Incarcerated gravid uterus liberated by vaginal gauze packing under general anesthesia: a case report.

Incarceration of the gravid uterus is a rare and serious obstetric complication that can lead to severe complications. We present the case of a 32-year-old woman (gravida 5, para 2022) at 12 weeks and 5 days of gestation who presented with urinary retention and lower abdominal pain. Despite attempts at positional changes and manipulative repositioning under epidural anesthesia, the incarceration of the gravid uterus persisted. Subsequent intervention under general anesthesia involved partially reducing the uterine fundus into the abdominal cavity and using gauze strips in the posterior vaginal fornix to maintain traction. In addition, the bilateral round ligaments of the uterus were sutured to release the incarcerated uterus via laparoscopy. Vaginal gauze packing under general anesthesia may be a beneficial intervention for addressing cases of an incarcerated uterus, particularly in patients in whom passive maneuvers and manual pressure fail to resolve the condition.

Incarceration of the gravid uterus: Ultrasound diagnosis and pregnancy outcomes.

BACKGROUND: This research aims to summarize the ultrasound features and pregnancy outcomes of incarceration of the gravid uterus (IGU), providing a basis for clinical management. METHODS: A retrospective cohort study was conducted on pregnant patients with IGU at Hunan Provincial Maternal and Child Health Care Hospital in China, spanning from September 30, 2016, to May 31, 2024. Data on maternal age, parity, medical history, risk factors, gestational age, clinical manifestations, ultrasound examination, treatment methods, time, and method for terminating pregnancy, and pregnancy outcomes were collected. We compared cases diagnosed before and after 20 gestational weeks. RESULTS: During the study period, 13 pregnant women were diagnosed with IGU, and 140 162 deliveries were recorded at our hospital. Two cases were referred from other hospitals and did not deliver in our hospital. Accordingly, the incidence of IGU was 0.08‰ (11/140, 162). The most prevalent risk factor for IGU was previous abdominal or pelvic surgery (61.54%, 8/13). Dysuria or even urinary retention was the primary symptom (38.46%, 5/13). Spontaneous resolution occurred in only one case (7.69%). All cases were detected using prenatal ultrasound examination with typical characteristics, including a retroverted uterus and the fundus located behind the cervix. No statistically significant differences between the two comparison groups were found in successful uterine reduction (p > 0.05). CONCLUSION: The definition of IGU should include symptomatic cases of any gestational age. Despite a low prevalence of this pregnancy complication, the overall prognosis of IGU is good. In the absence of severe symptoms, regular monitoring may be an option. Typical ultrasound imaging features enable a definitive diagnosis of IGU.

Do Not Get Your Uterus Twisted: A Case Report of a 180-Degree Torsion of Term Gravid Uterus and a Review of the Literature.

Gravid uterine torsion less than 45 degrees is a common phenomenon of the third trimester. Torsion greater than 45 degrees represents a rare, pathologic, and obstetric emergency. The rotation of the uterus on a longitudinal plane can result in vascular compromise, and it has potential for catastrophic maternal-fetal complications. We report the case of a 22-year-old G3P1011, third pregnancy with history of one full-term live newborn, one spontaneous abortion, and presented at 38 weeks gestation with complaints of abdominal pressure and recurrent transverse fetal presentation. She underwent an external cephalic version (ECV), which resulted in fetal distress necessitating an emergency cesarean section. After successful delivery of the live newborn, an inspection of the uterus identified a uterine torsion of 180 degrees with delivery through a posterior hysterotomy incision. She had no postoperative complications and carried a subsequent pregnancy to term that was delivered via repeat cesarean section five years later. Gravid uterine torsion should be included in the differential diagnosis for patients presenting with abdominal pain and fetal intolerance to labor. A higher suspicion should be held for patients with a known history of uterine abnormalities or those having undergone an ECV. Our case also highlights a safe repeat cesarean section after this rare complication and brief narrative review of existing literature on this rare obstetrical emergency.

A case report of torsion of the gravid uterus caused by pelvic adhesion.

Key Clinical Message: In this case, a patient experienced rare uterine torsion during pregnancy, detected by MRI. Diagnosis before Cesarean is helpful to achieve better outcomes, highlighting the importance of attention in high-risk groups. Abstract: Uterine torsion during pregnancy is a rare complication and its risk factors and diagnostic modalities have not yet been clearly defined. Here we present a case of uterine torsion due to unexpected pelvic adhesion. A 34-years-old primigravida patient underwent an emergency cesarean section for aggravated maternal preeclampsia symptoms at 34 + 0 weeks of gestation. Intraoperatively, after the baby was out, it was found that the uterus was rotated about 90 degrees to the right by dense pelvic adhesion in posterior uterine wall. In this patient, a rightward vaginal stretch was represented through a retrospective review of magnetic resonance imaging (MRI) before childbirth. To our knowledge, this is the first reported case of uterine torsion during pregnancy with MRI. Diagnosing uterine torsion in advance or paying attention to incisions during operative delivery will lead to better management in this condition and good perinatal outcomes.

Asymptomatic Patient With Incarcerated Gravid Uterus Diagnosed in the Third Trimester: A Case Report of a Rare Potential Obstetric Emergency.

Incarcerated gravid uterus (IGU) is a rare condition that occurs when a retropositioned gravid uterus becomes entrapped within the pelvic cavity. Most patients present around the 17th week of pregnancy with symptoms such as pelvic fullness, urinary incontinence, abdominal pain, constipation, and vaginal bleeding. Rarely, patients are asymptomatic throughout pregnancy, leaving IGU undiagnosed and untreated. Here, we present an asymptomatic 26-year-old female who presented at 30 weeks of gestation with severe intrauterine growth retardation (IUGR) on serial obstetric ultrasounds. Further evaluation with ultrasound and MRI revealed an incarcerated uterus. This was complicated by severe fetal IUGR, abnormal biophysical profile, and oligohydramnios. This case highlights the importance of early diagnosis and treatment of IGU in order to prevent complications associated with the condition. Clinicians should be aware that, although uncommon, patients with IGU may be asymptomatic and that diagnosis should depend primarily on imaging findings rather than symptoms.

Regulatory mechanisms of HMGB1 and its receptors in polycystic ovary syndrome-driven gravid uterine inflammation.

High-mobility group box 1 (HMGB1) is critical for inflammatory homeostasis and successful pregnancy, and there is a strong association among elevated levels of HMGB1, polycystic ovary syndrome (PCOS), chronic inflammation and pregnancy loss. However, the mechanisms responsible for PCOS-driven regulation of uterine HMGB1 and its candidate receptors [toll-like receptor (TLR) 2 and 4] and inflammatory responses during pregnancy remain unclear. In this study, we found a gestational stage-dependent decrease in uterine HMGB1 and TLR4 protein abundance in rats during normal pregnancy. We demonstrated that increased expression of HMGB1, TLR2 and TLR4 proteins was associated with activation of inflammation-related signalling pathways in the gravid uterus exposed to 5α-dihydrotestosterone and insulin, mimicking the clinical features (hyperandrogenism and insulin resistance) of PCOS and this elevation was completely inhibited by treatment with the androgen receptor (AR) antagonist flutamide. Interestingly, acute exposure to lipopolysaccharide suppressed HMGB1, TLR4 and inflammation-related protein abundance but did not affect androgen levels or AR expression in the gravid uterus with viable fetuses. Furthermore, immunohistochemical analysis revealed that, in addition to being localized predominately in the nuclear compartment, HMGB1 immunoreactivity was also detected in the cytoplasm in the PCOS-like rat uterus, PCOS endometrium and pregnant rat uterus with haemorrhagic and resorbed fetuses, possibly via activation of nuclear factor κB signalling. These results suggest that both AR-dependent and AR-independent mechanisms contribute to the modulation of HMGB1/TLR2/TLR4-mediated uterine inflammation. We propose that the elevation of HMGB1 and its receptors and disruption of the pro-/anti-inflammatory balance in the gravid uterus may participate in the pathophysiology of PCOS-associated pregnancy loss.

Importance of the early diagnosis of incarcerated gravid uterus: Case report and systematic review.

OBJECTIVE: To examine whether the early diagnosis of uterine incarceration before 20 weeks of gestation improves maternal-perinatal prognoses. METHODS: A systematic review of all of the cases published in the past 30 years that met the inclusion and exclusion criteria was performed and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. A comparative analysis of diagnoses before and after 20 weeks of gestation was performed. RESULTS: Eighty-nine studies with a total of 146 cases of uterine incarceration during pregnancy were included. For cases of incarceration diagnosed before 20 weeks of gestation, a higher proportion of clinical symptoms was observed; however, a lower proportion of complications, such as premature delivery, need for cesarean section, and poor perinatal outcomes, were observed (P < 0.05). The proportion of spontaneous resolution and minimally invasive techniques for the treatment of incarceration was significantly higher among patients diagnosed with this pathology before 20 weeks (P < 0.05). CONCLUSION: The literature indicates that uterine incarceration is a rare complication during pregnancy with better maternal-perinatal results if diagnosed earlier than 20 weeks.

Preanesthetic ultrasonography assessment of inferior vena cava diameter in the supine position, left lateral tilt position, and with the left uterine displacement maneuver in full-term pregnant women: A randomized cross-over design study.

Preanesthetic ultrasonography assessment of inferior vena cava diameter (IVCD) in the supine position (SP), left lateral tilt position (LLT), and with the left uterine displacement maneuver (LUD) in full-term pregnant women: a randomized cross-over design study. AIM: We pre-anesthetically measured IVCD using ultrasonography in the SP, LLT, and the LUD in full-term pregnant women, using a cross-over design, to evaluate the effectiveness of LLT and LUD on increasing IVCD, and the presence of inter-individual differences among patients in the effect of posture on IVCD. METHODS: Twenty-two parturients scheduled for elective cesarean section under spinal anesthesia were recruited. All patients were sequentially placed in the SP, LLT, and with LUD before spinal anesthesia induction. Indices of IVCD, measured by subxiphoid ultrasonography, including maximum IVCD (IVCDmax), minimum IVCD (IVCDmin), and collapsibility index (CI) were recorded in each of the postures. Mean or median values of all measurements were compared among the postures. RESULTS: The mean values of IVCDmax observed with both LLT and LUD were significantly larger than those in the SP, respectively (SP vs. LLT: p < 0.05, SP vs. LUD: p < 0.01), although there were no significant differences between IVCDmax with LLT and LUD. There were no significant differences in IVCDmin and CI between any of the postures. IVCDmax was highest with LUD in 11 patients (55%), in the LLT in seven patients (35%) and in the SP in two patients (10%). CONCLUSIONS: LLT and LUD might be equally effective in enlarging the narrowed IVCD as compared to SP. However, both LLT and LUD might not necessarily be appropriate treatments to relieve IVC compression in some cases.

The ElectroUteroGraph: A Novel Tool for Assessing Uterine Contractions of Non-Pregnant Women.

Goal: Uterine contractility is known to play significant role in women's health. Ultrasonography and magnetic resonance imaging have been used for assessing uterine peristalsis, however they lack practicality, objectivity, and cost-effectiveness. In this paper, the ElectroUteroGraph (EUG) and novel electrodes are introduced, to cover the unmet need of practical intrauterine contractility assessment. The EUG measures biopotentials produced by uterine muscle contraction, similar to the basis of electrocardiography. Methods: The EUG was used to fifteen healthy, non-pregnant women of reproductive age. Amplitude and frequency-related features were derived from our recordings. Results: The EUG and novel electrodes did not cause any pain or discomfort to the patients, over their multiple recording sessions. The collected data showed difference between the proliferative and luteal phase of menstrual cycle (p < 0.05). Conclusions: The EUG can accurately measure uterine electrical activity, in a simple, standardized, safe and pain-free approach, leading to objective evaluation of uterine peristalsis.

Incarcerated gravid uterus: A rare but potentially devastating obstetric complication.

Incarceration of the gravid uterus is a rare obstetric complication characterized by entrapment of the gravid uterus between the sacral promontory and pubic symphysis. Clinical symptoms are highly variable and may include low back pain, urinary retention, and nausea. A presumptive diagnosis can often be established based on correlation of clinical history and physical examination. However, ultrasound and/or pelvic magnetic resonance imaging are essential for confirmation. Herein, we describe a 30-year-old female who presented with uterine incarceration and discuss the diagnosis, imaging features, and management of this uncommon but important clinical entity.

Overactivation of the androgen receptor exacerbates gravid uterine ferroptosis via interaction with and suppression of the NRF2 defense signaling pathway.

The mechanisms through which the androgen-dependent activation of the androgen receptor (AR) regulates gravid uterine ferroptosis remain unknown. We show that while co-exposure of pregnant rats to the androgen 5α-dihydrotestosterone (DHT) and insulin (INS) triggered uterine ferroptotic signaling cascades, additional treatment with the anti-androgen flutamide increased expression of the key ferroptosis-inhibitory proteins SLC7A11, GSH, and GPX4; reduced iron content; normalized levels of ferroptosis-associated Tfrc, Fpn1, and Ho1 mRNAs; reduced levels of proteins modified by 4-HNE (a marker of ferroptosis); and restored protein levels of NRF2, a key transcription factor regulating antioxidant defense signaling, in the gravid uterus. Furthermore, exposure to DHT alone increased uterine ferroptosis, and NRF2 abundance was negatively correlated with AR status. Co-immunoprecipitation and Western blot assays revealed that the AR physically interacted with endogenous NRF2, and this interaction was increased by DHT exposure in vivo. Our results suggest that AR overactivation and NRF2 suppression cooperate in the regulation of NRF2-targets in uterine ferroptosis.

Suppression of uterine and placental ferroptosis by N-acetylcysteine in a rat model of polycystic ovary syndrome.

The mechanisms that link hyperandrogenism and insulin (INS) resistance (HAIR) to the increased miscarriage rate in women with polycystic ovary syndrome (PCOS) remain elusive. Previous studies demonstrate that increased uterine and placental ferroptosis is associated with oxidative stress-induced fetal loss in a pre-clinical PCOS-like rat model. Here, we investigated the efficacy and molecular mechanism of action of the antioxidant N-acetylcysteine (NAC) in reversing gravid uterine and placental ferroptosis in pregnant rats exposed to 5α-dihydrotestosterone (DHT) and INS. Molecular and histological analyses showed that NAC attenuated DHT and INS-induced uterine ferroptosis, including dose-dependent increases in anti-ferroptosis gene content. Changes in other molecular factors after NAC treatment were also observed in the placenta exposed to DHT and INS, such as increased glutathione peroxidase 4 protein level. Furthermore, increased apoptosis-inducing factor mitochondria-associated 2 mRNA expression was seen in the placenta but not in the uterus. Additionally, NAC was not sufficient to rescue DHT + INS-induced mitochondria-morphological abnormalities in the uterus, whereas the same treatment partially reversed such abnormalities in the placenta. Finally, we demonstrated that NAC selectively normalized uterine leukemia inhibitory factor, osteopontin/secreted phosphoprotein 1, progesterone receptor, homeobox A11 mRNA expression and placental estrogen-related receptor beta and trophoblast-specific protein alpha mRNA expression. Collectively, our data provide insight into how NAC exerts beneficial effects on differentially attenuating gravid uterine and placental ferroptosis in a PCOS-like rat model with fetal loss. These results indicate that exogenous administration of NAC represents a potential therapeutic strategy in the treatment of HAIR-induced uterine and placental dysfunction.

Incarcerated Gravid Uterus: Spontaneous Resolution Is Not Rare.

AIM: Incarcerated gravid uterus is a rare obstetrical complication that leads to adverse outcomes, especially if the uterus remains incarcerated and the condition goes undiagnosed until delivery. However, there is no consensus regarding the optimal management of this complication because of its rarity. In this study, we aimed to elucidate the incidence of incarcerated gravid uterus, as well as its natural courses and perinatal outcomes. METHODS: We retrospectively reviewed medical records of patients who had incarcerated gravid uterus and managed at Osaka City University Hospital between April 2011 and March 2021. Incarcerated gravid uterus was defined as a retroverted or retroflexed uterus after 16 weeks of gestation. RESULTS: There were 14 incarcerated cases among 6958 pregnant women, and 13 of them had some kind of gynecological complication and/or history. Spontaneous resolution of incarcerated gravid uterus after 16 gestational weeks was observed in six cases before the late second trimester and five cases at the late second trimester to early third trimester. Three cases remained incarcerated at term or near-term. One case with adenomyosis had severe abdominal pain, although it was difficult to ascertain whether the cause of pain was triggered by adenomyosis and/or incarceration. One case was misdiagnosed as placenta previa, and the uterine cervix was subsequently injured during cesarean delivery, resulting in massive hemorrhaging. CONCLUSIONS: Approximately 1 in 2300 pregnancies continued to be in an incarcerated condition at term or near-term, and 78.5% of cases showed a spontaneous resolution after 16 weeks of gestation. Expectant management with careful attention to the incarcerated gravid uterus may be one option in situations where there are no severe symptoms related to the incarceration itself.

Clinical approach and management of uterine incarceration according to trimester of pregnancy: Case report and literature review.

OBJECTIVE: The purpose of present report is an effective clinical approach to incarcerated uterus by the trimester of pregnancy, in this case and 54 cases reported previously. CASE REPORT: A woman at 18 + 5 weeks of gestation was referred with abdominal pain and urinary dysfunction. In pelvic examination, the cervix was not seen and huge myoma was located at retroverted anterior uterine wall and the elongated cervix was pulled up above the bladder in ultrasonography. The uterine incarceration was confirmed by magnetic resonance imaging. The manual reduction of uterus was attempted with knee-chest-position repeatedly. However, this was unsuccessful because large fibroid was impacted and immovable. Therefore, laparotomy was conducted for repositioning of uterus. Pregnancy was maintained without any complication and a 4250 g healthy female infant was delivered by cesarean section. CONCLUSION: By analyzing of several cases, useful diagnostic modalities and effective management should be approached according to trimester of pregnancy.

The Embryonic re-Development of an Anatomy Museum : Visualising Anatomical Collections: Human Female Reproductive Anatomy and Biology and Foetal Development.

This chapter discusses the history of the Museum of Anatomy at the University of Glasgow in the context of a planned themed display on obstetrics and pregnancy, centred around human female reproductive anatomy, to support a showcase of Plaster Casts made and used by William Hunter. This exhibition aims to enhance the audience's experience with an educational display of historical specimens as well as anatomical artwork and medical models. It is anticipated that the resultant exhibition will include a series of visualisations and diagrams for use within the collection display to support the audience's understanding of the biological processes involved in reproduction, foetal development and women's experiences of childbirth. The chapter considers historical and contemporary methods of visualising embryos, as well as the developing discourse around menstruation, the gendered body and the lack of diverse representation in gynaecological images, and reflects on some of the historical, scientific, situational and societal considerations needed to achieve an inclusive and accessible exhibition. It also reflects on the artist's role in the embryonic development of this exhibition. The artworks in this chapter and the more that are planned should guide viewers with intentionally inclusive visual content. The project requires considerable further development and discussion with the team of experts involved. It is hoped that this intervention will broaden the impact of the collections in this space and provide opportunities to improve audience engagement by creating content that reflects and includes the voices of society in its creation.

Efficacy of well-planned management in patients with incarcerated gravid uterus: A case series and literature review.

OBJECTIVE: Incarcerated gravid uterus is a condition in which uterine myoma and intraperitoneal adhesion lead to persistent uterine retroversion. Accurate diagnosis before cesarean section is crucial so that the procedure can be planned with regard to the spatial relationship between the uterine incision and other organs. This study investigated the effects of well-planned management on the outcome of cesarean sections. MATERIALS AND METHODS: Four patients with incarcerated gravid uterus who received well-planned management and preoperative magnetic resonance imaging were compared with three unexpected patients who were operated without preoperative diagnosis. RESULTS: In the preoperatively diagnosed group, compared with the non-preoperatively diagnosed group, the frequency of cervical canal damage tended to be lower (0% vs. 100%), blood loss tended to be less (1171 ± 290 mL vs. 2000 ± 300 mL), and surgery duration tended to be shorter (82 ± 17 min vs. 147 ± 84 min). None of the preoperatively diagnosed cases required allogeneic blood transfusion, and no organ damage was observed. CONCLUSION: The early detection of a suspected incarcerated uterus, and a thorough understanding of diagnostic methods and the use of preoperative magnetic resonance imaging and ultrasonography facilitate the safe performance of a cesarean section.

Remembering William Hunter (1718-1783) the Pioneer in Obstetrics: A Prelude to Sestercentennial Anniversary of Anatomia uteri humani gravidi.

William Hunter (1718-1783) was a Scottish anatomist and physician. He started his career as a man midwife and went on to become the leading obstetrician in London. He prepared anatomically dissected specimens depicting anatomy of gravid uterus and undelivered fetus with placenta in different stages of gestation. Hunter compiled illustrations prepared from these specimens with his clinical notes and published his treatise Anatomia uteri humani gravidi in 1774. This article is a tribute to William Hunter as we approach the 250th year of publication of his work which is a significant milestone in the history of obstetrics and its practice.

Hyperandrogenism and insulin resistance modulate gravid uterine and placental ferroptosis in PCOS-like rats.

Women with polycystic ovary syndrome (PCOS) have hyperandrogenism and insulin resistance and a high risk of miscarriage during pregnancy. Similarly, in rats, maternal exposure to 5α-dihydrotestosterone (DHT) and insulin from gestational day 7.5 to 13.5 leads to hyperandrogenism and insulin resistance and subsequently increased fetal loss. A variety of hormonal and metabolic stimuli are able to trigger different types of regulated cell death under physiological and pathological conditions. These include ferroptosis, apoptosis and necroptosis. We hypothesized that, in rats, maternal hyperandrogenism and insulin-resistance-induced fetal loss is mediated, at least in part, by changes in the ferroptosis, apoptosis and necroptosis pathways in the gravid uterus and placenta. Compared with controls, we found that co-exposure to DHT and insulin led to decreased levels of glutathione peroxidase 4 (GPX4) and glutathione, increased glutathione + glutathione disulfide and malondialdehyde, aberrant expression of ferroptosis-associated genes (Acsl4, Tfrc, Slc7a11, and Gclc), increased iron deposition and activated ERK/p38/JNK phosphorylation in the gravid uterus. In addition, we observed shrunken mitochondria with electron-dense cristae, which are key features of ferroptosis-related mitochondrial morphology, as well as increased expression of Dpp4, a mitochondria-encoded gene responsible for ferroptosis induction in the uteri of rats co-exposed to DHT and insulin. However, in the placenta, DHT and insulin exposure only partially altered the expression of ferroptosis-related markers (e.g. region-dependent GPX4, glutathione + glutathione disulfide, malondialdehyde, Gls2 and Slc7a11 mRNAs, and phosphorylated p38 levels). Moreover, we found decreased expression of Dpp4 mRNA and increased expression of Cisd1 mRNA in placentas of rats co-exposed to DHT and insulin. Further, DHT + insulin-exposed pregnant rats exhibited decreased apoptosis in the uterus and increased necroptosis in the placenta. Our findings suggest that maternal hyperandrogenism and insulin resistance causes the activation of ferroptosis in the gravid uterus and placenta, although this is mediated via different mechanisms operating at the molecular and cellular levels. Our data also suggest that apoptosis and necroptosis may play a role in coordinating or compensating for hyperandrogenism and insulin-resistance-induced ferroptosis when the gravid uterus and placenta are dysfunctional.

High prevalence of intrapelvic parasitic arteries in patients with placenta accreta spectrum: A case-control study using unenhanced magnetic resonance angiography.

PURPOSE: To compare the prevalence of enlarged ovarian and intrapelvic parasitic arteries to the gravid uterus between cases of placenta accreta spectrum (PAS) and those with normal placentation using unenhanced magnetic resonance (MR) angiography. METHODS: Unenhanced time-of-flight MR angiography was performed in 12 consecutive women with PAS (mean age, 34 years; range, 23-42 years) and 24 women with normal placentation (mean age, 31 years; range, 24-42 years) in their third trimester and reviewed by two independent observers. The consensus reading served as the reference standard. Findings of pelvic arteriography performed at cesarean hysterectomy were reviewed in all cases of PAS. The prevalence of enlarged ovarian and intrapelvic parasitic arteries was compared using Fisher's exact test. The interobserver agreement was assessed with Kappa statistics. RESULTS: The prevalence of enlarged ovarian arteries was not significantly different between cases of PAS and normal placentation (17% [4/24 pelvic sides] vs. 4% [2/48 pelvic sides], P = .091). The prevalence of intrapelvic parasitic arteries was significantly higher in cases of PAS than in those with normal placentation (67% [16/24 pelvic sides] vs. 0% [0/48 pelvic sides], P < .0001). On a patient-by-patient basis, the intrapelvic parasitic artery was frequently present in women with PAS (92% [11/12 patients]). The Kappa values were 0.915 and 0.852 for detecting enlarged ovarian and intrapelvic parasitic arteries, respectively, indicating excellent interobserver agreement. CONCLUSIONS: The development of intrapelvic parasitic arteries was an anomalous phenomenon observed on unenhanced MR angiography in the majority of women with PAS but was not observed in those with normal placentation.

Body composition changes of crossbred Holstein × Gyr cows and conceptus during pregnancy.

This study aimed to evaluate the effects of plane of nutrition and advancing days of pregnancy (DP) on maternal body composition and fetal development. Differing planes of nutrition were established by 2 feeding regimens (FR): ad libitum (AL) or maintenance (MA). Sixty-two nonlactating multiparous Holstein × Gyr cows with average body weight of 480 ± 10.1 kg and an age of 5 ± 0.5 yr were used. Cows were divided into 3 groups: pregnant (n = 44), nonpregnant (n = 12), and baseline reference cows (n = 6). The 56 pregnant and nonpregnant cows were randomly allocated into 2 different FR: AL or MA. Cows fed at MA received 1.15% of their body weight on a dry matter (DM) basis, receiving corn silage and a concentrate-based diet at a ratio of 93:7 on a DM basis. Reference group cows were slaughtered at the beginning of the experimental period to estimate body composition and empty body weight. To evaluate the effects of DP, pregnant and nonpregnant animals were slaughtered at d 140, 200, 240, and 270 of gestation. Feeding regimen affected maternal tissue composition. Days of pregnancy affected fresh weight (FW), DM, and energy content, but no differences were observed for crude protein (CP) and ether extract (EE) because of DP. Feeding regimen affected mammary gland components (CP, EE, and energy content), but not fresh or dry weights. Days of pregnancy influenced almost all mammary gland components except energy content. Regarding the uterus, FR affected only fresh and dry weights; however, DP affected every uterus component measured. The only interaction between FR and DP in this study was observed for placental FW. Cows fed AL on d 270 presented the same placental FW as cows at MA and AL on d 200 and 240. Further, pregnant cows fed at MA on d 270 had greater placental FW than cows fed AL at this day. Days of pregnancy, but not FR, influenced the composition of fetal fluids in pregnant cows. Finally, cows fed at MA had greater FW for the fetus than cows fed AL; however, fetus composition changed over DP. The FW, DM, EE, and energy content increased until d 270, but CP decreased. In conclusion, the novelty of our data presents how changes due to FR and DP occur in maternal tissues and the conceptus.