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Wombs with a view : illustrations of the gravid uterus from the Renaissance through the nineteenth century
This volume provides an archive of some of the most beautiful illustrations ever made of the gravid uterus with fetus and placenta, which will serve future generations of investigators, educators and students of reproduction. The approximately two hundred figures from over one hundred volumes included are from the late fifteenth through the nineteenth century.
Book
The uterine health companion : a holistic guide to lifelong wellness
\"For women interested in a holistic approach to maintaining optimal uterine health and addressing specific health disorders of the uterus, from menarche to menopause and beyond\"--Provided by publisher.
Book
A High-Fidelity, Cost Efficient Model for Simulated Resuscitative Hysterotomy
Learning Objectives: To design an anatomically accurate, reusable model of resuscitative hysterotomy providing learners realistic practice without utilizing biological tissue. Secondary objectives included minimizing utilization costs, while developing procedural proficiency for large groups of trainees.Introduction/Background: High-acuity and low-frequency procedures are an important component of emergency medicine training that not all residents encounter before graduation. The pregnant patient in cardiac arrest requiring resuscitative hysterotomy exemplifies this phenomenon. High-fidelity commercial models are expensive, thus less suitable for repeated use by inexperienced learners. Conversely, many low cost models lack anatomic fidelity required to replicate the procedure. We present a low cost, high-fidelity option that is non-tissue based and conducive to repeated use. This allows learners to practice the technique prior to performing an invasive procedure on a patient.Curricular Design: Gaumard S500 Original Childbirth Simulator, a childbirth skills trainer was repurposed as a rapidly reusable model for resuscitative hysterotomy. The empty pelvic base was fitted with a plastic sac containing a baby in simulated amniotic fluid and adjacent placenta. Pelvic organs including a bladder, uterus, subcutaneous tissue and skin were designed using soft pourable silicone rubber. Layers were colored to match soft tissue texture and appearance prior to assembly within the pelvic base. As learners successively perform the procedure, the abdominal covering and uterus layers can be easily resealed for repeated incisions.Impact/Effectiveness: A cost-effective and reusable model allows residents to practice high-acuity, low-frequency procedures in realistic patient care scenarios. This model was implemented with 40 GME and UME learners performing the procedure during a simulated case during weekly didactics. Each participant described the experience as realistic and effective in improving confidence. The model will be integrated annually into simulation activities with plans to expand to other healthcare professionals via in-situ simulation scenarios in the ED.
Journal Article
Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial
Objective To investigate whether uterus preserving vaginal sacrospinous hysteropexy is non-inferior to vaginal hysterectomy with suspension of the uterosacral ligaments in the surgical treatment of uterine prolapse.Design Multicentre randomised controlled non-blinded non-inferiority trial.Setting 4 non-university teaching hospitals, the Netherlands.Participants 208 healthy women with uterine prolapse stage 2 or higher requiring surgery and no history of pelvic floor surgery.Interventions Treatment with sacrospinous hysteropexy or vaginal hysterectomy with suspension of the uterosacral ligaments. The predefined non-inferiority margin was an increase in surgical failure rate of 7%.Main outcome measures Primary outcome was recurrent prolapse stage 2 or higher of the uterus or vaginal vault (apical compartment) evaluated by the pelvic organ prolapse quantification system in combination with bothersome bulge symptoms or repeat surgery for recurrent apical prolapse at 12 months’ follow-up. Secondary outcomes were overall anatomical recurrences, including recurrent anterior compartment (bladder) and/or posterior compartment (bowel) prolapse, functional outcome, complications, hospital stay, postoperative recovery, and sexual functioning.Results Sacrospinous hysteropexy was non-inferior for anatomical recurrence of the apical compartment with bothersome bulge symptoms or repeat surgery (n=0, 0%) compared with vaginal hysterectomy with suspension of the uterosacral ligaments (n=4, 4.0%, difference −3.9%, 95% confidence interval for difference −8.6% to 0.7%). At 12 months, overall anatomical recurrences, functional outcome, quality of life, complications, hospital stay, measures on postoperative recovery, and sexual functioning did not differ between the two groups. Five serious adverse events were reported during hospital stay. None was considered to be related to the type of surgery.Conclusions Uterus preservation by sacrospinous hysteropexy was non-inferior to vaginal hysterectomy with suspension of the uterosacral ligaments for surgical failure of the apical compartment at 12 months’ follow-up.Trial registration trialregister.nl NTR1866.
Journal Article
Dysregulated proliferation and immune response induced by estrogen in Egr1 knockout uterus are similar to those in immature uterus
Background
A balance between estrogen (E2) and progesterone (P4) is vital for a successful pregnancy, and an imbalance between these two hormones yields female infertility. E2 mediates uterine receptivity and regulates endometrial growth, the immune system, and hormone signaling by rapidly inducing early growth response 1 (EGR1). However, the precise mechanism by which EGR1 regulates E2-mediated uterine growth remains unclear. This study examined the transcriptional signatures of ovariectomized (OVX)
Egr1
knockout (KO) mice compared to those of wild-type (WT) mice to clarify the function of EGR1 in the E2-dependent uterine response.
Results
Egr1
KO uteri exhibited an impaired E2 response, with significant changes in the expression of the key genes
Bgn
,
c-Kit
,
Ripor2
, and
Arg2
. During early E2 response,
Egr1
KO uteri showed upregulated insulin-like growth factor (IGF) signaling pathway genes and downregulated reproduction-related genes. During late E2 response,
Egr1
KO uteri showed enhanced proliferative processes, such as DNA replication and mitotic cell cycle phase transition, potentially related to poly-ADP ribosylation (PARylation), along with a reduction in immune response. Notably, the transcriptional signatures in mature OVX
Egr1
KO uteri resembled those in immature uteri, with similar increases in proliferation and decreases in immune response at the pathway level.
Conclusions
Our findings indicate that EGR1 is essential for regulating immune response and uterine proliferation via IGF signaling and PARylation, and acts as a gatekeeper transcription factor that mediates E2 actions in the mature uterus. Notably, we found that the transcriptional signatures of EGR1 in mature uteri overlapped with the primary E2 function and suggested a novel concept that these transcriptional signatures in mature
Egr1
KO uteri are similar to those of immature uteri. Our findings offer novel insights into the role of EGR1 as an E2 mediator in the uterus at the molecular level.
Journal Article
A spatially resolved timeline of the human maternal–fetal interface
Beginning in the first trimester, fetally derived extravillous trophoblasts (EVTs) invade the uterus and remodel its spiral arteries, transforming them into large, dilated blood vessels. Several mechanisms have been proposed to explain how EVTs coordinate with the maternal decidua to promote a tissue microenvironment conducive to spiral artery remodelling (SAR)
1
–
3
. However, it remains a matter of debate regarding which immune and stromal cells participate in these interactions and how this evolves with respect to gestational age. Here we used a multiomics approach, combining the strengths of spatial proteomics and transcriptomics, to construct a spatiotemporal atlas of the human maternal–fetal interface in the first half of pregnancy. We used multiplexed ion beam imaging by time-of-flight and a 37-plex antibody panel to analyse around 500,000 cells and 588 arteries within intact decidua from 66 individuals between 6 and 20 weeks of gestation, integrating this dataset with co-registered transcriptomics profiles. Gestational age substantially influenced the frequency of maternal immune and stromal cells, with tolerogenic subsets expressing CD206, CD163, TIM-3, galectin-9 and IDO-1 becoming increasingly enriched and colocalized at later time points. By contrast, SAR progression preferentially correlated with EVT invasion and was transcriptionally defined by 78 gene ontology pathways exhibiting distinct monotonic and biphasic trends. Last, we developed an integrated model of SAR whereby invasion is accompanied by the upregulation of pro-angiogenic, immunoregulatory EVT programmes that promote interactions with the vascular endothelium while avoiding the activation of maternal immune cells.
A multiomics approach is used to produce a spatiotemporal atlas of the human maternal–fetal interface in the first half of pregnancy, revealing relationships among gestational age, extravillous trophoblasts and spiral artery remodelling.
Journal Article
Sprachentwicklung bei Frühgeborenen
Frühgeborene Kinder zeigen über alle Teilgruppen hinweg eine deutlich erhöhte Wahrscheinlichkeit für das Auftreten von Problemen der Sprach- und Kommunikationsentwicklung. Diese betreffen sowohl expressive als auch rezeptive Sprachfertigkeiten, die Anwendung von Sprache in der sozialen Kommunikation und auch die Lesekompetenz. Die zumeist komplexe Konstellation der Korrelate von Sprachenwicklungsproblemen umfasst einerseits neurologische und auditorische sowie andererseits sozioökonomische Faktoren und dysfunktionale Eltern-Kind-Kommunikation. Einschränkungen der Sprachentwicklung haben häufig negative Effekte auf das Lernen, soziale Beziehungen und die psychische Gesundheit. Die Stabilität von Sprachentwicklungsproblemen ist bereits ab dem frühen Kleinkindalter hoch. Demnach sind die frühe Erkennung und kontinuierliche Kontrolle sprachlich-kommunikativer Fertigkeiten entscheidende Komponenten von Nachsorgeprogrammen. Präventive Intervention vor und nach der Entlassung aus der Klinik ist effektiv, wenn sie die Entwicklung responsiver Eltern-Kind-Beziehungen und das Wohlbefinden der Eltern kontinuierlich unterstützt.
Journal Article
Prevalence of dysmorphic uterus in infertile women by 3D-TVUS: a retrospective longitudinal cohort study
Background
The true prevalence and clinical significance of congenital uterine malformations (CUM), particularly the dysmorphic uterus, in infertile populations remain a matter of debate, largely due to historical limitations in diagnostic methods. This study aimed to (1) determine the prevalence of CUM in an infertile cohort using modern, objective three-dimensional transvaginal ultrasound (3D-TVUS) criteria; (2) evaluate reproductive outcomes following surgical correction; and (3) investigate associated intrauterine pathologies that may contribute to infertility.
Methods
This a retrospective longitudinal cohort study included 154 women presenting for infertility investigation at a university hospital tertiary referral center between January 2020 and December 2022. All patients underwent 3D-TVUS for uterine assessment based on Congenital Uterine Malformation by Experts (CUME) criteria. Women diagnosed with CMU underwent hysteroscopic metroplasty. The primary outcomes were the prevalence of CMU subtypes and the 1-year cumulative live birth rate (LBR). Statistical analysis was performed using one-way ANOVA and chi-square tests.
Results
CMU was identified in 47/154 (30.5%) women. Dysmorphic uterus was the most common anomaly, present in 42/154 women (27.3% of the total cohort; 89.4% of all anomalies). A significant association was found between dysmorphic/septate uteri and the presence of endometrial polyps (45.2%/40.0% vs. 8.5% in normal uteri;
P
< 0.001). After metroplasty, the 1-year cumulative LBR for the dysmorphic uterus group (26.2%) was comparable to the normal uterus group (20.6%;
P
= 0.907). The miscarriage rate per clinical pregnancy was also similar between the dysmorphic (15.4%) and normal uterus (25.7%) groups.
Conclusions
Using modern, objective 3D-TVUS criteria, the prevalence of a dysmorphic uterus in infertile women is substantially higher than previously reported. Surgical correction may improve reproductive outcomes to levels comparable to those in infertile women with normal uterine anatomy. Furthermore, the novel association with endometrial polyps warrants further investigation and underscores the importance of a comprehensive uterine assessment during the infertility workup.
Journal Article
Assisted reproductive technology outcomes in women with congenital uterine anomalies: a systematic review
Purpose
The present systematic review aimed to assess the fecundity of women with congenital uterine anomalies (CUAs) undergoing assisted reproductive technology (ART).
Methods
The present systematic review of the literature was reported according to the PRISMA guidelines. We systematically searched PubMed, MEDLINE, Embase and Scopus, from database inception to 17th October 2023. Studies were deemed eligible only if they included women with CUAs clearly fitting into one of the categories of the ASRM Müllerian anomalies classification 2021.
Results
Data relevant to the reproductive outcomes of women with CUAs who underwent ART were extracted from 55 studies. Regarding Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, studies on gestational surrogacy reported a live birth rate (LBR) ranging from 37 to 54%. Uterus transplant, although still experimental, showed promising results. Most studies reported a negative impact of unicornuate uterus and partial or complete septate uterus on both the miscarriage rate (MR) and the live birth rate (LBR). The reproductive prognosis of women with unicornuate uterus was shown to be particularly poor in case of twin pregnancy. Uterus didelphys, bicornuate and arcuate uterus seem not to negatively impact the ART reproductive outcomes. Uterus didelphys was associated with an increased risk of preterm birth (PTB), cesarean section and low birth weight (LBW).
Conclusion
Women with CUAs should be informed regarding the impact (if any) of their congenital anomaly on both the chances of success of ART and on pregnancy-related complications. Elective single embryo transfer (eSET) should always be the first choice in patients with an increased baseline obstetric risk.
Journal Article