Uterine rupture is a rare and life-threatening condition. It usually occurs in patients with uterine scars (most commonly for a previous myomectomy or caesarean section), but it can also affect an unharmed uterus. This complication is more frequent in the third trimester and during delivery. There is not yet a recognised method of prediction of uterine rupture and the ultrasound features still need a consensus. In this article, we have reported a case of uterine dehiscence diagnosed by a pelvic ultrasound and magnetic resonance (MRI) at 24 weeks of gestation. The finding was confirmed intraoperatively at the caesarean section at 29 weeks of gestation. The 40-year-old patient has had a previous pregnancy complicated by uterine rupture at 22 weeks of gestation, following six previous abdominal surgeries for stage IV endometriosis, diffuse and nodular adenomyosis, and pelvic adhesion syndrome. The early detection of uterine dehiscence allowed us to prolong the pregnancy and perform a subsequent fertility-sparing surgery, reducing maternal and neonatal morbidity and mortality. Our case report proves that women with severe endometriosis/adenomyosis are at a high risk of uterine rupture and scar dehiscence. The antenatal ultrasound can describe a uterine dehiscence (even in asymptomatic patients) and prevent complications.

Background: Endometriosis is a gynecological condition affecting up to 10% of women of reproductive age and characterized by chronic pain. Pain is the major cause of the impairment of quality of life in all aspects of these patients. Previous studies have shown that endometriosis treatment, hormonal or surgical, has proven effective not only in controlling the disease but also in improving symptoms, and we can assume also effective in improving quality of life. Methods: This study evaluates quality of life and sexual function in patients with endometriosis at the time of diagnosis and after 6 months of medical therapy, to assess the impact of treatment on these aspects. We evaluated retrospectively patients with a diagnosis of endometriosis between 2018 and 2020. All patients underwent gynecological examination and transvaginal ultrasound and filled in three questionnaires. The same evaluation was provided after taking medical hormonal therapy. Results: The improvement of dysmenorrhea, chronic pelvic pain, and dyspareunia after medical treatment were statistically significant. Instead, items concerning arousal, lubrication, and sexual satisfaction showed a statistically significant worsening after therapy. Conclusions: We can state that hormone therapy alone is not sufficient to achieve an improvement in the patient’s quality of life and sexual function. Emerging evidence suggests that most of these patients showed a central sensibilization phenomenon characterized by an amplification of the response to a peripheral and/or neuropathic nociceptive trigger, which is expressed by hyperalgesia and allodynia. For this reason, in these patients, it is better to adopt a multimodal and multidisciplinary approach, including other professional figures, that acts on pain and also intervenes in all those conditions that contribute to worsening quality of life.

Endometriosis is linked to an increased risk of epithelial ovarian cancer (EOC), especially clear cell and endometrioid subtypes. The extent and prognostic significance of this link are still not fully understood. This systematic review and meta-analysis compiles existing evidence on ovarian cancer risk, histotype distribution, and survival outcomes in women with endometriosis. Systematic search up to August 2025 METHODS OF STUDY SELECTION: A systematic search of PubMed and Google Scholar was performed up to August 2025. Studies reporting ovarian cancer risk estimates or survival outcomes in endometriosis-associated ovarian cancer (EAOC) were included. Random-effects models generated pooled odds ratios (OR), hazard ratios (HR), and standardized incidence ratios (SIR). Risk analyses included >500,000 women; survival analyses >10,000. Sixty-seven studies met inclusion criteria. Endometriosis increased ovarian cancer risk (OR 1.82, HR 3.03, SIR 1.62). EAOC patients were younger, more often premenopausal, and more frequently diagnosed with early-stage (OR 0.29) and low-grade tumors (OR 1.71). Clear cell and endometrioid histotypes predominated. Overall survival was significantly better in EAOC (HR 0.48); recurrence and mortality were lower, while platinum resistance was similar. Endometriosis confers an increased relative but still low absolute risk of ovarian cancer. EAOC exhibits distinct clinicopathologic features and improved survival compared with non-EAOC. These findings support personalized counseling and emphasize the need for phenotype-based risk stratification and molecular markers of malignancy transformation.

Background/Objectives: Vascular complications during ovarian cancer surgery are rare but potentially severe. The objective of this review was to underline the need to standardize and optimize the management of these rare complications within an evidence-based framework. Methods: This review included the literature until 29 December 2024 and finally analyzed 17 studies, with 40 vascular complications reported. Results: Complications primarily occurred intraoperatively and involved both arterial and venous systems. Management approaches involved interdisciplinary collaboration, including vascular surgeons and interventional radiologists. Nevertheless, the collected data do not accurately reflect the reality of vascular complications in ovarian cancer surgery, as more than half of the included studies were case reports or research letters. This highlights the lack of standardized guidelines and limited training in vascular surgery for gynecologic oncologists, the importance of preoperative planning, including detailed imaging, risk stratification, and a multidisciplinary approach to mitigate complications. The authors propose an algorithm emphasizing prevention, timely identification, and effective management of vascular injuries alongside postoperative monitoring. Conclusions: The findings stress the need for treatment in high-volume tertiary centers and advocate advanced surgical training, incorporating virtual reality simulations to address vascular complications. Future research should focus on large multicenter studies to establish evidence-based guidelines for managing vascular complications in ovarian cancer surgery. Innovations in technology and education may further improve outcomes, ensuring optimal care for patients undergoing these complex procedures.

This feasibility study explores the potential of salivary microRNAs (miRNAs) as non-invasive biomarkers for diagnosing endometriosis and assessing treatment response. Almost one-third of patients with endometriosis do not respond to the standard progestin treatment due to various mechanisms of progesterone resistance. MiRNAs, recognized for their stability in body fluids and role in gene regulation, may offer new diagnostic and prognostic opportunities as they are involved in the pathogenic pathways of endometriosis and progesterone resistance. We sequenced salivary miRNAs in three cohorts of patients: control women without endometriosis and patients with endometriosis who responded and did not respond to standard progestin treatment. This aims to identify the differential miRNA expression profiles associated with therapeutic response to dienogest. The preliminary results demonstrate the feasibility of miRNA sequencing from saliva and reveal distinct miRNA profiles between responders, non-responders, and controls. Key miRNAs, including mir-3168, the mir-200a family, and mir-93-5p, emerged as potential biomarkers, showing significant differential expression linked to both endometriosis presence and treatment response. Further validation of these findings in larger cohorts could pave the way for miRNA-based diagnostic and prognostic tools, potentially reducing diagnostic delays and personalizing treatment approaches for endometriosis patients, also with new target therapies.

Background: Hormonal intrauterine systems are widely used for long‐acting reversible contraception and for managing gynecological conditions such as heavy menstrual bleeding and endometrial hyperplasia. Although rare, complications such as uterine embedment and perforation can occur, potentially leading to device malfunction or injury displacement. This is the first reported case describing the removal of a fully incarcerated hormonal intrauterine system using a combined hysteroscopic and laparoscopic approach. Our findings suggest that this technique may offer a safe and effective alternative for managing cases of embedded intrauterine devices where conventional hysteroscopic removal is unsuccessful. Case Presentation: We report the case of a 35‐year‐old asymptomatic woman with a hormonal intrauterine system fully embedded in the posterior myometrial wall, positioned 4.3 mm from the uterine serosa. The device was initially confirmed to be intracavitary upon insertion but was later found to have migrated into the myometrium during a routine 30‐day follow‐up ultrasound. Initial attempts at hysteroscopic removal failed due to poor visualization and a broken retrieval string. Given the high risk of iatrogenic injury, a combined laparoscopic–hysteroscopic approach was planned. Under laparoscopic visualization and transrectal ultrasound guidance, a careful myometrial excision using a hysteroscopic‐angled loop was performed, successfully freeing and removing the intrauterine device. A bilateral salpingectomy was also conducted at the patient′s request. Conclusion: A combined laparoscopic–hysteroscopic approach under ultrasound guidance may be regarded as a viable technique for complex cases of intrauterine device incarceration within the myometrium, minimizing the risk of uterine perforation and adjacent organ injury.