In pregnancy, endothelial dysfunction serves as a key mechanism linking maternal-fetal immune maladaptation and soluble antiangiogenic factors to the clinical presentation of preeclampsia. Although most of these aspects have been elucidated in isolation in humans and in animal models, a complete picture of their relationship with the clinical manifestations of preeclampsia has been elusive. Perturbation of endothelial glycocalyx results from conflicting inflammatory messages and leads to a paradoxical situation involving tissue distress and stimulation of maternal syndrome. Increased endothelial permeability and exposure of the endothelial cell membrane are key to the pathogenesis of this syndrome. Nude membranes, which flack the glycocalyx cover, lose critical functions in modulating local platelet aggregation, thrombosis, inflammation, and leukocyte migration. Leukocyte migration into tissues and subsequent inflammation alter the normal functioning of important organs such as the placenta, maternal kidney, liver, heart, lung, and brain, and consequently lead to the broad spectrum of clinical manifestations of preeclampsia. Moreover, glycocalyx injury has an important role underlying the mechanisms leading to diverse forms of preeclampsia. Herein, we provide a comprehensive view of glycocalyx disruption as the common link among the preeclamptic alterations observed in all maternal organs.

Objectives: The identification of methods to improve the endometrial receptivity (ER) is increasingly of interest. The effect of the electromagnetic field associated with Quantum Molecular Resonance (QMR) on ER was investigated here. Methods: Ishikawa cells were used to evaluate the effects of QMR both on the expression of a group of genes involved in ER, i.e., HOXA10, HOXA11, LIF, ITGB3, and ITGAV, and on cell toxicity. Endometrial samples were obtained from six patients during routine diagnostic procedures, four of which were subsequently used to assess the transcriptional response to QMR through microarray. Results: Compared to unexposed controls, a single exposure of Ishikawa cells to QMR for 20 min was associated with a significant and power-dependent up-regulation of all the selected ER-related genes up to 8 power units (PU). Repeated exposure to QMR, up to three consecutive days, showed a significant up-regulation of all the selected genes at power values of 4 PU, from day two onwards. Negligible cytotoxicity was observed. Gene set enrichment analysis, on microarray data of endometrial biopsies stimulated for three consecutive days at 4 PU, showed a significant enrichment of specific gene sets, related to the proteasome system, the cell adhesion, the glucocorticoid receptor, and cell cycle pathways. Conclusions: Our results suggest a possible favorable impact of QMR on ER.

This paper updates the 2017 article, “Historical Evolution of Ideas on clampsia/Preeclampsia: A Proposed Optimistic View of Preeclampsia”, published in the Journal of Reproductive Immunology, incorporating advances in preeclampsia research from 2017 to 2025. Eclampsia, documented for over 5000 years, remains a critical challenge in maternal-fetal medicine. We outline the historical progression of understanding preeclampsia, from early observations of proteinuria and hypertension to modern molecular insights. Key advancements include recognizing preeclampsia as a systemic endothelial disorder, the primipaternity concept, and distinguishing early-onset (EOP) and late-onset (LOP) preeclampsia. A 2024 study reaffirms primipaternity as a major risk factor, resolving a 22-year debate over birth intervals. We explore inositol phosphoglycans P-type (IPG-P) as a specific biomarker, antiangiogenic factors like sFlt-1, and proteomic subclassifications identifying four molecular subtypes. Additionally, 75 % of fetal growth restriction (FGR, i.e. known pathological ultrasound Doppler) cases occur without maternal preeclampsia, suggesting an evolutionary protective mechanism. Despite progress, affordable treatments remain elusive, particularly for low-income countries. Targeting IPG-P, pravastatin, or ergothioneine, and leveraging proteomic insights, could lead to breakthroughs in preeclampsia prevention and treatment, potentially resolving related conditions like FGR and preterm birth.

OBJECTIVES:To evaluate the relative importance of changing paternity ("primipaternity", direct inquiry with patients) in multiparas versus prolonged birth/pregnancy interval as risk factors for preeclampsia (PE) by a logistic regression model comparing the adjusted odds ratios of both exposures. DESIGN:Assessment of all consecutive singleton deliveries (from 22 weeks onwards) at South-Reunion University's maternity (Reunion Island, Indian Ocean) over 23 years (2001-2023) using an epidemiological perinatal database on obstetrical factors (264 items in total, of which, chronic or gestational hypertension, proteinuria, HELLP syndrome). RESULTS:Among the 53,572 multiparous singleton pregnancies, we identified 33,312 (62%) of multiparas who gave consecutive births, allowing calculation of birth intervals. Primipaternity multipara (N = 2790) were on average older than those in stable relationships (N = 50,782), 31 vs 30 years, p< 0.0001; they had almost systematically longer birth intervals compared with controls of approximately 1.5 year from the 2nd to the 4th pregnancy and approximately 1year after the 5th pregnancy (all p < 0.05). In the logistic regression model of 11 risk factors, intervals between pregnancies had similar adjusted odds ratios (1.05, p = 0.002) as increasing maternal age (AdjOR 1.02, p = 0.02), increasing parity (adjOR 1.09, p = 0.02) and pre-pregnancy BMI (AdjOR 1.05, p< 0.0001). Smoking was associated with an AdjOR of 0.85 (non-significant),primipaternity multiparas were twice as likely to be smokers (23.8% vs 13.4%, p< 0.0001) compared with controls. AdjOR for primipaternity was 3.34 (p < 0.0001) indicating that primipaternity as risk belonged in the category of well-established risk factors like history of preeclampsia (11.2, p< 0.0001) and chronic hypertension (6.45, p< 0.0001). CONCLUSIONS:Primipaternities in multiparae belongs to the major risk factors such as history of preeclampsia, chronic hypertension, multiple pregnancies while prolonged birth intervals belongs to moderate "regular physiological aging processes" such as increasing maternal age, parity or increasing pre-pregnancy BMI.

Objective: This study primarily focuses on examining the criticalities of optimizing gestational weight for obese women to reduce fatal morbidities. We retrospectively did a simulation applying the optimal gestational weight gain (optGWG) equation (that we proposed in 2018) on our population, and observed if its effect on maternal/fetal morbidities in singleton term pregnancies (\(\ge\)37 weeks).Design: This is a Retrospective observational study.Setting: The setting for this study was in a single large tertiary maternity unit in Reunion Island, Indian Ocean, overseas French department.Population or Sample: All consecutive singleton births delivered at the Centre Hospitalier Universitaire Hospitalier Sud Reunion's maternity was the chosen population for this study. A standardized epidemiological perinatal database was used here. Methods: This study employed mathematical simulation on a 19-year historical cohort (2001-2019)'. Data was presented as numbers and proportions for categorical variables and as mean and Standard Deviation (SD) for continuous ones.Main Outcome Measures: Five Maternal/fetal morbidities were measured for this study.Results: Beginning with overweight women, and enlarging the effect with the rise of different obesities (class I to III) and considering maternal pre- pregnancy BMI (ppBMI), individualized counselling women on their GWG (optimal gestational weight gain, optGWG) lowers significantly maternal/ fetal morbidities: in a logistic regression model among overweight/obese women, with the outcome optGWG, several morbidities have a negative coefficient as independent factors: cesarean-section, birthweight \(\ge\) 4000 g, term preeclampsia, lowering the effect of rising maternal ppBMI per increment of 5 kg/m² (coefficient -0.13), all p < 0.001. Dietary and lifestyle interventional studies have reduced GWG by 0.7kg or 3.7kg and had no effect on other pregnancy and birth outcomes including GDM, PE, PIH, LGA and macrosomic infants.We propose as a prediction to be verified in future prospective studies that a follow-up and counselling since the first prenatal visit should also lower gestational diabetes mellitus rates. Conclusion: We may have significant health (and cost) benefits by lowering c-section rates, term preeclampsia, macrosomic babies and LGA babies in overweight/obese women and low-birthweight babies in lean women. We may have much to win from reducing weight gain during pregnancy in overweight/obese women. It is urgent to verify and establish in all continents the specific linear curve of optGWG for each geographic/ethnic area.

OBJECTIVE:The aim of the study was to evaluate the diagnostic accuracy for parametria endometriosis (PE) of transvaginal sonography (TVS) performed following a systematic approach for the assessment of the lateral parametria.DESIGN:A diagnostic accuracy study was employed based on a prospective observational design.PARTICIPANTS:All consecutive patients who underwent laparoscopic surgery for endometriosis between January 2016 and December 2020 were considered.SETTING:The study was conducted at endometriosis referral hospitals.METHODS:We prospectively collected clinical, imaging, and surgical data of all consecutive patients who underwent laparoscopic surgery for endometriosis between January 2016 and December 2020. A standardized technique with a systematic approach for the assessment of the lateral parametria following specific anatomic landmarks was used for the TVS. The diagnostic accuracy for PE in TVS was assessed using the intraoperative and pathologic diagnosis of PE as the gold standard.RESULTS:In 476 patients who underwent surgery, PE was identified in 114 out of 476 patients (23.95%): 91 left and 54 right PE out of 476 surgical procedures were identified (19.12% vs. 11.34%; p = 0.001); bilateral involvement in 27.19% (31/114 patients) cases. The sensitivity of TVS for PE was 90.74% (79.70-96.92%, 95% CI) for the right side and 87.91% (79.40-93.81%, 95% CI) for the left side. The specificity was almost identical for both sides (98.58% vs. 98.18%). For the right parametrium, the positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 63.82 (28.70-141.90, 95% CI) and 0.09 (0.04-0.22, 95% CI), respectively. On the left parametrium, the PLR and NLR were 48.35 (23.12-101.4, 95% CI) and 0.12 (0.07-0.21, 95% CI), respectively. The diagnostic accuracy for right and left PE was 97.69% (95.90-98.84%, 95% CI) and 96.22% (94.04-97.74%, 95% CI), respectively.LIMITATIONS:The principal limit is the high dependence of TVS on the operator experience. Therefore, although a standardized approach following precise definitions of anatomical landmarks was used, we cannot conclude that the observed accuracy of TVS for PE is the same for all sonographers. In this regard, the learning curve was not assessed. In the case of negative TVS for parametrial involvement with an absent intraoperative suspect, a complete dissection of the parametrium was not performed to avoid surgical complications; therefore, cases of minor PE may be missed, underestimating false negatives.CONCLUSIONS:TVS performed following a systematic approach for assessing the lateral parametria seems to have good diagnostic accuracy for PE with large changes in the posttest probability of parametrial involvement based on the TVS evaluation. Considering the clinical and surgical implications of PE, further studies implementing a standardized approach for assessing the parametrium by TVS are recommended to confirm our observations and implement a standardized protocol in clinical practice.

The 2023 goal is to halve the incidence of preeclampsia worldwide to reach 3 million cases per year vs the current approximately 7 million cases. Preventive treatment by low dose aspirin only halves the incidence of early-onset preeclampsia (EOP < 34 weeks gestation) in high-risk women. However, 90% of PE cases are the late onset form (LOP, 34 weeks onward) proportionally associated with increasing maternal pre-pregnancy BMI. In 2018, we published a new method to calculate individualized optimal gestational weight gain based on normal Gaussian distribution of neonatal birthweights (SGA 10%, LGA 10%) and demonstrated that this optimal gestational weight gain (GWG) follows a linear equation suitable for all maternal PRE-pregnancy BMIs (from lean to obesities classes 1-2-3). A similar linear equation has been published recently based on a 2022 US database of 200,000 multiple pregnancies. Subsequently, we demonstrated in a prospective population study that in over-weight and obese women who are able to achieve an optimal GWG, the rate of term preeclampsia (> 37 week's gestation) halves. Providing individual app-based calculations of optimal individual GWG, all patients will be aware of their personal weight gain target over the pregnancy. Conclusion: Halving the incidence of early -onset-and term preeclampsia worldwide by prevention is now theoretically achievable. Appropriate and timely start of low-dose Aspirin and providing women clear advice on their optimal GWG are they ingredients to achieve this goal.

The etiology of the pregnancy syndrome preeclampsia is still unclear, while most hypotheses center on the placenta as the major contributor of the syndrome. Especially changes of the placental metabolism, including the use of glucose to produce energy, are important features. As an example, inositol phosphoglycan P-type molecules, second messengers involved in the glucose metabolism of all cells, can be retrieved from maternal urine of preeclamptic women, even before the onset of clinical symptoms. Alterations in the placental metabolism may subsequently lead to negative effects on the plasma membrane of the placental syncytiotrophoblast. This in turn may have deleterious effects on the glycocalyx of this layer and a disruption of this layer in all types of preeclampsia. The interruption of the glycocalyx in preeclampsia may result in changes of inositol phosphoglycan P-type signaling pathways and the release of these molecules as well as the release of soluble receptors such as sFlt-1 and sEndoglin. The release of placental factors later affects the maternal endothelium and disrupts the endothelial glycocalyx as well. This in turn may pave the way for edema, endothelial dysfunction, coagulation, all typical symptoms of preeclampsia.

Objective: Deep infiltrating endometriosis(DIE) of the bowel may require segmental bowel resection. The subsequent reconstruction can be performed through an end-to-end(E-E) or a side-to-end (S-E)anastomosis, the latter being used in low resection due to the reduced risk of anastomotic leakage. This study aims at com-paring those two anastomosis techniques in women submitted to bowel resection for DIE, in terms of post-operative morbidity and functional outcomes.Methods: This was a single-center retrospective study on women undergoing laparoscopic rectal resection for deep infiltrating endometriosis with subsequent E-E or S-E anastomosis performed according to the level of rectal resection. The two groups were compared for postoperative complication rates and functional out-comes by means of validated questionnaires.Results: The study population included 30 patients undergoing a S-E anastomosis (group A), and 49 cases undergoing an E-E anastomosis (group B). No differences were found between the two groups in terms of length of hospital stay, anastomotic leakages, protective ileostomies and short-term complications. At follow up no differences were found between the two groups in terms of bowel function and pain symptoms.Conclusions: A S-E anastomosis in case of low rectal resections for DIE presents similar complication rates and functional outcomes compared with an E-E anastomosis.(c) 2022 Published by Elsevier Masson SAS.

Objectives:To present a comprehensive overview of different risk factors for early onset preeclampsia (<34 weeks gestation, EOP) vs. late onset (LOP). Study design:South-Reunion University's maternity (Reunion Island, Indian Ocean). 18.5 year-observational population-based cohort study (2001-2019). Epidemiological perinatal database with information on obstetrical and neonatal risk factors. All consecutive singleton pregnancies (>21 weeks) compared with all preeclamptic pregnancies delivered in the south of Reunion island. Main outcome measures:Comparing risk factors between EOP and LOP. Results:Among 1814 singleton preeclamptic pregnancies (600 EOP and 1214 LOP), EOP women were older than LOP 29.5 vs. 28.6 years,p = .009, primigravidas (OR 0.78 [0.63-0.96],p = .02) were prone to LOP. History of preeclampsia (PE) (aOR 12.8 vs. 7.1), chronic hypertension (aOR 6.5 vs. 4.5) had much higher adjusted odds ratios for EOP than for LOP,p < .001. Specific to EOP: coagulopathies (aOR 2.95,p = .04), stimulated pregnancies (aOR 3.9,p = .02). Specific to LOP: renal diseases (aOR 2.0,p = .05) and protective effect for smoking (aOR 0.75,p = .008). EOP women were prone to have a lower BMI. Conclusion:"Placental preeclampsia" (defective placentation) being linked to early onset PE (<34 weeks gestation) while "maternal preeclampsia" (maternal cardiovascular predisposition) being typically manifesting as the late form of the disease LOP is not systematically verified. Future researches are needed to propose a more adapted paradigm.

Objective: To compare in singleton multiparous pregnancies the effect of having a new father for an index pregnancy as compared with multiparas with the same male partner and primiparas.Material and methods: 21 year data, 2001-2021, Reunion island. We compared 2233 multiparas who had a new partner NewPMP (cases) with 50,364 same partner multiparas samePMP (controls) and 30,741 primiparas. Paired t-test in for parametric, Mann-Whitney U test for non-parametric continuous variables. P-values < 0.05.Results: As compared with primiparas, New paternity multiparas had similar neonatal outcomes: average birthweights 3044 g and 3017 g (vs 3125 g grams SamePMP, p < 0.0001), rates of low birthweights, very low birthweights (< 1500 g), rate of prematurity < 37 weeks, rate of early prematurity < 33 weeks and also "placental " intrauterine growth retardation, IUGR. Both primiparas and NewPMP had significant worse neonatal outcomes as compared with same partner multiparas for all these same items (all p < 0.05)). NewPMP had a much higher risk of preeclampsia than primiparas and samePMP (respectively, OR 1.74 and 2.9, p < 0.001), fetal deaths and perinatal mortality respectively, OR 1.4 and 1.8, p < 0.001. In 4 logistical models (primiparity, primipaternity, preeclampsia and "placental IUGR") new paternity multiparas had similar results compared with primiparas but very different results when compared with same partner multiparas.Conclusions: New paternity multiparas share with primiparas a significantly higher risk of perinatal and maternal morbidities than same partner multiparas. Paternity needs to be specified in all obstetrical files, perinatal da- tabases-Health Registries.

Objective: we performed a systematic review/meta-analysis to evaluate the impact of septate uterus and hysteroscopic metroplasty on pregnancy rate-(PR), live birth rate-(LBR), spontaneous abortion-(SA) and preterm labor (PL) in infertile/recurrent miscarriage-(RM) patients. Data sources: a literature search of relevant papers was conducted using electronic bibliographic databases (Medline, Scopus, Embase, Science direct). Study eligibility criteria: we included in this meta-analysis all types of observational studies that evaluated the clinical impact of the uterine septum and its resection (hysteroscopic metroplasty) on reproductive and obstetrics outcomes. The population included were patients with a diagnosis of infertility or recurrent pregnancy loss. Study appraisal and synthesis methods: outcomes were evaluated according to three subgroups: (i) Women with untreated uterine septum versus women without septum (controls); (ii) Women with treated uterine septum versus women with untreated septum (controls); (iii) Women before and after septum removal. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for the outcome measures. A p-value < 0.05 was considered statistically significant. Subgroup analysis was performed according to the depth of the septum. Sources of heterogeneity were explored by meta-regression analysis according to specific features: assisted reproductive technology/spontaneous conception, study design and quality of papers included Results: data from 38 studies were extracted. (i) septum versus no septum: a lower PR and LBR were associated with septate uterus vs. controls (OR 0.45, 95% CI 0.27–0.76; p < 0.0001; and OR 0.21, 95% CI 0.12–0.39; p < 0.0001); a higher proportion of SA and PL was associated with septate uterus vs. controls (OR 4.29, 95% CI 2.90–6.36; p < 0.0001; OR 2.56, 95% CI 1.52–4.31; p = 0.0004). (ii) treated versus untreated septum: PR and PL were not different in removed vs. unremoved septum(OR 1.10, 95% CI 0.49–2.49; p = 0.82 and OR 0.81, 95% CI 0.35–1.86; p = 0.62); a lower proportion of SA was associated with removed vs. unremoved septum (OR 0.47, 95% CI 0.21–1.04; p = 0.001); (iii) before-after septum removal: the proportion of LBR was higher after the removal of septum (OR 49.58, 95% CI 29.93–82.13; p < 0.0001) and the proportion of SA and PL was lower after the removal of the septum (OR 0.02, 95% CI 0.02–0.04; p < 0.000 and OR 0.05, 95% CI 0.03–0.08; p < 0.0001) Conclusions: the results show the detrimental effect of the uterine septum on PR, LBR, SA and PL. Its treatment reduces the rate of SA.

ABSTRACTObjectivesTo evaluate and compare the diagnostic test accuracy (DTA) of three‐dimensional transvaginal ultrasound (3D‐TVS) and magnetic resonance imaging (MRI) for deep myometrial infiltration (DMI) and cervical invasion for preoperative staging and surgery planning in patients with endometrial cancer (EC).MethodsThis systematic review and meta‐analysis investigated the DTA of MRI and 3D‐TVS for DMI and cervical invasion in patients with EC. A literature search was performed using MEDLINE, Scopus, EMBASE, ScienceDirect, The Cochrane library, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, EU Clinical Trials Register and World Health Organization International Clinical Trials Registry Platform to identify relevant studies published between January 2000 and December 2021. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies‐2 (QUADAS‐2) tool.ResultsFive studies, including a total of 450 patients, were included in the systematic review. All five studies compared the DTA of 3D‐TVS vs MRI for DMI, and three studies compared the DTA of 3D‐TVS vs MRI for cervical invasion. Pooled sensitivity, positive likelihood ratio and negative likelihood ratio for detecting DMI using 3D‐TVS were 77% (95% CI, 66–85%), 4.57 and 0.31, respectively. The respective values for detecting DMI on MRI were 80% (95% CI, 73–86%), 4.22 and 0.24. Bivariate metaregression indicated a similar DTA of 3D‐TVS and MRI (P = 0.80) for the correct identification of DMI. Pooled ln diagnostic odds ratio for detecting cervical invasion was 3.11 (95% CI, 2.09–4.14) for 3D‐TVS and 2.36 (95% CI, 0.90–3.83) for MRI. The risk of bias was low for most of the four domains assessed in QUADAS‐2.Conclusion3D‐TVS demonstrated good diagnostic accuracy in terms of sensitivity and specificity for the evaluation of DMI and cervical invasion, with results comparable with those of MRI. Thus, we confirmed the potential role of 3D‐TVS in the preoperative staging and surgery planning in patients with EC. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Ultrasound in Obstetrics & GynecologyVolume 59, Issue 3 p. 399-401 Letter to the Editor Fallopian tube entrapped within inflammatory or endometriotic ovarian cyst may mimic malignancy M. Scioscia, Corresponding Author M. Scioscia marcoscioscia@gmail.com orcid.org/0000-0002-5757-2793 Unit of Gynecological Surgery, Mater Dei Hospital, Bari, Italy Department of Obstetrics and Gynecology, Policlinico of Abano Terme, Abano Terme, Padua, ItalyCorrespondence. (e-mail: marcoscioscia@gmail.com)Search for more papers by this authorB. A. Virgilio, B. A. Virgilio orcid.org/0000-0002-7268-7468 Department of Obstetrics and Gynecology, Policlinico of Abano Terme, Abano Terme, Padua, ItalySearch for more papers by this authorD. Sacchi, D. Sacchi Department of Medicine (DIMED), Surgical Pathology Unit, University of Padova, Padua, ItalySearch for more papers by this authorL. Iaria, L. Iaria Department of Pathology, Policlinico of Abano Terme, Abano Terme, Padua, ItalySearch for more papers by this authorS. Guerriero, S. Guerriero orcid.org/0000-0002-1359-7155 Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, ItalySearch for more papers by this author M. Scioscia, Corresponding Author M. Scioscia marcoscioscia@gmail.com orcid.org/0000-0002-5757-2793 Unit of Gynecological Surgery, Mater Dei Hospital, Bari, Italy Department of Obstetrics and Gynecology, Policlinico of Abano Terme, Abano Terme, Padua, ItalyCorrespondence. (e-mail: marcoscioscia@gmail.com)Search for more papers by this authorB. A. Virgilio, B. A. Virgilio orcid.org/0000-0002-7268-7468 Department of Obstetrics and Gynecology, Policlinico of Abano Terme, Abano Terme, Padua, ItalySearch for more papers by this authorD. Sacchi, D. Sacchi Department of Medicine (DIMED), Surgical Pathology Unit, University of Padova, Padua, ItalySearch for more papers by this authorL. Iaria, L. Iaria Department of Pathology, Policlinico of Abano Terme, Abano Terme, Padua, ItalySearch for more papers by this authorS. Guerriero, S. Guerriero orcid.org/0000-0002-1359-7155 Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, ItalySearch for more papers by this author First published: 23 June 2021 https://doi.org/10.1002/uog.23716Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Open Research DATA AVAILABILITY STATEMENT Data available on request from the authors Supporting Information Filename Description uog23716-sup-0001-TableS1.docxapplication/docx, 14.5 KB Table S1 Characteristics of five patients with Fallopian tube entrapped within an ovarian cyst uog23716-sup-0002-TableS2.docxapplication/docx, 14.5 KB Table S2 International Ovarian Tumor Analysis (IOTA) scores of five patients with Fallopian tube entrapped within an ovarian cyst uog23716-sup-0003-VideoS1.mp4MPEG-4 video, 56.2 MB Videoclip S1 Sonographic and macroscopic features of Fallopian tube entrapped within an ovarian endometriotic or inflammatory cyst. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. Volume59, Issue3March 2022Pages 399-401 RelatedInformation

Among mammalian species, human reproduction has 2 outstanding features. The human hemochorial placentation is characterized by a very deep endovascular trophoblast invasion in the spiral arteries, reaching deep into the myometrium. This requires an agonistic direct cell-cell interaction between the maternal immune system and semiallogeneic trophoblast. The second feature is preeclampsia, a heterogeneous syndrome, a uniquely human condition. The human female is one of the few mammals exposed to her partner's semen on multiple occasions before conception. Regulatory T cells, especially paternal antigen-specific regulatory T cells, play an important role in the maintenance of pregnancy. Sexual intercourse increases the number of dendritic cells in the uterus that play an important role in the induction of paternal antigen-specific regulatory T cells. Paternal antigen-specific regulatory T cells maintain pregnancy by inducing tolerance. In the decidua basalis of preeclamptic cases, clonal regulatory T cells are reduced; these would normally monoclonally expand to recognize fetal or paternal antigens. Programmed cell death-1 expressed on T cells regulate cytotoxic T-cell activity and protect the fetus against maternal rejection. Programmed cell death-1 expression on clonal cytotoxic T cells is reduced in preeclampsia especially in early-onset preeclampsia, making the fetus and placenta vulnerable to attack by cytotoxic T cells. These phenomena can explain the epidemiologic phenomenon that preeclampsia is more common in couples using condom contraception, with shorter cohabitation periods, first pregnancies, first pregnancies in multiparous women when they change partner, and pregnancies after assisted reproduction using donated gametes. In contrast to its importance in early-onset preeclampsia, shallow trophoblast invasion does not play a role in the development of preeclampsia, that is, immune maladaptation does not seem to be involved. Late-onset preeclampsia (>34 weeks' gestation), representing 80% to 90% of preeclampsia in most developed countries with a "Western lifestyle," is strongly associated with maternal cardiometabolic variables (metabolic syndrome). Although the underlying pathophysiology might be quite different, syncytiotrophoblast stress is the final common pathway leading to the maternal syndrome among the subtypes of preeclampsia by causing an imbalance between proangiogenic factors (placental growth factor and vascular endothelial growth factor) and antiangiogenic factors (soluble fms-like tyrosine kinase-1 and soluble endoglin). Low-dose aspirin, started before 16 week's gestation, will prevent up to 60% of early-onset preeclampsia but will not prevent late-onset preeclampsia. Optimizing prepregnancy weight and controlling gestational weight gain may be the most effective ways to prevent preeclampsia.

Laparoscopic rectosigmoid resection for endometriosis is usually performed with the section of the inferior mesenteric artery (IMA) distal to the left colic artery (low-tie ligation). This study was to determine outcomes in IMA-sparing surgery in endometriosis cases. A single-center retrospective study based on the analysis of clinical notes of women who underwent laparoscopic rectosigmoid segmental resection and IMA-sparing surgery for deep infiltrating endometriosis with bowel involvement between March the 1st, 2018 and February the 29th, 2020 in a referral hospital . During the study period, 1497 patients had major gynecological surgery in our referral center, of whom 253 (17%) for endometriosis. Of the 100 patients (39%) who had bowel endometriosis, 56 underwent laparoscopic nerve-sparing rectosigmoid segmental resection and IMA-sparing surgery was performed in 53 cases (95%). Short-term complications occurred in 4 cases (7%) without any case of anastomotic leak. Preservation of the IMA in colorectal surgery for endometriosis is feasible, safe and enables a tension-free anastomosis without an increase of postoperative complication rates.

The role of ultrasound in the detection of the parametrial localisation of deep endometriosis although associated with ureteral stenosis and linked with a complex surgery with a high risk of intra and post-operative complications, is poor investigated. The aim was to evaluate the diagnostic accuracy of transvaginal ultrasonography in the identification of parametrial deep endometriosis. Consecutive women scheduled for surgery in a single centre for clinically suspected endometriosis were included in this prospective study. All women underwent transvaginal ultrasonography before surgery. The presence of parametrial endometriosis was considered when an infiltrating irregular hypoechogenic tissue extending laterally to the cervix was visualised. Sensitivity, specificity and likelihood ratios (LR+/-) were calculated with 95% confidence intervals (CIs). We included 476 women; surgery associated with histopathological evaluation revealed deep endometriosis in parametrial locations in 114 patients. With respect to the left parametrium, transvaginal ultrasonography had a sensitivity of 88% (95% CI, 79-94%), specificity of 98% (95% CI, 96-99%), an LR+ of 48.2 and an LR- of 0.12. Regarding to the right parametrium, transvaginal ultrasonography had a sensitivity of 91% (95% CI, 80-97%), specificity of 98% (95% CI, 96-93%), an LR+ of 63.8 and an LR- of 0.09. This technique shows, in a large population, a high specificity and sensitivity in the detection of parametrial endometriosis. This study was partly supported by Fondazione di Sardegna grant F74I19001010007.

Ultrasound is an effective tool to detect and characterize lesions of the uterosacral ligament, parametrium, and paracervix. They may be the site of diseases such as endometriosis and the later stages of cervical cancer. Endometriosis and advanced stages of cervical cancer may infiltrate the parametrium and may also involve the ureter, resulting in a more complex surgery. New functional, surgical anatomy requires the complete diagnostic description of retroperitoneal spaces and tissues that contain vessels and nerves. Most endometriosis lesions and cervical cancer spread involve the cervical section of the uterosacral ligament, which is close to tissues, namely the parametrium and paracervix, which contain vessels and important nerves and nerve anastomoses of the inferior hypogastric plexus. Efferent fibers of the plexus travel to the rectum, uterus, rectovaginal ligament, deep vesicouterine ligament, and bladder. These efferent fibers are essential for bladder and rectal functionality so tailored nerve-sparing surgery became a standard approach for treating deep infiltrating endometriosis and cervical cancer. An accurate diagnosis by ultrasound has significant clinical impact and is important for appropriate treatment. In this article, we try to establish a common terminology between imaging diagnostic and modern surgical anatomy.

We sincerely thank Szabó et al [...].