Objectives The most common reason for discontinuation of long-acting progestogen-only contraceptives is irregular bleeding following local endometrial vascular changes. To reduce unpredictable bleeding episodes among depot medroxyprogesterone acetate (DMPA) users, the combined injectable contraceptive, Cyclofem ® , was offered as an alternative. However, there is a gap in our knowledge about the effects of Cyclofem on the endometrial vasculature and patterns of bleeding. This study aimed to compare the effects of Cyclofem and DMPA on endometrial vascular density, endometrial histology and pattern of bleeding.Methods Sixty-eight healthy women with regular menstrual bleeding and seeking injectable long-acting contraceptives were recruited. Two endometrial samples (before and 3 to 6 months after initial exposure to DMPA or Cyclofem) were collected from each participant. The samples were stained using an immunohistochemical method and anti-CD34 to visualise the endometrial vasculature. Endometrial vascular density was assessed using standard techniques.Results Sixty-eight women were randomly assigned to Cyclofem (38 women) or DMPA (30 women). Endometrial vascular density was 149.3 ± 6.7 (mean ± SD)/mm 2 before 271 IntroductionProgestogen-only contraceptives provide a safe and highly effective method of fertility regulation. Unfortunately, they are commonly associated with the problem of endometrial breakthrough bleeding, often leading to discontinuation of use. 1 Depot medroxyprogesterone acetate (DMPA) is an aqueous suspension of pregn-4-ene-3,20-dione,17-(acetyloxy)-6-methyl-(6α) administered by intramuscular injection (150 mg once every 3 months) for long-term contraception. MPA is detected in the serum within 30 minutes following injection. Serum concentrations generally plateau at about 1.0 ng/ml for about 3 months, after which there is a gradual decline. injection. This significantly decreased to 132.4 ± 12.2 after DMPA use, and from 151.9 ± 5.8 to 131.8 ± 12.8 vessels/mm 2 following Cyclofem use (paired t-test, p<0.05). However, there was no significant difference between endometrial vascular density during treatment with Cyclofem or DMPA. Total bleeding days in the first and second 3-month time intervals were 28 ± 23 and 18 ± 12 days in DMPA users and 22 ± 14 and 16 ± 9 days in Cyclofem users, respectively, Spotting was the most common type of bleeding experienced, and atrophic endometrium was the most common histological pattern observed in both groups.Conclusions This study demonstrated that both Cyclofem and DMPA use are associated with decreased endometrial vascular density and atrophic endometrium, in addition to irregular bleeding, mainly spotting. There was no significant difference in bleeding patterns or endometrial findings observed for these two injectable contraceptives in Iranian women. long-acting injectable method that produces a more regular vaginal bleeding pattern. The extensive literature indicates that although combined oestrogen-progestogen once-amonth injectable contraceptives ...

Key Clinical Message Lethal multiple pterygium syndrome is a very rare genetic disorder. The manifestations of this condition include growth deficiency of the fetus, craniofacial anomalies, joint contracture, and skin webbing (pterygia). This disorder is fatal before birth or shortly after birth. We reported a case of lethal multiple pterygium syndrome with multiple anomalies including pterygia involving the axilla, bilateral antecubital fossa, and groin. Arthrogryposis involving multiple lower and upper extremities joints. Cleft palate, microstomia and limitation of mouth opening, webbed neck, asymmetric small and narrow chest, ambiguous genitalia, depressed and wide nasal bridge, antemongoloid slant, low‐set, malformed, and posteriorly rotated ears, pterygia, syndactyly and camptodactyly of hands and rocket bottom feet. LMPS is a congenital genetic disease with multiple anomalies that is fatal in the second and third trimesters of pregnancy or shortly after birth. With genetic testing and counseling, it can be prevented from recurring in subsequent pregnancies.

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