Uterine scar defects after cesarean sections are increasingly common and elevate the risk of life-threatening complications in subsequent pregnancies. From various sonomorphological measurement parameters, the residual myometrial thickness (RMT) is crucial for predicting an obstetric complication in a subsequent pregnancy. A low RMT can be improved by surgical correction. The purpose of this paper is to present our technique for robotic-assisted laparoscopic niche repair (RALNR), to sonomorphologically characterize the niches pre- and postoperatively and to surveil subsequent symptoms and pregnancies. A cohort study of 35 patients with a niche and the wish to conceive, who had undergone RALNR between 05/2019 and 09/2023 at the university hospital of Zurich, was conducted. Sonomorphological parameters before and 6 weeks after surgery, as well as surgical, clinical and obstetrical outcomes were assessed. The mean widths and depths of the niche were significantly reduced (p < 0.001), width from 10.0 ± 3.5 mm preoperatively to 2.6 ± 3.4 mm postoperatively, and depths from 9.1 ± 3.7 mm preoperatively to 1.8 ± 2.6 mm postoperatively. RMT was significantly improved after RALNR (p < 0.001) with mean 1.5 ± 1.5 mm preoperatively compared to 8.3 ± 2.9 mm postoperatively. The pregnancy rate was 13 of 18 (77

Endometriosis, a disease affecting about one out of ten women, is characterized by the growth of endometrial-like tissue outside the uterine cavity. There is significant disease heterogeneity, but the pathophysiological mechanisms underlying differences in clinical presentation are poorly understood. Here, we investigated endometrial stromal cells (ESCs) from different types of endometrial lesions (endometrioma, superficial, and deep endometrial lesions), which revealed distinct differences in proliferation, migration, and contractility among different lesion types and when compared to ESC from normal (eutopic) endometrium. In particular, ESCs from endometriotic lesions showed reduced proliferation but increased migratory capacity, an effect most pronounced in endometrioma ESCs but also evident in ESCs from superficial and deep lesions. ESCs from superficial and deep lesions—but not those from endometrioma—showed increased contractility, a feature involved in tissue scarring and pain perception. Transcriptomics and proteomics revealed changes in genes and proteins involved in cell division, proliferation, extracellular matrix organization, and migration in endometriosis vs. healthy ESCs. Overall, our results demonstrate that stromal cells from different endometriotic lesions show distinct in vitro phenotypes that might explain differences in clinical presentation. Further, these cells represent an excellent in vitro model for studying patho-mechanisms involved in endometriosis heterogeneity.

INTRODUCTION:Many women with endometriosis turn to digital sources for information. Meanwhile, large language models (LLMs) appear capable of offering health advice. This study aimed to evaluate the potential in answering endometriosis-related queries. METHOD:This comparative study used 150 anonymized endometriosis Q&As from online forums (2021-2023), answered by human specialists. Another 150 responses were generated using an LLM (ChatGPT-4o). Eight expert reviewers, split into two groups, blindly evaluated either the human or artificial intelligence (AI) response for each question. The primary endpoint was whether responses could be correctly identified as human or AI. Secondary endpoints included incorrect information, harm, and suitability for patient communication. RESULT:Each reviewer group assessed 600 responses; human and AI responses were differentiated significantly (χ2 = 246.162, p < 0.001, slight interrater agreement). Most responses were accurate (84.8 %), harmless (87.2 %), and patient-suitable (73.8 %). There were no significant differences regarding incorrect information (p = 0.308), harm likelihood (p = 0.944), harm extent (p = 0.892), medical consensus alignment (p = 0.235), or suitability for patients (p = 0.544). CONCLUSION:This study found that AI was not inferior to human specialists in answering endometriosis-related queries. While reviewers were able to distinguish AI- from human-generated responses significantly, interrater agreement was only slight. No substantial differences were observed in medical content. As AI continues to evolve, patients increasingly turn to it for medical guidance, highlighting the need for greater specialization in endometriosis care. Future research should further investigate the risks, benefits, and patient acceptance of AI in clinical practice.

Endometriosis is a chronic inflammatory condition marked by the presence of endometrial-like tissue outside the uterus, often co-occurring with leiomyoma and presenting a diagnostic challenge. We analyzed 96 plasma cytokines and inflammatory markers in 86 women undergoing surgery for suspected endometriosis, using multiplex assays and unsupervised clustering methods. Patients were classified using both rASRM and the more granular #Enzian system to assess lesion-specific and stage-specific biomarker patterns. We identified five distinct patient clusters reflecting disease heterogeneity, with improved resolution using the #Enzian classification. Notably, the presence of leiomyoma influenced cytokine profiles, potentially obscuring biomarker signals. Key biomarkers including perforin, TRAIL, sFasL, IL-17F, PDGF, VEGFA, and MCP-2 were associated with disease presence and stage. These findings highlight the value of advanced classification systems and emphasize the importance of accounting for comorbid conditions. Our results support the development of non-invasive biomarker panels for earlier and more accurate diagnosis of endometriosis.

STUDY QUESTION:What are the attitudes and perceptions towards endocrine endometriosis therapy? SUMMARY ANSWER:Among the study population, endocrine endometriosis therapies are associated with negative mental images and emotions and there seems to be a pre-therapeutic information deficit on the part of physicians. WHAT IS KNOWN ALREADY:Endocrine therapies, as the current standard of conservative endometriosis treatment, have good efficacy and improve symptoms and quality of life in most patients. Nevertheless, clinical practice repeatedly shows rejection on the part of patients, which may result in reduced compliance and discontinuation of therapy. STUDY DESIGN, SIZE, DURATION:Cross-sectional study among endometriosis patients using a multilingual questionnaire distributed via the most popular social media channels between November 2020 and February 2021. A total of 3348 women participated in the study. PARTICIPANTS/MATERIALS, SETTING, METHODS:Based on a pilot phase, an international, multilingual online survey was conducted among women affected by endometriosis. The questionnaire included free-word associations and questions about personal medical history, source of information, and demographic data. Mental representations were detected based on modules of the co-occurrence network of associations. MAIN RESULTS AND THE ROLE OF CHANCE:Six modules with different dominant emotional labels emerged from the confluence of associations to endocrine endometriosis therapy mentioned by participants. Five modules reflected negative mental associations, with the most frequently mentioned words being 'side effects', 'pain', 'ineffective', 'depression', and 'uncertainty'. Of the 12 most frequently selected emotions, only 'optimistic' was positive. Side effects affecting mental health are the most important reason for deciding against endocrine therapy in our survey population. Twenty-seven percent of respondents reported knowing little about endocrine therapies for endometriosis. Social media are the most frequently used sources of information and were rated as the most useful. LIMITATIONS, REASONS FOR CAUTION:By translating the questionnaire, questions might have been understood differently depending on the language. By using social media channels for distribution, digitally literate patients were targeted. The survey population might not be representative as patients who are critical/unhappy with therapy are more likely to seek advice from peer groups. WIDER IMPLICATIONS OF THE FINDINGS:The findings of this study replicate the findings of a recent survey in three European countries. Given the prevalence of endometriosis and the few emerging pharmaceutical alternatives, these data point to a growing need for further research and development of non-hormonal drugs for treating endometriosis. Most endometriosis patients are young and digitally literate, and much information is obtained from alternative sources, such as social media. Careful education before starting therapy should be taken seriously, and patients' concerns should be addressed individually by health care providers. This could help reduce misunderstanding and misinformation and improve treatment adherence and satisfaction. STUDY FUNDING/COMPETING INTEREST(S):There is no funding or conflict of interest to declare. TRIAL REGISTRATION NUMBER:The trial is not registered at any trial registry.

Migraine and endometriosis are chronic disabling pain conditions. There is evidence for a shared genetic background. Migraine phenotype and course in patients with the comorbidity are insufficient investigated. Both conditions can be treated with progestins. For this observational study we included women with migraine and endometriosis, visiting our clinic from 2015 to 2021. We collected available information from charts and complemented these data by a structured phone interview to collect more specific information on migraine and the course of both diseases. From 344 patients fulfilling the inclusion criteria, 94 suffered from both, endometriosis and migraine. Migraine with aura was reported by 41

IntroductionPartnership is an important resource in dealing with endometriosis related chronic pain. Hence, our objective was to assess partnership in the context of endometriosis and its symptoms, considering the perspectives of both individuals involved.MethodsThe study was designed as a multi-center matched case–control study in Switzerland, Germany and Austria. Altogether 381 women with surgically/histologically confirmed endometriosis and 381 control women, 250 male partners of endometriosis-affected women and 229 of control women were evaluated. Partnership quality, partnership happiness, separation thoughts, and areas of conflict were evaluated through the Partnership Questionnaire and a validated list of conflict areas.ResultsQuality of partnership was rated as high by 60.1% of the women with endometriosis and 66.7% of the control women, as well as by 45.8 and 50.2% of their respective partners. Women with endometriosis mentioned separation thoughts, mostly related to sexual satisfaction, more often (34.9%/28.3%) and experienced more partnership-related conflicts than control women. Chronic pain, dyspareunia, dissatisfaction with sexuality, fatigue, and infertility were significantly associated with partnership conflicts. Fatigue and infertility but not pain experiences were related to lower partnership quality. Male partners in both groups reported separation thoughts equally often. In men, a high intensity of pain experienced by their partner was associated with reduced partnership happiness.ConclusionGiven the significance of partnership in dealing with chronic diseases and the connection between symptoms of endometriosis and a decrease in partnership quality, it is essential to incorporate strategies that alleviate the negative impacts on relationships for both partners into medical support.Clinical trial registrationidentifier NCT 02511626.

We present a new systematic, comprehensive, checklist-based sonographic assessment of endometriosis in the female true pelvis. Emphasis is placed on practical skills teaching. The newly introduced White Sliding Line (WSL) is the core structure. The WSL separates five compartments (anterior, central, posterior, and lateral right and left) containing dedicated endometriosis signs of mobility and morphology to be checked. This approach relies on the 2016 IDEA Consensus and further developments. It directly connects to the 2021 #ENZIAN Classification Standard. In practice, evaluation follows the proposed checklist in all compartments, judging first sliding mobility between organs and structures in a highly dynamic investigation. A rigorous search for deep endometriosis (DE) is then performed. We treat adhesions due to their great clinical importance and possible, reliable diagnosis by TVS as the fifth endometriosis unit, next to endometrioma, DE, adenomyosis, and superficial endometriosis. Including superficial (peritoneal) endometriosis is a future goal.

This study extended the original Dignity Therapy (DT) intervention by including partners and family caregivers (FCs) of terminally-ill cancer patients with the overall aim of evaluating whether DT can mitigate distress in both patients nearing the end of life and their FCs. In this multicenter, randomized controlled trial (RCT), a total of 68 patients with life expectancy < 6 months and clinically-relevant stress levels (Hospital Anxiety Depression total score; HADStot ≥ 8) including their FCs were randomly assigned to DT, DT + (including their FCs), or standard palliative care (SPC) in a 1:1:1 ratio. Study participants were asked to complete a set of questionnaires pre- and post-intervention. The coalesced group (DT and DT +) revealed a significant increase in patients’ perceived quality of life (FACIT-Pal-14) following the intervention (mean difference 6.15, SD = 1.86, p < 0.01). We found a statistically significant group-by-time interaction effect: while the HADStot of patients in the intervention group remained stable over the pre-post period, the control group’s HADStot increased (F = 4.33, df = 1, 82.9; p < 0.05), indicating a protective effect of DT. Most patients and their FCs found DT useful and would recommend it to other individuals in their situation. The DT intervention has been well-received and shows the potential to increase HRQoL and prevent further mental health deterioration, illness burden and suffering in terminally-ill patients. The DT intervention holds the potential to serve as a valuable tool for facilitating end-of-life conversations among terminally-ill patients and their FCs. However, the implementation of DT within the framework of a RCT in a palliative care setting poses significant challenges. We suggest a slightly modified and less resource-intensive version of DT that is to provide the DT inventory to FCs of terminally-ill patients, empowering them to ask the questions that matter most to them over their loved one’s final days. This study was registered with Clinical Trial Registry (ClinicalTrials.gov -Protocol Record NCT02646527; date of registration: 04/01/2016). The CONSORT 2010 guidelines were used for properly reporting how the randomized trial was conducted.

Journal Article Reply: Strengthening patient education on endometriosis therapies Get access N Thurnherr, N Thurnherr Department of Gynecology, University Hospital Zurich, Zurich, Switzerland Correspondence address. Department of Gynecology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland. Tel: +41-76-818-56-66; E-mail: nicole.thurnherr@gmail.com https://orcid.org/0000-0002-5215-0110 Search for other works by this author on: Oxford Academic PubMed Google Scholar L Burla, L Burla Department of Gynecology, University Hospital Zurich, Zurich, Switzerland https://orcid.org/0000-0002-5457-3272 Search for other works by this author on: Oxford Academic PubMed Google Scholar J M Metzler, J M Metzler Department of Gynecology, University Hospital Zurich, Zurich, Switzerland https://orcid.org/0000-0002-0000-8577 Search for other works by this author on: Oxford Academic PubMed Google Scholar P Imesch P Imesch Department of Gynecology, University Hospital Zurich, Zurich, Switzerland https://orcid.org/0000-0001-6322-6005 Search for other works by this author on: Oxford Academic PubMed Google Scholar Human Reproduction, Volume 39, Issue 4, April 2024, Page 858, https://doi.org/10.1093/humrep/deae035 Published: 29 February 2024

Objective The aim of this review is to analyse the progression of endometriosis research from 2007 to 2022. Material and methods The PubMed database was searched for publications with titles containing the keyword endometriosis, being created in January and July of the years 2007, 2012, 2017 and 2022. Each publication was categorized by research design and topic. We defined a total of seven groups containing twenty-three categories. Results The total number of publications per year increased from 393 in 2007 to 1042 in 2022. Regarding categories, the relative fraction of the Observational Study category increased from 32% to 45%. A similar development can be seen in the Laboratory Study/Experiment category which increased from 4% to 10%. Meanwhile, Interventional Study decreased from 7% to 5%. The relative number of Case Reports dropped from 25% to 13%. The absolute number of every category increased from 2007 to 2022. Concerning topics, the Diagnostics group increased from 10% to 15%. The Pathophysiology group decreased from 63% to 51%. In the Treatment group, a decrease of 33% to 26% was observed. Finally, the Other group saw an increase from 11% to 16%. Conclusion We saw an increase in the number of publications in several categories. However, we identified a need for more research in the Diagnostics, Pathophysiology and Treatment categories. Overall, we concluded that more basic research and more clinical studies are needed to better understand endometriosis as a disease and to better help affected patients.

Background: MRI diagnostics are important for adenomyosis, especially in cases with inconclusive ultrasound. This study assessed the potential of MRI-based radiomics as a novel tool for differentiating between uteri with and without adenomyosis. Methods: This retrospective proof-of-principle single-center study included nine patients with and six patients without adenomyosis. All patients had preoperative T2w MR images and histological findings served as the reference standard. The uterus of each patient was segmented in 3D using dedicated software, and 884 radiomics features were extracted. After dimension reduction and feature selection, the diagnostic yield of individual and combined features implemented in the machine learning models were assessed by means of receiver operating characteristics analyses. Results: Eleven relevant radiomics features were identified. The diagnostic performance of individual features in differentiating adenomyosis from the control group was high, with areas under the curve (AUCs) ranging from 0.78 to 0.98. The performance of ML models incorporating several features was excellent, with AUC scores of 1 and an area under the precision-recall curve of 0.4. Conclusions: The set of radiomics features derived from routine T2w MRI enabled accurate differentiation of uteri with adenomyosis. Radiomics could enhance diagnosis and furthermore serve as an imaging biomarker to aid in personalizing therapies and monitoring treatment responses.

Background: This study examines endometriosis (EM) features in women with EM and migraines (MG) (EM-MG) and women with EM alone (EM-O). The comorbidity of MG and EM is well known. However, knowledge about differences in symptoms, clinical manifestations, and severity of EM between EM-MG and EM-O is scarce. Materials and Methods: We conducted a cross-sectional observational study of premenopausal patients with biopsy-confirmed EM treated in our department from 2015 to 2021. All patients underwent surgical treatment for EM. Information about infiltration depth and localization of EM was available. We interviewed patients using a structured questionnaire that includes questions about clinical characteristics, symptoms, and treatment history. We reported categorical variables as frequencies and continuous variables as means with standard deviations. We compared subgroups (EM-MG vs. EM-O) using an independent sample t-test, the Wilcoxon-Mann-Whitney test, chi-square test, and Fisher's exact test. The significance level was 0.05. Results: We included 344 participants: 250 with EM-O and 94 with EM-MG. EM-MG had less severe revised American Society of Reproductive Medicine scores (p = 0.023), more deliveries (p = 0.009), more and higher scores of dysmenorrhea at menarche (p = 0.044; p = 0.036), prolonged heavy menstrual bleeding (p = 0.009), more and prolonged pain during menstrual bleeding (p = 0.011, p = 0.039), and more dyschezia (p < 0.001) compared with EM-O. Conclusion: Migraineurs experienced more intense EM symptoms at lower EM stages. This discrepancy strongly indicates pain sensitizations and a lower pain threshold in patients with EM-MG. Knowledge about EM features allows early diagnosis and treatment of women with potential EM-MG, both highly disabling conditions. Clinical Trials.gov (NCT04816357).

Background While the sexuality of patients with endometriosis is an established topic in research, the possible effect of endometriosis on partnership sexuality has come to the fore only recently. To improve counseling, more information is needed on how both partners experience sexuality in the context of endometriosis.Aim Previous research regarding endometriosis and sexuality normally focused on one partner to explore couples' intimate relations, whereas this study provides a comparison on both partners' perspectives on their common sexuality.Methods An overall 302 couples received a questionnaire based on the Brief Index of Sexual Functioning and Sexual History Form, which was modified by endometriosis specialists to better focus on endometriosis-specific aspects. To detect different perspectives on common sexuality within the couple, the Wilcoxon test and the Pearson chi-square test were performed.Outcomes Various aspects of couple sexuality were assessed by both partners to investigate divergent perspectives between the man and the woman within a couple.Results On one hand, male and female partners seem to have divergent perspectives on sexual satisfaction in general, desired frequency of sexual contacts, and the question of the female partner engaging in sexual activity despite discomfort. On the other, they have similar perspectives on who takes initiative in sexual contacts, satisfaction with variety in the sexual relationship, and the impact of sexual limitations on their satisfaction within the partnership.Clinical implications Endometriosis research addressing issues related to sexuality should include male partners; the same applies to consulting women with endometriosis in the context of their relationships rather than as individuals.Strengths and Limitations This is the first analysis conducted on a larger scale of data from both partners in couples dealing with endometriosis. As it provides quantitative information only, some qualitative information remains unexplored.Conclusion As both partners showed tendencies to overestimate their partners' sexual satisfaction and had different perspectives on sensitive topics in sexuality, such as the female partner engaging in sexual activity despite discomfort, addressing sexual communication could be a starting point in counseling couples dealing with endometriosis.

Objective: Primary aim of this study was to investigate endometriosis characteristics of patients with psychiatric conditions or depression. The secondary aim was to study tolerability of dienogest in this context.Methods: This observational case-control study included endometriosis data from patients visiting our clinic from 2015-2021. We collected information from patient charts and in phone interviews based on a structured survey. Patients with surgical confirmed endometriosis were included.Results: 344 patients fulfilled the inclusion criteria: n = 255 no psychiatric disorder, n = 119 any psychiatric disorder and n = 70 depression. Patients with depression (EM-D, p=.018; p=.035) or psychiatric condition (EM-P, p=.020; p=.048) suffered more often from dyspareunia and dyschezia. EM-P patients had more often primary dysmenorrhoea with higher pain scores (p=.045). rASRM stage or localisation of lesions did not differ. EM-D and EM-P patients discontinued dienogest treatment more often related to worsening of mood (p= .001, p=.002).Conclusion: EM-D or EM-P had a higher prevalence of pain symptoms. This could not be attributed to differences in rASRM stage or location of endometriosis lesions. Strong primary dysmenorrhoea might predispose to develop chronic pain-based psychological symptoms. Therefore, early diagnosis and treatment are relevant. Gynaecologist should be aware of the potential impact of dienogest on mood.

PURPOSE:To define the predictive value of morphological types (MTs) and further criteria in diagnosing ectopic pregnancy (ECP) by transvaginal sonography (TVS) prior to operative confirmation and treatment.MATERIALS AND METHODS:Retrospective cohort analysis of 321 consecutive patients with suspected ECP who were advised to undergo operation.RESULTS:ECP was investigated by TVS in all 321 patients. Application of the five selected MTs (blob sign, bagel sign, yolk sac, embryo, heart action) resulted in 85 % of cases receiving a conclusive diagnosis and 12 % receiving a presumed ECP diagnosis. 3 % remained nondiagnostic due to large or multiple ovarian cysts, large myoma, extended hemoperitoneum, or severe pain. ECP diagnosis was confirmed intraoperatively in 97 % of cases and was otherwise (3 %) immediately followed by curettage (CUR). The assessment of free fluid by TVS was achieved in most cases and correlated significantly with free blood. In the majority of cases, free blood was not bound to transmural ECP rupture. Histology confirmed the ECP diagnosis directly or by exclusion in 99 % of cases. Three cases of tubal ECP were diagnosed by TVS but not confirmed by LSC (1 %) and, finally, histology from CUR proved miscarriage (false-positive rate 1 %).CONCLUSION:We confirm the high accuracy of TVS diagnosis of ECP relying on five clearly different MTs, independent of its location. The blob and bagel sign emerged as important types (75 % of all ECPs). Histology from CUR was needed when ECP could not be visualized in LSC. Assessment of free fluid was essential and accurate in predicting free blood.

IntroductionEndometriosis is a common disabling pain condition in women of childbearing age, frequently showing familial clustering. Nevertheless, little is known about whether familial predispositions influence its severity or presentation. In this study, we investigate disease characteristics in endometriosis patients with a family history (FH) for endometriosis or the comorbidities migraine, depression and early menopause (EMP).Materials and MethodsWe performed an observational case-control study enrolling women with histologically confirmed endometriosis in a tertiary center.Based on surgical findings, patient records and phone interviews, we examined the relations between a FH for endometriosis, migraine, depression or EMP and endometriotic signs and symptoms, such as response to combined hormonal contraceptives (CHC) and analgesics, disease localization, infiltration depth, Enzian- and rASRM-scores.ResultsA positive FH for endometriosis, migraine, depression or EMP was reported by 10.2%, 33.4%, 32.6% and 9.9% of the 344 patients. A positive FH of endometriosis was associated with an increased risk for high rASRM-scores (rASRM 3+4: OR 2.74 (95% CI 1.16-6.49), p=0.017) and the presence of endometriomas (OR 2.70 (1.22-5.95), p=0.011). A positive FH for migraine was associated with less response of endometriosis symptoms to CHC (OR 0.469 (0.27-0.82) p=0.025). Depression in the family was linked to less severe rASRM-scores (rASRM 3+4: OR 0.63 (0.39-0.99), p=0.046) and less endometriomas (OR 0.58 (0.67-0.92), p=0.02), but increased the risk of both migraine (OR 1.66 (1.01-2.73), p=0.043) and depression (OR 3.04 (1.89-4.89), p<0.001) while showing a better response to CHC (OR 2.0 (1.15-3.48, p<0.001). Patients with EMP in their family reported more current endometriosis symptoms at present (OR 3.72 (1.67-8.30), p=0.001), more dysmenorrhea (OR 2.13 (1.04-4.35), p=0.037), more frequent severe dysmenorrhea (OR 2.32 (1.14-4.74), p=0.019) and suffered significantly more often >5 days of non-cyclic pain (OR 3.58 (1.72-7.44), p<0.001).ConclusionsAround 30% reported a positive FH for migraine or depression. Patients with a positive FH for endometriosis, migraine, depression or EMP differ in symptoms and surgical findings when compared to controls. While a FH for endometriosis is associated with higher rASRM scores and more endometriomas, women with a FH for depression had lower rASRM scores and less endometriomas while responding better to CHC. In contrast, women with a FH for migraine showed less response to CHC.

Abstract Objectives Assessing urgency in ectopic pregnancies (ECP) remains controversial since the disorder covers a large clinical spectrum. Severe conditions such as acute abdomen or hemodynamic instability are mostly related to intra-abdominal blood loss diagnosed as free fluid (FF) on transvaginal sonography (TVS). The aims of the current study were to investigate the value of FF and to assess other potentially predictive parameters for judging urgency. Methods Retrospective cohort analysis on prospectively collected cases of proven ECP (n = 343). Demographics, clinical and laboratory parameters, and findings on TVS and laparoscopy (LSC) were extracted from the digital patient file. FF on TVS and free blood (FB) in LSC were evaluated. Low urgency was defined as FB (LSC) < 100 ml and high urgency as FB (LSC) ≥ 300 ml. The best subset of variables for the prediction of FB was selected and predictors of urgency were evaluated using receiver operator characteristic (ROC) curves. Results Clinical symptoms, age, β-HCG, hemoglobin (HB) preoperative, and FF were examined in multivariate analysis for the cutoff values of 100 ml and 300 ml. FF was the only independent predictor for low and high urgency; HB preoperative was only significant for high urgency offering marginal improvement. ROC analysis revealed FF as an excellent discriminatory parameter for defining low (AUC 0.837, 95% CI 0.794–0.879) and high urgency (AUC 0.902, 95 % CI 0.860–0.945). Conclusion Single assessment of FF on TVS is most valuable for judging urgency. However, the exact cutoff values for a low- and high-risk situation must still be defined.