Dysfibrinogenemia is a rare qualitative fibrinogen disorder associated with both bleeding and thrombotic risks, presenting unique diagnostic and management challenges in pregnancy. Physiological increases in fibrinogen during pregnancy may obscure underlying abnormalities, and reliance on functional assays alone can result in misinterpretation and inappropriate management. We present a case series of three pregnant patients in whom dysfibrinogenemia was either incidentally identified during antenatal care or recognised through prior family screening. All cases demonstrated persistently low functional fibrinogen levels measured using the Clauss method, with normal antigenic fibrinogen levels on enzyme-linked immunosorbent assay (ELISA), consistent with qualitative fibrinogen defects. Rotational thromboelastometry (ROTEM) was used to aid real‑time haemostatic assessment. Multidisciplinary management involving obstetricians, anaesthetists, and haematologists enabled individualised care, resulting in successful outcomes including spontaneous vaginal delivery, caesarean section under general anaesthesia, and medically indicated termination, without significant haemorrhagic complications. This series highlights the importance of distinguishing qualitative from quantitative fibrinogen disorders and cautions against reflexive fibrinogen replacement based solely on functional assays. A structured diagnostic approach, supported by antigen testing and viscoelastic assessment, is essential to guide safe and effective management in pregnancy.

This case report describes the complete excision of a parasitic fibroid using the vaginal natural orifice transluminal endoscopic surgery (vNOTES) technique in a 49-year-old morbidly obese female patient. The patient presented with heavy menstrual bleeding and pelvic organ prolapse, and imaging revealed a right degenerated subserosal fibroid. Due to her significant comorbidities, a classical vaginal hysterectomy was performed. During the procedure, a parasitic fibroid was identified and excised using the vNOTES technique.The fibroid measured 7.5 × 5.5 cm and was successfully removed without complications. This report presents the first documented case of spontaneous parasitic fibroid excision using vNOTES, highlighting the possibility of using this approach in managing parasitic fibroids, particularly in obese patients.

Placenta accreta spectrum (PAS) is a major cause of obstetric hemorrhage and maternal morbidity. Despite advances in antenatal imaging, some cases remain undiagnosed until delivery. We report a case of intraoperative diagnosis of placenta accreta in a 32-year-old woman with a history of two prior cesarean sections. Following delivery of a healthy neonate, the placenta failed to separate and was found to be abnormally adherent to the uterine wall. In the setting of ongoing bleeding and absence of a cleavage plane, a subtotal hysterectomy was performed. The patient had a favorable postoperative outcome. This case underscores the importance of anticipating PAS in high-risk patients and highlights the need for rapid intraoperative decision-making when the diagnosis is unexpected.

Pregnancy of uncertain viability affects up to 30% of early pregnancies. Among women presenting with per-vaginal bleeding and absence of a fetal pole, prognosis remains indeterminate. The lack of validated prediction tools contributes to clinical uncertainty and maternal anxiety.

The postpartum period is associated with a wide spectrum of potential complications that may lead to significant maternal morbidity and mortality if not promptly diagnosed and treated. Clinical presentation is frequently nonspecific - including symptoms such as pelvic pain, fever, and vaginal bleeding - rendering imaging indispensable for differentiating normal postpartum changes from pathologic conditions. Radiologists should be familiar with the expected postpartum imaging appearance of the uterus as well as the imaging findings of common and uncommon complications. This review provides an imaging-centered overview of postpartum complications after vaginal and cesarean delivery, including endometritis, retained products of conception, postpartum hemorrhage, uterine rupture, uterine dehiscence, along with key extrauterine complications. We discuss the strengths and limitations of ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) in the evaluation of these conditions. Key imaging features and diagnostic pitfalls across modalities are highlighted to aid radiologists in accurate interpretation. This review aims to improve diagnostic confidence and ultimately enhance patient outcomes in the postpartum population.

The 2025 FIGO Cancer Report updates recommendations for the diagnosis, staging, and management of the 6 major gynecologic malignancies, including cervical, endometrial, vaginal, vulvar, ovarian, and fallopian tube cancer, and gestational trophoblastic disease (GTD). The role of ultrasound differs considerably across the 6 cancers. In cases of endometrial and GTD, ultrasound is used to guide initial diagnosis, risk stratification, and surgical planning. In postmenopausal bleeding, a transvaginal ultrasound can assess endometrial thickness and determine the need for further evaluation. In cervical cancer, transrectal ultrasound allows local tumor assessment and brachytherapy guidance. Ovarian and fallopian tube cancers rely on ultrasound as the first-line tool for adnexal mass assessment and contribute to the Risk of Malignancy Index. For vaginal cancer, sonography has a complementary role in the anatomic assessment of the primary tumor. In vulvar cancer, ultrasound use is limited, as it is mainly for lymph node evaluation in early disease, when used in conjunction with clinical examination and cross-sectional imaging. Although ultrasound has limitations when assessing nodal spread or distant metastases, it can be used in combination with cross-sectional imaging and serial biomarkers to provide a complete evaluation. This review aims to summarize the ultrasound-relevant content from the 2025 FIGO update reports and serve as a practical reference for radiologists.

This paper presents a comprehensive cadaveric dissection atlas detailing the retroperitoneal anatomy essential to advanced pelvic surgery. Developed by a multidisciplinary team of anatomists, gynecologists, and gynecologic oncologists, the study provides a systematic, layer-by-layer guide for navigating the pelvic avascular spaces. It details five critical surgical corridors: the presacral (retrorectal) space, the pararectal space (divided into the Latzko and Okabayashi compartments), the paravesical space (medial and lateral compartments), the prevesical (retropubic/Retzius) space, and the medial psoas space (laterovascular plane). This atlas emphasizes the use of reliable landmarks, such as the sacral promontory, the obliterated umbilical artery, and the ureter, to define anatomical boundaries and ensure safe surgical practice. The primary objective is to maintain adequate exposure after retroperitoneal entry and to perform layer-by-layer surgical dissection to identify critical anatomical structures. The superior hypogastric plexus; hypogastric nerve; pelvic splanchnic nerves; inferior hypogastric plexus with its vesical and rectal branches; the internal iliac artery with its posterior and anterior trunk branches (including the superior gluteal, iliolumbar, lateral sacral, uterine, inferior gluteal, pudendal, obturator, middle rectal, and inferior and superior vesical arteries, and the obliterated umbilical artery); the external iliac artery; and the corresponding internal and external iliac veins were discussed. Additionally, the somatic nerves, obturator nerve, lumbosacral trunk, sacral nerves, sciatic nerve, genitofemoral nerve, and femoral nerve were reviewed. The parietal fascial planes, pubocervical fascial structure, and visceral compartments were evaluated as part of the whole. Respecting fascial planes-particularly the presacral fascia-is mandatory to avoid catastrophic hemorrhage and autonomic nerve injury. These spaces serve as the "neurovascular roadmap" for complex procedures, including radical hysterectomy, nerve-sparing pelvic surgery, pelvic lymphadenectomy, and hemorrhage control. Mastery of these interconnected retroperitoneal compartments facilitates a transition from organ-based to space-oriented surgery, significantly reducing morbidity while maintaining oncologic radicality.

Background and objectives Optimum dose, route, and timing of oxytocin administration to prevent postpartum haemorrhage during caesarean section are uncertain. We compared the effect of oxytocin infusion initiated either at skin incision or after head delivery on blood loss and ease of foetal head delivery during elective caesarean section. Methods In this open-label, randomised trial with parallel arms, 68 women with singleton pregnancies in cephalic presentation, undergoing elective caesarean delivery at term in a tertiary centre in Puducherry, were enrolled. Randomisation was performed using a simple random approach. Allocation was concealed in sequentially numbered, opaque, sealed envelopes, which were opened after informed consent to allocate participants to receive an oxytocin infusion (6 mIU/min), started either at the time of skin incision (intervention group) or after foetal head delivery (control group). All received oxytocin 5IU bolus after head delivery, followed by infusion for four hours postpartum. The primary outcome was the amount of blood loss. Results Mean blood loss was lower among those started on oxytocin skin incision than the control group (485.8±159.2 mL vs. 589.1±216.6 mL, P=0.029). Median haemoglobin decline was significantly lower in the intervention group (0.6 vs. 1.0 g/dL, P=0.011). Ease of foetal head delivery, need for additional uterotonics, and neonatal outcomes were comparable between the groups. Interpretation and conclusions The initiation of oxytocin at the skin incision may lead to significantly lower blood loss and a lower fall in haemoglobin level compared to its initiation after foetal head delivery among women undergoing elective pre-labour caesarean section at term.

Human papillomavirus (HPV) infection, cervical intraepithelial neoplasia (CIN), pelvic organ prolapse (POP), cervical polyps, abnormal uterine bleeding, and vaginitis are common gynecological disorders. This study characterized the vaginal microbiome and its cytokine-mediated immune interactions in Chinese women with gynecological disorders. Vaginal swabs from 310 patients diagnosed with gynecological disorders and 112 healthy controls were analyzed via 16S rRNA gene sequencing and cytometric bead array (CBA) to evaluate proinflammatory cytokines. Findings on correlation were validated through in vitro co-culture experiments. HPV infection and CIN were associated with dysbiotic microbial profiles and elevated levels of IL-1α, IL-1β, IL-6, IL-8, MCP-1, and MIG. Stratification by microbial composition demonstrated that HPV/CIN patients with non-Lactobacillus-dominant microbiomes harbored the highest IL-1α and IL-1β concentrations. Validated through computational modeling and in vitro analyses, Lactobacillus crispatus and Lactobacillus iners were identified as being strongly inversely correlated with IL-1α and IL-1β expression. Conversely, non-Lactobacillus taxa, including Bifidobacterium breve, Prevotella bivia, Gardnerella vaginalis, Sneathia amnii, Sneathia sanguinegens, Prevotella amnii, Escherichia coli, and Chlamydia trachomatis, exhibited positive correlations with proinflammatory cytokines. These findings highlight a connection between Lactobacillus species and reduced inflammation, while non-Lactobacillus dominance is linked to increased cytokine-driven responses. This study provides valuable insights into microbiome-immune crosstalk in gynecological diseases.