In this article,we comment on the paper by Kakinuma et al published recently.We focus specifically on the diagnosis of uterine pseudoaneurysm,but we also review other uterine vascular anomalies that may be the cause of life-threating hemorrhage and the different causes of uterine pseudoaneurysms.Uterine artery pseudoaneurysm is a complication of both surgical gynecological and nontraumatic procedures.Massive hemorrhage is the consequence of the rupture of the pseudoaneurysm.Uterine artery pseudoaneurysm can develop after obstetric or gynecological procedures,being the most frequent after cesarean or vaginal deliveries,curettage and even during pregnancy.However,there are several cases described unrelated to pregnancy,such as after conization,hysteroscopic surgery or laparoscopic myomectomy.Hemorrhage is the clinical manifestation and it can be life-threatening so suspicion of this vascular lesion is essential for early diagnosis and treatment.However,there are other uterine vascular anomalies that may be the cause of severe hemorrhage,which must be taken into account in the differential diagnosis.Computed tomography angiography and embolization is supposed to be the first therapeutic option in most of them.
Teresa Gastañaga-HolgueraIsabel Campo GestoLaura Gómez-IrwinMarta Calvo Urrutia
Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with limited resources, reflecting the poor quality of obstetric care and, consequently, an unmet obstetric need. Methods: This was a descriptive and analytical cross-sectional study with prospective data collection over a four-year period from 1 January 2020 to 31 December 2023 at the University Hospital Centre (CHU) of Bouaké, in the Obstetrics and Gynaecology Department. The variables studied were epidemiological characteristics, therapeutic aspects and factors associated with maternal. Results: The prevalence of uterine rupture was 0.63%. The average age was 32, with patients aged 35 and over accounting for 33.68%, married 44.21% and 70% not in education. Patients with uterine rupture had been evacuated in 85.26% of cases. Uterine rupture was diagnosed in 97.89% of cases during labour. Maternal lethality due to rupture was 15.79%. The causes of maternal death were dominated by haemorrhagic shock (53.33%). Factors statistically associated with death were age ≥ 35 years (OR: 3.14), duration of labour ≥ 12 hours (OR: 5.8), multiparity (OR: 19.04), admission delay beyond 2 hours (OR: 4.36), haemoglobin level ≤ 7 g/dl (OR: 36.84), coma or obnubilation (OR: 71.82), haemorrhagic shock (OR: 243.94) and occurrence of post-operative complications (OR: 76.45). Conclusion: The frequency of uterine rupture remains significant in the department (0.63%), with maternal mortality still high (15.79%). The key to reducing uterine rupture and its consequences lies in timely referral and early, appropriate management.
BACKGROUND Uterine injury can cause uterine scarring,leading to a series of complications that threaten women’s health.Uterine healing is a complex process,and there are currently no effective treatments.Although our previous studies have shown that bone marrow mesenchymal stem cells(BMSCs)promote uterine damage repair,the underlying mechanisms remain unclear.However,exploring the specific regulatory roles of BMSCs in uterine injury treatment is crucial for further understanding their functions and enhancing therapeutic efficacy.AIM To investigate the underlying mechanism by which BMSCs promote the process of uterine healing.METHODS In in vivo experiments,we established a model of full-thickness uterine injury and injected BMSCs into the uterine wound.Transcriptome sequencing was per-formed to determine the enrichment of differentially expressed genes at the wound site.In in vitro experiments,we isolated rat uterine smooth muscle cells(USMCs)and cocultured them with BMSCs to observe the interaction between BMSCs and USMCs in the microenvironment.RESULTS We found that the differentially expressed genes were mainly related to cell growth,tissue repair,and angiogenesis,while the phosphoinositide 3-kinase(PI3K)/protein kinase B(AKT)pathway was highly enriched.Quantitative reverse-transcription polymerase chain reaction was used to validate differentially expressed genes,and the results demonstrated that BMSCs can upregulate genes related to regeneration and downregulate genes related to inflammation.Coculturing BMSCs promoted the migration and proliferation of USMCs,and the USMC microenvironment promoted the myogenic differentiation of BMSCs.Finally,we validated the PI3K/AKT pathway in tissues and cells and showed that BMSCs activate the PI3K/AKT pathway to promote the regeneration of uterine smooth muscle both in vivo and in vitro.CONCLUSION BMSCs upregulated uterine wound regeneration and anti-inflammatory factors and enhanced uterine smooth muscle proliferation through the PI3K/AKT pathway both in vivo and in vi
