WooSeok Lee

Differences in omega-3 and fatty acid profiles between patients with endometriosis and those with a functional ovarian cyst

Endometriosis is a chronic inflammatory gynaecological disease. Problems associated with endometriosis include dysmenorrhoea, dyspareunia and infertility. We evaluated the omega-3 and fatty acid profiles in erythrocytes and tissues in patients with endometriosis (n = 10) or a functional ovarian cyst (n = 12), using a food frequency questionnaire that included questions about 117 food items typical of Korean meals. Erythrocyte levels of 20:5n3 and 22:6n3, the omega-3 index, and n-3 PUFA were significantly higher, and the n-6:n-3 ratio was significantly lower in the endometriosis group than in the functional ovarian cyst group. The functional ovarian cyst group consumed significantly more fruit than the group with endometriosis.

The triple-flap method for huge uterine adenomyosis with pelvic adhesions

We report surgery performed on a 44-year-old unmarried woman with the aim of preserving the uterus. Pelvic examination revealed a presumed uterus size of over 1000 g. Because of the size of the uterus and pelvic adhesions, we performed surgery using the triple-flap method described by Osada et al. (2011). During the operation, we could not remove the uterus from the pelvic cavity because of extensive adenomyosis, pelvic adhesions from rectosigmoid endometriosis and right ovarian endometriosis. After the uterus was extra-peritonealized, it was not possible to place a tourniquet around the cervix. Based on the description of the triple-flap method, the operator attempted to use a tourniquet on the lower part of the uterus and a vascular clamp on the ovarian vessel pedicle to decrease blood loss during the operation. However, these measures proved impossible because of the huge adenomyosis (over 1000 g) and cul-de-sac adhesion and the pelvic adhesion with endometriosis, which was hard to approach using the tourniquet and vascular clamp. It is difficult to predict pelvic adhesion and rectovaginal endometriosis before the operation. Without the tourniquet and vascular clamp, it is burdensome for the surgeon to perform an adenomyomectomy. We recommend two additional safety steps for preserving the uterus when using the triple-flap method. First,

P20.08: Ultrasonographic findings among transferred intrauterine fetal loss

The measurement of the lower uterine segment (LUS) during the third trimester seems to be the best technique available to estimate the risk of uterine rupture, but there is a great heterogeneity in the techniques used. It appears necessary to standardize the interventions and their teaching prior to extend its use to clinical settings beyond well-defined research purposes. Recent studies suggest that firsttrimester evaluation of LUS could be used as well. We report a case of a woman with a very large first-trimester uterine scar defect. Case: A woman with prior cesarean had an evaluation of her uterine scar at the time of her 11–13 weeks ultrasound. The transvaginal examination revealed a large uterine scar defect (width: 8 mm; depth: 10 mm) with a residual myometrium thickness of 2.4 mm (figure). She was advised of the potential risk of uterine scar dehiscence and uterine rupture later in pregnancy and serial ultrasound examinations were planned. However, the following transvaginal ultrasound performed at 16, 24 and 35 weeks’ gestation did not reveal a scar defect anymore and the residual myometrium thickness remained around 2.3 mm. She had no evidence of uterine scar dehiscence at her 35 weeks’ ultrasound, neither at the time of her repeated cesarean. Discussion: While the third-trimester evaluation of LUS thickness for diagnosis of uterine scar dehiscence and prevention of uterine rupture is becoming a common procedure in several countries, first and second trimester evaluation of uterine scar is not as well described. First-trimester evidence of ‘‘wedge defect’’, ‘‘hypoechogenic areas’’ and residual myometrial thickness on ultrasound have been reported as potential markers of uterine scar defect. However the current case suggests that residual myometrial thickness is possibly the most reliable predictor of uterine scar defect in each trimester. Prospective longitudinal cohort studies including first and third trimester evaluation of uterine scar using transvaginal ultrasound are warranted.