TO THE QUESTION ON UTERINE FIBROIDS DURING PREGNANCY

Uterine fibroids is an extremely common tumor of the female reproductive system, among whose manifestations are infertility, spontaneous abortions, incorrect fetal position, placenta previa, premature delivery, bleeding during and after delivery, and an increased risk of cesarean section. According to the literature, myomas are changing in size during pregnancy and in the postpartum period. Aim of the study. To assess the dynamics of uterine fibroid size change during pregnancy and the effect of an existing uterine fibroid on the course of pregnancy and labor. Materials and methods. Outpatient records of patients aged 24 to 45 years (mean age 33.36 ± 4.63 years) who were diagnosed with Pregnancy and uterine fibroids from 2016 to 2021 at Verum Medical Center were evaluated (n = 57). The size of the fibroids (volume and diameter) before, during (I or II prenatal screening) and after pregnancy (first pelvic ultrasound after delivery) was used for statistical analysis. Forty-one of the 57 patients had pelvic ultrasound before, during, and after pregnancy and were included in the statistical analysis of changes in uterine myoma size. Results. Among the patients included in the statistical analysis, uterine fibroids increased in volume by 194.38% ± 86.9 (40.98% ± 18.4 in diameter) during pregnancy, and decreased by 53.98% ± 14.93 in diameter and by 54.28% ± 29.62 of baseline in the postpartum period. A significant number of fibroids (39.47%) did undergo involutionary changes and were not visualized in the first postpartum ultrasound. The live birth rate was high at 90% (64% of deliveries were through natural childbirth and 26% through cesarean section). Conclusions. There was no effect of intramural, intramural-subserosal, and subserosal uterine fibroids with an average diameter of £20 mm on pregnancy and live birth in women. A great amount of uterine fibroids nearly triple in size during pregnancy, but after delivery they return to their original size and even halve in size. This can be regarded as a confirmation of the absence of a negative effect of pregnancy, or, possibly, a positive effect on uterine fibroid size, which requires further investigation.

Hypothalamic Hamartoma Revealed by Precocious Puberty in Girls: About A New Case

Precocious puberty is a multifactorial process whose diagnosis is based, first of all, on the clinic but also on the realization of the bone age, the pelvic ultrasound and the cerebral IRM. Moreover, the GnRH test constitutes the cornerstone to highlight a premature activation of the Hypothalamo-hypophyseal axis. We report the case of a 3-year-old girl admitted for exploration of precocious puberty. The central origin was confirmed by a GnRH test with a peak reaching 45 mIU/L. A hypothalamohypophyseal MRI was performed, showing a mass consistent with a hypothalamic hamartoma. Treatment with GnRH analogues is the treatment of choice for central precocious puberty.

Breast fibroadenomas are less frequent in women with uterine fibroids

BACKGROUND: The etiology and incidence of Fibroadenoma (FA) as the most frequent benign breast mass and uterine fibroma (UF) as the most benign gynecological disorders are unknown. OBJECTIVE: Considering the dependency of FA and UF to sex hormones, our objective was to investigate the association of these two neoplasms. METHODS: Among women attending the hospital Gynecology Clinic, those with typical uterine fibroids in their pelvic ultrasound constituted cases and those with no pathology the controls. All participants underwent breast ultrasound for FA. Criteria for diagnosis of FA were a typical image for lumps <2 cm in women aged <40 and <1 cm in ages ≥ 40, and a histologic diagnosis for all other participants or larger lumps. RESULTS: The mean age of cases and controls was 42.4 and 41.7 years, respectively. FA were detected in 140 (23%) of all participants; 19.7% of the cases, and 26.2% of the controls (p = 0.07). FA and UF had a borderline reverse association (OR = 0.69, 95% CI = 0.46–1.02, p = 0.07). CONCLUSION: The incidence of FA is lower in patients with UF. Further studies are needed to find the selective effects of estrogen and progesterone on hormonal receptors of these two tumors.

The Correlation of the IETA Ultrasound Score with the Histopathology Results for Women with Abnormal Bleeding in Western Romania

In the early differential diagnosis of endometrial cancer (EC), decisive and mandatory histological aspects are considered, in addition to obvious clinical manifestations. In addition, sonographic aspects are characteristic in relation to the stage, degree, and histological types of identified cancer. This bi-center retrospective observational study included 594 women with abnormal uterine bleeding outside pregnancy, for which a biopsy was performed in the Obstetrics and Gynecology Departments of the Emergency County Hospitals of Arad and Timis Counties, Romania, between 2015 and 2019. Most of the cases were represented by EC or endometrial hyperplasia (EH). Of the 594 cases, 25.5% (n = 153) were EC at women aged between 41 and 85 years. High International Endometrial Tumor Analysis (IETA) scores (3, 4) were associated with a relative risk of 2.9335 compared with other endometrial lesions (95% CI 2.3046 to 3.734, P < 0.0001, NNT 1.805). Histological aspects and pelvic ultrasound using IETA scores represent valuable noninvasive assets in diagnosing and differentiating endometrial cancer from benign uterine pathology.

Accuracy of Preoperative Pelvic Ultrasound in Predicting Uterine Weight Across Varying Pathologies

Objectives: The purpose of this study is to evaluate the accuracy of preoperative pelvic sonography in predicting the weight of a non-gravid uterus at the time of hysterectomy. Additionally, the study seeks to examine the effect of varying uterine pathologies on the accuracy of these predictions. Methods: This was a retrospective comparative study in a tertiary care hospital with a total of 318 patients who underwent pelvic ultrasound, with reported uterine volumes, prior to undergoing hysterectomy in 2018. Estimated uterine weights from preoperative pelvic ultrasounds were compared to actual uterine weights from post-hysterectomy pathology reports. A Bland-Altman plot was constructed to determine intermethod agreement with 95% limits of agreement. Simple linear regression analysis was used to correlate estimated and actual uterine weights. Multivariable linear regression was performed, allowing for subgrouping by uterine pathology. Results: While a strong positive correlation was identified between the two measurements (r = .93, p <.01), the Bland-Altman analysis showed that actual uterine weight ranged from 0.51 to 1.99 times the magnitude predicted by preoperative ultrasound. These wide deviations in intermethod agreement were similar amongst the various uterine pathologies. Multivariable linear regression analysis demonstrated the difference in estimated and actual uterine weight was 2 to 3.5 times larger for patients with endometrial pathology, adenomyosis, and leiomyomata as compared to normal uteri (p < .03). Conclusion: This study shows that in 95% of cases, actual uterine weight ranged from half to twice as large as estimated by preoperative pelvic ultrasound. Uterine pathology had a significant impact on the reliability of ultrasound for estimation of uterine weight. In gynecologic practices where preoperative estimations of uterine weight are instrumental in choosing a surgical approach for hysterectomy, reliance on pelvic ultrasound as a means of predicting uterine weight should be carefully considered.

Accuracy of Doppler Assessment of the Uterine Arteries in Healthy Girls for the Diagnosis of Pubertal Onset

Purpose: To evaluate the accuracy of the uterine artery pulsatility index (PI) for the diagnosis of pubertal onset in girls. Methods: Cross-sectional study of girls with normal pubertal development. Puberty was diagnosed by the presence of Tanner breast development score ≥2. All girls underwent pelvic ultrasound and Doppler imaging of the uterine arteries. We evaluated the uterine artery PI and uterine, endometrial, and ovarian measurements. We used ROC curves with cutoffs determined by Youden index for data analysis. Results: We included 169 girls aged 5-16 years who underwent 202 pelvic ultrasound examinations. Prepubertal girls had a significantly higher mean PI (mean, 6.70; SD, 2.15) than girls in initial puberty (mean, 4.14; SD, 1.55) and in late puberty (mean, 2.81; SD, 1.05) (P<0.001 for all comparisons), which reflects a progressive increase in blood flow to the uterus with the progression of puberty. ROC curve analysis showed that the PI was able to identify the onset of puberty with a mean area under the curve of 0.838 (SD, 0.04) (P<0.001), and the PI cutoff point of 5.05 had a sensitivity of 77%, specificity of 85%, positive predictive value (PPV) of 92%, and accuracy of 79%. The combination of PI <5.05 plus uterine volume >3.75 cm³ had a sensitivity of 73%, specificity of 95%, PPV of 97%, and accuracy of 79% to detect initial puberty. Conclusions: The significant reduction in the PI during pubertal development combined with increasing uterine volume can be a valuable, highly specific, noninvasive tool to confirm the onset of puberty.

Contribution of imaging to the management of acute generalized peritonitis in the visceral surgery department of the Sino-Guinean hospital

Introduction: Acute generalized peritonitis is a life-threatening emergency. It is most often secondary to a perforation of the digestive organ and or to the spread of an intra-abdominal septic area. Methodology: We carried out a descriptive retrospective study lasting from January 1, 2018 to December 31, 2018 on the contribution of imaging in the management of acute generalized peritonitis general surgery department of the hospital Chinese-Guinean. Were included in our study, all records of patients with acute generalized peritonitis will be confirmed by imaging. We carried out an exhaustive recruitment of all complete files. Our variables were analyzed using the Epi-info 7.2 software. Result: Out of 578 hospitalized patients, peritonitis represented 8.8% of cases. We noted a male predominance with 60.8% and a Sex-ratio: M / F = 1.6 whose mean age was 41.9 ± 13.5 years; extremes ranging from 17 and 67 years with a modal class ≥ 30 years or 88.3%. Housewives were the most collected with 25.5% Abdominal pain was the main reason for consultation, i.e., 90.2%, the physical sign was dominated by a convex and sensitive Douglas-fir, i.e., 27.5%. The clinical diagnosis was supported by abdomen without preparation and abdominal ultrasound; performed in 84.3% and 15.7% of patients, respectively. We noted a morbidity rate of 15.7% dominated by septic shock (15.7%). Conclusion: Our study made it possible to determine the contribution of imaging in the management. In addition, in our study, the abdomen without preparation and the abdomino-pelvic ultrasound were revealed as a key link in the management of acute generalized peritonitis.