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Objectives

Endometriosis is a chronic condition primarily affecting young women of reproductive age. Although some women with bowel endometriosis may be asymptomatic patients typically report a myriad of symptoms such as alteration in bowel habits (constipation/diarrhoea) dyschezia, dysmenorrhoea and dyspareunia in addition to infertility. To date, there are no clear guidelines on the evaluation of patients with suspected bowel endometriosis. Several techniques have been proposed including transvaginal and/or transrectal ultrasonography, magnetic resonance imaging, and double-contrast barium enema. These different imaging modalities provide greater information regarding presence, location and extent of endometriosis ensuring patients are adequately informed whilst also optimizing preoperative planning. In cases where surgical management is indicated, surgery should be performed by experienced surgeons, in centres with access to multidisciplinary care. Treatment should be tailored according to patient symptoms and wishes with a view to excising as much disease as possible, whilst at the same time preserving organ function. In this review article current perspectives on diagnosis and management of bowel endometriosis are discussed.

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1Cervical ripening is necessary for successful delivery. As cytokines are believed to be 2 involved in this process, the aim of this study was to investigate possible changes in the 3 mRNA and protein expression of pro-inflammatory (interleukin (IL)-1α, IL-1β, IL-12, IL-18) 4 and anti-inflammatory (IL-4, IL-10, IL-13) cytokines in the human cervix during pregnancy, 5 term and preterm labor. Cervical biopsies were taken from 59 women: 21 at preterm labor, 24 6 at term labor, 10 at term not in labor and 4 from non-pregnant women. mRNA was analyzed 7 with real-time RT-PCR and protein expression and/or secretion with immunohistochemistry 8 and ELISA. There was an upregulation of mRNA for IL-10, IL-13, IL-1α and IL-1β in the 9 laboring groups, while mRNA for IL-12 and IL-18 was downregulated (p<0.05). IL-4 mRNA 10 was detected more frequently, while IL-12 mRNA expression was lower, in the preterm labor 11 group than in the term labor group (p<0.05). The protein levels of IL-4 and IL-12 were lower 12 and IL-18 tended to be higher in the labor groups, while IL-10 protein levels were unaffected 13 by labor. IL-4 protein levels were significantly higher in the preterm subgroup with bacterial 14 infection than in the non-infected group (p<0.05). IL-10 had higher expression in squamous 15 epithelium at preterm labor than at term (p<0.05). In conclusion, the major changes in pro-16 inflammatory and anti-inflammatory cytokine mRNA and protein expression in cervix occur 17 during the labor process irrespective of the length of gestation. However, our results indicate 18 that dysregulation of anti-inflammatory cytokines in the human cervix could be involved in 19 the pathogenesis of preterm labor. 20 21

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Polycystic ovary syndrome (PCOS) affects 5-10% of the population of women. The exact etiology of PCOS remains unclear, but it is believed to result from complex interactions between genetic, behavioral and environmental factors. The spectrum of its symptoms such as hirsutism, skin problems, obesity and finally infertility has a huge negative impact on the individuals' psychological and interpersonal functioning. PCOS symptoms can lead to significant deterioration in quality of life and be highly stressful negatively affecting psychological well-being and sexuality. Fear symptoms like palpitation, being out of breath and tension might be caused by many somatic diseases. Moreover, detection and continuous thinking about illness can lead to significant negative impact on individual functioning in society. PCOS may be a factor potentially favoring the occurrence of mood disorders and depression. Biological, social and psychological consequences of PCOS among women of reproductive age are opening a new perspective on management of women's health in these patients.

To study the interobserver reproducibility of our new ultrasonographic mapping system to define the type and extension of uterine adenomyosis. Design: Interobserver study involving two observers with different medical backgrounds and gynecological ultrasound experience. Setting: University hospital. Patients: Seventy consecutive women who underwent transvaginal ultrasound for suspected endometriosis, pelvic pain, heavy menstrual bleeding, and infertility. Intervention: Two operators (observers A and B), who were blinded, independently reviewed the ultrasound videos offline, assessing the type of adenomyosis and the severity of the disease. Diagnosis of adenomyosis was made when typical ultrasonographic features of the disease were observed at the examination. Adenomyosis was defined as diffuse, focal, and adenomyoma according to the ultrasonographic characteristics. The severity of adenomyosis was described using a new schematic scoring system that describes the extension of the disease considering all possible ultrasound adenomyosis features. Main Outcome Measures: Reproducibility of the new mapping system for adenomyosis and rate agreement between two operators. Results: Multiple rate agreements to classify the different features and the score of adenomyosis (diffuse, focal adenomyoma, and focal or diffuse alteration of junctional zone) ranged from substantial to almost perfect (Cohen k ¼ 0.658-1) except for adenomyoma score 4 (one or more adenomyomas with the largest diameter >40 mm) in which interobserver agreement was moderate (k ¼ 0.479). Conclusion: Our new scoring system for uterine adenomyosis is reproducible and could be useful in clinical practice. The standardization of the transvaginal approach and of the sonographer training represent a crucial point for a correct diagnosis of myometrial disease. (Fertil Steril Ò 2018;110:1154-61. Ó2018 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.