The Mullerian ducts are the anlagen of the female reproductive tract, which regress in the male fetus in response to MIS. This process is driven by subluminal mesenchymal cells expressing Misr2, which trigger the regression of the adjacent Mullerian ductal epithelium. In females, these Misr2+ cells are retained, yet their contribution to the development of the uterus remains unknown. Here, we report that subluminal Misr2+ cells persist postnatally in the uterus of rodents, but recede by week 37 of gestation in humans. Using single-cell RNA sequencing, we demonstrate that ectopic postnatal MIS administration inhibits these cells and prevents the formation of endometrial stroma in rodents, suggesting a progenitor function. Exposure to MIS during the first six days of life, by inhibiting specification of the stroma, dysregulates paracrine signals necessary for uterine development, eventually resulting in apoptosis of the Misr2+ cells, uterine hypoplasia, and complete infertility in the adult female.

Background Ectopic pregnancy is common among young women. Treatment can consist of either surgery with salpingectomy or salpingostomy or medical management with methotrexate. In addition to acute complications, treatment of ectopic pregnancy can result in long term sequelae including decreased fertility. Little is known about the patterns of care and predictors of treatment in women with ectopic pregnancy. Similarly, data on outcomes for various treatments are limited. Objective We examined the patterns of care and outcomes for women with ectopic pregnancy. Specifically, we examined predictors of medical (vs. surgical) management of ectopic pregnancy and tubal conservation (salpingostomy vs. salpingectomy) among women who underwent surgery. Study Design The Perspective database was used to identify women with a diagnosis of tubal ectopic pregnancy treated from 2006–2015. Perspective is an all-payer database that collects data on patients at hospitals from throughout the U.S. Women were classified as having undergone medical management if they received methotrexate and surgical management if treatment consisted of salpingostomy or salpingectomy. Multivariable models were developed to examine predictors of medical treatment and of tubal conserving salpingostomy among women treated surgically. Results Among the 62,588 women, 49,090 (78.4%) were treated surgically and 13,498 (21.6%) received methotrexate. Use of methotrexate increased from 14.5% in 2006 to 27.3% by 2015 (P<0.001). Among women who underwent surgery, salpingostomy decreased over time from 13.0% in 2006 to 6.0% in 2015 (P<0.001). Treatment in more recent years, at a teaching hospital, and at higher volume centers were associated with increased use of methotrexate (P<0.05 for all). In contrast, Medicaid recipients (aRR=0.92; 95% CI, 0.87–0.98) and uninsured women (aRR=0.87; 95% CI, 0.82–0.93) were less likely to receive methotrexate than commercially insured patients. Among those who underwent surgery, black (aRR=0.76; 95% CI, 0.69–0.85) and Hispanic (aRR=0.80; 95% CI, 0.66–0.96) patients were less likely to undergo tubal conserving surgery than white women and Medicaid recipients (aRR=0.69; 95% CI, 0.64–0.75) and uninsured women (aRR=0.60; 95% CI, 0.55–0.66) less frequently underwent salpingostomy than commercial insured patients. Conclusion There is substantial variation in the management of ectopic pregnancy. There are significant racial and insurance related disparities associated with treatment.

Drawing on interviews conducted among leading local and international NGOs operating in China, this article examines how NGOs understand and implement good governance and accountability principles and practices. It also examines how Chinese constituents and the general public perceive local and international NGOs. The discussion provides a basis on which to assess ways of improving governance and accountability practices for NGOs operating in China.

Background-Ectopic pregnancy is common among young women. Treatment can consist of either surgery with salpingectomy or salpingostomy or medical management with methotrexate. In addition to acute complications, treatment of ectopic pregnancy can result in long term sequelae including decreased fertility. Little is known about the patterns of care and predictors of treatment in women with ectopic pregnancy. Similarly, data on outcomes for various treatments are limited.Objective-We examined the patterns of care and outcomes for women with ectopic pregnancy. Specifically, we examined predictors of medical (vs. surgical) management of ectopic pregnancy and tubal conservation (salpingostomy vs. salpingectomy) among women who underwent surgery.Study Design-The Perspective database was used to identify women with a diagnosis of tubal ectopic pregnancy treated from 2006-2015. Perspective is an all-payer database that collects data on patients at hospitals from throughout the U.S. Women were classified as having undergone medical management if they received methotrexate and surgical management if treatment consisted of salpingostomy or salpingectomy. Multivariable models were developed to examine predictors of medical treatment and of tubal conserving salpingostomy among women treated surgically.Results-Among the 62,588 women, 49,090 (78.4%) were treated surgically and 13,498 (21.6%) received methotrexate. Use of methotrexate increased from 14.5% in 2006 to 27.3% by 2015 (P<0.001). Among women who underwent surgery, salpingostomy decreased over time from