Both vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy are safe procedures in cases of large uteri with no significant difference between them except in terms of costs as VH appears to be more cost effective. CLINICAL TRIALS.GOV: NCT02826304.

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Pelvic organ prolapse (POP), the herniation of the pelvic organs to or beyond the vaginal walls, is a common condition. Many women with prolapse experience symptoms that impact daily activities, sexual function, and exercise. The incidence of uterine prolapse in young women of reproductive age is low. The incidence rises for young women who have delivered one or two children. As this type of prolapse occurs at a younger age, the surgical technique should not only reduce the prolapse but also retain the reproductive function. Abdominal sacral hysteropexy with mesh is the gold standard regarding conservative surgery for apical prolapse. However, the modified Purandare's cervicopexy remains a valuable alternative with low-risk profile and high success rate. Patients and methods. Thirty patients of reproductive age suffering from apical prolapse were randomized into two groups to undergo either modified Purandare's cervicopexy or abdominal sacrohysteropexy with mesh as a conservative surgery for apical prolapse. The primary outcome measure was the operative time of both surgeries with the exclusion of any concomitant procedures. Other measures of outcome included recurrence of prolapse, which was assessed 3, 6 and 12 months after the procedure, intraoperative blood loss, need for blood transfusion, and intraoperative complications. Postoperative pain was assessed during the first 24 hours after surgeries using the visual analogue scale as well as the postoperative hospital stay. Results. The operative time in minutes was significantly shorter among the modified Purandare's cervicopexy group compared to the abdominal sacral hysteropexy group (77.1 ± 6.8 vs. 94.2 ± 7.5 with p-value = 0.001). There was no significant difference between the two groups regarding the postoperative recurrence of symptoms with only one case in the modified Purandare's cervicopexy group experiencing recurrence one year after the procedure. There was no significant difference detected between the two groups regarding neither the intraoperative blood loss nor the need for blood transfusion with p-values of 0.094 and 0.999, respectively. No significant difference between the two groups existed regarding the intraoperative and postoperative complications. Postoperative pain and postoperative hospital stay were measured as well with no significant difference between the study groups. Conclusion. Abdominal sacral hysteropexy with mesh is the gold standard regarding conservative surgery for apical prolapse. However, the modified Purandare's cervicopexy remains an attractive alternative with low-risk profile and high success rate. It can be beneficial in certain conditions like obese patients, patients with medical history of abdominal surgeries, in whom it is difficult to access the retroperitoneum and anterior longitudinal ligament of the sacrum due to adhesions from past surgeries. Key words: pelvic organ prolapse, apical prolapse, modified Purandare's cervicopexy, abdominal sacral hysteropexy

Background Preterm delivery is a leading cause of neonatal mortality and morbidity. History of spontaneous preterm birth is the greatest risk factor for another preterm delivery. So, every effort should be made to prevent the recurrence of preterm delivery in this vulnerable group. This study aimed to evaluate the predictive ability of the anterior uterocervical angle and cervical length in preterm birth. Patients andMethods This was a prospective cohort study that included 70 patients with a history of spontaneous preterm birth. Ultrasound measurements of cervical length and anterior uterocervical angle were set to be measured for each patient at three visits; first between 16 0/7 and 24 0/7 weeks, second between 24 1/7 and 32 0/7 weeks, and the third was between 32 1/7 and 36 6/7 weeks. The correlation between both measures and the prediction of preterm birth among study participants was the primary outcome of the study. Neonatal outcome among the study patients was a secondary measure of outcomeResults The incidence of preterm birth among study participants was 31.41%. Cervical length and uterocervical angle showed progressive decrease and increase respectively throughout pregnancy. At the 2nd visit, the two measures were significantly different between those who delivered at term and those with preterm delivery with the cervical length being significantly shorter in the preterm arm (3.0 ± 0.49 versus 3.38 ± 0.36, p < 0.001) and uterocervical angle being significantly bigger among the same arm (110.1 ± 18.48 versus 84.42 ± 12.24, p < 0.001). A uterocervical angle > 89.8° at the second visit predicted preterm birth with 81.8% sensitivity and 70.8% specificity while cervical length ≤ 3.22 cm at the second visit predicted preterm birth with 68.1% sensitivity and 62.5% specificity. Multivariant logistic regression analysis showed that uterocervical angle > 89.8° at the second visit increased the odds ratio for preterm birth by 9.Conclusion Uterocervical angle can be a useful ultrasound marker for the prediction of preterm birth among high risk patients. A cutoff value of 89.8° can be used as a threshold above which prophylactic measures such as cervical cerclage or progesterone therapy can be provided. Keywords: Preterm birth, anterior uterocervical angle, cervical lengthClinicalTrials.gov ID: NCT05632003 (First posted date: 30/11/2022)

The aim of the study was to evaluate the association between placental thickness and placenta accreta spectrum (PAS) in patients with placenta previa. Materials and Methods: In this prospective study, 40 patients diagnosed with placenta previa were included. The maximum placental thickness in the lower uterine segment was obtained using a transabdominal scan. For the image to be deemed suitable, a midline sagittal section of the lower uterine segment (with the implanted placenta) and the cervical canal, with the intervening urinary bladder had been required. Intraoperative attendance was ensured for the detection of cases with spontaneous separation and cases with morbid adherence. All specimens removed were sent for histopathology to confirm PAS. The primary outcome of the study was to detect a threshold of placental thickness which can be used as a cut-off value in such screening test. The number of units of packed RBCs transfused during the operation and bladder injury were secondary measures of outcome. Results: Forty patients were included in the study; 20 patients were ultimately diagnosed with PAS while 20 patients did not have PAS. Mean placental thickness was significantly higher in the PAS patients compared with those with no invasive placentation (61.00 mm Vs 43.00 mm, P value 0.000). Using receiver operating characteristic (ROC) curve, a threshold placental thickness of 58mm was associated with 55% sensitivity, 90% specificity, 84.6% positive predictive value, and 66.7% negative predictive value. Multivariate logistic regression showed that placental thickness more than 58mm and having past history of more than three cesarean sections were independent risk factors for PAS among patients with placenta previa. Conclusion: Placental thickness in the lower uterine segment is increased in patients with placenta previa with PAS compared to those with no PAS. Such finding can be implemented into clinical practice by using placental thickness as a screening test for PAS in patients with placenta previa. ClinicalTrials.gov ID: NCT05500404.