First birth from a deceased donor uterus in the United States: from severe graft rejection to successful cesarean delivery.

Uterus transplantation is the only known potential treatment for absolute uterine factor infertility. It offers a unique setting for the investigation of immunologic adaptations of pregnancy in the context of the pharmacologic-induced tolerance of solid organ transplants, thus providing valuable insights into the early maternal-fetal interface. Until recently, all live births resulting from uterus transplantation involved living donors, with only 1 prior birth from a deceased donor.

Thy-1 predicts poor prognosis and is associated with self-renewal in ovarian cancer.

Background: Ovarian cancer is the leading cause of gynecologic cancer death in the United States despite effective first-line systemic chemotherapy. Cancer stem cells (CSCs) retain the ability to self-renew and proliferate and may be a means of harboring disease that evades standard treatment strategies. We previously performed a high-throughput screen to assess differential protein expression in ovarian CSCs compared to non-CSCs and observed that Thy-1 was more highly expressed in CSCs.

Resident Education in Complex Obstetric Procedures: Are We Adequately Preparing Tomorrow's Obstetricians?

Objectives: The Accreditation Council for Graduate Medical Education (ACGME) milestones for obstetrics and gynecology (OB/GYN) residents include obstetrical technical skills. We sought to describe resident experience with surgical obstetrics and comfort performing procedures independently postgraduation.

Study Design: An anonymous 27-question e-survey was sent to OB/GYN residents in United States in March 2018, using the Council of Resident Education in Obstetrics and Gynecology coordinator listserv.

Predicting non-home discharge in epithelial ovarian cancer patients: External validation of a predictive model.

Objective: To externally validate a model predicting non-home discharge in women undergoing primary cytoreductive surgery (CRS) for epithelial ovarian cancer (EOC).

Methods: Women undergoing primary CRS via laparotomy for EOC at three tertiary medical centers in an academic health system from January 2010 to December 2015 were included. Patients were excluded if they received neoadjuvant chemotherapy, had a non-epithelial malignancy, were not undergoing primary cytoreduction, or lacked documented model components.

Management Strategies for Recurrent Endometrial Cancer.

Endometrial cancer is the most common gynecologic malignancy in the developed world, and its incidence is increasing. Mortality from this cancer has not improved in recent decades and is primarily driven by high-grade carcinomas that are more likely to present at an advanced stage and ultimately are more likely to recur. The prognosis for recurrent endometrial cancer is poor, especially for the 50% of these women that present with extrapelvic disease recurrence.

Intestinal Surgery in Gynecologic Oncology: Are We Training for the Future?

Objective: The objective of this study was to assess the scope of intestinal surgery training across gynecologic oncology fellowships in the United States and identify factors associated with perceived preparedness to perform intestinal surgery independently.

Materials/methods: An institutional review board-approved survey was distributed to Society of Gynecologic Oncology fellows and candidate members within the first 3 years of practice. Questions addressed demographics, operative experience, preparedness and plans for performing intestinal surgery, and attitudes toward gynecologic oncologists (GOs) performing intestinal surgery.

Comparison of Long-Term Fertility Outcomes after Myomectomy: Relationship with Number of Myomas Removed.

Study Objective: To determine if the number of myomas removed during myomectomy for symptomatic relief affects long-term fertility outcomes in reproductive-aged women.

Design: Retrospective cohort survey study (Canadian Task Force classification II-2).

Setting: University hospital.

Effect of disease-modifying anti-rheumatic drugs on therapeutic outcomes among women with endometriosis.

Objective: To determine whether disease-modifying anti-rheumatic drugs (DMARDs) affect the use of hormonal treatments, subsequent ablative surgery, and need for pain management, including opioids, non-steroidal anti-inflammatory drugs and anti-depressants, among women with endometriosis.

Methods: In a retrospective study, data were reviewed from women with surgically confirmed endometriosis who were not treated (n=234) or treated with DMARDs for 6 weeks or more (n=25) before surgical diagnosis at a single healthcare system in the USA between 2003 and 2013. The postoperative use of hormonal treatments, proportion of women undergoing subsequent ablative surgery, and use of adjunct therapies such as antidepressants, steroids, and opioids after surgery were compared between the two groups.

Versatility of the suprapubic port in robotic assisted laparoscopic myomectomy.

Objective: To demonstrate the multiple advantages of the suprapubic port in robotic assisted laparoscopic myomectomy.

Design: Video demonstration of a robotic assisted laparoscopic myomectomy technique using a suprapubic incisional retractor (GelPOINT).

Setting: Hospital.

Metabolites and microbial composition of stool of women with fecal incontinence: Study design and methods.

Aims: This paper aims to report the rationale, design, and the specific methodology of an ongoing nested observational study that will determine the association of the metabolite and microbial composition of stool with fecal incontinence (FI).

Methods: Eligible cases are participants with FI enrolled in the Controlling Anal Incontinence in women by Performing Anal Exercises with Biofeedback or Loperamide (CAPABLe) trial, a Pelvic Floor Disorders Network trial across eight clinical centers in the United States. Women of similar age without FI in the last year served as controls.

Implications of Ohio's 20-Week Abortion Ban on Prenatal Patients and the Assessment of Fetal Anomalies.

Ohio's governor recently signed into law Senate Bill 127, a bill that makes it a fourth-degree felony for a health care provider to perform an abortion "when the probable post-fertilization age of the unborn child is 20 weeks or greater," joining a series of other states that have enacted such legislation or are moving toward similar legislation. Twenty-week bans have salient implications for women's health, quality of care, and access to services, particularly in the context of the delivery of prenatal care. Because of the timeline of the initiation of prenatal care and assessments of fetal genetic and anatomic anomalies, patients may increasingly find themselves at or near the 20-week postfertilization gestational threshold when they have insufficient information to decide about continuing or ending the pregnancy.

Versican Proteolysis by ADAMTS Proteases and Its Influence on Sex Steroid Receptor Expression in Uterine Leiomyoma.

Context: Leiomyomas have abundant extracellular matrix (ECM), with upregulation of versican, a large proteoglycan.

Objective: We investigated ADAMTS (a disintegrin-like and metalloprotease with thrombospondin type 1 motifs) protease-mediated versican cleavage in myometrium and leiomyoma and the effect of versican knockdown in leiomyoma cells.

Design: We used quantitative reverse transcription polymerase chain reaction (qRT-PCR), western blotting, immunohistochemistry, and RNA in situ hybridization for analysis of myometrium, leiomyoma and immortalized myometrium and leiomyoma cells.

The Effect of Salpingectomy on Ovarian Function.

Tubal surgery is performed for a variety of indications in gynecology. Salpingectomy is the most aggressive form of tubal surgery and may be performed for potential risk reduction for epithelial ovarian cancer, sterilization, and ectopic pregnancy and as a method to enhance fertility in the setting of hydrosalpinx. Depending on the indication, alternatives include conservative therapy alone, tubal occlusion, and salpingostomy.

Obesity risk awareness in women with endometrial cancer.

Purpose: To assess whether women with endometrial cancer could accurately classify their weight and identify the association between obesity and risk of endometrial, breast, and colon cancers.

Methods: This was an IRB-approved (Project No. 14-0075), survey-based cross-sectional study of women ages 18-80 years with a diagnosis of endometrial cancer.

Methodology for a vaginal and urinary microbiome study in women with mixed urinary incontinence.

Introduction And Hypothesis: We describe the rationale and methods of a study designed to compare vaginal and urinary microbiomes in women with mixed urinary incontinence (MUI) and similarly aged, asymptomatic controls.

Methods: This paper delineates the methodology of a supplementary microbiome study nested in an ongoing randomized controlled trial comparing a standardized perioperative behavioral/pelvic floor exercise intervention plus midurethral sling versus midurethral sling alone for MUI. Women in the parent study had at least "moderate bother" from urgency and stress urinary incontinence symptoms (SUI) on validated questionnaire and confirmed MUI on bladder diary.

The Impact of Obesity on the 30-day Morbidity and Mortality After Surgery for Ovarian Cancer.

Objectives: To examine the effect of body mass index (BMI) on postoperative 30-day morbidity and mortality after surgery for ovarian cancer (OC).

Methods: Patients with OC were identified from the American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2011. Women were divided into 3 groups: nonobese (BMI <30 kg/m), obese (30 to <40 kg/m), and morbidly obese (≥40 kg/m).

The medical management of abnormal uterine bleeding in reproductive-aged women.

In the treatment of women with abnormal uterine bleeding, once a thorough history, physical examination, and indicated imaging studies are performed and all significant structural causes are excluded, medical management is the first-line approach. Determining the acuity of the bleeding, the patient's medical history, assessing risk factors, and establishing a diagnosis will individualize their medical regimen. In acute abnormal uterine bleeding with a normal uterus, parenteral estrogen, a multidose combined oral contraceptive regimen, a multidose progestin-only regimen, and tranexamic acid are all viable options, given the appropriate clinical scenario.

Introduction: Robot-assisted laparoscopic surgery.

In this Views and Reviews contribution there are four articles that provide insight into the present and future applications of robot assisted surgery. The potential application of this technology in reproductive surgery, oncology, general gynecology and urology is an ongoing controversy.

Predictors of surgical site infection in women undergoing hysterectomy for benign gynecologic disease: a multicenter analysis using the national surgical quality improvement program data.

Study Objective: To estimate the rate and predictors of surgical site infection (SSI) after hysterectomy performed for benign indications and to identify any association between SSI and other postoperative complications.

Design: Retrospective cohort study (Canadian Task Force classification II-2).

Setting: National Surgical Quality Improvement Program data.

Development and validation of a laparoscopic sacrocolpopexy simulation model for surgical training.

Study Objective: To develop a valid laparoscopic sacrocolpopexy simulation model for use as an assessment and learning tool for performing this procedure.

Design: Simulation study (Canadian Task Force classification II-2).

Setting: Two tertiary academic centers.

Surgical management of leiomyomas for fertility or uterine preservation.

Leiomyomas are the most common pelvic tumors in women. These tumors are not always symptomatic but can cause abnormal uterine bleeding and anemia, pelvic pressure and pain, urinary frequency, and adverse reproductive outcomes-symptoms that can diminish the quality of life of women. Myomectomy is the primary treatment modality for women with symptomatic leiomyomas who are of reproductive age and desire future fertility.

A randomized trial comparing conventional and robotically assisted total laparoscopic hysterectomy.

Objective: The purpose of this study was to compare operative time and intra- and postoperative complications between total laparoscopic hysterectomy and robotic-assisted total laparoscopic hysterectomy.

Study Design: This study was a blinded, prospective randomized controlled trial conducted at 2 institutions. Subjects consisted of women who planned laparoscopic hysterectomy for benign indications.