YTP Digital Dec' 2025 issue

YTP

FUTURE CHRONICLES

Editor in Chief: Dr. Sunita Tandulwadkar, Dr. Rohan Palshetkar Editorial Coordinators: Dr. Annith Kumar VM, Dr. Priyanka Sureddi

Total Pages : 30 December 2025 Vol 1* Issue - 3

Gynaecology Worldwide Contemporary Gynaecology is marked by rapid evolution as scientific discovery and clinical innovation reshape how women’s health is approached worldwide. Across diverse healthcare settings, evidence-based practice, minimally invasive techniques, and emerging regenerative therapies are redefining standards of care, while advances in diagnostic modalities and strengthened multidisciplinary collaboration continue to improve outcomes for women. At the same time, increased recognition of conditions such as endometriosis, abnormal uterine bleeding, and placental disorders has reinforced the importance of early diagnosis, comprehensive management and sustained long-term follow-up, reflecting the expanding scope and clinical impact of the speciality.

Dr. Sunita Tandulwadkar President, FOGSI (2025)

Collectively, these developments highlight the dynamic nature of modern Gynaecology and its commitment to integrating the best available evidence into clinical practice. As the field evolves, the challenge remains to translate emerging knowledge into equitable, accessible care—ensuring that every woman, regardless of geography or circumstance, benefits from the progress of contemporary reproductive medicine.

We hope this editorial perspective encourages reflection and a continued commitment to advancing Gynaecological care on a global scale.

Contents 08

NEWER TREATMENT MODALITIES AND REGENERATIVE MEDICINE FOR THIN ENDOMETRIUM - Dr. Rohan Palshetkar, Dr. Nandita Palshetkar, Dr. Mayuri More, Dr. Chiranjeev Shetty

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PLACENTA ACCRETA SPECTRUM (PAS): INSIGHTS FROM MODERN PRACTICE - Dr. Sunil Tambvekar

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ENDOMETRIOSIS: THE BENIGN MALIGNANCY - Dr. Priyanka Sureddi

YTP FUTURE CHRONICLES VOLUME 1, ISSUE 3, DECEMBER 2025

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YTP

FUTURE CHRONICLES

EXECUTIVE EDITOR & PUBLISHER Dom Daniel

CORPORATE OFFICE 22, Shreeji Bhavan, 275-279, Samuel Street, Masjid Bunder (W), Mumbai-4000 03, INDIA. EMAIL: paradigminfocomobgyn@gmail.com Website: ytpfuturechronicles.com Published at 22 Shreeji Bhavan, 275/279, Samuel Street, Masjid Bunder (West), Mumbai - 400003.

India.

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Published for the period of December -2025

Editorial Contributors Dr. Rohan Palshetkar

MBBS, MS (Obstetrics and Gynaecology), FRM, BDRME, ADRME Professor, Pad. Dr. D.Y. Patil Hospital & Research Centre, Navi Mumbai Unit Head & Consultant, Bloom IVF, Pad. Dr. D.Y. Patil Hospital & Research Centre, Navi Mumbai Chairperson of Young Talent Promotion Committee, FOGSI

Dr. Nandita Palshetkar

MD, FRCOG (HON), FCPS, FICOGObstetrics & Gynaecologist Head Consultant of IVF and Infertility at Lilavati Hospital and Research Centre, Mumbai Founder and Medical Director – Bloom IVF Group FOGSI Representative to FIGO FIGO Committee on Women’s Health & Technology Past President, FOGSI- 2019

Dr. Mayuri More

MBBS, MS - Obstetrics & Gynaecology, FRM (ICOG), DRM (Germany) Founder of Vardaan Speciality Hospital, Mumbai Assistant Professor, Department of Obstetrics and Gynecology Dr. D. Y. Patil Hospital, Navi Mumbai

Dr. Chiranjeev Shetty

Junior Resident Department of Obstetrics and Gynecology Dr. D. Y. Patil Hospital, Navi Mumbai

Dr. Sunil Tambvekar

MBBS, DNB (Obstetrics & Gynaecology), MNAMS, DFP, FMAS, PGDMLS, CCBIMIE (MUHS) Jt. Assistant Secretary, JOGI Consultant obstetrician, Gynecologist & Endoscopic Surgeon Wadia Maternity Hospital, Mumbai Well Woman Clinic and Surgical Centre, Mumbai

Dr. Priyanka Sureddi

MBBS, MS OBGY (KEM), DNB, MNAMS, FMAS-ICOG, FCG Consultant Obstetrics & Gynaecology Specialist in Minimal access surgery (Laparoscopy & Robotic)

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Dear Readers, This issue of YTP Future Chronicles brings into focus three important topics that underscore the advancing horizons of modern Obstetrics and Gynaecology. Each article addresses critical clinical challenges and presents evidence-based insights relevant to contemporary practice.

The review on Newer Treatment Modalities and Regenerative Medicine for Thin Endometrium discusses innovative therapeutic approaches aimed at enhancing endometrial receptivity and improving reproductive outcomes. Placenta Accreta Spectrum (PAS): Insights from Modern Practice offers an updated perspective on early diagnosis, risk stratification, and the importance of multidisciplinary management in optimizing maternal outcomes. Rounding out this issue, “Endometriosis: The Benign Malignancy” explores the complex biological behaviour and long-term impact of endometriosis, highlighting the importance of early diagnosis and comprehensive care.

Dr. Rohan Palshetkar YTP Committee Chairperson

Through these focused scholarly contributions, our aim is to assist clinicians in informed decision-making and to ultimately improve patient care. We extend our sincere gratitude to our authors and readers for their continued support and commitment to academic excellence.

We wish you a rewarding and insightful reading experience.

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Editorial Coordinators Dear Readers, As we arrive at the close of the year, it is a privilege to present the December edition of YTP Future Chronicles—an edition that invites reflection, renewal, and a forward-looking vision for the future of Obstetrics and Gynaecology in India.

The past year has reminded us that our specialty is not defined solely by clinical milestones, but by our ability to respond thoughtfully to change. As members of FOGSI, we stand at the intersection of science, empathy, and social responsibility. Through YTP Future Chronicles, we continue our commitment to nurturing curiosity, encouraging innovation, and empowering the next generation of clinicians to lead with both skill and sensitivity.

Dr. Annith Kumar VM

MS OG (Obstetrics & Gynaecology), MRCOG (UK) Fellowship Reproductive Medicine Director – Promise Fertility Center, Chennai Consultant – Sri Kumaran Hospital, West Tambaram, Chennai

December is a time to pause and reflect—not just on where we have been, but on where we are headed. Women’s health today extends far beyond disease management; it encompasses wellbeing across life stages, informed choice, dignity, and resilience. From adolescents navigating identity and reproductive awareness to women seeking balance during midlife transitions, our role as Gynaecologists continues to expand in scope and significance.

This edition focuses on themes that encourage deeper introspection—clinical advances alongside ethical practice, evolving patient expectations, and the importance of mental and emotional health in comprehensive care. It urges us to ask important questions: Are we listening closely enough to our patients? Are we adapting our practices to meet the needs of a changing society? And how do we ensure that progress remains inclusive and patient-centred?

I extend my sincere gratitude to Dr. Rohan Palshetkar for his unwavering mentorship and vision. His guidance continues to shape the ethos of the Young Talent Promotion Committee, inspiring young clinicians to think boldly, act responsibly, and contribute meaningfully to our fraternity.

Dr. Priyanka Sureddi

MBBS, MS OBGY (KEM), DNB, MNAMS, FMAS-ICOG, FCG Consultant Obstetrics & Gynaecology Specialist in Minimal access surgery (Laparoscopy & Robotic)

YTP FUTURE CHRONICLES VOLUME 1, ISSUE 3, DECEMBER 2025

As the year draws to a close, I hope this December edition serves not only as a source of knowledge, but as a moment of connection—between colleagues, ideas, and shared purpose.

May YTP Future Chronicles continue to evolve as a vibrant forum for dialogue, learning, and collective growth.

Here’s to ending the year with reflection, and stepping into the future of women’s health with clarity, compassion, and confidence.

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NEWER TREATMENT MODALITIES AND

REGENERATIVE MEDICINE FOR THIN ENDOMETRIUM

T

INTRODUCTION

Dr. Nandita Palshetkar

Dr. Rohan Palshetkar

MD, FRCOG (HON), FCPS, FICOGObstetrics & Gynaecologist Head Consultant of IVF and Infertility at Lilavati Hospital and Research Centre, Mumbai Founder and Medical Director – Bloom IVF Group FOGSI Representative to FIGO FIGO Committee on Women’s Health & Technology Past President, FOGSI- 2019

MBBS, M.S. (Obstetrics and Gynaecology), FRM, BDRME, ADRME Professor, Pad. Dr. D.Y. Patil Hospital & Research Centre, Navi Mumbai Unit Head & Consultant, Bloom IVF, Pad. Dr. D.Y. Patil Hospital & Research Centre, Navi Mumbai Chairperson of Young Talent Promotion Committee, FOGSI

Dr. Mayuri More

MBBS, MS - Obstetrics & Gynaecology, FRM (ICOG), DRM (Germany) Founder of Vardaan Speciality Hospital, Mumbai Assistant Professor, Department of Obstetrics and Gynecology Dr. D. Y. Patil Hospital, Navi Mumbai

Dr. Chiranjeev Shetty

Junior Resident Department of Obstetrics and Gynecology Dr. D. Y. Patil Hospital, Navi Mumbai

YTP FUTURE CHRONICLES VOLUME 1, ISSUE 3, DECEMBER 2025

hin endometrium, defined as an endometrial thickness of less than 7 mm during the implantation window, presents a significant challenge in reproductive medicine and is strongly associated with reduced endometrial receptivity, recurrent implantation failure (RIF), infertility and adverse pregnancy outcomes.

A functional endometrium is essential for embryo implantation, and thinning of the endometrial lining may arise from hormonal disturbances, prior uterine procedures, infections, or prolonged use of agents such as clomiphene citrate, which exert anti-oestrogenic effects on the endometrium.1, 2, 3 The pathophysiology of this condition involves a multifactorial interplay of hormonal, vascular, cellular, molecular, structural, and inflammatory mechanisms that collectively impair endometrial 8

Newer Treatment Modalities and Regenerative Medicine for Thin Endometrium

development and receptivity.4

vascular endothelial growth factor (VGEF) and insulinHormonal dysregulation, like growth factor-1 (IGF-1) particularly involving disrupts angiogenesis and oestrogen, and plays a central cellular turnover.4 role, as oestrogen is critical Structural abnormalities, for endometrial proliferation during the follicular phase of including congenital uterine the menstrual cycle. Deficiency anomalies, fibroids or scarring of oestrogen, encountered from procedures such as in hypogonadotrophic dilation and curettage, may hypogonadism or poor ovarian also alter normal endometrial reserve, limits endometrial architecture and limit the growth, while excessive use surface area available for cyclical of ovulation-inducing agents regeneration.7 such as clomiphene citrate may Additionally, chronic produce anti-oestrogenic effects inflammatory states, such as at the endometrial level, further chronic endometritis, impair contributing to thinning.5 endometrial receptivity by Adequate endometrial altering cytokine expression, development also requires inhibiting angiogenesis and optimal uterine blood flow to interfering with stromal supply oxygen and nutrients proliferation; elevated profor its growth. Vascular inflammatory cytokines such impairment, including reduced as tumour necrosis factor-alpha uterine artery perfusion or further disrupt normal repair vascular disruption from and regeneration, contributing intrauterine scarring as seen to persistent endometrial in Asherman’s syndrome, can thinning.8 compromise angiogenesis and This review article therefore hinder proper endometrial outlines contemporary growth.6 evidence-based therapeutic Endometrial responsiveness strategies and emerging depends on the appropriate regenerative approaches aimed expression of oestrogen at restoring endometrial and progesterone receptors, thickness and improving and dysregulation or down- reproductive outcomes, regulation of these receptors with emphasis on their diminishes the tissue’s ability practical relevance in modern to respond to hormonal signals reproductive medicine. necessary for proliferation and NEWER TREATMENT differentiation.4 Cellular and molecular factors further contribute to poor endometrial regeneration, as chronic infections, pelvic inflammatory disease (PID), and oxidative stress may damage stromal and epithelial cells, while reduced expression of key growth factors such as

MODALITIES AND REGENERATIVE.........

MEDICINE 1. Growth Factors and Platelet-Rich Plasma (PRP) Platelet-rich plasma (PRP) has gained increasing attention as a therapeutic modality for the management of thin

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endometrium.

Platelet-rich plasma (PRP) is an autologous product derived from the patient’s blood, containing a high concentration of platelets and key growth factors such as vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β).9, 10 Mechanism of Action: These bioactive molecules promote angiogenesis, enhance tissue regeneration and stimulate endometrial cellular proliferation. VEGF contributes significantly to improved vascularisation, while PDGF supports fibroblast and epithelial proliferation— processes essential for repairing and restoring endometrial receptivity.9, 10 Clinical Application: PRP is instilled directly into the uterine cavity under ultrasound guidance, most commonly during the proliferative phase of the menstrual cycle to optimise endometrial responsiveness.9, 10 Evidence: • A meta-analysis demonstrated significant improvement in endometrial thickness and Pregnancy rates following PRP therapy, with the majority of participants achieving an endometrial thickness greater than 7 mm.9,10 • In an Indian study involving women with recurrent implantation failure (RIF), PRP therapy resulted in notable improvement in endometrial thickness, with successful implantation achieved in a considerable proportion of patients.9,10 9

Newer Treatment Modalities and Regenerative Medicine for Thin Endometrium

• Advantages: PRP is minimally invasive, utilizes autologous material (reducing immunologic risk), and has shown encouraging outcomes in multiple clinical studies.9,10 • Limitations: Treatment response may vary among patients, and the lack of largescale randomized controlled trials continues to limit the development of standardized treatment protocols.9,10 2. Stem Cell Therapy Stem cell therapy represents a cutting-edge regenerative approach for thin endometrium. Mesenchymal stem cells (MSCs), derived from sources such as bone marrow, adipose tissue, and menstrual blood, have demonstrated remarkable potential in promoting endometrial regeneration.11, 12, 13 Mechanism: MSCs promote endometrial repair by differentiating into stromal and epithelial cells, secreting paracrine factors that enhance angiogenesis, reduce fibrosis, and stimulate cellular proliferation, and modulating the immune environment to reduce chronic uterine inflammation.11, 12, 13 Application: MSCs can be delivered intrauterinely or via systemic infusion. Intrauterine infusion ensures localised delivery, enhancing the targeted regenerative effect on the endometrium.11, 12, 13 Evidence: • MSC therapy has been shown to significantly improve endometrial thickness and pregnancy outcomes in women with refractory Asherman

syndrome, enabling embryo transfer in patients otherwise unresponsive to conventional treatments.11 • Clinical Findings: Clinical observations indicate that autologous bone marrow– derived mesenchymal stem cells enhance endometrial thickness, whereas menstrual blood–derived MSCs exhibit significant regenerative potential due to their ease of collection and strong proliferative capacity.12 • Advantages: Stem cell therapy is minimally invasive, utilizes autologous material, and offers a favourable safety profile with versatile clinical applications.13 • Challenges: High cost, ethical and regulatory considerations, and limited long-term safety and efficacy data remain barriers, emphasizing the need for further well-designed clinical studies to standardize protocols.11, 12, 13 3. Hysteroscopic Management of Thin Endometrium Hysteroscopy is a minimally invasive procedure used to diagnose and treat thin endometrium caused by intrauterine adhesions or Asherman syndrome.14 • Indications: Hysteroscopy is used to diagnose and treat thin endometrium caused by intrauterine adhesions or Asherman syndrome, which can result from uterine trauma, infections, or surgical procedures, leading to scarring, reduced cavity volume, menstrual abnormalities, and infertility.14 • Procedure: Hysteroscopic adhesiolysis involves inserting a

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hysteroscope through the cervix to visualize the uterine cavity and carefully dissect scar tissue using scissors or electrocautery, aiming to restore normal cavity shape and volume while minimizing endometrial trauma.15 • Adjunctive Therapies: Postoperative management includes high-dose estrogen therapy to stimulate stromal and epithelial proliferation and intrauterine balloon placement to maintain cavity patency and prevent adhesion recurrence.16 • Outcomes: Combined hysteroscopic management and adjunctive measures improve endometrial thickness, normalize menstrual cycles, and enhance pregnancy rates, with prognosis dependent on the extent of pre-existing endometrial damage.16 4. Low-Level Laser Therapy (LLLT) Low-Level Laser Therapy enhances endometrial regeneration by stimulating cellular activity, mitochondrial function and angiogenesis.

Clinical evidence indicates improvements in endometrial blood flow and thickness following LLLT. The therapy is non-invasive, well-tolerated,7 and presents a safe adjunctive option for patients with thin endometrium.17 5. Hormonal Therapies • Estrogen Therapy: Highdose estradiol is administered to stimulate endometrial proliferation and can be delivered orally, transdermally or vaginally.18 • Gonadotropins: These agents are used to enhance 10

Newer Treatment Modalities and Regenerative Medicine for Thin Endometrium

ovarian stimulation, thereby increasing endogenous estrogen production.19 • Progestins: Administered during the luteal phase, progestins support the secretory transformation of the endometrium, promoting optimal endometrial receptivity.18

can improve endometrium.20

pregnancy outcomes in women with thin

7. Endometrial Scratch Technique The procedure involves deliberate injury to the endometrium during the luteal phase to stimulate regenerative and inflammatory responses, and although it is widely practiced, current studies show mixed results regarding its effectiveness.21

8. Uterine-Specific Therapies: Intrauterine devices incorporating oestrogen-releasing systems provide localized hormonal delivery that promotes endometrial 6. Angiogenic Agents regeneration and supports restoration of a functional uterine • Sildenafil citrate and lining. Additionally, intrauterine application of hyaluronic acid pentoxifylline are used to gel following hysteroscopic procedures is employed to minimize enhance endometrial blood adhesion formation and facilitate optimal endometrial healing.22 flow and vascularization.

Clinical evidence demonstrates A summary of the above treatment modalities is provided in that sildenafil administration Table 1.

Table 1: Therapeutic Approaches for Enhancing Endometrial Receptivity Therapy

Mechanism

Advantages

Limitations

PRP

Angiogenesis and regeneration

Minimally invasive

Stem Cell Therapy

Tissue regeneration

Promising results

Hysteroscopic Adhesiolysis

Removal of adhesions

Restores uterine integrity

High cost, ethical concerns Requires surgical expertise

LLLT

Stimulates cellular activity

Non-invasive

Limited availability

Estrogen Therapy

Endometrial proliferation

Widely used

Variable response rates

Angiogenic Agents

Enhances blood flow

Improves vascularization

Mixed evidence

Endometrial Scratch Technique Uterine-Specific Therapies

Controlled endometrial injury stimulating Simple, low cost regenerative pathways Local oestrogen delivery and Targeted action, hyaluronic acid support supports postendometrial regeneration operative healing and reduce adhesions

CONCLUSION Thin endometrium remains a significant clinical challenge in reproductive medicine. Emerging treatment modalities, including plateletrich plasma, stem cell therapy, and angiogenic agents, have demonstrated potential in

Limited RCTs

Inconsistent efficacy Requires device/gel application; variable effectiveness

enhancing endometrial thickness and receptivity. Regenerative approaches, such as stem cell and growth factor–based therapies, offer promising avenues for advancing management strategies.

Optimizing outcomes requires individualized, evidence-based approaches that integrate these novel interventions with established hormonal and surgical therapies. Ongoing research and high-quality clinical trials are essential to develop standardized protocols and further refine these treatment strategies.

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Newer Treatment Modalities and Regenerative Medicine for Thin Endometrium

REFERENCES 1. Du J, Lu H, Yu X, Lü Z, Mi L, Zhang X. Efficacy and safety of platelet-rich plasma for the treatment of thin endometrium: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2020; 99(3):e18848. doi:10.1097/MD.0000000000018848.

2. Gharibeh N, Aghebati-Maleki L, Madani J, Pourakbari R, Yousefi M, Ahmadian Heris J. Cell-based therapy in thin endometrium and Asherman syndrome. Stem Cell Res Ther. 2022; 13(1):33. Published 2022 Jan 28. Doi: 10.1186/s13287-021-02698-8 3. Mahajan N, Sharma S. The endometrium in assisted reproductive technology: How thin is thin? J Hum Reprod Sci. 2016; 9(1):3-8. doi:10.4103/0974-1208.178632 4. Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril. 2012; 98(3):511-519. doi:10.1016/j. fertnstert.2012.06.029 5. Craciunas L, Zdoukopoulos N, Vinayagam S, Mohiyiddeen L. Hormone therapy for uterine and endometrial development in women with premature ovarian insufficiency. Cochrane Database Syst Rev. 2022; 10(10):CD008209. Published 2022 Oct 6. doi:10.1002/14651858.CD008209.pub2 6. Awano-Kim S, Hosoya S, Yokomizo R, Kishi H, Okamoto A. Novel therapeutic strategies for Asherman's syndrome: Endometrial regeneration using menstrual blood-derived stem cells. Regen Ther. 2025; 29:328-340. Published 2025 Apr 5. doi:10.1016/j. reth.2025.03.019 7. Hu X, Wu H, Yong X, et al. Cyclical endometrial repair and regeneration: Molecular mechanisms, diseases, and therapeutic interventions. MedComm (2020). 2023; 4(6):e425. Published 2023 Dec 1. doi:10.1002/mco2.425 8. Kitaya K, Matsubayashi H, Yamaguchi K, Nishiyama R, Takaya Y, Ishikawa T, Yasuo T, Yamada H. Chronic Endometritis: Potential Cause of Infertility and Obstetric and Neonatal Complications. Am J Reprod Immunol. 2016 Jan; 75(1):13-22. doi: 10.1111/aji.12438.

Epub 2015 Oct 18. PMID: 26478517.

9. Desai, K., Desai, F., Sharma, H., Bambhaniya, H., Sharma, S. (2023). Effect of intrauterine instillation of autologous platelet-rich plasma on endometrial thickness and pregnancy outcome. Indian J Obstet Gynecol Res, 10(1), 36-41. https://doi.org/10.18231/j. ijogr.2023.008d 10. Asawari Deo, Deepti Shrivastava and Arzoo Chadha (2021) “Autologous Intrauterine Platelet Rich Plasma Versus G-CSF instillation for Improvement of Endometrial Growth and Vascularity in Recurrent in Vitro Fertilization Failure”, Journal of Pharmaceutical Research International, 33(60B), pp. 536–542. doi: 10.9734/jpri/2021/v33i60B34651.

11. Zhang Y, Shi L, Lin X, et al. Unresponsive thin endometrium caused by Asherman syndrome treated with umbilical cord mesenchymal stem cells on collagen scaffolds: a pilot study. Stem Cell Res Ther. 2021; 12(1):420. Published 2021 Jul 22. doi:10.1186/ s13287-021-02499-z 12. Singh N, Shekhar B, Mohanty S, Kumar S, Seth T, Girish B. Autologous Bone Marrow-Derived Stem Cell Therapy for Asherman's Syndrome and Endometrial Atrophy: A 5-Year Follow-up Study. J Hum Reprod Sci. 2020; 13(1):31-37. doi:10.4103/jhrs.JHRS_64_19.

13. Rungsiwiwut R, Virutamasen P, Pruksananonda K. Mesenchymal stem cells for restoring endometrial function: An infertility perspective. Reprod Med Biol. 2020;20(1):13-19. Published 2020 Jul 20. doi:10.1002/rmb2.12339 14. Khan Z, Goldberg JM. Hysteroscopic Management of Asherman's Syndrome. J Minim Invasive Gynecol. 2018 Feb; 25(2):218-228. doi: 10.1016/j.jmig.2017.09.020. Epub 2017 Oct 9. PMID: 29024798.

15. Moore JF, Carugno J. Hysteroscopy. 2025 Apr 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–.

PMID: 33232015.

16. Feng L, Sun Y, Zhang S, et al. A novel intrauterine estrogen-releasing system for preventing the postoperative recurrence of intrauterine adhesion: a multicenter randomized controlled study. BMC Med. 2024; 22(1):395. Published 2024 Sep 16. doi:10.1186/ s12916-024-03608-4 17. El Faham DA, Elnoury MAH, Morsy MI, El Shaer MA, Nour Eldin GM, Azmy OM. Has the time come to include low-level laser photobiomodulation as an adjuvant therapy in the treatment of impaired endometrial receptivity? Lasers Med Sci. 2018 Jul; 33(5):11051114. doi: 10.1007/s10103-018-2476-y. Epub 2018 Mar 15. PMID: 29546619.

18. Wang Y, Tang Z, Teng X. New advances in the treatment of thin endometrium. Front Endocrinol (Lausanne). 2024; 15:1269382.

Published 2024 Apr 30. doi:10.3389/fendo.2024.1269382 19. Wei L, Tian B, Wang S, Xu S, Zhang C. Gonadotropin Releasing Hormone Agonists Combined with Hormone Replacement Therapy Significantly Improves Reproductive Outcomes for Patients with Thin Endometrium and Intramural Fibroids in Frozen Embryo Transfer Cycles. Drug Des Devel Ther. 2025; 19:173-183. Published 2025 Jan 10. doi:10.2147/DDDT.S501809 20. Ranisavljevic N, Raad J, Anahory T, Grynberg M, Sonigo C. Embryo transfer strategy and therapeutic options in infertile patients with thin endometrium: a systematic review. J Assist Reprod Genet. 2019; 36(11):2217-2231. doi:10.1007/s10815-019-01576-w 21. Izquierdo A, de la Fuente L, Spies K, Lora D, Galindo A. Is Endometrial Scratching Beneficial for Patients Undergoing a Donor-Egg Cycle with or without Previous Implantation Failures? Results of a Post-Hoc Analysis of an RCT. Diagnostics (Basel). 2021; 11(7):1167.

Published 2021 Jun 26. doi:10.3390/diagnostics11071167 22. Zheng F, Xin X, He F, Liu J, Cui Y. Meta-analysis on the use of hyaluronic acid gel to prevent intrauterine adhesion after intrauterine operations. Exp Ther Med. 2020; 19(4):2672-2678. doi:10.3892/etm.2020.8483 YTP FUTURE CHRONICLES VOLUME 1, ISSUE 3, DECEMBER 2025

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News AI TECHNOLOGY ENHANCES SELECTION OF OPTIMAL EMBRYOS FOR IVF

A reproductive technologies (ART) to optimize embryo selection

rtificial intelligence (AI) is increasingly being applied in assisted

in in vitro fertilization (IVF), with the goal of improving implantation rates and reducing the number of cycles required to achieve successful pregnancy, as published in Human Reproduction.

IVF outcomes are influenced by maternal age, with a substantial proportion of pre-implantation embryos exhibiting chromosomal abnormalities that contribute to implantation failure or miscarriage.

The study demonstrates that AI-based assessment using time-lapse imaging can monitor embryogenesis and evaluate parameters such as blastomere symmetry, cleavage timing, and morphokinetics.

Machine learning algorithms can predict implantation potential and chromosomal normality without manipulating embryos, thereby avoiding ethical concerns associated with genetic modification. The predictive models identified embryos with up to a 70% probability of being chromosomally normal, representing a marked improvement over conventional morphological assessment. Beyond embryo selection, AI can assist in tailoring ovarian stimulation protocols and optimizing sperm retrieval strategies, while iterative learning from prior cycles enhances predictive accuracy and may reduce the psychological burden of repeated IVF attempts. Ethical considerations remain central, emphasizing informed consent and the option for patients to decline AIassisted selection. Experts underscore that AI serves as an adjunct to clinical judgment, providing evidencebased guidance to improve live birth outcomes in contemporary reproductive medicine.

CERVICAL CANCER SCREENING UPDATE AIMS TO IMPROVE ACCESS AND EARLY DETECTION

T issued updated cervical cancer screening he American Cancer Society (ACS) has

guidelines, reflecting advancements in diagnostic technology and efforts to expand access to screening. The new recommendations, published in CA: A Cancer Journal for Clinicians, introduce two major changes for individuals at average risk: self-collected vaginal samples are now considered an acceptable option for primary human papillomavirus (HPV) testing, and new criteria have been established for safely discontinuing screening. ACS continues to recommend initiating screening at age 25, with primary HPV testing every five years through age 65 as the preferred method; co-testing every five years or cytology alone every three years remain acceptable alternatives when primary HPV tests are unavailable. Clinician-collected cervical samples remain the preferred specimen type, but validated self-collection tools offer a new pathway to improve access and adherence, particularly for underserved populations. Individuals may discontinue screening at age 65 if they have documented negative primary HPV tests or negative co-tests at ages 60 and 65, or, if HPV testing is unavailable, three consecutive negative cytology tests at recommended intervals with the last at age 65. ACS notes that screening is not recommended for those under 25, adults over 65 with adequate prior screening, or individuals post-hysterectomy with removal of the cervix unless they have a history of highgrade precancer. FDA approval of HPV self-collection played a key role in prompting the update, which ACS leaders say will strengthen early detection efforts and help reduce persistent disparities, particularly in populations with limited access to healthcare services. The ACS National Roundtable on Cervical Cancer and the American Cancer Society Cancer Action Network continue to advocate for expanded screening access and follow-up care. The guideline release is accompanied by a patient information page designed to provide clear, evidence-based guidance on cervical cancer prevention and screening.

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PLACENTA ACCRETA SPECTRUM (PAS): INSIGHTS FROM MODERN PRACTICE —

A contemporary clinical review with reflections from real-world management

P

INTRODUCTION

Dr. Sunil Tambvekar

MBBS, DNB (Obstetrics & Gynaecology), MNAMS, DFP, FMAS, PGDMLS, CCBIMIE (MUHS) Jt. Assistant Secretary, JOGI Consultant obstetrician, Gynecologist & Endoscopic Surgeon Wadia Maternity Hospital, Mumbai Well Woman Clinic and Surgical Centre, Mumbai

lacenta Accreta Spectrum (PAS) has shifted from a once-rare surgical surprise to a predictable challenge in modern obstetrics.

Rising Cesarean rates, Assisted Reproductive Technologies, and more women entering pregnancy with scarred uteri have transformed PAS into one of the most important contributors to obstetric 1–3 hemorrhage today.

to anticipatory planning, structured imaging, and multidisciplinary coordination.

Today, PAS is not just a pathology — it is an entire care pathway requiring anticipation, communication, disciplined planning and surgical maturity.

In modern practice with advances measures like Internal Iliac Artery Balloon Catheters (IIABO) placements ranging from hope of conservative Over the last decade, management to the need of emphasis has moved from Obstetric Hysterectomy reactive intraoperative struggle (OH)—demonstrate how PAS

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Placenta Accreta Spectrum (PAS): Insights from Modern Practice

demands vigilance, flexibility, and humility. Some cases reward preparation with controlled bleeding; others remind us that even modern tools have limits.

accreta: Mid-sagittal (m) is thinned at the level of the sonographic image at 32 weeks’ placental bulge.8 gestation reveals multiple placental lacunae (asterisks).8

ETIOLOGY PAS is primarily a disorder of defective decidualization over a damaged uterine wall.

1. Previous Cesarean Section The most important risk factor. PAS risk rises from 0.3% (1 prior LSCS) to 6–7% with ≥3 LSCS.4,5

Figure .4. A 28-year-old woman with suspected placenta accreta spectrum disorder. Ultrasound demonstrates focal bulging of placental tissue beyond the expected uterine contour, indicated by a dashed line. The length of the placental bulge is shown by a solid doubleheaded arrow, and the depth is indicated by a dashed doubleheaded arrow.9

Abnormal healing → deficient Nitabuch layer → deep villous invasion.

2. Placenta Previa on Scar When placenta previa overlies a previous scar, risk of PAS increases to 30–40%.6 3. ART and IVF Pregnancies IVF pregnancies show twofold higher PAS risk7, possibly due to altered decidualization and scar implantation patterns.

4. Others • Myomectomy • Curettage/Asherman's • Uterine anomalies • Advanced maternal age

Figure .2. Cervix and anterior placenta accreta: Sonographic mid-sagittal plane. Views in gray-scale (A) and color Doppler (B) US at 35 weeks’ gestation reveal multiple lacunae in A and vascular invasion of the cervix in B.8

PAS reflects the anatomy of modern reproductive choices.

DIAGNOSIS

Ultrasound — cornerstone of PAS evaluation

Figure .3. Anterior placenta accreta with distended bladder. Transabdominal US, mid-sagittal plane. On a scan at 18 weeks’ gestation, the bladder wall (BW) is hyperechoic and disrupted by a placental bulge (arrows) into the bladder. The Figure .1. Anterior placenta retroplacental myometrium YTP FUTURE CHRONICLES VOLUME 1, ISSUE 3, DECEMBER 2025

p – placenta; L – length; D – depth; b – bladder.

Key markers:10, 11 • Placental lacunae (“Swiss cheese” sign) • Loss of retroplacental clear zone • Myometrial thinning <1 mm • Bridging vessels beyond serosa • Hypervascularity at bladder interface With experienced operators, sensitivity reaches 85–90%.

MRI — Refined mapping MRI is selectively useful in: • Posterior placentas • Obese patients • Bladder or parametrial invasion mapping MRI markers include T2 dark 15

Placenta Accreta Spectrum (PAS): Insights from Modern Practice

intraplacental bands and preparedness myometrial interruption.12 • Blood bank preparedness MRI complements—does not (cell-saver if available- Limited role in developing countries) replace—ultrasound.

• Consent for hysterectomy, ureteric stenting, bladder repair • IR support when available2,3

Figure.5. A 34-year-old woman with suspected placenta accreta spectrum disorder. MRI shows a focal bulge of placental tissue extending toward the expected uterine contour (dashed line).

The length of the placental bulge is indicated by a solid double-headed arrow, and the depth by a dashed doubleheaded arrow.9 p – placenta; L – length; D – depth; b – bladder

catheterization.

Intra-op: Classical LSCS (placental vessels invading serosa); male infant delivered (2.74 kg).

Procedure: Obstetric hysterectomy.

Complication: Bladder injury Most morbidity in PAS is → repaired immediately. prevented outside the operating Blood loss: ~800 mL (excellent theatre—through planning. control).

ENDOVASCULAR........ Transfusion: Only 1 PCV + 4 FFP. SUPPORT IN PAS MICU Stay: One day Internal Iliac Artery Balloon Occlusion (IIABO) Temporary occlusion of pelvic arterial supply can reduce bleeding during surgery.

Reported benefits:14–16 • Reduces Pulse pressure • 40–60% reduction in blood loss • Better visibility during dissection • Lower transfusion requirement

First-Trimester PAS Prediction Emerging literature suggests PAS precursors may be identified as early as 6–8 weeks: • Low, eccentric GS at scar • Extremely thin myometrium But balloon occlusion is • Abnormal β-hCG kinetics not a substitute for surgical readiness—collateral..........

Early diagnosis may become circulation often limits its the future of PAS prevention.13 impact in percreta.

Clinical Insights: This case demonstrates how structured preoperative IR support can convert a potentially catastrophic PAS into a controlled surgical experience with virtually no blood loss

MANAGEMENT:..........

CLINICAL INSIGHTS MODERN STRATEGIES CASE 1 — IIABO + CASE 2 — Complete Anterior & PITFALLS Classical LSCS + Obstetric Previa with Placenta Percreta Preoperative Planning Hysterectomy17 SMFM and FIGO guidelines A 34-year-old G4P2L2A1 emphasize: with prev 2 LSCS and complete • Scheduled delivery at 34– placenta previa with suspected 35+6 weeks PAS on USG and MRI. • Multidisciplinary team Pre-op: Uterine artery balloon YTP FUTURE CHRONICLES VOLUME 1, ISSUE 3, DECEMBER 2025

→ Massive Hemorrhage Despite IIABO A 40-year-old G4P2L with prev 2 LSCS and Anterior and Complete placenta previa with PAS on USG and MRI. 16

Placenta Accreta Spectrum (PAS): Insights from Modern Practice

Here, despite balloon most dangerous scenario occlusion, deep percreta caused is unscheduled labour in torrential hemorrhage. a suspected PAS. Lack of controlled environment Blood products used: escalates risk instantly.

• 7 RBC CASE 4 — Post–Placenta Previa • 6 FFP PPH (Non-PAS) → Stepwise • 1 SDP Failure → Hysterectomy • +1 RBC on POD 3 In a 33-year-old G3P2L2 Procedure: Obstetric Previous one LSCS, A hysterectomy.

Complete- Posterior placenta • MICU Stay: 4 days previa case developed uncontrolled PPH.

focal cases (requires weeks of monitoring).

• Partial myometrial resection in very experienced hands.19 • Methotrexate no longer recommended.2 Conservative management must be individualized and never improvised.

WHAT FAILS: LEARNING FROM GLOBAL DATA

• Attempted manual placental removal → catastrophic Interventions attempted: hemorrhage.

• B-Lynch suture • Unplanned surgery in non• Stepwise devascularisation specialized setup → mortality up • B/L Uterine artery ligation to 7× higher.19 • Internal Iliac ligation • Poor imaging → missed • Still bleeding → Obstetric bladder involvement.

Specimen of the uterus with hysterectomy.

• Conservative management Transfusion: 3 PCV + 4 FFP Dense Placental Invasion by inexperienced surgeons → reoperation up to 45%.18 MICU Stay: One day.

Clinical Insights: Balloon occlusion reduces bleeding Excellent Recovery.

PAS punishes lack of but does not prevent massive Clinical Insights: Not all preparation. hemorrhage when invasion catastrophic hemorrhage is LITERATURE is extensive and collateral PAS. Previa alone can be LATEST WHAT’S vasculature is from all around. lethal. This case reinforces the (2020–2025): This is where planned importance of decision-to- NEW? hysterectomy saves lives.

1. SMFM 2023 Update2 hysterectomy timing.

CASE 3 — Midnight Labour in O B S T E T R I C . . . . . . . . . . . . . • MRI only if USG insufficient.

• Referral to PAS centers.

Previous 3 LSCS → Emergency HYSTERECTOMY........

• Avoid methotrexate.

Hysterectomy — STILL THE GOLD A 36-year-old patient 2. FIGO PAS Staging 20231 STANDARD with three prior LSCS with A unified staging system For most PAS stage 2–3 diagnosis of Anterior placenta replacing older terminology. cesarean previa with suspicion of PAS cases, planned 3 without 3. Lancet Series 2022 on USG presented at 30 weeks hysterectomy • Asia shows fastest increase in in preterm labour at midnight. attempting placental removal 2, 3 PAS. On laparotomy: highly vascular remains safest.

• IR reduces transfusion but lower segment with dense Attempts to forcibly remove adhesions and near-PAS the placenta can trigger not hysterectomy rates. behaviour. instantaneous life-threatening • Maternal outcome improves significantly in high-volume 18 Procedure: Emergency hemorrhage.

PAS centers. obstetric hysterectomy.

CONSERVATIVE......... 4. UOG + AJOG Advances 10–13 Early Decision, Controlled OPTIONS — HIGHLY • Improved scoring systems.

Blood Loss.

SELECTIVE • First-trimester PAS detection Clinical Insights: The single • Placenta left in situ in selected emerging.

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Placenta Accreta Spectrum (PAS): Insights from Modern Practice

• MRI–USG combined prediction models

- Prepared teams - Multidisciplinary planning CONCLUSION PAS sits at the crossroads of modern obstetrics — a condition - Respect for the biology of shaped by scars, technology, and timing. When anticipated early abnormal placentation and managed in a structured pathway, outcomes are dramatically PAS ultimately teaches us better. These four cases highlight the variability inherent in that preparation is treatment, PAS: sometimes controlled, sometimes unforgiving. and teamwork is the strongest surgical instrument.

What remains constant is the need for:

REFERENCES 1. Society for Maternal-Fetal Medicine (SMFM). Consult Series #52: Diagnosis and Management of PAS. Am J Obstet Gynecol. 2023.

2. Jauniaux E, et al. Placenta accreta spectrum: Epidemiology and burden. Lancet. 2022; 399:1796–1810.

3. Silver RM, et al. Maternal morbidity associated with multiple caesarean deliveries. Obstet Gynecol. 2006; 107(6).

4. Marshall NE et al. Trends and determinants of PAS. Obstet Gynecol. 2017.

5. Warshak CR et al. Placenta previa–accreta risk. Am J Obstet Gynecol. 2010.

6. Eshkoli T et al. IVF and PAS risk. Fertil Steril. 2013.

7. Collins SL et al. Ultrasound diagnosis of PAS. Ultrasound Obstet Gynecol. 2017.

8. Philips, J., & Abuhamad, A. (2018). Diagnosing placenta accreta spectrum with prenatal ultrasound. OBG Manag, 30(38-44), 34-36.

9. Thiravit S, Ma K, Goldman I, et al. Role of Ultrasound and MRI in Diagnosis of Severe Placenta Accreta Spectrum Disorder: An Intraindividual Assessment With Emphasis on Placental Bulge. AJR Am J Roentgenol. 2021;217(6):1377-1388. doi:10.2214/ AJR.21.25581 10. Cali G et al. Color Doppler scoring systems for PAS. UOG. 2019.

11. D’Antonio F et al. MRI markers for PAS. Ultrasound Obstet Gynecol. 2020.

12. Timor-Tritsch IE et al. Early PAS precursors. AJOG. 2021.

13. Carnevale FC et al. Internal iliac balloon occlusion outcomes. Cardiovasc Intervent Radiol. 2017.

14. Panici PB et al. IR-assisted PAS surgery. Obstet Gynecol. 2018.

15. Fang Q et al. Endovascular strategies in PAS. Int J Gynaecol Obstet. 2021.

16. Wasicek PJ et al. REBOA in obstetric hemorrhage. J Trauma Acute Care Surg. 2020.

17. Sentilhes L et al. Conservative management outcomes in PAS. BJOG. 2018.

18. Palacios-Jaraquemada JM. Myometrial resection in PAS. Obstet Gynecol. 2012.

19. Shamshirsaz AA et al. Outcomes in PAS centers vs non-centers. Am J Obstet Gynecol. 2019.

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News THE FUTURE OF AESTHETIC GYNAECOLOGY: REGENERATION, TECHNOLOGY, AND PATIENT-CENTERED CARE Gynaecology A esthetic is rapidly evolving into a

dynamic, technology-driven field aimed at improving intimate health, functional outcomes, and overall quality of life. Once considered primarily cosmetic, modern procedures now offer therapeutic benefits for conditions such as genitourinary syndrome of menopause, urinary incontinence, vaginal dryness, dyspareunia, and postpartum anatomical changes.

Beyond physical improvements, these interventions also enhance psychosexual health, self-esteem, and sexual satisfaction.

The field focuses on the female external genitalia—including the labia majora and minora, clitoris, vaginal vestibule, urethral meatus, and Bartholin’s glands—which are vital for protection, sensation, and sexual function. Aging, hormonal changes, obstetric trauma, chronic illnesses, and oncological treatments can lead to epithelial thinning, reduced elasticity, vaginal laxity, sexual discomfort, and stress urinary incontinence. Aesthetic Gynaecology addresses these challenges through minimally invasive, energy-based, and surgical procedures that restore both form and function. Injectable therapies such as hyaluronic acid for volumization and hydration, and platelet-rich plasma for tissue regeneration, improve elasticity, vascularization, and tissue repair, while needle and microneedle mesotherapy deliver bioactive substances intradermally to enhance mucosal health. Energy-based devices—including fractional CO₂ and Er:YAG lasers, radiofrequency, and high-intensity focused ultrasound—stimulate collagen production, improve tissue tone, and manage atrophy, laxity, pigmentation disorders, and urinary incontinence. Surgical interventions, such as labiaplasty, clitoroplasty, and lipofilling, provide definitive correction, while thread-based procedures and supportive treatments like chemical peels, skin-brightening procedures, and carboxytherapy enhance tissue quality, circulation, and durability of results.

Looking ahead, the future of Aesthetic Gynaecology is increasingly regenerative, reconstructive, and patient-centered. Emerging therapies such as microneedle radiofrequency and high-intensity focused ultrasound are showing superior results in treating vaginal laxity, stress urinary incontinence, and menopausal changes, while fractional CO₂ and Er:YAG lasers remain effective for atrophy and pigmentation concerns. Combined protocols, integrating energy-based devices with regenerative injectable like platelet-rich plasma or tropocollagen, are demonstrating synergistic improvements in tissue elasticity and functional outcomes.

Digital tools are also transforming patient care. Electronic health records, secure telemedicine platforms, and patient engagement apps are enabling real-time communication between clinicians and patients, supporting personalized treatment, continuity of care, and long-term monitoring. These technologies empower patients to actively participate in decisions, track progress, and adhere to follow-up care.

Ethical and legal considerations—including informed consent, patient autonomy, and realistic expectations—will continue to guide practice. Standardized training and certification programs, ideally endorsed by professional societies, are essential to ensure quality, safety, and consistent outcomes.

Overall, Aesthetic Gynaecology is moving toward a holistic, technology-driven model that integrates regenerative therapies, minimally invasive techniques, and digital tools to enhance intimate health, functional restoration, and psychological well-being for women worldwide.

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ENDOMETRIOSIS: THE BENIGN MALIGNANCY

E

INTRODUCTION

ndometriosis is an estrogen-dependent,..... benign, inflammatory disease in which endometrial glands and stroma are active outside the uterine cavity.

organs has now spread far and wide.

Endometriosis also affects metabolism in liver and adipose tissue, leads to systemic inflammation, and alters gene What was once considered expression that causes severe as a disease of the reproductive pain sensitisation.

Dr. Priyanka Sureddi

MBBS, MS OBGY (KEM), DNB, MNAMS, FMAS-ICOG, FCG Consultant Obstetrics & Gynaecology Specialist in Minimal access surgery (Laparoscopy & Robotic)

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Endometriosis: The Benign Malignancy

In general, the most common sites of endometriosis, are the ovaries, anterior and posterior cul-de-sac, broad ligament, uterosacral ligaments, uterus (adenomyosis).

disease. Studies have reported an average diagnostic delay of 7 to 12 years.

Aetiology While no single theory is definitive. Several theories have been proposed.

1. Ectopic transplantation of endometrial tissue: Trans-tubal regurgitation causing implantation of endometrial cells during menstruation.

2. Coelomic metaplasia: Transformation of coelomic epithelium into endometrial tissue.

3. The induction theory: Induction of undifferentiated peritoneal cells to cultivate into endometrial tissue by an indeterminate endogenous biochemical component.

However with the increasing incidence of endometriosis, structures involved include the vaginal episiotomy scars, previous caesarean scars, rectovaginal septum, cecum, ileum, urinary bladder, ureters and umbilicus, silent kidney hydronephrosis and scarring. Other factors Rarely even extending to the 1. Familial factors. diaphragm!

2. Genetic factors– polygenic mode of inheritance.

3. Immune factors and Inflammatory factors.

The illustration shows the typical localizations of endometriosis: 1. ovarian endometrioma.

2. retrocervical endometriosis.

3. deep bowel endometriosis.

4. bladder endometriosis.

5. abdominal wall endometriosis

10-15 percent of reproductive-age women globally have endometriosis.

But numbers are consistently rising both due to increasing incidence, better imaging and increasing sensitivity of clinicians picking up the

Clinical features- Women with endometriosis classically present during their reproductive years with pelvic pain (including dysmenorrhea and dyspareunia), infertility, bowel and bladder dysfunction(dysuria , dyschezia), endometrioma, abnormal uterine bleeding, low back pain, or chronic fatigue.

Findings suggestive of endometriosis 1. Tenderness on vaginal examination, 2. Nodules in the posterior fornix, 3. Adnexal masses, and 4. Immobility or lateral placement of the cervix or uterus.

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Laboratory- There are no specific pathognomonic laboratory 21

Endometriosis: The Benign Malignancy

findings for endometriosis.

endometriosis versus healthy controls.

Several newer non invasive modalities utilise salivary, urinary and endometrial biomarkers are being used to diagnose endometriosis.

Imaging: The traditional thought was that no imaging modality can replace operating visible detection and biopsy for diagnosis hence laparoscopic visualization of lesions with histologic confirmation was the gold standard for diagnosing endometriosis.

However this is no longer followed.

Serum cancer antigen (CA) 125 concentration can be elevated in women with endometriosis greater than 35 units/ml, however this is not a specific marker. CA-125 is used for monitoring disease severity rather than primary diagnosis.

Transvaginal ultrasound (TVUS) achieved a sensitivity of 93 % and a specificity of 96 % for identifying endometriomas. it is less invasive and less expensive than other imaging modalities like MRI. This makes it a preferred initial approach for diagnosing deep pelvic endometriosis, endometriomas, adenomyosis, involvement of the parametrium in the pouch of Douglas, nodules of the rectovaginal septum, and bladder nodules. Advanced operators are able to identify neural involvement as well.

Endometrial Receptivity The International Deep Endometriosis Analysis (IDEA) Testis: is an endometrial biopsy group has established a standardized 4-step protocol for assessing test that identifies biomarkers endometriosis via TVS: protein marker BCL6 to detect silent endometriosis and progesterone resistance, which may cause unexplained infertility or implantation failure, and can indicate a uterine environment that is less receptive to embryo implantation.

Non-Invasive................

Endometriosis Saliva Test: A non-invasive, diagnostic tool for endometriosis that uses saliva to study micro RNAs using AI and Next-Generation Sequencing (NGS). This allows for the early detection of all types of endometriosis with a better diagnostic rate than that of conventional diagnostic tests (sensitivity >97% and specificity >93%) Serum Biomarker Test for Endometriosis: The immunoassay measures the levels of two biomarkers in human serum: Brain Derived Neurotrophic Factor (BDNF) and Cancer Antigen 125 (CA125). Both BDNF and CA125 have been shown in studies to be elevated in the serum of patients with

Morphological Uterus Sonographic Assessment (MUSA) group published a consensus on which terminology to use when describing myometrial lesions seen on ultrasonography.

It has limitations in detecting various types and locations of endometriosis lesions, particularly in cases of minimal or superficial disease hence TVUS alone may not be sufficient for diagnosing all cases of endometriosis. Operator dependant skilled assessment of disease is essential to improve accuracy of diagnosis.

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Endometriosis: The Benign Malignancy

MRI is particularly useful for detecting deep infiltrating endometriosis and assessing the extent of the disease. It has demonstrated high accuracy in diagnosing both anterior and posterior endometriosis, allowing for comprehensive lesion mapping prior to surgery.

Endometriosis MRI protocol is followed for accurate diagnosis of endometriosis.

Optimal magnetic resonance imaging protocol in the diagnosis of pelvic endometriosis.

Note: GPP good practice point; MRI = magnetic resonance imaging; T1W=T1-weighted.

Bazot Deep endometriosis and imaging techniques. Fertil Steril 2017.

MANAGEMENT: Medical: NSAIDs: Primarily provide symptomatic pain relief, especially for dysmenorrhea, by inhibiting prostaglandin synthesis. Considered first-line agents for pain control, but does not affect disease progression.

Often used adjunctively with hormonal or surgical therapy.

Combined Hormonal Contraceptives (CHCs): Effectively reduce dysmenorrhea, pelvic pain, and dyspareunia. Continuous regimens are more effective than cyclic use.

Well tolerated, cost-effective, and suitable for long-term use YTP FUTURE CHRONICLES VOLUME 1, ISSUE 3, DECEMBER 2025

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Endometriosis: The Benign Malignancy

in many patients.

efficacy and safety.

No clear evidence supports Surgical: When to opt for surgical management over medical superiority of one CHC management: formulation over another.

Indications for surgical exploration include Progestins: Suppress 1. Diagnosis of persistent pelvic pain that does not respond to endometrial proliferation and medical therapy reduce pain and lesion activity. 2. Evaluation of severe symptoms that limit function Effective as first-line therapy, 3. Treatment of anatomic abnormalities, such as bladder lesions. particularly for chronic pelvic FINDINGS DURING LAPAROSCOPY: pain. Generally suitable for • Raised flame-like patches, Whitish opacifications, Yellow-brown long-term management discolorations with favourable tolerability for suppression of disease • Translucent blebs or reddish or reddish-blue irregularly-shaped islands. progression.

• Blue/brown lesions(“powder burns”) GnRH Agonists: Induce • The peritoneal surface can be scarred or puckered, have defects a hypoestrogenic state via (Allen-Masters syndrome) or give rise to nodules or cysts pituitary downregulation, • Dense fibrous adhesions signify severe disease. reducing lesion size and pain.

Highly effective for moderate to severe endometriosis. Use is limited by hypoestrogenic side effects, especially bone mineral loss. Typically reserved for short-term or second-line treatment.

GnRH Antagonists: Provide rapid and reversible ovarian suppression without initial estrogen flare. Effective in relieving endometriosisassociated pain.

Potential for improved tolerability compared to agonists, though long-term data are limited.

SURGICAL STAGING OF DISEASE-

Endometriosis is surgically staged according to the revised American Society for Reproductive Medicine scoring system.

The utility of the classification system is that it provides a standard approach for reporting operative findings. ENZIAN is a comprehensive system for staging endometriosis, moving beyond traditional methods like r-ASRM by detailing specific anatomical locations (Peritoneum (P), Ovarian (O), Tubo-ovarian (T), Uterosacral Ligament (USL), Bladder (B), Rectum (R), Ureter (U), etc.) and depth of disease (superficial, deep, adenomyosis), using letters for sites and numbers (1, 2, 3) for severity, allowing for unified assessment in imaging (MRI/Ultrasound) and surgery.

Designed for use in both preoperative planning involving finding from diagnostic imaging (MRI, TVUS) and during surgery.

Novel Targeted Therapies: Aim to address underlying disease mechanisms (inflammation, angiogenesis, r-ASRM classification hormonal signalling).

Include SPRMs, SERMs, antiangiogenic agents, statins, and TNF inhibitors.

Show promising results in preclinical and early clinical studies. Require further research to establish clinical YTP FUTURE CHRONICLES VOLUME 1, ISSUE 3, DECEMBER 2025

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Endometriosis: The Benign Malignancy

endometriosis.

CONCLUSION

Enzian (Classification of Endometriosis)

INDOCYANINE DYE:

As it is a chronic disease, it requires a lifelong management plan that maximizes medical treatment and avoids repeat surgical intervention.

Management should be individualized, depending upon the chief complaint taking into account the severity of the disease and its treatment on quality of life. Similarly for patients presenting with infertility shared clinical decision making should be applied while choosing between surgery and medically assisted reproduction.

GREEN

1. Usage of NIR- ICG based imaging has improved the diagnosis and treatment of ureteral endometriosis by providing better visualization of the ureters by placement of intra-ureteric stents. Thus reducing the incidence of injury to the ureters.

2. Intravenous indocyanine green (ICG) injection, enhances visualization of macro and microvascular anatomy as well as tissue perfusion, thereby improving the intraoperative assessment of neovascularized lesions across various conditions.

3. Additionally it has also been used to assess perfusion of the resection anastomosis of bowel.

4. Icg dye has also been used for sentinel mapping of lymph nodes.

Laparoscopic excision of endometriosis is an effective treatment for patients across all stages, with better outcomes achieved when the affected structures are surgically removed. Presacral neurectomy (PN) is an additional surgical procedure that involves the removal of nerve fibres located in the presacral space. It has been investigated as a potential treatment for pelvic pain related to YTP FUTURE CHRONICLES VOLUME 1, ISSUE 3, DECEMBER 2025

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A YTP Initiative

FUNGAL MASTER CLASS, BENGALURU ON OVERVIEW OF EFFECTIVE MANAGEMENT STRATEGIES

“VULVAR AND PERIANAL INFECTIONS”

The Fungal Master Class, Bengaluru CME, held on 7th December 2025, on “Overview of Effective Management Strategies for Vulvar and Perianal Infections” was successfully conducted, featuring two hours of in-depth clinical discussions and expert engagement.

The event was organized under Opening address by Mr. Dom Daniel the auspices of Young Talent (CEO drscourseslive.com) Promotion (YTP) Committee of FOGSI (The Federation of Obstetric and Gynaecological Societies of India), in collaboration with the BSOG (Bengaluru Society of Obstetrics and Gynaecology), YTP Future Chronicles ytpfuturechronicles.com and drscourseslive.com. Marking its 6th edition, the Fungal Master Class which continues to serve as a trusted academic platform for advancing knowledge on challenging infections that significantly impact women’s health.

The welcome address was delivered

by Dr. Mangala Devi K R, President of BSOG.

The session was anchored by Dr. Gyaneshwari, who ensured the smooth functioning of the event. Dr. Mangala Devi K R, President of the Bengaluru Society of Obstetrics and Gynaecology (2025–26) delivered her Presidential The audience was formally greeted by address. The speakers Dr. Phani Madhuri V, Consultant Gynaecologist, Mr. Chirag Shah, GPM, Glenmark. and Dr. Rashmi Patil, Consultant Gynaecologist and Joint Treasurer of BSOG (2025–26) and Executive Committee Member of BRCOG (Bengaluru Rural Chapter of Obstetrics and Gynaecology) joined in for ceremonial lighting of the traditional lamp.

The event was Moderated by Dr. BS Susheela Rani, Consultant Gynaecologist and Past President of BSOG, Chapter Secretary of IMS. The expert panel comprised Dr. Shilpashree H, Consultant Gynaecologist and Executive Committee Member of BSOG, and Dr. Latha Shankar, Consultant in Obstetrics and Gynaecology. Collectively, the panelists shared valuable clinical perspectives on vulvar, perianal, and vulvovaginal fungal infections, enhancing the session with practical management strategies and evidence-based insights to improve women’s health outcomes.

KEY CLINICAL INSIGHTS ON VULVAR AND PERIANAL FUNGAL INFECTIONS

Speaker Dr. Phani Madhuri V shared an insightful presentation.

YTP FUTURE CHRONICLES VOLUME 1, ISSUE 3, DECEMBER 2025

The Bengaluru Fungal Masterclass featured a presentation by Dr. Phani Madhuri V that provided a comprehensive overview of vulvar and perianal fungal infections, covering their types, clinical features, predisposing factors, and diagnostic approach. The presentation also highlighted effective management strategies for recurrent vulvovaginal candidiasis, emphasizing a holistic, 26

Post-Event Report patient-centered approach aimed women’s health and quality of life.

at

improving

KEY CLINICAL INSIGHTS URINARY TRACT INFECTIONS

ON

The interactive panel discussion was moderated by Dr. BS Susheela Rani, Panelist Dr. Phani Madhuri V, Dr. Latha Shankar, Dr. Shilpashree H, and Dr. Rashmi Patil discussed vulvar, perianal, and vulvovaginal fungal infections as well as urinary tract infections.

The panel addressed diagnostic challenges, treatmentresistant cases, differential diagnoses, and care for special populations. The session included an engaging Q&A session, emphasizing personalized, evidencebased, and multidisciplinary approaches for improved patient outcomes.

Profile of the Attentive Audience at the Event Speaker Dr. Rashmi Patil delivered an informative presentation on urinary tract infections.

The session continued with a detailed overview of urinary tract infections (UTIs), delivered by Dr. Rashmi Patil. It covered their prevalence across all age groups, particularly in women, and included discussion on bacteriuria and fungal infections, as well as common post-operative and Gynaecological complications, providing valuable clinical insights for effective management.

INTERACTIVE PANEL SESSION

The closing ceremony by the Glenmark team along with Faculty members and BSOG office bearers.

This Fungal Master Class, Bengaluru was supported

by Glenmark and concluded with a heartfelt note of appreciation from the Glenmark team to the esteemed faculty —Dr. Gyaneshwari, Dr. Mangala Devi K R, Dr. BS Susheela Rani, Dr. Phani Madhuri V, Dr. Shilpashree H, Dr. Rashmi Patil, Dr. Latha Shankar and attendees ,along with all other contributors, for their invaluable support in making the event insightful, impactful, and a resounding success.

FEEDBACK Dr. Navin Srinivasan “I found this CME highly informative, and clinically oriented”.

Dr. Jameela Khalid “All the speaker sessions were very good” Dr.Nimeesha Venkatesh “This CME will improve my knowledge on Vulvar and Perianal infections” Panel discussion L to R: Moderator Dr. BS Susheela Rani, Panelist Dr. Phani Madhuri V, Dr. Latha Shankar, Dr. Shilpashree H, and Dr. Rashmi Patil

Dr.Viharika Gowda “The content of this CME was very informative”

This Event was conceptualized and executed by Paradigm Infocom Pvt. Ltd, Publisher of this Newsletter.

For more information, Contact: +919820507771 Email id: - paradigminfocomobgyn@gmail.com YTP FUTURE CHRONICLES VOLUME 1, ISSUE 3, DECEMBER 2025

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News WHO RELEASES FIRST GLOBAL GUIDELINE ON INFERTILITY

T its first global guideline on infertility, urging countries he World Health Organization (WHO) has released

to make fertility care safer, more equitable, and widely accessible. Infertility, defined as the inability to achieve pregnancy after 12 months of regular unprotected sexual intercourse, affects an estimated one in six people of reproductive age. Access to care remains limited, with many patients facing substantial out-of-pocket costs for diagnostics and treatments, including IVF, which can exceed the average annual household income in some regions. The guideline presents 40 evidence-based recommendations to strengthen prevention, diagnosis, and treatment of infertility. It emphasizes integrating fertility care into national health strategies and financing, promoting cost-effective interventions, public education, and lifestyle measures such as healthy diet, exercise, and tobacco cessation. Clinical pathways provide stepwise management for male and female infertility, from basic counseling to intrauterine insemination or IVF. The guideline also highlights the psychosocial impact of infertility, advocating access to ongoing mental health and social support. Implementation requires adaptation to local healthcare systems and coordination among health authorities, professional bodies, civil organizations, and patient groups. Fertility care should be embedded in rights-based sexual and reproductive health frameworks to support informed, patientcentered decisions and promote gender equity. Evidence gaps and future research priorities include fertility preservation, third-party reproduction, and management in patients with pre-existing conditions. Overall, WHO’s guidance represents a global effort to standardize infertility care, improve access, and integrate reproductive health services into broader healthcare systems, marking a key step in addressing infertility as a public health priority.

GENETIC AND ENVIRONMENTAL INTERACTIONS IN ENDOMETRIOSIS: INSIGHTS FROM RECENT FINDINGS

R Journal of Human Genetics, highlights a

ecent research, published in the European

complex interplay between genetic variants and modern environmental exposures in endometriosis susceptibility, offering new insights into disease pathophysiology and potential precision medicine approaches.

Endometriosis, a chronic gynecological condition, is frequently underdiagnosed due to limited recognition of early risk factors. Analyses identified significant regulatory variants in IL-6, CNR1, IDO1, and KISS1R that affect transcription factor binding, gene expression, and epigenetic regulation, potentially promoting immune dysregulation, chronic inflammation, fibrotic lesion formation, and heightened pain sensitivity. Modern environmental pollutants, including endocrine-disrupting chemicals such as BPA and phthalates, exacerbate these genetic predispositions by altering methylation and expression levels, transforming once-adaptive immune responses into drivers of chronic disease. These findings underscore the convergence of genetic, epigenetic, and environmental factors in shaping endometriosis risk, providing a framework for integrating genomic and environmental data into early diagnosis and personalized therapeutic strategies. Functional validation, assessment of geneenvironment interactions, and studies in diverse populations are essential to clarify inheritance patterns and susceptibility, advancing understanding of endometriosis pathogenesis and supporting individualized approaches for detection, monitoring, and management.

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CME Credits#

3-Days Program Highlights* 3 Half-days Lectures by DHA Certified Faculty 3 Half-days Observership in Aesthetic Procedures with UAE DHA@CME Credits

Package to be announced shortly Inclusions: * 3-Nights 4-Days Stay, in a 4-STAR Hotel with breakfast and dinner, Lunch at Academy/Aesthetic Centre, To and fro - Hotel to Academy/Aesthetic Centre SIC◊ Exclusions: Air fare to Dubai and back , airport transfer, Sight seeing etc. @ DHA- Dubai Health Authority # Proposed s/t confirmation ◊ SIC- Seat in Coach

Interested Drs kindly call for further details: +91 8779515551