Association between endometriosis and obstetric complications: Insight from the National Inpatient Sample.

OBJECTIVE: This study aimed to investigate the relationship between endometriosis and adverse obstetric outcomes using data from the National Inpatient Sample (NIS) database. METHODS: The ICD-10 coding system was used to identify codes for endometriosis and obstetric outcomes, and data from the NIS (2016-2019) were analyzed. Descriptive statistics were used to summarize variables, while the chi-square test was used to detect significant differences for categorical variables. Univariate and multivariate regression analyses were conducted to assess the association between endometriosis and obstetric outcomes. On multivariate analysis, adjustment was done for age, race, hospital region, smoking status, and alcohol misuse. Forest plots were used to visualize odds ratios and their 95% confidence intervals. RESULTS: Overall, 2,854,149 women were included in this analysis, of whom 4,006 women had endometriosis. The post-hoc Bonferroni correction was applied to account for multiple comparisons, and our analyses revealed several statistically significant associations (p < 0.004). Specifically, on univariate analysis, significant associations with endometriosis were identified for ruptured uterus, placenta previa, placental abruption, postpartum hemorrhage, preeclampsia, amniotic fluid abnormality, gestational diabetes, preterm labor, and multiple gestation. On multivariate analysis, significant associations with endometriosis were observed for placenta previa, placental abruption, postpartum hemorrhage, preeclampsia, amniotic fluid abnormality, preterm labor, premature rupture of membranes, and multiple gestation. CONCLUSION: The present findings provide important insights into the potential relationship between endometriosis and various adverse obstetric outcomes and may help inform clinical practice and future research. Further studies that use more detailed clinical data and longitudinal designs are needed to solidify the presented conclusions.

Comparison of Letrozole and Clomiphene Citrate in Pregnancy Outcomes in Patients with Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis.

Clomiphene citrate (CC) and letrozole are the predominant medical interventions for the management of infertility in patients with polycystic ovary syndrome (PCOS). To comprehensively summarize the evidence, a systematic review and meta-analysis of randomized clinical trials (RCTs) was carried out to assess the effect of letrozole and CC on pregnancy outcomes in PCOS patients. We searched PubMed/MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials from inception to January 2023. We included RCTs conducted on PCOS women comparing letrozole to CC and assessing endometrial thickness, the number and size of follicles, and ovulation and pregnancy rates. The endpoints were summarized as risk ratio (RR) or standardized mean difference (SMD) with 95% confidence interval (CI) using the random-effects model. Heterogeneity was examined using the I2 statistic. Fifty trials met our inclusion criteria. The mean endometrial thickness was significantly higher in the letrozole group compared to CC group (SMD: 0.89; 95% CI: 0.49, 1.28; I2=97.72%); however, the number of follicles was higher in the CC group (SMD: -0.56; 95% CI: -0.96, -0.17; I2=96.34%). Furthermore, letrozole intake induced higher ovulation rate (RR: 1.20; 95% CI: 1.13, 1.26; I2=54.49%) and pregnancy rate (RR: 1.44; 95% CI: 1.28, 1.62; I2=65.58%) compared to CC. Compared to CC, letrozole has a positive effect on endometrial thickness, monofollicular development, and ovulation and pregnancy rates suggesting that letrozole may be a strong alternative to CC as a first-line medical intervention for chronic anovulation in PCOS women. Larger studies are warranted to further clarify these findings.

Knowledge about cervical cancer risk factors and human papilloma virus vaccine among Saudi women of childbearing age: A community-based cross-sectional study from Saudi Arabia.

Objective: To examine the knowledge of cervical cancer risk factors and human papilloma virus (HPV) vaccine among Saudi women of childbearing age. Methods: An anonymous, survey-based, cross-sectional study was conducted from November 2022 to March 2023. Results: Overall, 422 participants were included in the current study. Most participants were within the age group of 15-25 years old (42.9%), single (47.9%), and educated with a bachelor's degree (70%). Out of a total of 14 points, the average knowledge score for all participants was 7.3 ± 2.31 (range: 2-14). More than three-quarters of the surveyed participants correctly identified the following risk factors for cervical cancer: multiple sexual partners (78.2%), having weakened immunity (82.7%), infection with HPV (82.9%), and positive family history of cervical cancer (88.9%). Concerning HPV vaccine, 153 (36.3%) participants heard about HPV vaccine and only 20 (4.4%) of them were vaccinated. Only 128 (30.3%) participants stated correctly that 9-13 years old is the best age to start HPV vaccine, whereas 51 (12.1%) participants correctly stated the number of HPV vaccine doses to be three over six months. Overall, 167 (39.6%) participants declined to receive the HPV vaccine. The three most frequently reported reasons included not hearing about HPV vaccine (35.3%), fear from HPV-related side effects (30.5%), and apprehension from HPV vaccine injection (16.2%). Among several socio-demographic characteristics, occupation was statistically significantly associated with knowledge score (p < 0.001), with students in health specialties tended to have the highest knowledge score compared with others. Conclusion: Most participants displayed good knowledge about cervical cancer risk factors, but not about HPV vaccine. Very alarmingly, less than 5% of the participants received HPV vaccine and close to 40% of them declined to receive the HPV vaccine. Mechanisms to increase public awareness about HPV vaccine and its acceptance by women are recommended.

Abdominal trachelectomy in a case of cervical myoma as a fertility sparing surgery.

Cervical leiomyoma is considered a rare pathology with limited treatment options especially if preserving fertility is a concern. Traditional fertility-preserving surgery such as myomectomy has been the mainstay of management if it is possible (Ferrari F, Forte S, Valenti G, Ardighieri L, Barra F, Esposito V, et al. Current treatment options for cervical leiomyomas: a systematic review of literature. Medicina (Kaunas) 2021;57:1-15). Trachelectomy was described as fertility-preserving surgery in patients with early-stage cervical cancer. However, recent studies manage patients with trachelectomy for benign pathology and suggest that; it as an alternative option that otherwise will be treated as hysterectomy (Ferrari F, Forte S, Valenti G, Ardighieri L, Barra F, Esposito V, et al. Current treatment options for cervical leiomyomas: a systematic review of literature. Medicina (Kaunas) 2021;57:1-15). A 33-year-old female, Para 3, referred to a gynecology clinic with a history of heavy menstrual flow, pelvic pain and pressure symptoms. She is known case of fibroid uterus however after having done pelvic MRI with contrast it confirmed the diagnosis of cervical myoma, measured 10 cm × 10 cm, which is intraoperatively managed by trachelectomy as a fertility preservation surgery. The surgery was complicated by ureterovaginal fistula, which was managed with a DJ stent conservatively. Cervical myoma is a rare pathology, and trachelectomy should be considered as an option for a woman who wants to preserve her fertility. Complication and obstetrical outcome should be discussed with the patient; hence, more studies are needed to address the management of cervical myoma, surgical complications and outcome of this procedure, especially in a benign condition.

Prophylactic tranexamic acid during myomectomy: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To conduct a systematic review and meta-analysis of randomized controlled trials on the clinical efficacy and safety of prophylactic tranexamic acid (TXA) versus control (normal saline/no treatment) during myomectomy. METHODS: Six databases were screened from inception until 21-February-2022. The eligible studies were assessed for risk of bias. The outcomes were summarized as mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI) in a random-effects model. RESULTS: Seven studies, comprising eight arms and 571 patients (TXA = 304 patients, control = 267 patients) were analyzed. The included studies had an overall low risk of bias. The mean intraoperative blood loss (MD = -224.34 ml, 95% CI [-303.06, -145.61], p < 0.001), mean postoperative blood loss, and mean total blood loss were significantly reduced in favor of the prophylactic TXA group. Additionally, the mean postoperative hemoglobin (MD = 0.4 mg/dl, 95% CI [0.11, 0.68], p = 0.006) and mean postoperative hematocrit levels were significantly higher in favor of the prophylactic TXA group. While the mean hospital stay was significantly reduced in favor of the prophylactic TXA group (MD = -0.39 d, 95% [-0.74, -0.04], p = 0.03), there was no significant difference between both groups regarding the mean operation time and rate of blood transfusion. None of the participants in both groups developed any incidence of thromboembolic events. The rate of nausea was significantly higher in disfavor of the prophylactic TXA group (RR = 2.68, 95% CI [1.11, 6.43], p = 0.03). CONCLUSION: Among patients undergoing myomectomy, prophylactic TXA was largely safe and linked to substantial reductions in perioperative blood loss and related morbidities.

Collision Glial Neoplasms Arising in an Ovarian Mature Cystic Teratoma: A Rare Event.

Germ cell neoplasms represent around 20% of all ovarian tumors. They most frequently affect children and young adults. Mature cystic teratoma is a common benign ovarian neoplasm comprising about 95% and is made up of all three germ cell embryonic layers. By definition, mature cystic teratoma may be derived from any of the three germ cell lines. On the other hand, immature teratomas contain primitive neuroepithelial elements. However, it is quite uncommon in the English literature to have a neuroepithelial glial neoplasm arising in a mature cystic teratoma of an adolescent. Interestingly enough, all published cases described a single type of glial neoplasm arising in mature ovarian teratoma. Herein, the authors discuss a unique case of concomitant occurrence of two different glial neoplasms, namely pilocytic astrocytoma and subependymoma arising in an ovarian mature cystic teratoma. To the best of our knowledge, this is the first reported case with such a distinctive histopathologic finding.

Rhabdomyosarcoma of the genital tract in an 18-month-old girl.

Embryonal Rhabdomyosarcoma 'Botryoid Type' is a rare soft tissue tumor that arises within the wall of the bladder or vagina and seen almost exclusively in infants. Treatment is combination of surgery with adjuvants chemotherapy and radiotherapy. We report a case of an 18-month-old Saudi girl presented with history of abdo-pelvic mass, bleeding per vagina and a mass protruding through the introitus. Computed tomography (CT) done reveling large heterogeneous pelvic mass arising from the uterus, biopsy of mass confirmed the diagnosis (sarcomabotryoidal). The patient received multiple cycles of combination chemotherapy as a neoadjuvant treatment then underwent total abdominal hysterectomy with upper vaginectomy. Postoperatively, the patient received more cycles of chemotherapy. CT scan for post-treatment evaluation was done and showed no evidence of local recurrence or distant metastasis. Currently, she is disease-free on remission with no complains.

Mclndoe Neovagina in patients with Mullerian Agenesis: A single center experience.

OBJECTIVES: To evaluate the surgical feasibility and the long-term anatomical and functional results and complication rates in patients with Mullerian aplasia who underwent vaginal reconstruction. METHODS: A retrospective observational case series study over 8 years was conducted in King Faisal Specialist Hospital & Research Centre - Jeddah, Saudi Arabia. All cases diagnosed as Mullerian aplasia and who underwent surgical correction were included. Painless and satisfactory vaginal intercourse after surgery were the main outcome measured. RESULTS: A total of 19 patients were diagnosed with Mullerian agenesis and underwent vaginal reconstruction by Mclndoe technique with minor modification. All of our patients who were sexually active and were compliant with mold use postoperatively were able to achieve 100% painless and satisfactory sexual intercourse. CONCLUSIONS: Minor modification in McIndoe technique provides easier, safer and deeper dissection that minimizes the complications and helps in maximizing the vaginal length. It provides satisfactory and functional vagina in the majority of the patients.

Placental site trophoblastic tumor and choriocarcinoma: an unusual presentation.

BACKGROUND: Mixed trophoblastic tumor composed of choriocarcinoma and placental site trophoblastic tumor was diagnosed on histopathology slides review, is a very rare mixed tumor and cured after adjuvant chemotherapy. CASE PRESENTATION: Twenty-nine years old, Para 2 female presented with 4 months history of irregular vaginal bleeding after an uncomplicated vaginal delivery. Abdominal examination showed 14 weeks uterus with ß-hCG level of 14,889 mIU/ml. Slides review confirmed the diagnosis of placental site trophoblastic tumor (PSTT). Patient underwent total abdominal hysterectomy and resection of anterior vaginal wall mass. Post operative (48 h) ß-hCG level was 6016 mIU/ml. Final pathology showed mixed trophoblastic tumor composed of choriocarcinoma (CC) and PSTT. Adjuvant chemotherapy started and continued for three cycles after achieving normal ß-hCG. CONCLUSION: PSTT is a rare disease and potentially curable. Differential diagnosis in women presented with vaginal bleeding and a uterine mass in the post partum period must include gestational trophoblastic disease.

Malignant transformation of persistent endometriosis after hysterectomy.

The malignant transformation of persistent endometriotic implants into endometrioid adenocarcinoma is rare, especially after remote hysterectomy and salpingo-oophorectomy (TAH-BSO), and there are few cases reported in the English language literature. Patients receiving estrogen replacement therapy are common among the reported cases. We present a case that demonstrates the possibility of malignant transformation in a 53-year-old female, known case of endometriosis, who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy with no evidence of malignancy in the final pathology report. After 9 years, she presented with lower abdominal mass, and histopathological studies confirmed the diagnosis of well-differentiated endometrioid adenocarcinoma. The possibility of malignant transformation and possible risk factors are discussed with a brief literature review. 

Cervical cancer in the province of Manitoba: a 30-year experience.

OBJECTIVES: This study was undertaken to analyze trends in cervical cancer incidence by histological type and to track the survival rate in the province of Manitoba over a 30-year period. METHODS: Data from the Manitoba Cancer Registry (MCR) relating to all cases of cervical cancer that occurred between 1970 and 1999 in the province of Manitoba were analyzed to calculate incidence and survival rates according to histological subtype. RESULTS: Over this 30-year span, invasive cervical cancer was diagnosed in 1927 women, and carcinoma in situ was diagnosed in 10 006 women. Cervical cancer was the fifth most frequent cancer diagnosis for women in 1970, and by 1999 it had become the eleventh most frequent. The incidence rate for cervical cancer decreased from 21.6/100 000 women in 1970 to 8.8/100 000 women in 1999. The mortality rate for women with cervical cancer fell from 7.3/100 000 women in 1970 to 2.8 /100 000 women in 1999. Squamous cell carcinoma (SCC) was the most frequently diagnosed histologic subtype, but its incidence decreased from 1970 to 1999; the proportion of women with adenocarcinoma increased gradually over the same time from 7% to 22%. Survival rates were comparable in women with SCC and adenocarcinoma. In 1999, the incidence of cervical cancer in Manitoba was comparable to the Canadian rate. However, the mortality rate from cervical cancer was higher in Manitoba than in Canada overall. CONCLUSION: The incidence of cervical cancer and the incidence of cervical cancer-related deaths in Manitoba both dropped between 1970 and 1999. However, the incidence of cervical carcinoma in situ has increased steadily during the same period. These observations may reflect the effect of screening programs on the detection and treatment of cervical cancer precursors. Squamous cell carcinoma is still the most frequently diagnosed subtype of invasive cervical cancer, but the proportion of women with adenocarcinoma has increased. Deaths from cervical cancer showed a non-significant reduction over the study period.