BACKGROUND: This case describes the youngest patient documented in the literature who presented with a giant hydatidiform mole, effectively addressed through conservative treatment.
METHODS: Our department received a 20-year-old Caucasian patient who was admitted due to significant metrorrhagia in an undisclosed pregnancy. During examination, we identified a massive, highly vascularized hydatidiform mole measuring 22 cm (cm). We performed a surgical dilatation and curettage. The anatomopathological findings confirmed the presence of a complete hydatidiform mole (CHM). Following the established guidelines, we conducted weekly monitoring of human chorionic gonadotropin (hCG). Unfortunately, the patient discontinued the follow-up and became pregnant again before achieving hCG negativation.
CONCLUSIONS: This case suggests that conservative treatment is a viable option regardless of the size of gestational trophoblastic disease (GTD), especially when the preservation of fertility is a crucial consideration, as effectively demonstrated in our case.

BACKGROUND: Abnormal uterine bleeding (AUB) refers to any symptomatic deviation from normal menstruation. AUB is a common gynecological disorder in non-pregnant women of reproductive age, accounting for approximately 33% of gynecological outpatient visits. The early diagnosis and management cause of AUB is important because of increased incidence of endometrial carcinoma with rapid growth. Transvaginal ultrasound is non-invasive imaging technique used to find endometrial carcinoma before referring patients for invasive techniques. Dilatation and curettage (D&C) and endometrial biopsy are surgical procedures that scrape the endometrial lining of the uterus for diagnosis and treatment. The aim of this study is to describe the clinicopathologic pattern of endometrial specimens in women with AUB and ultrasonographic correlation.
METHODS: Tissues from endometrial biopsy and curettage of 411 patients with AUB who referred to Shahid Mohammadi hospital were prospectively selected from 2021 to 2023. Patients were divided into three groups based on age and menstrual status including: premenopausal (18-39 years), perimenopausal (40-49 years) and postmenopausal (≥50 years). The results were correlated to patient\'s age and other data and evaluated with statistical analysis.
RESULTS: During the two-year study period, a total of 411 endometrial specimens with clinical diagnosis of AUB were submitted and the results were analyzed. The youngest patient presenting with AUB was 21 years old, while the oldest was 77 years old. The most common complaint was menorrhagia in 201 (48.0%) out of 411 patients. The most common pathology finding in three groups was polyp in 100 (24.3%) cases. Hormonal effect was the next commonly observed pattern seen in 70 (17.0%) cases. P value was calculated as 0.003 which was significant using chi-square for the trend seen in age.
CONCLUSIONS: Endometrial sampling is a useful tool for evaluation of women with AUB and referring patients for treatment. Histopathological evaluation of the endometrium is very useful in detecting the etiology of AUB. Transvaginal sonography has high sensitivity in detecting polyps.

暂无摘要。

Background and Objectives: Cesarean scar pregnancy (CSP) represents a type of ectopic pregnancy in which the embryo implants inside the scar of a previous cesarean section. This condition can lead to maternal morbidity and mortality. The best therapeutic approach in terms of clinical effectiveness and patient safety for CSP has not been described yet, although different therapeutic strategies are currently available. The purpose of the present study was to analyze the success rate of two different treatments in a single institution. Materials and Methods: A retrospective study was performed among patients diagnosed with CSP at the Gynecology and Obstetrics Department of the \"Cannizzaro\" Hospital in Catania (University of Enna-Italy) from January 2016 to December 2022. The diagnosis was made by 2D/3D transvaginal ultrasound, following Timor-Tritsch criteria. Two treatment strategies were performed: local and systemic methotrexate (MTX) injection and uterine artery embolization (UAE) with subsequent dilatation and curettage (D&C). All treated women underwent subsequent clinical and sonographic follow-up. Complete recovery was defined as the reduction of β-HCG values until it was undetectable and the disappearance of the mass in the uterine scar on ultrasound. Results: Nineteen patients were included; nine were in the MTX group and ten were in the UAE + D&C group. No significant differences were found between the two groups in terms of clinical parameters. Treatment was successful in 4 of 10 (44%) patients in the MTX group and 10 of 10 (100%) in the UAE + D&C group (p = 0.01); the length of hospital stay was significantly shorter in the latter group (p < 0.0001). Conclusions: In our experience, administration of MTX is not recommended as the primary treatment or pre-treatment. Dilatation and curettage after uterine artery embolization are better than methotrexate injection for the treatment of cesarean scar pregnancy in a single-institution series in terms of complete recovery and length of hospital stay.

UNASSIGNED: Microbiological diagnosis of endometritis and appropriate antibiotic treatment based on the antibiogram is essential. We should remain critical about the potential etiologic pathogens, especially when traveling abroad and during pregnancy. Therefore, it is essential to obtain cultures prior to the administration of antibiotics.
UNASSIGNED: We present a case of postoperative endometritis in a patient with incomplete miscarriage, who underwent dilatation and curettage. Blood, cervical and stool cultures revealed the presence of Salmonella hvittingfoss. Gynecological postoperative infections with Salmonella spp. are rare according to the current literature.

OBJECTIVE: To investigate whether routine intraoperative ultrasonographic guidance during second-trimester dilatation and evacuation (D&E) reduces procedure-related complications in an Ethiopian setting.
METHODS: We conducted a pre-post study on routine ultrasonography during second-trimester D&E at St. Paul\'s Hospital Millennium Medical College (Ethiopia). Second-trimester D&E cases that were managed at the hospital between 2017 and 2022 were retrospectively analyzed by grouping them into an intervention group (using routine ultrasound intraoperatively for all cases) and a non-intervention group (problem-based intraoperative use of ultrasound, where ultrasound was used in problem cases only). SPSS version 23 was used for analysis and simple descriptive statistics, χ2 test, multivariate regression analysis, and Fisher exact test were performed as appropriate. P values less than 0.05 and odds ratio with 95% CI were used to present the results\' significance.
RESULTS: A total of 242 second-trimester D&E cases were analyzed (84 cases managed under routine intraoperative ultrasound guidance and 158 cases managed with a problem-based intraoperative use of ultrasound). Compared with problem-based intraoperative use of ultrasound (using it only in selected cases), routine intraoperative ultrasound use was not associated with a decrease in D&E complications (adjusted odds ratio [aOR] 0.22, 95% confidence interval [CI] 0.04-1.16). The two factors associated with increased D&E procedure complications were advanced gestational age (aOR 13.52, 95% CI 1.86-98.52), and need for additional mechanical cervical dilatation during the D&E procedure (aOR 9.53, 95% CI 1.32-69.07). Provider experience, cervical preparation methods (laminaria vs Foley), and maternal age were not associated with occurrence of D&E complications.
CONCLUSIONS: Our study does not support the preference of routine intraoperative ultrasound guidance over problem-based (in selected cases) intraoperative ultrasound use during the second-trimester D&E procedure. More research is needed to make a strong clinical recommendation on using routine intraoperative ultrasound guidance during all second-trimester D&E procedures.

OBJECTIVE: Endometrial cancer is diagnosed by obtaining uterine biopsies by pipelle, dilatation and curettage (D&C), or hysteroscopy. In 15%-25% of the cases, the preoperative and postoperative grades do not match. This discrepancy may carry significant clinical and prognostic consequences. We aimed to assess how body mass index (BMI) affects preoperative and postoperative grade mismatches and whether biopsy methods mitigate this effect.
METHODS: We conducted a retrospective review of patients with endometrial cancer who underwent surgery at our center between 2014 and 2022. We stratified patients into six classes of BMI based on the WHO classification. Preoperative and postoperative grades were compared for concordance with regards to patient BMI and sampling method.
RESULTS: A total of 158 patients were included, diagnosed by pipelle (n = 99), hysteroscopy (n = 15), or D&C (n = 44). For all methods, every unit increase in BMI increased the odds of having a gap between histology grades by 5.2%. In the pipelle group, the odds of a larger gap between the histology grades was 62% higher than that of women in the other groups. Among the D&C group, the odds of having a bigger difference between histology grades were 91.8% lower compared to the other groups. Patients with BMI over 30 had nearly 50% discrepancy when diagnosed with pipelle or hysteroscopy, but less than 10% with D&C.
CONCLUSIONS: Increasing BMI is associated with decreasing concordance between preoperative and postoperative grades in endometrial cancer, especially when it exceeds 30. This effect is much less pronounced, however, when the diagnostic method is D&C.

OBJECTIVE: To investigate the impact of repeated dilatation and curettage or hysteroscopic biopsy on fetomaternal outcomes in patients receiving progestin treatment for endometrial hyperplasia or early-stage carcinoma.
METHODS: This was a population-based study using the Taiwan National Health Insurance Research Database between 2009 and 2017 of women who gave birth and had a history of endometrial hyperplasia and early-stage carcinoma treated with progestins. Logistic regression analysis was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) reflecting the association between repeated procedures and fetomaternal outcomes.
RESULTS: A total of 6956 women with 8690 deliveries were identified. Compared with those who had two or fewer procedures, women who received more than two procedures had a significantly higher risk for cervical insufficiency (aOR, 5.09 [95 CI, 2.31-11.24]). Furthermore, women who had more than two procedures were prone to have adverse neonatal outcomes, including Apgar score < 7 at 1 min (aOR, 1.97 [95% CI, 1.13-3.43]) and 5 min (aOR, 3.11 [95% CI, 1.33-7.23]) and preterm delivery <32 weeks (aOR, 2.86 [95% CI, 1.50-5.45]).
CONCLUSIONS: Undergoing more than two procedures was associated with subsequent maternal cervical insufficiency, preterm delivery <32 weeks, and low neonatal Apgar score. Health care providers should be aware of the potential risks and balance the benefits and harms of repeated procedures.

暂无摘要。

BACKGROUND: The surgical and medical options for management of pregnancy termination procedures are acceptable in practice but differ in clinical efficacy, costs, and patient experiences, and deciding what the best method is not clear always. This study aimed to compare clinical efficacy, outcomes, and patient acceptance of dilatation and curettage (D and C) versus medical abortion using misoprostol for first trimester of gestation in Iranian context.
METHODS: A prospective, multicenter, quasi-experimental research conducted from July 2021 to January 2022. The primary outcomes were the rate of composite complications or complete abortion. Data were analyzed with SPSS 18 using descriptive statistics, independent t-test, analysis of variance and non-parametric tests. Secondary outcomes were quality of life using EQ5D questionnaire, estimated blood loss, pelvic infection, pain level, hospital stay, and acceptability of intervention and relative risk as the effect size.
RESULTS: Finally, 168 patients were included in this study. The composite complication rate among medical abortion patients is significantly more than that of surgical abortion patients (39.3% vs. 4.76%). The relative risk calculated 8.25 (3.05-22.26 CI). Medical abortion patients have experienced higher levels of ongoing bleeding, pain, and symptoms of pelvic infection. The higher level of acceptance has been reported by surgical group patients in comparison to the medical group patients (85.7% vs. 59.5%). Quality of life scores for surgical and medical group estimated 0.6605 and 0.5419, respectively.
CONCLUSIONS: Surgical method of abortion using D and C is a very safe and highly successful option in comparison to the medical method using misoprostol alone and is associated with better clinical outcomes, acceptance, and quality of life in first trimester of pregnancy among Iranian women.