The objective of our study was to report on the clinical outcome, fertility and uterine artery Doppler scans in patients with major postpartum haemorrhage, treated with bilateral internal iliac artery ligation or embolisation. We performed an observational analysis of successful bilateral internal iliac artery ligation or embolisation for postpartum haemorrhage in a tertiary hospital between 2001 and 2006. Clinical data and other medical/ surgical manoeuvres were recorded. Fertility data, menstrual cycle characteristics and uterine artery Doppler scans were assessed. Our success rate in bleeding control was 81%. Three patients got pregnant again 13, 16 and 23 months after the procedure. The one patient whose uterine artery was not identified in the Doppler scan was the only one who presented with secondary infertility. Three patients presented with secondary dysmenorrhoea. We concluded that internal iliac artery occlusion is an effective fertility-sparing procedure for postpartum haemorrhage. The absence of uterine revascularization could be a negative factor in future reproduction. Due to our limited sample size, larger studies are required to confirm these findings.

We have studied an automated in situ hybridization (ISH) method as a possible alternative approach for detecting high-risk human papillomavirus (HPV) in monolayer (ThinPrep) cervico-vaginal samples, comparing the results with those obtained by polymerase chain reaction (PCR) using consensus primers and studying the relationship between the ISH staining pattern and the viral integration in HPV 16-positive cases. Eighty atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) cases were used for our purposes. The patients were monitored through periodic cytologies. ISH with was performed with an automated Ventana System, analysis by PCR was performed with consensus primers and integration of HPV16 was performed by realtime PCR analyzing E2 and E6 genes. Additionally, 27 HSIL cases were also studied to observe the ISH staining patterns. HPV infection was detected by ISH in 21.7% of the ASCUS cases and 55.8% of the LSIL cases. Two distinct staining patterns were observed: multipunctated (MP) and diffuse (DI). In some cases, a mixed pattern (MP + DI) was observed and these cases were considered as MP. The MP pattern increased with the degree of lesion and seemed to have a prognostic value in ASCUS/LSIL cases. The lesion in MP pattern cases persisted throughout the entire study in 77% of cases, whereas in cases with a DI staining pattern, only 41% of them showed persistence of the lesion (p <0.001). No correlation was found between HPV integration and the ISH staining pattern. Given the lower sensitivity and negative predictive value of ISH and its incapacity to demonstrate the integration of high-risk HPV in ASCUS and LSIL cases using liquid-based cytology, we do not recommend this technique for the triage of ASCUS and LSIL cases.

Arthrogryposis multiplex congenital is a rare condition defined as contractures in multiple joints at birth due to disorders starting in fetal life. Its etiology is associated with many different conditions and in many instances remains unknown. The final common pathway to all of them is decreased fetal movement (fetal akinesia) due to an abnormal intrauterine environment. Causes of decreased fetal movements may be neuropathic abnormalities, abnormalities of connective tissue or muscle, intrauterine vascular compromise, maternal diseases, and space limitations within the uterus. When the cause of arthrogryposis is space limitations in uterus, the most common etiology is oligohydramnios. The same can result from intrauterine tumours as fibroids, although to our knowledge there are only two papers reporting cases of fetal deformities related to uterine leiomyomas. We describe a well-documented exceptional case of arthrogryposis associated with the presence of a large uterine fibroid. It could illustrate the importance of a careful and appropriate assessment of uterine fibroids before and in the course of a pregnancy considering that they can cause both serious maternal and fetal complications.

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Sir, Nowadays, the detection of high-risk human papilloma virus (HPV) is relevant to select those cases of cervical atypical squamous cells of undetermined significance (ASCUS) that probably will progress to cancer. In addition to morphology, we have several techniques, such as in situ hybridization (HIS) or polymerase chain reaction (PCR), to detect viral DNA in different samples. Liquid cytology is promoted in gynecological screening to have homogeneous material preserved for further study in suspicious cases, avoiding anxiety and the time spent taking a second sample. We decided to compare HPV detection in liquid cytology (ThinPrep Cytic) with HIS (Dako Genpoint) and PCR (HPVfast Pharma Gen S.A.), both wide-range HPV serotypes, using morphology as gold standard [1, 2, 3].We selected 18 women with previous diagnoses of ASCUS or low-grade squamous intraepithelial lesions (LSIL) using conventional pap-smear and took a sample from each for liquid cytology. From this suspension, we prepared two slides-one stained with Papanicolau for morphology and one for HIS-the rest was used for PCR. We assessed the different nuclear alterations (enlargement, hypercromacy, irregular contours, binucleation, and perinuclear halos). In the HIS slide, we separated nuclear and cytoplasmic positivity. We registered in both slides the volume of pathological cells. PCR was considered positive when it showed a 450-pb band, which corresponded to HPV genoma, in addition to the 1200-pb band of control. ResultsFrom 18 cases, 14 were LSIL with clear morphology of HPV infection, and 4 were ASCUS with few or no HPV nuclear changes. Results of HIS and PCR are in Table 1.From 13 HIS-positive cases, 11 were PCR-positive in the rest of the material. Of these, we found 4 cases with only cytoplasmic granular positivity-all 4 with very few affected cells. On a second screening of these 4 cases, we found one single nuclear-positive cell in 3 of these cases, and only 1 showed the positivity exclusively on the cytoplasm. This case was an LSIL. We performed PCR procedures using samples obtained from scraping the cytoplasmic positive of these 4 cases. The results were negative. We believe that in clinical practice, the cases with only cytoplasmic positivity should be confirmed with a PCR.From 5 HPV-negative cases, 2 were PCR positive. In this short series, the sensibility and specificity were similar for both techniques: 84.6% and 60%, respectively. Conclusions-Though our series is short, both techniques have shown similar sensibility (84.6%) and specificity (60%) to detect HPV in liquid cytology. Discordances and false negatives may be justified because of the paucity of affected cellularity in all samples.

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were initially recruited from April 2020 to April 2021. Patients were categorized as acute , confirmed by RT-PCR (COVID-19 group), and healthy individuals with normozoospermic semen samples (n¼22; Control group). Were evaluated seminal parameters, cryosurvival rates (%), mitochondrial activity (%; 3,3 0 -diaminobenzidine stain), reactive oxygen species levels (ROS; chemiluminescent technique) and DNA fragmentation (%; SCSA method) in precryopreservation and post-thaw samples. Samples were cryopreserved by the slow freezing technique. A complementary retrospective study was performed comparing post-thawed samples from COVID-19 group with data from patients with others male diseases: Male infertility (n¼35); Severe infertility (n¼62), caused severe oligozoospermia, grade 3 varicocele, gonadal dysgenesis, testicular nodule, testicular hypotrophy; testicular cancer (n¼55); and other malignant diseases (leukemia, lymphoma, sarcoma, multiple myeloma; n¼30). Was used T-test to statistical analysis (p<0.05). RESULTS: Macroscopy analysis of COVID-group revealed abnormal viscosity in 53.33%, semen volume ¼ 4.50 AE 1.72 ml and pH ¼ 8.13 AE 0.23. COVID-19 fresh samples demonstrated mean of progressive motility ¼ 29.07AE16.83%, sperm morphology ¼ 2.07AE1.58%, and DNA fragmentation index ¼ 42.91AE33.38%. Cryopreservation decreased progressive motility (to 5.39AE7.92%; p¼0.02), sperm vitality (70.46AE8.50 vs. 72.20AE23.27; p¼0.042) and ROS (0.516AE0.978 vs. 4.393AE9.956 x 10 4 cpm; p¼0.018). When we compared with cryopreserved normozoospermic samples, there was observed a significant difference in HDS (p¼0.002). Cryosurvival rate from COVID-19 samples was 19.93; 19.71%, and had significant difference when compared with severe infertility (40.16; 31.05%; p¼0.003), and other malignant diseases (53.14; 28.55%, <0.001).CONCLUSIONS: Seminal samples from patients with COVID-19 showed reduced fertile potential, especially when compared to the reference values. In the comparisons performed with samples from patients with different andrological diagnoses, common in the specialized andrology laboratory routine, we can suggest that samples from patients with the acute form of COVID-19 had the worst quality, with low cryosurvival rates. This information contribute to the conduct of these patients during assisted reproduction routines and preservation of male fertility.IMPACT STATEMENT: It will contribute to conducts in the cryopreservation of sperm in patients with acute COVID-19.