OBJECTIVE: The objectives of this study were to evaluate the vascularization pattern of uterine myoma (UM) by ultrasonography using Superb Microvascular Imaging (SMI) and tissue stiffness elastography.
METHODS: A prospective and cross-sectional study was carried out between March 2020 and December 2022 among women with clinical and ultrasound diagnosis of UM who would subsequently undergo radiofrequency ablation. Ultrasound examination was performed using both transvaginal and transabdominal routes. UM vascularization pattern was assessed by power Doppler (PD) and SMI, while elastographic pattern was assessed by shear wave (SWE) and strain (STE). FIGO classification, location, and measurement of the largest UM were also described.
RESULTS: A total of 21 women diagnosed with UM were evaluated. There was a predominance of nulliparous women and 20 women (95.2%) reported desire for pregnancy. Of the 18 women with abnormal uterine bleeding, 15 (83.3%) had abdominal cramping. As far as previous treatment, 7 (33.3%) had undergone myomectomy for other UM. The mean uterine and UM volumes were 341.9 cm3 (90-730) and 126.52 cm3 (6.0-430), respectively. There was a predominance of hypoechogenic lesions (90.5%). There was also preponderance of UM in the FIGO 2-5 classification (n = 9; 42.9%). Vascularization patter was mostly moderate (score 2) in 9 cases (42.9%). The majority of UM were considered to have intermediate stiffness (n = 10; 47.6%).
CONCLUSIONS: The majority of UM showed vascularization and moderate stiffness. A relationship was observed between the stiffness of the UM assessed by elastography and its FIGO classification.

暂无摘要。

BACKGROUND: Embryo transfer (ET) is an important step in assisted reproductive technology. Uterine length measurement before ET (ULMbET) enables the determination of catheter length and anatomical variation before the ET. Therefore, in this study, we aim to compare ULMbET and transabdominal ultrasound-guided ET (TAUGET).
METHODS: This open-label randomised clinical trial enrolled 264 women who were scheduled for frozen- thawed ET (FET) cycles. The women were randomised to the ULMbET or TAUGET group for ET. The primary outcome of this study was clinical pregnancy.
RESULTS: A total of 132 women were randomly assigned to the ULMbET group and 132 women to the TAUGET group. However, four women in the ULMbET group did not receive the allocated method after randomisation. Finally, 128 women from the ULMbET group and 132 women from the TAUGET group were assessed. No statistically significant differences existed in chemical pregnancy rate (31.3 vs. 36.4%, P=0.384), clinical pregnancy rate (23.4 vs. 28%, P=0.397), and implantation rate (15 vs. 17.8%, P=0.401) between the ULMbET and TAUGET groups, respectively.
CONCLUSIONS: The results of this clinical trial show no differences in pregnancy outcomes in FET cycles following ULMbET and TAUGET (registration number: IRCT20110509006420N240).

OBJECTIVE: To summarize and compare the accuracy of transvaginal ultrasound (TVS), 3D-TVS, and sonohysterography (SHG) for the diagnosis of intrauterine adhesions (IUA).
METHODS: The computer searches databases such as web of science, Medline, EMBASE, and PubMed collecting diagnostic studies of IUA via ultrasound. The retrieval time was included from inception to January 1, 2023. Two researchers independently screened the literature, extracted information, and used RevMan 5.3 to complete an assessment of the risk of bias in the included literature. Meta-analysis of included studies using Stata 16.0 and Meta Disc 1.4 software.
RESULTS: Thirteen studies were included. The analysis results of 2D-TVS are The sensitivity (SEN): 0.54 (95% CI [0.28078]), specificity (SPE): 0.96 (95% CI [0.78, 0.99]), and the area (AUC) under the operating characteristic curve (SROC): 0.83 (95% CI [0.80, 0.86]); the SEN, SPE, and AUC of 3D-TVS are: 0.96 (95% CI [0.90, 0.98]), 0.84 (95% CI [0.68, 0.93]), 0.97 (95% CI [0.95, 0.98]); and the SEN, SPE, and AUC of SHG are: 0.74 (95% CI [0.53, 0.88]), 0.97 (95% CI [0.94, 0.99]), 0.95 (95% CI [0.93, 0.97]).
CONCLUSIONS: The current results show that the diagnostic value of 3D-TVS for IUA is better than SHG and significantly higher than that of 2D-TVS. However, the analysis of subgroups is still limited by the number of included studies. In order to better explore the application of ultrasound in intrauterine adhesion, more high-quality studies are needed in the future.

BACKGROUND: Transvaginal cervical length (TVCL) surveillance post-transvaginal cerclage placement is not universally performed, despite the correlated risk of short TVCL with spontaneous preterm birth (sPTB). This study evaluated if patients with a TVCL <2.5 cm after cerclage placement had higher odds of sPTB than those with a TVCL ≥2.5 cm after cerclage placement.
METHODS: This retrospective cohort study included patients with a singleton, non-anomalous gestation with a transvaginal cerclage who had TVCL surveillance post-cerclage placement. The primary outcome was the odds of sPTB among patients with TVCL <2.5 cm vs TVCL ≥2.5 cm after cerclage placement. Transvaginal cerclage placement indications included history indicated, physical exam indicated, and ultrasound indicated. Outcomes were assessed using univariate and multivariate analysis while adjusting for progesterone use, TVCL before cerclage placement, and cerclage indication.
RESULTS: The analysis included 210 patients, and the sPTB rate was 46.7%. Those with sPTB underwent cerclage placement at later gestational ages, had higher rates of exam-indicated cerclage, and were more likely to be prescribed vaginal progesterone. Patients with a TVCL of <2.5 cm after cerclage placement did not have significantly increased odds of sPTB (OR: 2.8, 95% CI: 0.9-8.7, p=0.07); however, patients with a TVCL <2.0 cm had significantly increased odds of sPTB (OR: 6.3, 95% CI: 2.2-18.8, p<0.001).
CONCLUSIONS: In patients with transvaginal cerclage, there does not appear to be increased odds of sPTB with TVCL <2.5 cm after cerclage placement; however, there does appear to be an increased odds of sPTB in patients with a TVCL of <2.0 cm after cerclage placement.

Automated perimetrium segmentation of transvaginal ultrasound images is an important process for computer-aided diagnosis of uterine diseases. However, ultrasound images often contain various structures and textures, and these structures have different shapes, sizes, and contrasts; therefore, accurately segmenting the parametrium region of the uterus in transvaginal uterine ultrasound images is a challenge. Recently, many fully supervised deep learning-based methods have been proposed for the segmentation of transvaginal ultrasound images. Nevertheless, these methods require extensive pixel-level annotation by experienced sonographers. This procedure is expensive and time-consuming. In this paper, we present a bidirectional copy-paste Mamba (BCP-Mamba) semi-supervised model for segmenting the parametrium. The proposed model is based on a bidirectional copy-paste method and incorporates a U-shaped structure model with a visual state space (VSS) module instead of the traditional sampling method. A dataset comprising 1940 transvaginal ultrasound images from Tongji Hospital, Huazhong University of Science and Technology is utilized for training and evaluation. The proposed BCP-Mamba model undergoes comparative analysis with two widely recognized semi-supervised models, BCP-Net and U-Net, across various evaluation metrics including Dice, Jaccard, average surface distance (ASD), and Hausdorff_95. The results indicate the superior performance of the BCP-Mamba semi-supervised model, achieving a Dice coefficient of 86.55%, surpassing both U-Net (80.72%) and BCP-Net (84.63%) models. The Hausdorff_95 of the proposed method is 14.56. In comparison, the counterparts of U-Net and BCP-Net are 23.10 and 21.34, respectively. The experimental findings affirm the efficacy of the proposed semi-supervised learning approach in segmenting transvaginal uterine ultrasound images. The implementation of this model may alleviate the expert workload and facilitate more precise prediction and diagnosis of uterine-related conditions.

暂无摘要。

BACKGROUND: Conjoined twins are a rare twin malformation commonly presenting as single amniotic sac twinning, with double amniotic sac twinning being extremely rare and poorly reported. Most conjoined twins are females.
METHODS: A woman of childbearing age conceived naturally, and at 8 wk of gestation, transvaginal ultrasonography showed an embryo and cardiac tube pulsation in both amniotic sacs. On dynamic observation, the two embryos were connected in the lower abdomen, with restricted movement. A repeat transvaginal ultrasound at 11 wk showed that the intestinal tubes of both fetuses were connected in the lower abdomen. The pregnancy was terminated and labor was induced.
CONCLUSIONS: Transvaginal ultrasound may detect conjoined twin malformations in an early stage. Our case provides diagnostic insights for ultrasonographers and can help develop early therapeutic interventions.

Pain after vaginal prolapse repair surgery with mesh is generally attributed to the mesh fixation, particularly to mesh erosion, dislocation or the development of hematoma. However, once all the causes have been excluded, the urinary system, bladder and ureters should be accurately examined by means of endovaginal ultrasound. This report concerns the case of a 72-year-old woman who had undergone mesh-supported prolapse surgery 3 months prior, with no other relevant diseases, who visited the emergency department complaining of dull, right-sided colic pain. The endovaginal ultrasound examination revealed a prevesical ureteral calculus on the right side with consequent dilatation of the proximal ureter. Computed tomography of the abdomen and pelvis confirmed the calculus in the distal right ureter and revealed a right renal lower pole calculus. The patient underwent treatment via an operative ureterorenoscopy with removal of stones and placement of a double-J-stent. Two months later, a second ureterorenoscopy was performed with double-J-stent removal and concomitant stone extraction. It appears that no similar cases have been reported in the literature. This is why, during the urogynecological postoperative follow-up, it is of paramount importance to examine the entire urogenital system with endovaginal ultrasound. This case report highlights how, through a simple, non-invasive, radiation-free examination, like ultrasound, most of the post-operative complications of vaginal prolapse repair surgery using mesh, including urolithiasis, can be excluded.

BACKGROUND: Endometriosis is a multifaceted gynecological condition that poses diagnostic challenges and affects a significant number of women worldwide, leading to pain, infertility, and a reduction in patient quality of life (QoL). Traditional diagnostic methods, such as the revised American Society for Reproductive Medicine (r-ASRM) classification, have limitations, particularly in preoperative settings. The Numerical Multi-Scoring System of Endometriosis (NMS-E) has been proposed to address these shortcomings by providing a comprehensive preoperative diagnostic tool that integrates findings from pelvic examinations and transvaginal ultrasonography.
METHODS: This retrospective study aims to validate the effectiveness of the NMS-E in predicting surgical outcomes and correlating with the severity of endometriosis. Data from 111 patients at Nippon Medical School Hospital were analyzed to determine the correlation between NMS-E scores, including E-score-a severity indicator-traditional scoring systems, surgical duration, blood loss, and clinical symptoms. This study also examined the need to refine parameters for deep endometriosis within the NMS-E to enhance its predictive accuracy for disease severity.
RESULTS: The mean age of the patient cohort was 35.1 years, with the majority experiencing symptoms such as dysmenorrhea, dyspareunia, and chronic pelvic pain. A statistically significant positive correlation was observed between the NMS-E\'s E-score and the severity of endometriosis, particularly in predicting surgical duration (Spearman correlation coefficient: 0.724, p < 0.01) and blood loss (coefficient: 0.400, p < 0.01). The NMS-E E-score also correlated strongly with the r-ASRM scores (coefficient: 0.758, p < 0.01), exhibiting a slightly more excellent predictive value for surgical duration than the r-ASRM scores alone. Refinements in the methodology for scoring endometriotic nodules in uterine conditions improved the predictive accuracy for surgical duration (coefficient: 0.752, p < 0.01).
CONCLUSIONS: Our findings suggest that the NMS-E represents a valuable preoperative diagnostic tool for endometriosis, effectively correlating with the disease\'s severity and surgical outcomes. Incorporating the NMS-E into clinical practice could significantly enhance the management of endometriosis by addressing current diagnostic limitations and guiding surgical planning.