T. Van den Bosch

The MUSA (Morphological Uterus Sonographic Assessment) statement is a consensus statement on terms, definitions and measurements that may be used to describe and report the sonographic features of the myometrium using gray-scale sonography, color/power Doppler and three-dimensional ultrasound imaging. The terms and definitions described may form the basis for prospective studies to predict the risk of different myometrial pathologies, based on their ultrasound appearance, and thus should be relevant for the clinician in daily practice and for clinical research. The sonographic features and use of terminology for describing the two most common myometrial lesions (fibroids and adenomyosis) and uterine smooth muscle tumors are presented.

Incomplete miscarriage is defined as residual pregnancy tissue after spontaneous or induced expulsion of the gestational sac. Typically, management options include surgical intervention, medical treatment or expectant management. However, the efficacy of this medical treatment administration remains unclear. To compare the efficacy (complete expulsion of retained product of conception (RPOC)) of medical treatment with misoprostol versus expectant management in women with retained product of conception after spontaneous early pregnancy loss or induced abortion. Surgical treatment was outside the scope of this manuscript. We conducted a systematic review according to the PRISMA guidelines. The search included PubMed/MEDLINE, SCOPUS, EMBASE, Web of Science and Cochrane Library electronic databases from inception to 02-05-2024. Our systematic review included studies concerning retained product of conception after incomplete early pregnancy loss or abortion that were managed expectantly of medically (with misoprostol). Complete early pregnancy loss or surgical treatment studies were excluded. A total of 1831 records were screened, and 2 studies were included. One randomized controlled trial (RCT) and 1 retrospective cohort study. The RCT did not demonstrate any significant difference between expectant management (N = 36/63 (57.1%), RR: 1.12, 95% CI (0.74-1.70), P = 0.590 ) or secondary medical treatment (N = 42/68 (61.8%), RR: 1.12, 95% CI (0.74-1.70), P = 0.590). Surgical intervention was avoided in 60% of the cases. The results of the retrospective case series showed a 64.4% efficacy for misoprostol versus 91.8% efficacy 3 weeks after expectant treatment. Despite the high incidence of early pregnancy loss, the lack of data is compelling. The limited data in this systematic review do not show any significant differences between expectant management or medical treatment at 3 to 4 weeks for RPOC in case of incomplete early pregnancy loss or abortion.

To review the currently available literature regarding the role of ultrasonography in the management of uterine fibroids. Literature review of articles concerning the conservative treatment of uterine fibroids. Ultrasound examination allows for a better preoperative evaluation of fibroids. Table 1 gives an overview of the features suggested to be important for different therapeutical options. Sonographic follow-up after UAE, ultrasound guided HIFU and/or magnetic resonance guided HIFU is used to assess the decrease in size/volume of the treated fibroids, and to document the absence or reduction of blood supply in fibroids. P30.06: Table 1. Management of uterine fibroids, criteria from the literature subserosal, intramural, intraligamentary - anterior wall of the uterus - close to the fundus Lp-scopic myomectomy intramural subserosal Lp-tomic myomectomy intramural subserosal Hscopic myomectomy type G1 type G2 ≤5-6 (G1) ≤4-5 (G2) type G0 type G1 intramural subserosal Contraindications: - submucosal and/or pedunculated - >10-12 cm - coexistent adenomyosis ? intramural subserosal - anterior - Contraindications: bowel interposition, abdominal scars, excessive thickness abdominal wall Ultrasound plays an important role in the management of uterine fibroids both before and during treatment and in post-treatment follow-up.