Adhesion formation following gynecological surgery remains a challenge. The adoption of minimally invasive surgical approaches, such as conventional or robotic-assisted laparoscopy combined with meticulous microsurgical principles and the application of adhesion–reducing substances, is able to reduce the risk of de novo adhesion formation but do not eliminate it entirely. Myomectomy is the most adhesiogenic surgical procedure and postoperative adhesions can have a significant impact on the ability to conceive. Therefore, when surgery is performed as infertility treatment, attention should be paid to whether the benefits outweigh the risks. Among several factors, the size and the location of fibroids are the most accountable factors in terms of adhesion development and post surgical infertility; therefore, the search for effective strategies against adhesion formation in this setting is of paramount importance. The purpose of this review is to evaluate the incidence and factors of adhesion formation and the best preventive measures current available.

Adenomyosis is a common disorder of the uterus, and is associated with an enlarged uterus, heavy menstrual bleeding (HMB), pelvic pain, and infertility. It is characterized by endometrial epithelial cells and stromal fibroblasts abnormally found in the myometrium where they elicit hyperplasia and hypertrophy of surrounding smooth muscle cells. While both the mechanistic processes and the pathogenesis of adenomyosis are uncertain, several theories have been put forward addressing how this disease develops. These include intrinsic or induced (1) microtrauma of the endometrial–myometrial interface; (2) enhanced invasion of endometrium into myometrium; (3) metaplasia of stem cells in myometrium; (4) infiltration of endometrial cells in retrograde menstrual effluent into the uterine wall from the serosal side; (5) induction of adenomyotic lesions by aberrant local steroid and pituitary hormones; and (6) abnormal uterine development in response to genetic and epigenetic modifications. Dysmenorrhea, HMB, and infertility are likely results of inflammation, neurogenesis, angiogenesis, and contractile abnormalities in the endometrial and myometrial components. Elucidating mechanisms underlying the pathogenesis of adenomyosis raise possibilities to develop targeted therapies to ameliorate symptoms beyond the current agents that are largely ineffective. Herein, we address these possible etiologies and data that support underlying mechanisms.

The junctional zone (JZ) is an important structure in the myometrium that maintains uterine fertility. Changes in the junctional zone are closely related to infertility and adenomyosis (ADS). As an increasing number of young women are affected by ADS, the disease is no longer considered typical of women over 40. With these changes, an increasing number of patients refuse hysterectomy and desire fertility preservation treatment. At the same time, ADS is a crucial factor causing female infertility. Therefore, the treatment of ADS-related infertility and preservation of reproductive function is one of the other major challenges facing clinicians. For these young patients, preserving fertility and even promoting reproduction has become a new challenge. Therefore, we searched and summarized these studies on PubMed and Google Scholar using keywords such as “adenomyosis”, “junctional zone”, and “infertility” to explore infertility causes, diagnosis, and treatment of ADS patients who wish to preserve their uterus or fertility and become pregnant, focusing on the junctional zone, to obtain a full appreciation of the new perspective on this disease.

To generate guidance for detailed uterine niche evaluation by ultrasonography in the non-pregnant woman, using a modified Delphi procedure amongst European experts.Twenty gynecological experts were approached through their membership of the European Niche Taskforce. All experts were physicians with extensive experience in niche evaluation in clinical practice and/or authors of niche publications. By means of a modified Delphi procedure, relevant items for niche measurement were determined based on the results of a literature search and recommendations of a focus group of six Dutch experts. It was predetermined that at least three Delphi rounds would be performed (two online questionnaires completed by the expert panel and one group meeting). For it to be declared that consensus had been reached, a consensus rate for each item of at least 70% was predefined.Fifteen experts participated in the Delphi procedure. Consensus was reached for all 42 items on niche evaluation, including definitions, relevance, method of measurement and tips for visualization of the niche. A niche was defined as an indentation at the site of a Cesarean section with a depth of at least 2 mm. Basic measurements, including niche length and depth, residual and adjacent myometrial thickness in the sagittal plane, and niche width in the transverse plane, were considered to be essential. If present, branches should be reported and additional measurements should be made. The use of gel or saline contrast sonography was preferred over standard transvaginal sonography but was not considered mandatory if intrauterine fluid was present. Variation in pressure generated by the transvaginal probe can facilitate imaging, and Doppler imaging can be used to differentiate between a niche and other uterine abnormalities, but neither was considered mandatory.Consensus between niche experts was achieved regarding ultrasonographic niche evaluation. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.© 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Uterine fibroids are the most common gynecologic neoplasm and contribute to significant morbidity, particularly when submucosal in location or large enough to cause bulk symptoms. Correctly classifying fibroids is essential for treatment planning and prevention of complications. Ultrasound is the first-line imaging modality for characterizing uterine fibroids. However, MRI allows for high-resolution, multiplanar visualization of leiomyomata that affords a more accurate assessment than ultrasound, particularly when fibroids are numerous. The FIGO system was developed in order to more uniformly and consistently describe and classify uterine fibroids. In this article, we review the MRI appearance of each of the FIGO classification types, detailing key features to report. Additionally, we present a proposed template for structured reporting of uterine fibroids based on the FIGO classification system.

To investigate the clinical efficacy of the hysteroscopic-assisted laparoscopic incised-suture versus folded-suture methods at the cesarean incision site for the treatment of previous cesarean scar defects (PCSD) and to evaluate pregnancy outcomes.This was a retrospective analysis of 95 patients with PCSD who underwent hysteroscopic-assisted laparoscopic surgery between June 2021 and September 2024 at the Third Xiangya Hospital of Central South University.There were no significant differences in population characteristics such as age and number of cesarean sections (P > 0.05). The folded-suture group had shorter operation time (39.03 ± 1.17 vs. 60.28 ± 1.14 min, P < 0.001) and volume of intraoperative hemorrhage (5.00, 2.00 vs. 20.00, 10.00 mL, P < 0.001). There were no statistically significant variations in the cure or effective rates regarding menstrual abnormalities between the two groups at 3 months, 6 months, 1-year post-surgery and the terms of overall clinical efficacy (P > 0.05). The overall effective rates for the incised- and folded-suture groups were 76.4% and 75.0%, respectively. In comparison to the incised-suture group, the desire to maintain postoperative fertility in the folded-suture group was significantly greater (odds ratio [OR] 8.33, 95% confidence interval [CI]: 2.27-30.58, P < 0.001), and the average time after surgery to pregnancy was shorter (5.60 ± 0.72 vs. 11.00 ± 2.70 months, P < 0.05). No substantial difference was observed in the pregnancy outcomes between the two groups.Hysteroscopic-assisted laparoscopic cesarean incised and folded suturing are both effective, with folded suturing being more safe and more suitable for patients requiring short-term fertility.© 2025 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

To analyze influencing factors of uterine rupture in pregnant women with a scarred uterus undergoing repeat delivery and to investigate the predictive value of transabdominal ultrasound measurement of lower uterine anterior wall thickness.A retrospective analysis of 159 pregnant women with scarred uterus (March 2022-May 2024) divided into rupture group (n=48) and non-rupture group (n=111). Lower uterine anterior wall thickness was measured via transabdominal ultrasound pre-delivery. Univariate/multivariate logistic regression and ROC curves were used to identify risk factors and evaluate predictive performance.The rupture group had higher rates of advanced maternal age, prenatal BMI ≥30 kg/m², multiparity, single-layer cesarean suturing, and shorter inter-pregnancy intervals (all P<0.05). Lower uterine anterior wall thickness was significantly thinner in the rupture group (1.24±0.31 mm vs 2.19±0.52 mm, P<0.001). Multivariate analysis identified thinner lower uterine anterior wall thickness (OR=2.359, 95% CI:1.362-4.134) and single-layer suturing (OR=1.863, 95% CI:1.125-3.086) as independent risk factors, while longer inter-pregnancy interval was protective (OR=0.256, 95% CI:0.091-0.634; all P<0.05). ROC analysis showed AUCs of 0.821 (scar thickness), 0.783 (single-layer suturing), and 0.759 (inter-pregnancy interval); combined prediction achieved an AUC of 0.894 (95% CI:0.837-0.946), sensitivity 90.23%, specificity 84.15%. Uterine rupture was associated with worse perioperative outcomes (eg, higher transfusion rates, longer hospitalization) and adverse neonatal outcomes (lower birth weight, more preterm births; all P<0.05).Lower uterine anterior wall thickness, single-layer suturing, and inter-pregnancy interval are key determinants of uterine rupture. Combined assessment of these factors provides high predictive accuracy (AUC=0.894) and improves risk stratification.© 2025 Zhang et al.