Objective
This study systematically analyzed coronavirus disease 2019 (COVID-19) and vaccination details during pregnancy by using the national health insurance claims data.
Methods
Population-based retrospective cohort data of 12,399,065 women aged 15-49 years were obtained from the Korea National Health Insurance Service claims database between 2019 and 2021. Univariate analysis was performed to compare the obstetric outcomes of pregnant women (ICD-10 O00-O94) and their newborns (ICD-10 P00-P96) with and without COVID-19. Univariate analysis was also performed to compare the age and obstetric outcomes of pregnant women receiving different types of vaccines.
Results
The percentage of pregnant women with COVID-19 during pregnancy was 0.11%. Some obstetric outcomes of pregnant women with COVID-19, including the rates of preterm birth or cesarean delivery, were significantly better than those of pregnant women without COVID-19. The rate of miscarriage was higher in pregnant women with COVID-19 than without COVID-19. However, the outcomes of newborns of women with and without COVID-19 were not significantly different. Regarding vaccination type, obstetric outcomes of pregnant women appeared to be worse with the viral vector vaccine than with the mRNA vaccine.
Conclusion
To the best of our knowledge, this is the first study to systematically analyze COVID-19 and vaccination details during pregnancy using the national health insurance claims data in Korea. The obstetric outcomes in pregnant women with and without COVID-19 and their newborns were similar.

Objective
To determine the effect of a social network-based cognitive-behavioral intervention on postpartum body image and sexual life of primiparous women.
Methods
In this single-blind randomized controlled trial, 82 postpartum women were allocated into two intervention and control groups (allocation ratio, 1:1) using permuted block randomization. Primary outcome was change in body image scores between the groups over time. Secondary outcomes were genital self-image, sexual quality of life, and sexual satisfaction. The intervention group participated in eight (2 weeks) 60-minute sessions through WhatsApp (WhatsApp Inc., Mountain View, CA, USA). Data were collected at recruitment, post-intervention, and 1-month of follow-up.
Results
Cognitive-behavioral intervention had a medium effect on improving body image in postpartum women (partial eta squared, 0.33; P<0.001). The results showed significant differences between the two groups regarding sexual quality of life and sexual satisfaction at 1-month follow-up.
Conclusion
The results of this study can be used to develop psychological interventions targeting body image in postpartum women.

Objective
To assess the predictive value of the preoperative modified frailty index (mFI) for postoperative complications in endometrial carcinoma, evaluate risk factors associated with complications, and compare the predictive properties of the mFI with the American Society of Anesthesiologists (ASA) physical status classification.
Methods
A total of 364 patients with endometrial cancer who underwent primary surgery between January 2009 and December 2016 were examined. The prognostic value of mFI in predicting severe postoperative complications, assessed according to the Clavien-Dindo classification, was analyzed and compared with ASA status. The risk factors for adverse outcomes were determined using multivariate analysis.
Results
The 30-day postoperative surgical- or medical-related complication rate was 26.6%. The rates of postoperative complications were 1.3%, 8.8%, 12.2%, and 60.0% for mFI scores of 0, 1, 2, and ≥3, respectively (P<0.001). The odds ratios for predicting postoperative complications in patients with mFI scores of 1, 2, and ≥3 were 7.38, 10.59, and 114.75, respectively. In the multivariate analysis, the significant predictive factors for postoperative complications were mFI ≥1, body mass index (BMI) ≥30 kg/㎡, and non-endometrioid cell type. At cut-off points of mFI ≥1 and ASA ≥2, both tools had similar sensitivities but mFI was more specific (sensitivities 92.9% vs. 100%; specificity 45.5% vs. 19.4%).
Conclusion
mFI provides a satisfactory predictive value for postoperative complications. Patients with an mFI score ≥1, a BMI ≥30 kg/㎡, and a non-endometrioid subtype, are at risk of postoperative complications and should receive comprehensive preoperative and postoperative management.

Objective
We investigated the feasibility of laparoscopic restaging surgery in patients with unexpected uterine cancer.
Methods
This retrospective study included eight patients who underwent laparoscopic restaging surgery for Iran University uterine cancer after a prior hysterectomy or myomectomy.
Results
The median age of the patients and their body mass index were 55 years (range, 44-78) and 23.8 kg/㎡ (range, 20.75-31.89), respectively. The median interval between the prior hysterectomy and the restaging surgery was 21 days (range, 10-35). The median operating time and time for the return of bowel activity were 325 minutes (range, 200-475) and 35 hours (range, 18-50), respectively. The median numbers of harvested pelvic and para-aortic lymph nodes were 17.5 (range, 14-29) and 20.5 (range, 7-36), respectively. In seven of the eight patients, uterine extraction was performed with vaginal or electronic morcellation. The final International Federation of Gynecology and Obstetrics stage was IA in all patients. Intraoperative and postoperative complications did not occur in any of the patients, except for the need for transfusion. Patient 4 had synchronous primary cancer (stage IA) of the endometrium and left ovary. Two of the eight patients with clear cell carcinoma received chemotherapy, and none received radiotherapy. All patients survived without disease recurrence.
Conclusion
Restaging surgery might be necessary for highly selective patients with unexpected uterine malignancies. This would be an alternative surgical modality for complete staging and planning tailored adjuvant treatments. However, lymphadenectomy might not be performed in patients with early uterine cancer.

Objective
Triphenyl phosphate (TPHP) is one of the most commonly used organophosphorus flame retardants that may accumulate in the environment. However, its effects on human reproductive organs have not been well studied. We aimed to investigate the in vitro effects of TPHP in human Ishikawa endometrial cancer cells to elucidate how TPHP exposure disrupts intracellular signaling and cell proliferation in reproductive tissues.
Methods
Human Ishikawa endometrial cancer cells were exposed to TPHP.
Results
Exposure to TPHP elevated the levels of estrogen receptor (ER) α and progesterone receptor-B and reduced ER β in human Ishikawa endometrial cancer cells. TPHP stimulated phosphoinositide 3-kinase/protein kinase B and mitogen-activated protein kinase/ extracellular signal-regulated kinases 1/2 kinase signaling, which may contribute to the activation of ER function and induce nuclear translocation of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) in human Ishikawa endometrial cancer cells. Activated ER and NF-κB stimulate the expression of cyclin D1/cyclin-dependent kinase (CDK) 4/CDK6, indicating cell cycle progression and proliferation.
Conclusion
This report may provide new information on the molecular mechanisms underlying how TPHP exposure dysregulates the cellular physiology of the human endometrium.

Objective
To evaluate the feasibility, safety, and surgical outcomes of laparoscopic trachelectomy after supracervical hysterectomy.
Methods
This multicenter study was conducted at Tanta University, Benha University, and Aminah Laparoscopy Center (Benha, Egypt) from June 1, 2018 to October 31, 2021. Forty patients were recruited for this study and counseled on laparoscopic trachelectomy to treat their symptoms after supracervical hysterectomy. Furthermore, cervical biopsy was performed to detect and exclude any malignancy. Histopathological examination of cervical specimens was performed after surgery. Operative details and outcomes were recorded.
Results
The median age of the patients was 42 years (range, 38-47). The median body mass index was 25 years (range, 22-28). The median interval between hysterectomy and the clinical presentation was 4.40 years (range, 3.58-5.25). Most patients presented with abnormal vaginal discharge (40%) and bleeding (25%). Moreover, a cervical biopsy result revealed stump carcinoma in three cases (7.5%) that were excluded. The median operative time was 210 minutes (range, 170-220). The median blood loss was 270 mL (range, 220-320). Additionally, histopathological examinations revealed that chronic non-specific cervicitis was present in 54.05% of trachelectomy specimens. There were no significant differences between symptomatic and asymptomatic patients regarding operative outcomes, except adhesions, which were more significantly increased in symptomatic patients (P=0.015). Minimal complications, both operative and postoperative, were related to the procedure.
Conclusion
Although the operative time was long and adhesions were common during laparoscopic trachelectomy, the procedure was feasible and safe, with minimal complications.

Objective
The effect of ropivacaine on postoperative hysteroscopy has not yet been evaluated; this study investigated the effect of diluted ropivacaine in distending media during hysteroscopy on postoperative cramping pain.
Methods
This double-blind randomized clinical trial was conducted on 60 women who underwent hysteroscopy at a tertiary hospital. Normal saline was used as the distending fluid in both groups. The intervention group received 10 mL of 2% ropivacaine in only one bottle of 1,000 mL normal saline as a distending fluid, while the control group received 10 mL of normal saline in 1,000 mL normal saline during hysteroscopy. Patients' pain scores were evaluated before hysteroscopy and at 2, 6, 12, 24, and 48 hours after hysteroscopy.
Results
Based on the results, the pain measured by visual analog scale (VAS) score was significant at 6 and 12 hours after the intervention was significantly lower than that in the ropivacaine group (3.03±1.57 vs. 4±1.49, P=0.02 at 6 hours and 1.28±1.36 vs. 2.4±1.43, P=0.003 at 12 hours). There were no significant differences in the VAS scores at 2, 24, and 48 hours after the intervention between the two groups.
Conclusion
Ropivacaine in the distending fluid during hysteroscopy is associated with a significant reduction in pain within a few hours after hysteroscopy with no remarkable adverse effects.