Effects of uterine artery occlusion during myomectomy on ovarian reserve: Serial follow-up of sex hormone levels, ultrasound parameters and Doppler characteristics

Efficacy of King's Combined Uterine Suture in Managing Placenta Accreta: A Retrospective Analysis

BACKGROUND Placenta accreta is a spectrum disorder that can include an abnormally adherent placenta to placental tissue that invades the endometrium and myometrium and results in hemorrhage during or after delivery. King's combined uterine suture is a combination of parauterine vascular ligation with longitudinal suturing of the lower uterine segment. This retrospective study aimed to evaluate outcomes from using King's combined uterine suture for hemostasis in 49 parturient women with placenta accreta spectrum (PAS). MATERIAL AND METHODS Clinical data of parturient women with placenta accreta in Fujian Maternal and Child Health Hospital from January 2020 to January 2023 were retrospectively collected. King's combined uterine suture ligation surgery was performed in these patients who had placenta accreta. Placenta accreta was diagnosed by the criteria for PAS. The outcomes of surgery and prognosis of newborns were analyzed. RESULTS A total of 49 parturient women were included and underwent successful intraoperative hemostasis without hysterectomy or ureteral injury. There were 4 cases of bladder rupture and 17 cases of uterine plastic surgery. The average intraoperative bleeding volume of the 49 patients was (507±162) mL. Patients had no long-term complications during postoperative follow-up. Apgar score of newborns was 9.67±0.77, and there was no asphyxia or neonatal death. CONCLUSIONS King's combined uterine suture ligation surgery is applied to placenta accreta, which not only has a definite and fast hemostatic effect, but can also effectively preserve the uterus.

Effect of radical trachelectomy on ovarian reserve: A single-institute prospective study

AIM

Reduced responses to controlled ovarian stimulation (COS) after radical trachelectomy (RT) have been previously reported. We aimed to assess the effect of RT on ovarian reserve by measuring anti-Müllerian hormone (AMH) levels before and after the procedure in this prospective study.

METHODS

We included 12 patients who underwent RT between September 2019 and December 2021 in this study. Serum AMH levels were measured preoperatively, 1 month postoperatively, and 6 months postoperatively. Differences in the AMH levels were assessed using a paired t-test.

RESULTS

The median age of the patients was 30.6 years, and the median follow-up time was 30.1 months. AMH levels at 1 and 6 months postoperatively did not show a consistent trend. At 1 month postoperatively, the average AMH level decreased insignificantly but returned to preoperative levels at 6 months. The differences in AMH levels before and after RT were insignificant.

CONCLUSION

Our findings indicate that RT did not affect ovarian reserve as measured by AMH levels. However, the relationship between unchanged ovarian reserve and reduced response to COS remains unclear. Further research with larger sample sizes and additional measures of ovarian function is needed to corroborate these results and investigate the long-term effects of RT on ovarian reserve. Understanding these mechanisms will help guide surgical practices and provide patients with valuable information about their reproductive outcomes after RT.

Application of ultrasound markers measured at different time points of COH cycle in the prediction of ovarian response for individualised ovulation induction

The purpose of this study was to evaluate the predictive value of ultrasound markers measured at different time points of the controlled ovarian hyperstimulation (COH) cycle on ovarian response and outcome indicators in the IVF-ET cycle. According to the oestrogen level and the number of retrieved oocytes, patients who planned for COH treatment were separated into low-response group, normal and high-response group. The ovarian stromal artery flow parameters on the day of pituitary down-regulation, day 1, day 7, day 10, and the day of hCG injection were collected prospectively. We also have collected the data of cumulus oophorus count on the day of hCG injection by transvaginal sonography. Compared with the low-response group, on the first day of the COH cycle PI, RI, and S/D were lower in the high-response group than they were in the low-response group (p < .05). PSV and EDV were significantly higher in the high-response group than they were in the low-response group (p < .01), and the PSV on the first day of the COH cycle have statistical significance in predicting the number of high-quality embryos. The number of cumulus oophorus on the day of hCG injection has statistical significance in predicting the number of oocytes retrieved and fertilised oocytes. We conclude that the ovarian stromal artery flow parameters on the first day of the COH cycle and cumulus oophorus count on hCG injection day can serve as efficient indicators for an early assessment of ovarian response and individualised ovulation induction.IMPACT STATEMENTWhat is already known on this subject? AMH, AFC, and the age of the patient are well-known effective parameters for the evaluation of ovarian response, but these are insufficient and full of individual differences. Some researchers have investigated the value of colour Doppler ultrasound and cumulus oophorus in assessing ovarian response, but no definitive conclusion has been reached.What do the results of this study add? The hemodynamic parameters of ovarian stromal artery on the first day of the COH cycle and the number of cumulus oophorus on the day of hCG injection detected by Transvaginal Colour Doppler Sonography (TV-CDS) could be used to predict the ovarian response.What are the implications of these findings for clinical practice and/or further research? Ovarian stromal artery flow parameters and cumulus oophorus detected by TV-CDS can potentially be offered as a complementary parameter for ovarian reserve.