Reliability and validity of impact absorption rate using accelerometers during single-leg drop-jump landings.

[Purpose] To assess the reliability and validity of accelerometer-based impact absorption rate measurements during single-leg drop-jump landings. [Participants and Methods] Study participants were healthy adult males. The task involved a single-leg drop-jump from the platform with a forward landing onto a floor reaction force plate. Accelerometers were fastened to the trunk, while foot switches were attached to the forefoot plantar surfaces. The impact absorption rate was calculated as the peak composite acceleration during the single-leg drop-jump landing divided by the duration from foot contact to the attainment of peak value. The loading rate (LR) was calculated by dividing the peak vertical force by the duration from foot contact to the attainment of peak value, leveraging the data obtained from a floor reaction force plate. Intraclass correlation coefficients (ICC) were used for intra- and inter-rater reliability analyses of 18 and 12 participants, respectively. The validity was examined through the correlation between impact absorption rate and LR in the 18 participants. [Results] The intra- (ICC (1,1)) and inter-rater (ICC (2,1)) reliabilities for the impact absorption rates were 0.89 and 0.88, respectively. A significant positive correlation was observed between impact absorption rates and LR (r=0.71). [Conclusion] The impact absorption rate may be valuable in clinical practice.

Differences in the Timed Up and Go Test under different measurement conditions in young healthy adults.

[Purpose] The purpose of this study was to verify whether Timed Up and Go (TUG) test measurements differed according to the seat height of the chair, presence or absence of armrests, and measurement location in young healthy adults, and to clarify the flexibility of the TUG settings. [Participants and Methods] Fifty-nine young healthy males and females participated in this study. The TUG test was performed under several conditions. Eight measurements were obtained at both the usual walking speed and the individual's fastest walking speed. [Results] There were no significant differences in TUG test measurements according to variation in seat height, different measurement locations, with and without the use of armrests, or at the usual walking speed or the fastest walking speed. [Conclusion] In young healthy adults, TUG test measurements were unaffected by differences in chair height, use of armrests, or the location of the measurement. If TUG measurements are found to differ according to these variables, it is necessary to consider the influence of the individual's ability rather than the measurement method.

The Impact of Assisted Reproductive Technology on Umbilical Cord Insertion: Increased Risk of Velamentous Cord Insertion in Singleton Pregnancies Conceived through ICSI.

Background and Objectives: Vasa previa (VP) is a significant perinatal complication that can have serious consequences for the fetus/neonate. Velamentous cord insertion (VCI) is a crucial finding in prenatal placental morphology surveillance as it is indicative of comorbid VP. Assisted reproductive technology (ART) has been identified as a risk factor for VCI, so identifying risk factors for VCI in ART could improve VP recognition. This study aims to evaluate the displacement of umbilical cord insertion (CI) from the placental center and to examine the relationship between the modes of conception. Materials and Methods: We conducted a retrospective study at the Obstetrics Department of Osaka Metropolitan University Hospital in Japan between May 2020 and June 2022. The study included a total of 1102 patients who delivered after 22 weeks of gestation. They were divided into three groups: spontaneous pregnancy, conventional in vitro fertilization (cIVF), and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). We recorded patient background information, perinatal complications, perinatal outcomes, and a numerical "displacement score", indicating the degree of separation between umbilical CI and the placental center. Results: The displacement score was significantly higher in the cIVF and IVF/ICSI groups compared with the spontaneous conception group. Additionally, the IVF/ICSI group showed a significantly higher displacement score than the cIVF group. Conclusions: Our study provides the first evidence that the methods of ART can affect the location of umbilical CI on the placental surface. Furthermore, we found that IVF/ICSI may contribute to greater displacement of CI from the placental center.

Barbed Sutures and Their Potential Role in Reducing Inflammatory Reaction After Cesarean Delivery: A Single-Center Experience.

Objectives The aim of this study was to investigate the short-term outcomes of knotless barbed sutures used for both closures of myometrium and subcuticular tissues in patients with various operative indications and who underwent cesarean delivery (CD) in a single tertiary center. Materials and methods A retrospective cohort study was conducted, and the patients were divided into two groups. The barbed suture group consisted of patients who underwent CD using barbed sutures for uterine closure (0 Stratafix® Spiral PDS Plus, Ethicon, Somerville, NJ, USA) and subcuticular closure (4-0 Stratafix® Spiral PDS Plus). The non-barbed group consisted of patients who underwent CD using monofilament sutures for uterine closure (0-Monocryl®, Ethicon) and subcuticular closure (3-0 Opepolyx®, Alfresa, Tokyo, Japan). Results White blood cell count on post-operative day 1 was statistically lower in the barbed suture group (p=0.01), while there were no other significant differences between the two groups. Conclusion Barbed sutures can be used without major complications in patients who have undergone CD, including high-risk pregnancies.

Verification of biomechanical factors of gait related to medial knee loading in patients 6 Months after total knee arthroplasty.

Background: The knee adduction moment (KAM) is considered an index for estimating the knee mechanical load, and increased KAM peak and KAM impulse are related to increased medial knee load and progression of knee joint degeneration. We aimed to verify the biomechanical factors of gait related to medial knee loading in patients 6 months after TKA. Methods: Thirty-nine women who underwent TKA were enrolled. A three-dimensional gait analysis was performed 6 months postoperatively to generate data on the lower limb joint angle, moment, and power at the backward component (braking phase) and forward component (propulsion phase) peaks of the ground reaction force. Medial knee loading was evaluated using the time-integrated value of KAM during the stance period (KAM impulse). The higher the value of the KAM impulse, the higher the medial knee joint load. The relationships between the KAM impulse and the data for biomechanical factors were evaluated using partial correlation analysis with gait speed as a control factor. Results: In the braking phase, the KAM impulse positively correlated with the knee adduction angle (r = 0.377) and negatively correlated with the toe-out angle (r = -0.355). The KAM impulse positively correlated with the knee adduction angle (r = 0.402), the hip flexion moment (r = 0.335), and the hip adduction moment (r = 0.565) and negatively correlated with the toe-out angle (r = -0.357) in the propulsive phase. Conclusion: The KAM impulse 6 months after TKA was related to the knee adduction angle, hip flexion moment, hip adduction moment, and toe-out angle. These findings may provide fundamental data for controlling variable medial knee joint load after TKA and implementing patient management strategies to ensure implant durability.

Changes of Coagulation and Fibrinolytic Status Detected by Thromboelastography (TEG6s®) in Pregnancy, Labor, Early Postpartum, Postpartum Hemorrhage and Heparin Treatment for Perinatal Venous Thrombosis.

The aims of this study are to evaluate coagulation and fibrinolytic features using TEG6s® in normal pregnant courses, in the early postpartum period and in cases with postpartum hemorrhage (PPH) caused by uterine atony. We also analyze cases with deep venous thrombosis (DVT) and/or pulmonary embolism (PE) under treatment with unfractionated heparin. The non-pregnant women (n = 13) and healthy pregnant women (at 9-13 weeks of gestation (n = 13), at 27-30 weeks of gestation (n = 14), at 35-38 weeks of gestation (n = 14)) were cross-sectionally studied, while the normal pregnant women at delivery (n = 14) were sequentially investigated. Blood samples from those patients with PPH (n = 15) and DVT and/or PE (n = 11) were also obtained and compared with those of normal women. Significant changes of clot formation parameters were observed in all parameters and, interestingly, fibrinolytic parameter (LY30) was maintained at a low value even within 120 min after placental delivery (median of LY30; 0) and also in cases with uterine atony (median of LY30; 0.1). The parameter that indicates the effectiveness of heparin showed strong correlation (R = 0.788) with activated partial thromboplastin time. Thromboelastography may be less sensitive to fibrinolysis in the conditions of uterine atonic bleeding.

The Hematopoietic Effect of Ninjinyoeito (TJ-108), a Traditional Japanese Herbal Medicine, in Pregnant Women Preparing for Autologous Blood Storage.

Background and Objectives: There are no reports showing the hematopoietic effect of TJ-108 on pregnant women. The aim of this study was to investigate the effect of TJ-108 on the hemoglobin and hematocrit levels, and white blood cell and platelet counts of pregnant women complicated with placenta previa who were managed with autologous blood storage for cesarean section. Materials and Methods: We studied two groups of patients who were complicated with placenta previa and who underwent cesarean delivery. Group A consisted of women who were treated with oral iron medication (100 mg/day), and Group B consisted of women who were treated with TJ-108 at a dose of 9.0 g per day, in addition to oral iron medication, from the first day of blood storage until the day before cesarean delivery. To evaluate the effect of TJ-108, the patients' red blood cell (RBC); Hb; hematocrit (Ht); white blood cell (WBC); and platelet count (PLT) levels were measured 7 days after storage and at postoperative days (POD) 1 and 5. Results: The study included 65 individuals, 38 in group A and 27 in group B. At the initial storage, a 0.2 g/dL reduction in Hb levels was observed, as compared to the initial Hb levels, in the TJ-108 treated patients, whereas a 0.6 g/dL reduction in Hb levels was observed in the non-TJ-108 treated group. On the other hand, regarding the second and subsequent storages, no significant difference was found in the decrease in the Hb levels of both groups. Conclusions: This study is the first report showing the effect of TJ-108 on improving anemia in pregnant women, presumably by its boosting effect on myelohematopoiesis. Therefore, the combined administration of both iron and TJ-108 is effective as a strategy for pregnant women at a high risk of PPH due to complications such as placenta previa.

Preliminary Outcomes of Cervical Cerclage for Shortened Cervix with Decidual Polyp.

The aim of this study was to elucidate the nature of decidual polyp (DP) and to compare DP outcomes treated with cervical cerclage for a shortened cervix with the outcomes of cases treated with cervical cerclage without DP. The medical records of pregnant women who were complicated with cervical polyps were retrospectively reviewed. Cervical cerclage was considered for those cases with a shortened cervical length of under 25 mm and before 25 gestational weeks. We also reviewed pregnant women who had no cervical polyps, and who underwent cervical cerclage during the same study period, and defined them as the control group. A total of 56 pregnant women with cervical polyps were identified. All of the polyps in the 14 cases that had undergone cervical cerclage migrated into the cervical canal. Of the thirty seven cases with cervical polyps that did not necessitate cervical cerclage, eight women delivered preterm and six of these cases were diagnosed as DP. In all of the women studied, polyp migration was observed in 68.6 %. Cervical cerclage was performed significantly earlier in the DP group than in the control group of 46 cases (p < 0.001; 18.4 weeks vs. 21.4 weeks, respectively). Cervical cerclage is effective in DP cases with a shortened cervical length and polypectomy should not be performed during pregnancy because of the risk of miscarriage.

Altered Transmission of Cardiac Cycles to Ductus Venosus Blood Flow in Fetal Growth Restriction: Why Ductus Venosus Reflects Fetal Circulatory Changes More Precisely.

We aimed to investigate the relation between the time intervals of the flow velocity waveform of ductus venosus (DV-FVW) and cardiac cycles. We defined Delta A as the difference in the time measurements between DV-FVW and cardiac cycles on the assumption that the second peak of ductus venosus (D-wave) starts simultaneously with the opening of the mitral valve (MV). As well, we defined Delta B as the difference of the time measurements between DV-FVW and cardiac cycles on the assumption that the D-wave starts simultaneously with the closure of the aortic valve (AV). We then compared Delta A and Delta B in the control and fetal growth restriction (FGR) groups. In the control group of healthy fetuses, Delta A was strikingly shorter than Delta B. On the other hand, in all FGR cases, no difference was observed. The acceleration of the D-wave is suggested to be generated by the opening of the MV under normal fetal hemodynamics, whereas it precedes the opening of the MV in FGR. Our results indicate that the time interval of DV analysis might be a more informative parameter than the analysis of cardiac cycles.

Transcatheter Arterial Embolization (TAE) Using N-Butyl-2-cyanoacrylate (NBCA) as the First Choice for Postpartum Vulvovaginal Hematoma; Case Series and Reviews of the Literature.

Transcatheter arterial embolization (TAE) has long been reported to be safe, effective, and to have a high clinical and technical success rate for vulvovaginal hematoma. We used a permanent embolic material, diluted N-butyl-2-cyanoacrylate (NBCA), for the first choice intervention for six cases of vulvovaginal hematoma, in order to confirm the effectiveness of NBCA. Regarding post-embolization adverse events, we did not observe any fever nor necrosis or pain in the vaginal wall or vulva, in all cases. The use of NBCA as a first-line treatment for TAE of vulvovaginal hematoma is considered to be effective, in the following two ways: First, hemostasis can be achieved by adjusting the mixing ratio of NBCA and lipiodol, according to the distance between the tip of the catheter and the site of injury. Second, NBCA does not cause complications such as pain, necrosis, or infection, and it can be used safely. There are no reports clearly recommending NBCA as the first choice in the treatment of TAE for vulvovaginal hematoma. This is the first report to examine the efficacy and safety of NBCA as the first-line intervention for such cases.

Non-invasive continuous blood pressure monitoring using the ClearSight system for pregnant women at high risks of post-partum hemorrhage: comparison with invasive blood pressure monitoring during cesarean section.

OBJECTIVE: This study aimed to investigate the accuracy and precision of continuous, non-invasive blood pressure obtained using the ClearSight system by comparing it with invasive arterial blood pressure, and to assess the hemodynamic changes using invasive methods and the ClearSight system in patients undergoing cesarean section. METHODS: Arterial pressure was measured invasively with an intra-arterial catheter and non-invasively using the ClearSight system during cesarean section in patients with placenta previa or placenta accreta. Blood pressure measurements obtained using these two means were then compared. RESULTS: Total 1,277 blood pressure measurement pairs were collected from 21 patients. Under Bland-Altman analysis, the ClearSight system demonstrated an acceptable accuracy with a bias and standard deviation of 8.8±13.4 mmHg for systolic blood pressure, -6.3±7.1 mmHg for diastolic blood pressure, and -2.7±8.0 mmHg for median blood pressure. Cardiac index levels were significantly elevated during fetal delivery and 5 minutes after placental removal, and systemic vascular resistance index levels were significantly decreased during fetal delivery and 40 minutes after placental removal. CONCLUSION: In patients undergoing cesarean section, the ClearSight system showed excellent accuracy and precision compared to that of the currently used invasive monitoring system.

Factors affecting the recruitment of new obstetrician-gynecologists in Japan: A report of the MIRAI Committee of the Japanese Society of Obstetrics and Gynecology.

AIM: There is a chronic shortage of obstetrician-gynecologists in Japan. To increase the number of obstetrician-gynecologists, it is crucial to increase the number of residents being recruited. The purpose of this study was to identify the factors that led students and interns to specialize in obstetrics and gynecology through a questionnaire survey. METHODS: We sent a questionnaire to the obstetrics and gynecology departments of all the medical schools in Japan (N = 81) and collected data about the institutional background, including the location, total number of obstetrician-gynecologists employed, and number of newly joined obstetrics-gynecology residents and resigned obstetrician-gynecologists and the educational and recruitment activities for medical students and interns. The net balance (increased or decreased) over the fiscal years 2013-2015 was considered a surrogate marker for the number of newly joined obstetrics-gynecology residents. We used binomial logistic regression analysis to determine the factors related to a positive net balance of obstetrician-gynecologists. RESULTS: We obtained responses from 59 (72.8%) medical schools. Medical students who observed deliveries were more likely to become obstetrician-gynecologists than those who did not (95% confidence interval: 1.000-1.045, p = 0.052). Medical school location (rural or urban), providing medical students with preparatory lectures for national board examinations, and providing interns with experience as the first assistant during surgery were not associated with an increase in the number of newly joined obstetrician-gynecologists. CONCLUSIONS: The experience of observing deliveries may encourage medical students to become obstetrician-gynecologists.

Effect of Thrombopoietin Receptor Agonist on Pregnant Mice.

Thrombopoietin receptor agonists (TPO-RAs) are an effective treatment for refractory immune thrombocytopenia (ITP). However, the use of TPO-RAs is limited for ITP in pregnant women due to concerns about fetal toxicity. In this study, we examined the effects of romiplostim, one of the TPO-RAs, on pregnant mice. The mice were injected subcutaneously with romiplostim (1, 5, 10, 30, and 100 µg/kg) on gestational days (GD) 1, 8, and 15. We evaluated maternal and fetal platelet and megakaryocyte counts (MK), fetal weight at birth, placental morphology, and miscarriage rates. Romiplostim increased platelet and MK counts in pregnant mice at all doses and in fetuses at doses above 10 µg/kg. Fetal weight at birth was slightly reduced at a dose of 100 µg/kg, but there were no significant differences in placental weight, spiral artery wall thickness, placental growth factor signal changes, or the rate of resorption at that dosage. The dose of romiplostim used clinically for ITP patients (1-10 µg/kg) did not show any adverse effects on pregnant mice. Although the results of the present study are encouraging, until there are more conclusive data, the use of romiplostim should be evaluated individually in severe, life-threatening cases, and all relevant ethical aspects should be considered.

Early postoperative relationship between patient-reported outcome measures and gait biomechanical factors after total hip arthroplasty.

BACKGROUND: Patient-reported outcome measures (PROMs) have recently been considered as indicating clinical outcomes after total hip arthroplasty (THA). Although various factors are reportedly associated with post-THA and PROMs, the relationship with gait parameters, which are objective assessment factors after THA, remains unclear. RESEARCH QUESTION: What is the relationship between PROMs and gait biomechanical factors four weeks after THA? METHODS: Forty-five patients (six men and 39 women) who underwent THA were included. Three-dimensional gait analysis was performed four weeks post-THA; joint angle, internal moment, and power of the lower extremity at the first and second peaks of the vertical component of the floor reaction force were assessed for the operated side. PROMs were evaluated using the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ). The relationship between the JHEQ score and extracted gait parameters was analyzed using gender and gait speed as control factors. RESULTS: For the JHEQ sub-domain, movement was positively correlated with the internal knee extension moment values at the first peak (r = 0.347). There was no significant correlation between JHEQ and the internal hip abduction moment value at the first peak. Mental status was negatively correlated with the hip flexion angle value at the second peak (r = -0.373), and positively correlated with the hip flexion moment value (r = 0.348). Total JHEQ scores and mental status were negatively correlated with the power of hip flexion value at the second peaks, respectively (r = -0.316, -0.444). SIGNIFICANCE: The results of this study may provide recovery guidelines to be used as an index for gait assessment in the early post-THA period. Further studies are needed to verify whether gait parameters can improve PROMs in the early post-THA period.

Time interval analysis of ductus venosus and cardiac cycles in relation with umbilical artery pH at birth in fetal growth restriction.

BACKGROUND: The aims of this study were to evaluate the time intervals of flow velocity waveforms (FVW) of ductus venosus (DV) and cardiac cycles, as well as the pulsatility index of DV-FVW (DV-PI), in correlation with umbilical artery (UA) pH at birth in fetal growth restriction (FGR) complicated with placental insufficiency. METHODS: Data were retrospectively retrieved from pregnancies complicated by FGR. FGR was defined as an estimated fetal weight below - 2.0 S.D. with an elevated UA-PI. Time interval assessments of DV-FVW were as follows: the duration of systolic wave was divided by the duration of diastolic wave and defined as DV-S/D. We also measured the following time intervals of ventricular inflow through tricuspid valve (TV) and mitral valve (MV): (iii), from the second peak of ventricular inflow caused by atrial contraction (A-wave) to the opening of atrio-ventricular valves and: (iv), from the opening of atrio-ventricular valves to the peak of A-wave. (iii)/(iv) was expressed as TV-S/D and MV-S/D, for TV and MV, respectively. The time interval data were transformed into z-scores. RESULTS: Thirty-one FGR fetuses were included in this study. Both DV-PI and DV-S/D showed significant correlation with UA-pH (r = - 0.677, p = < 0.001 and r = 0.489, p = 0.005 for DV-PI and z-score of DV-S/D, respectively) and more significances were observed in FGR ≤ 28 + 6 gestational weeks (r = - 0.819, p < 0.001 and r = 0.726, p = 0.005, for DV-PI and z-score of DV-S/D, respectively) than in FGR > 28 + 6 gestational weeks (r = - 0.634, p = 0.007 and r = 0.635, p = 0.020, for DV-PI and z-score of DV-S/D, respectively). On the other hand, TV-S/D and MV-S/D showed no significant correlation with UA-pH, although these z-scores indicated significant decreases compared with normal references. CONCLUSIONS: Time interval analysis of DV-FVW might be a valuable parameter, as well as DV-PI, for the antenatal prediction of fetal acidemia in the management of FGR fetuses.

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.

Placental Types and Effective Perinatal Management of Vasa Previa: Lessons from 55 Cases in a Single Institution.

BACKGROUND: We aimed to identify clinical characteristics and outcomes for each placental type of vasa previa (VP). METHODS: Placental types of vasa previa were defined as follows: Type 1, vasa previa with velamentous cord insertion and non-type 1, vasa previa with a multilobed or succenturiate placenta and vasa previa with vessels branching out from the placental surface and returning to the placental cotyledons. RESULTS: A total of 55 cases of vasa previa were included in this study, with 35 cases of type 1 and 20 cases of non-type 1. Vasa previa with type 1 showed a significantly higher association with assisted reproductive technology, compared with non-type 1 (p = 0.024, 60.0% and 25.0%, respectively). The diagnosis was significantly earlier in the type 1 group than in the non-Type 1 group (p = 0.027, 21.4 weeks and 28.6 weeks, respectively). Moreover, the Ward technique for anterior placentation to avoid injury of the placenta and/or fetal vessels was more frequently required in non-type 1 cases (p < 0.001, 60.0%, compared with 14.3% for type 1). CONCLUSION: The concept of defining placental types of vasa previa will provide useful information for the screening of this serious complication, improve its clinical management and operative strategy, and achieve more preferable perinatal outcomes.

Relationships between early postoperative gait biomechanical factors and patient-reported outcome measures 6 months after total knee arthroplasty.

BACKGROUND: This study was focused on the gait parameters of the knee extensor and hip abductor muscle groups, which are believed to contribute to knee joint function improvement in early postoperative TKA. The associations between patient-reported outcome measures (PROMs) 6 months after total knee arthroplasty (TKA) and the early postoperative internal knee extension moment, knee extension negative joint power, and internal hip abduction moment while walking were investigated. METHODS: Twenty-one patients who underwent primary TKA for knee osteoarthritis were included. Three weeks after TKA, gait at a comfortable speed was measured by three-dimensional motion analysis. The lower limb joint angle, internal joint moment, and joint power parameters on the operated side while standing were calculated. The PROMs 6 months after TKA were assessed using the Japanese Knee Osteoarthritis Measure (JKOM). The relationship between each gait biomechanical parameter and the JKOM was determined. RESULTS: The maximum internal knee extension moment and maximum knee extension negative joint power during the early stance showed moderate negative correlations with the JKOM scores. The maximum internal hip abduction moment was not correlated with the JKOM scores. The maximum internal hip extension moment during the early stance and internal hip flexion moment during the late stance showed moderate negative correlations with the total JKOM scores. CONCLUSION: The early postoperative internal knee extension moment, maximum knee extension negative joint power, and internal hip extension and flexion moment are associated with patient PROMs 6 months after TKA.

Reply to Orsi, M.; Somigliana, E. Incarceration of the Gravid Uterus: Proposal for a Shared Definition. Comment on "Tachibana et al. Incarcerated Gravid Uterus: Spontaneous Resolution Is Not Rare. Diagnostics 2021, 11, 1544".

We appreciate the interest in our paper, and we are grateful for the comment by Orsi et al. [...].