarizes and discusses the progress of research on androgens and the involvement of AR in uterine diseases. Future studies should focus on developing new therapeutic strategies that precisely target specific AR and their related signaling pathways in uterine diseases.

Evaluation of complications, conversion rate, malignancy rate, and, surgeon's experience in laparoscopic assisted supracervical hysterectomy (LASH) of 1274 large uteri: A retrospective study.

INTRODUCTION: Hysterectomy now belongs to standard gynecological procedures. Moreover, a shift towards laparoscopic techniques is ever more apparent as they provide many advantages such as less traumatization and shorter convalescence. Large uteri are still mentioned as contraindications for laparoscopic hysterectomy even though those patients might benefit from the lower morbidity associated with minimal invasive techniques. In this study, the largest reported so far, we analyzed intraoperative and postoperative complications as well as the surgeon's experience of laparoscopic assisted supracervical hysterectomy (LASH) in patients with a uterus weight over 500 g. MATERIAL AND METHODS: The present retrospective study, between June 27, 1998 and August 31, 2019, evaluates 1274 patients with a uterus weight over 500 g who were treated with LASH for benign uterine diseases at the Clinic for Minimal Invasive Surgery (Berlin, Germany). All surgeries were performed by one of four in-house surgeons with experience in LASH: they had performed at least 500 LASH procedures before the study. Patients receiving surgical treatment for malignant tumors were not included in the study. Major and minor intraoperative and postoperative complications were recorded and evaluated. Additionally, medical files were evaluated for demographic data, American Society of Anesthesiologists score (I-IV), name of the surgeon, duration and indication for surgery, history of previous gynecological procedures and concomitant surgical interventions, weight of removed uterine tissue, duration of postoperative hospitalization in patients with complications, intraoperative conversion from laparoscopy to laparotomy, and malignancy rate. RESULTS: The mean age was 47.0 ± 7.3 years and mean body mass index was 25.6 ± 7.1 kg/m2 . Average parity was 1.04 ± 1.57. Average uterus weight was 761.8 ± 317.9 g (500-4065 g). The mean duration of surgery was 96.9 ± 49.5 min; 54% of all patients were treated without concomitant intervention, conversion rate was 2.12%. The malignancy rate was 0.4% and the complication rate was 6.81% with 1.36% intraoperative complications and 5.45% postoperative complications. CONCLUSIONS: The overall low complication and malignancy rates observed in this study allow us to present LASH as a safe and efficient alternative laparoscopic approach to remove uteri of any size in the hands of experienced surgeons.

Manual vacuum aspiration (women's MVA) for endometrial biopsy for patients with suspected endometrial malignancies.

AIM: Endometrial biopsy is generally performed with a metal uterine curette sonde; however, recently, many types of vacuum aspirators are available, including the manual vacuum aspiration (MVA) system. We used the women's MVA system for endometrial sampling and evaluated its effectiveness in determining the presence of endometrial malignancy. METHODS: Forty-seven samples were examined using the following procedures after measuring endometrial thickness by transvaginal ultrasonography: fractional curettage biopsy (Bx; 20 samples), total curettage under general anesthesia (T/C; 13 samples), and MVA (14 samples). The quality of the endometrial samples was classified into four types: 1-4, where 1 denoted poor and 4, good quality. RESULTS: The mean score of the MVA group was significantly higher than that of the partial curettage biopsy group (p = 0.0065). No differences were observed between the MVA and total curettage groups (p = 1.00). When patients were divided into two groups according to endometrial thickness (<10 mm or ≥10 mm) and analyzed, both the MVA and T/C groups did not show a significant difference in their scores compared to the Bx group when the endometrial thickness was <10 mm. However, when the endometrial thickness was ≥10 mm, the MVA and T/C groups had significantly better scores than the Bx group (p = 0.0225 and p = 0.0244, respectively). Vagal reflex, as an adverse event, was observed only in two patients in the Bx group (2/20, 10%). CONCLUSION: Considering its quality and safety, Karman-type MVA for endometrial sampling could be an alternative to fractional curettage using a metallic uterine curette sonde.

Surgical Indication and Approach are Associated with Transfusion in Hysterectomy for Benign Disease.

Objective: To identify pre-operative and intraoperative factors associated with the risk of red blood cell transfusion among women undergoing hysterectomy. Methods: A retrospective cohort study of hysterectomy for benign indications between January 1, 2011 - December 31, 2017. Patients receiving blood transfusion within 30 days of surgery were compared to patients who did not receive any transfusion. Multivariate logistic regression analysis was performed to identify clinical and surgical variables associated with blood transfusion. Results: Among 171,940 women who underwent hysterectomy for benign indication, 4,667 (2.7%) required blood transfusion. The rate of transfusion was highest among patients with uterine fibroids (4.3%) and lowest in patients with genital prolapse (1.1%) (p < 0.05). Odds of blood transfusion were significantly elevated in patients undergoing hysterectomy for uterine fibroids compared to patients with genital prolapse (adjusted odds ratio [aOR] 1.36, 95% confidence interval [CI] 1.15 - 1.61). Other patient characteristics included body mass index, smoking, bleeding disorders, pre-operative sepsis, and American Society of Anesthesiologists score ≥ 2 (p < 0.05). Higher pre-operative hematocrit significantly decreased the risk of blood transfusion (aOR 0.84, 95% CI 0.84 - 0.85 per percent increase in hematocrit). Abdominal and vaginal hysterectomies were associated with greater odds of transfusion compared with laparoscopic approaches (aOR 5.06, 95% CI 4.70 - 5.44; aOR 1.87, 95% CI 1.67 - 2.10, respectively). Conclusions: Certain patient comorbidities, surgical indication, and approach to hysterectomy are associated with increased risk of blood transfusion. These results may have implications for pre-operative patient counseling, perioperative care, and health system planning.

Canine cystic endometrial hyperplasia and pyometra may downregulate neuropeptide phoenixin and GPR173 receptor expression.

The most common uterine diseases affecting bitches are cystic endometrial hyperplasia (CEH) and pyometra. The neuropeptide phoenixin (PNX) and its receptor (GPR173) are potential key factors involved in the proliferative and inflammatory regulation of the reproductive system in females. This study aimed to evaluate the expression of PNX and GPR173 by qPCR, western blot and immunofluorescence assays in the endometrium of bitches suffering from CEH or pyometra compared to clinically healthy females. Additionally, PNX and progesterone (P4) plasma concentrations were analysed. The results showed a significantly lower expression levels of PNX and GPR173 (mRNA and protein production) in bitches with the CEH or pyometra groups compared to healthy animals. Immunofluorescence staining examination also confirmed a lower concentration of PNX and GPR173 signals in bitches with pathological uteri. Moreover, a lower concentration of PNX blood levels in bitches suffering from pyometra was observed. The PNX concentration was negatively correlated with P4 but only in healthy bitches. These results illustrate that the development of canine uterine disorders may cause a lower expression of PNX and its receptor GPR173.

Bacterial communities from vagina of dairy healthy heifers and cows with impaired reproductive performance.

Vaginal microenvironment plays a significant role in bovine fertility since its resident microorganisms interact with the host mucosa and constitutes the first barrier against ascending pathogens in the reproductive tract. In this study, the vaginal microbiome of healthy heifers (H) and cows with impaired reproductive performance, metritis complex (MT) or repeat breeders (RB), was assessed using a 16S rRNA gene sequencing approach. Analysis revealed that even though a vaginal microbiological guild (Firmicutes, Bacteroidetes, Proteobacteria, Tenericutes, Fusobacteria and Actinobacteria) was shared among healthy heifers and cows with uterine disease; further analysis at genus level showed significant differences depending on the reproductive health status. The relative abundances of recognized uterine pathogens such as Bacteroidetes, Fusobacterium and Helcococcus were higher in MT when compared with H and RB; therefore, their presence in vagina can be considered as a risk factor for fertility. The present study describes for the first time, the composition of native bacterial communities in the vagina of cows undergoing the repeat breeding syndrome (RBS), and reports an association between this disease and the presence of Porphyromonas and unassigned genera of the Pasteurellaceae family. In addition, this work highlights the bacteria associated with a healthy vagina: genera from the families Lachnospiraceae, Rikenellaceae and the genera Acinetobacter, Bacillus, Oscillospira, CF231 and 5-7NS. Results highlighted herein, signify the potential of the evaluation of the bovine vaginal microbiome to future design therapeutic interventions to improve pregnancy rates however, further research is needed to elucidate the balance of bacterial species resulting in an optimal reproductive health.

Effects of total laparoscopic hysterectomy on benign uterine diseases / 中国基层医药

Objective:To investigate the clinical efficacy of total laparoscopic hysterectomy in the treatment of benign uterine diseases.Methods:Fifty patients who underwent hysterectomy because of benign uterine diseases in Huainan Maternal and Child Health Care Hospital from January 2019 to December 2020 were included in this study. They were randomly assigned to undergo either total laparoscopic hysterectomy (TLH group, n = 25) or conventional open surgery (COS group, n = 25). Amount of blood loss, operative time, postoperative time to first anal exhaust, intraoperative and postoperative complications, length of hospital stay were compared between the TLH and COS groups. Results:Operative time, postoperative time to first anal exhaust, length of hospital stay in the TLH group were (98.2 ± 19.3) minutes, (19.7 ± 3.9) minutes, and (9.2 ± 2.2) days, respectively, which were significantly shorter than those in the COS group [(125.0 ± 44.5) minutes, (44.9 ± 6.0) minutes and (10.9 ± 2.8) days, t = 2.757, 17.369 and 2.394, all P < 0.05]. The amount of blood loss in the TLH group was significantly less than that in the COS group [(61.6 ± 3.9) mL vs. (266.0 ± 31.2) mL, t = 3.259, P < 0.05]. There were no significant differences in intraoperative and postoperative complications between the two groups (both P > 0.05). Conclusion:Total laparoscopic hysterectomy for the treatment of benign uterine diseases has advantages including minimal invasion, rapid postoperative recovery, and controllable operation difficulty.

Efficacy of transumbilical laparoendoscopic single-site supracervical hysterectomy in the treatment of benign uterine diseases / 中国基层医药

Objective:To investigate the efficacy of transumbilical laparoendoscopic single-site supracervical hysterectomy in the treatment of benign uterine diseases.Methods:The clinical data of 39 patients with benign uterine diseases with the volume of uterus less than that at the 14 weeks of pregnancy who underwent supracervical hysterectomy in People's Hospital of Hechuan District of Chongqing, China between January 2018 and December 2019 were retrospectively analyzed. These patients were divided into transumbilical laparoendoscopic single-site supracervical hysterectomy group (single-site group, n = 21) and transumbilical laparoendoscopic multiple-site supracervical hysterectomy group (multiple-site group, n = 18) according to different surgical approaches. Operation time, specimen removal time, intraoperative blood loss, incision suture time, tissue debris shedding rate, postoperative off-bed time, length of hospital stay, pain score on postoperative day 1, time to anal exhaust, and the incidence of complications within 30 days after surgery were compared between the two groups. Results:Tissue debris shedding rate in the single-site group was significantly lower than that in the multiple-site group [0.00% (0/21) vs. 100.00% (18/18), χ2 = 39.00, P < 0.001]. Operation time in the single-site group was significantly longer than that in the multiple-site group [(74.20 ± 9.15) minutes vs. (62.90 ± 6.20) minutes, t = 3.323, P < 0.05). Specimen removal time and incision suture time in the single-site group were (11.10 ± 2.33) minutes and (3.90 ± 0.88) minutes, respectively, which were significantly longer than those in the multiple-site group [(4.90 ± 0.88) minutes, (2.90 ± 0.74) minutes, t = 7.97, 0.386, both P < 0.05]. There were no significant differences in intraoperative blood loss, postoperative off-bed time, pain score on postoperative day 1, length of hospital stay, time to anal exhaust, and the incidence of complications within 30 days after surgery between the two groups (all P > 0.05). Conclusion:Transumbilical laparoendoscopic single-site and multiple-site supracervical hysterectomy can acquire similar short-term surgical outcomes in the treatment of benign uterine diseases at the time of less than 14 weeks of pregnancy and transumbilical laparoendoscopic single-site supracervical hysterectomy can eliminate the long-term complications caused by tissue dissemination.

Pre- and Post-partum Concentrations of Interleukin 1α, Interleukin 8, and α1-Acid Glycoprotein in Vaginal Fornix and Endometrium of Dairy Cows With Clinical Cervicitis.

Innate immunity is the principal sensor responsible of the local immune response to control mucosal bacterial contamination of the reproductive tract after parturition, triggering a pro-inflammatory process in the mucosa of the uterus, the vaginal and the cervix. However, knowledge about the inflammation process and outcome of the cervix in dairy cows is scarce even though it plays an important anatomic and functional role between the vagina and the uterus. The objective of the present study was to describe the cellular and humoral local innate immune response during clinical cervicitis (CC) in the uterus and vaginal fornix in pre- and post-partum periods of dairy cows. A retrospective descriptive study was performed involving 26 animals, characterized as clinical cervicitis cows (n = 19) and healthy cows (n = 7). Blood and mucus of the different compartments of the genital tract were sampled and records of the cows' genital exam were performed four times: -1 w (day -7 ± 2, prepartum), +1 w (day +7 ± 4), +3 w (day +21 ± 4) and +5 w (day +35 ± 4) postpartum. Clinical cervicitis was defined as cows exhibiting a cervix grade-2 and healthy cows were defined as a cow clinically normal with a grade-0 cervix at time +5 w. Blood white cell count, vaginal fornix and endometrial neutrophils percentage, and the concentrations of interleukin 1α (IL1), interleukin 8 (IL8), and α1-acid glycoprotein (AGP) in mucus were determined. The results showed that 23% of the cows were categorized as CC at time +5 w. Cases of CC with purulent vaginal discharge or subclinical endometritis shown the highest cytokine production. At +3 w, IL1, IL8, and AGP concentrations in the uterus and the fornix were significantly higher in CC than healthy cows (CH). In conclusion, the 3-week postpartum is a critical point to evaluate cytokines and acute phase proteins; where IL1 and IL8 variation kept a direct relation with neutrophils numbers and function. The presence of AGP in the endometrium infer a homeostatic proinflammatory protective balance effect, modulating the local uterine innate immune response during peripartum.

Sangrado uterino anormal y PALM COEIN / Abnormal uterine bleeding and PALM COEIN

Resumen OBJETIVO: Comunicar la nueva terminología del sangrado uterino anormal y de la clasificación PALM COEIN. MÉTODO: Búsqueda bibliográfica de artículos publicados en inglés o español con la palabra clave PALM COEIN. Desde el primer artículo publicado en 2010 hasta 2018 en las bases de datos MedLine, PubMed, Embase y Ovid. RESULTADOS: Se reunieron 64 artículos, pero solo 18 mencionaban el término, 24 eran repetidos. Se seleccionaron 22 que trataban el tema en estudio y eran referidos con la clasificación actual, de esos trabajos 6 eran de cohorte, 2 de revisión sistemática, 2 boletines y 12 revisiones de tema. CONCLUSIÓN: Esta nueva terminología facilitará el entendimiento y la comunicación, independiente del idioma y la cultura, además del acercamiento más entendible con nuestras pacientes. La clasificación PALM COEIN facilita la investigación epidemiológica, etiológica y el tratamiento de las pacientes con sangrado uterino anormal.

Abstract OBJECTIVE: To update the new terminology of abnormal uterine bleeding and the PALM COEIN classification METHOD: Bibliographic search of articles published in English or Spanish with the keyword PALM COEIN. From the first article published in 2010 to 2018 in the MedLine, PubMed, Embase and Ovid databases. RESULTS: 64 articles were collected, but only 18 mentioned the term, 24 were repeated. 22 were selected that dealt with the subject under study and were referred to with the current classification, of these works 6 were cohort, 2 systematic review, 2 newsletters and 12 theme reviews. CONCLUSION: This new terminology will facilitate understanding and communication, independent of language and culture, in addition to the most understandable approach with our patients. This classification of PALM COEIN facilitates the epidemiological, etiological investigation and treatment of patients with abnormal uterine bleeding.

Two Cases of Uterine Tumors Resembling Ovarian Sex-cord Tumors: Rare Case of Uterine Tumor / 이화의대지

Uterine tumors resembling ovarian sex-cord tumors (UTROSCT) are very rare tumors that occur mainly in the uterine fundus of women in reproductive age. These tumors can be classified into group 1 and group 2 by histological results. In group 1, epithelial-like differentiation is partially observed in the tumors. In group 2, sex-cord elements are predominant in uterine mural mass. We experienced UTROSCT group 1 in a 29-year-old woman who complained of severe abdominal pain that started one week after delivery and UTROSCT group 2 case in a 49-year-old woman who complained of dysfunctional uterine bleeding. We report two different types of UTROSCT cases that we experienced.

Application of three-dimensional ultrasonography in the diagnosis of uterine abnormalities / 中国基层医药

Objective@#To investigate the effect of three-dimensional ultrasound in the diagnosis of uterine abnormalities.@*Methods@#From January 2017 to December 2017, 50 patients with uterine abnormalities admitted to the Maternal and Child Health Care Hospital of Cixi were selected.GE Voluson E8 high-resolution color Doppler ultrasound system were used for all patients to conduct two-dimensional ultrasound and three-dimensional ultrasound examinations.The results of the two methods, including the time taken for the inspection and the correctness of the inspection were compared.@*Results@#The time used for three-dimensional ultrasonic testing[(2.39±0.25)min] and the accuracy of inspection (100%) were better than two-dimensional ultrasonic testing[(5.77±0.66)min, 80%], the differences were statistically significant (t=33.864, χ2=11.111, all P<0.05).@*Conclusion@#Three-dimensional ultrasonography can accurately present the external contour of the uterus and the shape of the intima.The abnormal uterus can be timely discovered.At the same time, it has advantages of non-invasive and safe.

Application of three-dimensional ultrasonography in the diagnosis of uterine abnormalities / 中国基层医药

Objective To investigate the effect of three -dimensional ultrasound in the diagnosis of uterine abnormalities.Methods From January2017 toDecember 2017,50 patients with uterineabnormalities admitted to the Maternal and Child Health Care Hospital of Cixi were selected .GE Voluson E8 high -resolution color Doppler ultrasound system were used for all patients to conduct two -dimensional ultrasound and three-dimensional ultrasound examinations.The results of the two methods ,including the time taken for the inspection and the correctness of the inspection were compared.Results The time used for three -dimensional ultrasonic testing[(2.39 ±0.25)min] and the accuracy of inspection (100％) were better than two -dimensional ultrasonic testing[(5.77 ±0.66)min, 80％],the differences were statistically significant (t=33.864,χ2 =11.111,all P <0.05).Conclusion Three -dimensional ultrasonography can accurately present the external contour of the uterus and the shape of the intima .The abnormal uterus can be timely discovered.At the same time,it has advantages of non -invasive and safe.