Andrea Olguín-Ortega

Background/Objective: Asherman syndrome is an acquired intrauterine adhesive disorder associated with menstrual abnormalities, infertility, recurrent pregnancy loss, and adverse reproductive outcomes. Data from Latin American tertiary referral centers remain limited. To characterize clinical history, classification, hysteroscopic management strategies, and anatomical and reproductive outcomes in a single cohort of Mexican women with Asherman syndrome. Methods: This retrospective cohort study included women identified through institutional electronic records between July 2016 and December 2023 with a diagnosis of Asherman syndrome and analyzable hysteroscopic records. Women were followed for twelve months. Recurrence was defined as hysteroscopic evidence of intrauterine adhesions during follow-up. Among women with follow-up hysteroscopy, two-sided Fisher’s exact tests were used to calculate odds ratios and 95% confidence intervals. Results: Fifty-four women were analyzed. A prior uterine procedure was documented in 44 women (81.5%), with sharp curettage in 35 (64.8%). The most common reasons for consultation were secondary infertility (29.6%), abnormal uterine bleeding (27.8%), primary infertility (20.4%), and recurrent pregnancy loss (13.0%). Disease severity was classified as mild in 30 women (55.6%), moderate in 11 (20.4%), and severe in 7 (13.0%). Hysteroscopic intervention was predominantly performed with cold knife adhesiolysis (83.3%). Twelve-month follow-up hysteroscopy was performed in 38 women (70.4%); recurrence was identified in 30 (55.6%). Among the 34 women with reproductive intent, 12 achieved a live birth, corresponding to a live birth rate of 35.3%. Conclusions: Prior uterine instrumentation, particularly sharp curettage, was the most frequent antecedent. Recurrence remained common despite surgical management, highlighting the need for standardized postoperative surveillance and preventive strategies.

Background/Objectives: Myomectomy is the preferred treatment for women with uterine fibroids who desire to preserve their fertility. This study aimed to compare perinatal outcomes between Mexican women with and without a history of myomectomy, matched in a 1:2 ratio based on maternal age and parity. Methods: A retrospective cohort study was conducted involving women with and without a history of myomectomy who received prenatal care and delivered at a tertiary care hospital in Mexico City. Women with comorbidities such as pregestational diabetes, chronic hypertension, autoimmune diseases, nephropathy, cardiomyopathy, and cancer were excluded from the study. Group 1 consisted of women with a history of myomectomy, and Group 2 included matched women without such a history. The following perinatal outcomes were evaluated: miscarriage, preterm birth, cesarean section, obstetric hemorrhage, placenta previa, surgical adhesions, and obstetric hysterectomy. Adjusted relative risk (aRR) with 95% confidence intervals (CI) was calculated. Results: A total of 122 women were analyzed in group 1, and 244 in group 2. The risk of obstetric hemorrhage aRR 7.5 (95% CI 3.9–11.9), surgical adhesions aRR 11.8 (5.3–20.7), and placenta accreta aRR 15.3 (1.3–111) were significantly higher in Group 1 compared to Group 2. Other outcomes, including miscarriage, preterm birth, cesarean section, placenta previa, and obstetric hysterectomy, were similar between groups. Conclusions: Mexican pregnant women with a history of myomectomy have a higher risk of obstetric hemorrhage, surgical adhesions, and placenta accreta compared to those without such a history.

Endometriosis is a disorder characterized by the presence of endometrial tissue outside the uterus, leading to dyspareunia, chronic pelvic pain, dysuria, and infertility. The latter has been related to implantation failure associated with alterations in decidualization, a process regulated by sex hormones such as progesterone. Membrane progesterone receptor β (mPRβ) exhibits a lower expression in endometriotic tissues than in normal endometrial ones. However, the role of mPRβ in decidualization is unknown. This work aimed to investigate whether mPRβ plays a role in the decidualization of endometrial stromal cells (ESCs) derived from women with and without endometriosis. The mPR agonist OrgOD-2 induced the gene expression of key decidualization markers (insulin-like growth factor binding protein 1, prolactin, transcription factor heart and neural crest derivatives-expressed transcript 2, and fork-head transcription factor) in healthy ESCs, eutopic (uterine cavity), and ectopic (outside of the uterine cavity) ESCs from women with endometriosis. Notably, the expression of the decidualization markers was lower in endometriotic cells than in healthy endometrial ones. An siRNA mediated knockdown of mPRβ reduced the expression of decidualization-associated genes in ESCs treated with a decidualization stimuli, regardless of whether cells were derived from healthy women or those with endometriosis. Our data suggest that progesterone, through mPRβ activation, regulates the decidualization process in endometrial stromal cells from women with and without endometriosis.

Müllerian malformations (MM) are congenital anomalies of the female reproductive tract that may have a hereditary component. We report the case of a 20-year-old woman with a notable family history of MM (mother and grandmother with a longitudinal vaginal septum and aunt with a bicornuate uterus) who presented with difficulty inserting tampons and menstrual cups. Physical examination revealed a 3 cm longitudinal vaginal septum, which was confirmed by magnetic resonance imaging (MRI) as a 4 cm septum in the lower two-thirds of the vagina, with no abnormalities in the uterus or cervix. Surgical resection was performed without complications, and the patient recovered uneventfully with standard postoperative care. This case points out the relevance of recognizing familial patterns in MM and suggests that early evaluation and counseling may improve reproductive outcomes and minimize associated complications.

Objective To evaluate the sterilization efficacy of hysteroscopy instruments using ultraviolet C (UV-C) light at a wavelength of 259 nm in the Endoscopic Diagnostic Center of the National Institute of Perinatology. Methods Consecutive patients undergoing office hysteroscopy via the Bettochi vaginoscopy technique were included, excluding those with conditions such as viable intrauterine pregnancy or acute pelvic infection. Samples were collected from six designated sites of the hysteroscope, including the inner sheath, internal holes of the inner sheath, lens, graspers, scissors, and outer sheath. Initially, samples were taken after the first sterilization using a LAOKEN LK/MJG-150 Plasma Sterilizer (Chengdu, China). Next, samples were collected after the routine use of the hysteroscope in the office setting to confirm contamination. Subsequently, a new set of samples were taken after a 20-minute UV-C sterilization cycle with the EsteriUV device. Results The initial sterilization achieved a 96.73% sterilization rate, with ten samples testing positive for Staphylococcus coagulase-negative. Post-hysteroscopy, contamination increased significantly. Afterward, UV-C sterilization achieved a 96.08% sterilization rate, with 11 samples positive for Staphylococcus coagulase-negative and one for Streptococcus anginosus (p=0.66). No clinical infections were reported in any patient within one-month post-procedure. Conclusion UV-C light is a viable alternative for hysteroscopy instrument sterilization, demonstrating comparable efficacy to conventional methods. Further studies are recommended to optimize UV-C parameters for enhanced sterilization efficiency.

Background and Objectives: Postoperative shoulder pain is a common issue after total laparoscopic hysterectomy (TLH). This study evaluated the impact of a shoulder movement routine on postoperative shoulder pain in women undergoing uncomplicated TLH. Materials and Methods: An open-label randomized clinical trial included women without prior shoulder pain undergoing TLH between 20 January and 20 March 2024. Participants were randomized into two groups: Group 1 (n = 36) received a shoulder movement routine, while Group 2 (control, n = 39) performed a hand movement routine. Shoulder pain was assessed using the visual analog scale (VAS) at 6 h, 24 h, and 7 days postoperatively. Results: Seventy-five women participated. No significant differences were found between the groups regarding demographic variables, surgery duration, or hospital stay. Shoulder pain scores (VAS) at three time points (6 h, 24 h, and 7 days) showed no significant differences between groups (p = 0.57, p = 0.69, and p = 0.91, respectively). Similarly, there were no significant differences in incisional or abdominal pain. Conclusions: The shoulder movement routine did not significantly reduce postoperative shoulder pain in women undergoing uncomplicated TLH.

Endometriosis is one of the most frequent gynecological diseases in reproductive age women, but its etiology is not completely understood. Endometriosis is characterized by progesterone resistance, which has been explained in part by a decrease in the expression of the intracellular progesterone receptor in the ectopic endometrium. Progesterone action is also mediated by nongenomic mechanisms via membrane progesterone receptors (mPRs) that belong to the class II members of the progesterone and adipoQ receptor (PAQR) family. The aim of the present study was to evaluate the expression at mRNA and protein levels of mPR members in the eutopic and ectopic endometrium of women with endometriosis. Total RNA and total protein were isolated from control endometrium (17 samples), eutopic endometrium (17 samples), and ectopic endometrium (9 samples). The expression of PAQR7 (mPRα), PAQR8 (mPRβ), and PAQR6 (mPRδ) at mRNA and protein levels was evaluated by RT‐qPCR and Western blot, whereas PAQR5 (mPRγ) gene expression was evaluated by RT‐qPCR. Statistical analysis between comparable groups was performed using one‐way ANOVA followed by Tukey’s multiple comparisons test with a confidence interval of 95 %. The analysis of gene expression showed that PAQR7 and PAQR5 expression was lower in both eutopic and ectopic endometrium as compared to the endometrium of women without endometriosis, whereas the expression of PAQR8 and PAQR6 was only reduced in eutopic endometrium. Furthermore, mPRα and mPRβ protein content was decreased in the ectopic endometrium of women with endometriosis. Our results demonstrate a decrease in the expression and protein content of mPRs in eutopic and ectopic endometrium of patients with endometriosis, which could contribute to the progesterone resistance observed in patients with this disease.