FUTURE GYNAECOLOGY LEADERS CONFERENCE

FUTURE GYNAECOLOGY LEADERS CONFERENCE

27 NOVEMBER 2025- SPIRE MANCHESTER HOSPITAL

ABSTRACTS

ORAL PRESENTATIONS

Name (Presenters)
Maya Whittaker

Grade
ST3

Hospital
St Mary’s Hospital

Authors
Maya Whittaker, Eleanor R. Jones, Suzanne Carter, Kelechi Njoku, Chloe E. Barr, Helena O’Flynn, Emma J. Crosbie

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Research

Abstract (400 words maximum)

Performance of the clinical diagnostic pathway for evaluation of postmenopausal bleeding among different ethnic groups in the United Kingdom

Objectives
Disparities in endometrial cancer outcomes exist between different sociodemographic groups. We aim to explore how the diagnostic pathway for postmenopausal bleeding (PMB) performs among different ethnic groups in the United Kingdom (UK).

Methods
We conducted a multicentre cross-sectional study of 1,864 women with PMB, recruited across Greater Manchester between 2018–2021. Ethnicity was self-reported. Logistic regression explored association between ethnicity and inconclusive investigations, defined as inability to measure endometrial thickness (ET) or detect endometrial irregularity on ultrasound; failed or inconclusive hysteroscopy; or failed or inadequate endometrial biopsy.

Results
The cohort were of White (n=1,589, 85.3%), Black (n=113, 6.1%), South Asian (n=99, 5.3%), South East Asian (n=13, 0.7%), Arab (n=8, 0.4%), and mixed (n=17, 0.9%) ethnic backgrounds. 25 (1.3%) women had missing data on ethnicity. There were 99 (5.3%) women with endometrial cancer.

There were a higher proportion of Black women with an inconclusive ultrasound compared to White women (n=12, 10.6% versus n=39, 2.5%), resulting in a 4.67-times higher odds of failure (95% confidence interval (CI) 2.37-9.20, p<0.001), which was not completely explained by the presence of fibroids (adjusted odds ratio 3.34, 95% CI 1.63-6.83, p=0.001). There was no difference in odds of inconclusive hysteroscopy (n=14, 25.9% versus n=135, 17.7%) or endometrial biopsy (n=25, 34.7% versus n=236, 24.5%) among Black women compared to their White counterparts. There were no differences in odds of inconclusive investigations by any other ethnicity.

Conclusions
We find that ultrasound for the investigation of suspected endometrial cancer is more likely to be inadequate among Black women. Guidelines for investigation of PMB hinge on ultrasound findings and fail to discuss management in the event of an inconclusive scan. This risks disproportionately impacting clinicians’ ability to provide guideline-concordant care to Black women. Future guidelines must address the disparate performance of diagnostic investigations for PMB to avoid delayed diagnoses that may perpetuate existing health inequalities.

Name (Presenters)
Amy Cyriac

Grade
Medical Student (4th year)

Hospital
Saint Mary’s Hospital, Royal Infirmary, Manchester, Oxford Rd, M13 9WL

Authors
Amy Cyriac, Dr Charlotte Mahoney

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Research

Abstract (400 words maximum)

Management of Pelvic Organ Prolapse after Radical Cystectomy -literature review and case series

Objectives
Pelvic organ prolapse (POP) following radical cystectomy (RC) is an underreported but emerging challenge in female patients, largely attributed to intraoperative disruption of pelvic support structures. Despite its significant impact on quality of life, there is limited guidance on optimal management, with most evidence derived from isolated case reports and small series. This study aimed to investigate current management strategies for POP after RC through a comprehensive literature review and a local case series analysis.

Methods
A systematic search identified 17 publications (n=34 patients) with POP following RC. Reported management strategies and outcomes were reviewed. Additionally, three local NHS cases from a tertiary care centre in Manchester were analysed to compare clinical experience with published evidence.

Results
The literature revealed a predominance of advanced-stage anterior enteroceles managed surgically, most frequently via colpocleisis. Recurrence was reported in approximately 35% of cases, while conservative strategies were rarely described.

Conversely, the local case series involved three medically complex patients with less severe prolapses, all ultimately managed conservatively either initially or following failed surgical attempts. Woman A underwent a pedicled flap reconstruction that failed and was subsequently managed with a pessary. Woman B was medically unfit for surgery, so a pessary was recommended instead. Woman C experienced a failed surgical colpopexy, declined a pessary and is receiving expectant management. Notably, the pedicled flap reconstruction represented a novel approach not previously described in the literature.

Conclusion:
Limitations identified across both groups included scarce long-term outcome data, inconsistent anatomical terminology and significant publication bias favouring surgical interventions. Conservative management, although clinically relevant, was underreported. Local case identification was also complicated by database inconsistencies and misclassification.

This study emphasises the need for personalised, multidisciplinary care pathways for managing POP after RC, particularly in high surgical risk patients. Future research should prioritise multicentre studies with extended follow-up and greater inclusion of conservative strategies to better reflect the realities of NHS practice.

Name (Presenters)
Sindhu Sekar

Grade
ST5

Hospital
Liverpool womens hospital

Authors
Sindhu Sekar, Lakshmi sandu aana

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Audit

Abstract (400 words maximum)

Aligning Hysteroscopy Practice with British Association of Day Surgery (BADS) and Getting It Right First Time (GIRFT) Standards: A Service Evaluation

Background
In line with the British Association of Day Surgery (BADS) recommendations, there is a national drive to increase the use of appropriate surgical settings, promoting a shift towards day-case and outpatient procedures for hysteroscopy and endometrial ablation. Hysteroscopy under general anaesthesia (GA) should be reserved for clearly defined clinical indications or when outpatient hysteroscopy (OPH) is unsuccessful or not feasible. Optimising OPH pathways supports NHS England’s elective recovery priorities and the Getting It Right First Time (GIRFT) agenda, improving clinical efficiency, patient experience, and resource utilisation. Our unit observed a higher proportion of hysteroscopies performed under GA compared with other trusts in same deanery.

Aim
To evaluate the indications for hysteroscopy under GA and assess compliance with GIRFT recommendations, with the goal of optimising OPH services.

Methods
A retrospective audit was conducted on all patients who underwent hysteroscopy under GA between 2 January 2023 and 29 December 2023 at Ormskirk district hospital. Data were collected from theatre records and electronic health systems. Variables included patient demographics (age, parity, mode of delivery), history of Tamoxifen use or LLETZ, referral indications, OPH attempts, analgesia use, and documented reasons for direct GA or conversion from OPH to GA. GIRFT standards were used as the audit benchmark.

Results
A total of 202 hysteroscopies under GA were identified. The most common indication was postmenopausal bleeding (PMB), accounting for 138 cases (68.3%). Of these, 127 patients (62.9%) were directly listed for GA without an OPH attempt. Among the direct-to-GA group, patient preference (n=93) and clinical decision due to anticipated technical difficulty (n=29) were the most frequently documented reasons. The remaining 74 cases (36.6%) were converted to GA following an attempted OPH; reasons included cervical stenosis (n=43), severe pain despite analgesia (n=15), procedure difficulty (n=12), and high blood pressure (n=4).
Among those who attempted OPH, most received pre-procedure counselling and appropriate analgesia, including Entonox and local anaesthesia.

Conclusion
A significant proportion of hysteroscopies were performed under GA without prior OPH attempts, suggesting scope for pathway optimisation. Enhancing patient counselling, standardising use of local anaesthesia and pre-procedure analgesia, and offering additional techniques to manage cervical stenosis may reduce GA rates. Aligning local practice with GIRFT and BADS recommendations could improve patient experience, reduce theatre burden, and support NHS recovery goals.

Name (Presenters)
Ashleigh Woodland

Grade
ST4

Hospital
Liverpool Women’s Hospital

Authors
Asheigh Woodland, Kohei Matsumoto, Lidia Kwasnicka

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Case Report

Abstract (400 words maximum)

Progesterone Hypersensitivity: a case report and discussion of treatment options

Context:
Progesterone hypersensitivity (previously termed autoimmune progesterone dermatitis) is a rare hypersensitivity reaction to endogenous progesterone occurring during the luteal phase. It typically presents with cyclical cutaneous symptoms appearing several days before menstruation and resolving with menses. Owing to its rarity, clinicians have limited experience diagnosing and treating the condition, and there is a paucity of evidence-based guidance to support management.

Case report:
A 37-year-old woman with ulcerative colitis and primary sclerosing cholangitis presented to the gynaecology clinic with a five-year history of recurrent widespread purpura and dry itchy eyes, occurring predictably a few days before menstruation and resolving by day 4–5 of the cycle. These symptoms are the classical features of progesterone hypersensitivity with most skin rashes being urticarial in nature. The patient’s symptoms were initially attributed to medication side effects, resulting in a delayed referral to gynaecology. Given the striking cyclical pattern and exclusion of alternative causes, progesterone hypersensitivity was suspected. Ovulation suppression with a gonadotropin-releasing hormone (GnRH) agonist induced amenorrhoea and complete symptom resolution, confirming the diagnosis. Owing to multiple prior abdominal surgeries and high operative risk, the patient remains on long-term, off-licence GnRH agonist therapy with sustained remission.

Discussion:
Diagnosis of progesterone hypersensitivity remains clinical, based on history, examination findings and response to ovulation suppression, as immunological tests lack standardisation and are not widely available. This case highlights the importance of recognising progesterone hypersensitivity as a cause of cyclical purpura as well as urticaria and demonstrates that medical ovulation suppression may be an effective alternative to surgical management.

Name (Presenters)
Mohammad Saaed Elfarran

Grade
Specialty doctor

Hospital
St Mary’s hospital

Authors
Mohammad Saaed Elfarran, Zaibun Khan, Saffa Elfaki, Uthman Hassan & Mr Kingshuk Majumder.

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Research

Abstract (400 words maximum)

Surgical outcomes of radical excision of rectovaginal endometriosis in the Northwest Pelvic Pain and Endometriosis Centre

Objectives
Rectovaginal (RV) endometriosis represents a severe form of deep infiltrating endometriosis involving the vagina, rectovaginal septum, and rectum, often obliterating the pouch of Douglas. Medical therapies are frequently ineffective or short-lived, surgical excision therefore, remains the gold standard management. However, surgery for RV endometriosis carries recognised risks including bleeding, infection, laparotomy, visceral injuries, urinary or bowel leaks, and fistulas. Data from the BSGE database (2009–2016) reported a 7.2% peri-operative complication rate, with bleeding and conversion to laparotomy being most common. Complication rates vary between 4.5% and 16%, depending on surgical complexity.
The Northwest pelvic pain and endometriosis centre is among the top ten UK centres performing high-volume RV endometriosis surgery. Surgeons performing high volume operative work have been associated with superior clinical outcomes.
The aim of this study was to generate centre-specific peri-operative complications data to improve informed consent and evaluate whether outcomes at a high-volume centre align with those reported nationally.
Methods
We conducted a retrospective cross-sectional study of women undergoing surgical excision of RV endometriosis at the Northwest Endometriosis Centre, UK. Data were collected between January 2023 and December 2024, including operative details, peri-operative complications and post-operative outcomes. Complications were graded according to the Clavien-Dindo classification. Data analysis was performed using Jamovi version 2.3.18.0.
Results
A total of 177 patients were included: 92 from 2023 and 85 from 2024. Peri-operative complications occurred in 9 patients (5%). The most frequent complication was intraoperative bleeding (2.8%), followed by conversion to laparotomy (2.3%). Major visceral injuries were rare: ureteric injury occurred in 2 patients (1%), bowel and bladder injuries occurred in 1 patient each (0.6%). Only two complications were classified as severe: one patient required return to theatre for ureteric re-anastomosis, and another developed delayed hydronephrosis with loss of renal function. No cases of stoma formation, anastomotic leaks, or rectovaginal fistulae were reported.
Conclusions
Our study demonstrates a peri-operative complication rate of 5%, which is lower than nationally reported rates. The low incidence of severe complications highlights the safety of RV endometriosis surgery in a specialised, high-volume setting. While improved outcomes may reflect surgical expertise and centralisation, potential confounders such as BMI, previous surgery, and use of GnRH analogues must be considered. Larger multicentre studies with multivariable adjustment are needed to validate these findings and further guide patient counselling and surgical consent.

Name (Presenters)
Theo Johnson

Grade
ST6

Hospital
Royal Oldham Hospital

Authors
Miss G.Ahmad, Dr T.Johnson

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Audit

Abstract (400 words maximum)

Retrospective Audit of Hysterectomy Routes and Outcomes at The Northern Care Alliance (NCA)

Background: Minimally invasive approaches (laparoscopic (LH) and vaginal (VH)) are favoured over abdominal hysterectomy (AH) due to benefits such as reduced blood loss and shorter hospital stays. This audit aimed to assess routes of hysterectomy and outcomes among those under the age of 50 having hysterectomy for benign indications. The Getting it Right First Time (GIRFT) standards and complication rates quoted from the British Society of Gynaecological Endoscopy (BSGE) consent advice were used as standards.

Methods: This retrospective audit looked at hysterectomies performed at NCA hospitals over a six-month period (January 2023 to June 2023). Data collected included patient demographics (age and BMI 30), primary indication, route of hysterectomy, length of stay (LOS) and complication rates (conversion to open, haemorrhage, visceral injury, and readmission).

Results: 141 hysterectomies were carried out, 67 LH (47%), 58 AH (41%), and 16 VH (11%). 76 (54%) were done in patients under 50 years old for a benign indication. Minimally invasive (LH or VH) rate was 59% (45/76), which is close to the 60% target. Abnormal uterine bleeding and endometriosis were the top contributors for this cohort.

Complication rates were as follows:
• Conversion to open: 4% (3/70 attempted LH), lower than the quoted 500 ml): 3% (4/141), meeting the <5% target.
• Visceral Injury: 4% (6/141), failing to meet the <1% target. This included two bowel and four urinary tract injuries.
• Readmission Rates: 5% (2/58) for AH (at the 5% target) and 3% (2/67) for LH (above the 2% target).
• Length of Stay (LOS): The median LOS for LH was 53 hours, just exceeding the 48-hour target. Even when accounting for outliers, LOS was the same for LH, VH and AH.

Conclusion: The unit demonstrates a rate of minimal access hysterectomy that is comparable to national standards and lower than anticipated conversion to open and haemorrhage rates. The audit was identified a higher-than-expected visceral injury rate (4%). This calls clinicians to reflect on their counselling regarding intra-operative complication rates. Despite accounting for outliers, there was no difference in length of stay between LH, AH or VH. Whilst the push for day case hysterectomy remains; case selection, timing of surgery and streamlining care remains a logistical challenge. Patients must be informed about alternative routes of hysterectomy available, and clinicians should refer to their colleagues if a patient is likely to benefit from an alternative approach.

Name (Presenters)
Naila Iftikhar

Grade
ST7 trainee Obstetrics and Gynaecology

Hospital
Royal Bolton Hospital

Authors
Guillame Antem(4th Year medical Student,University of Manchester),Dr.Naila Iftikhar(Royal Bolton Hospital),Dr.Kenn.Lim(Northern Care Alliance)

Select
Case Report

Abstract (400 words maximum)

Management of Recurrent Ovarian Torsion in a 37-Year-Old Nulliparous Woman with Oophoropexy: A Case Report

Objectives:
Ovarian torsion is a gynaecological emergency involving rotation of the ovary on its ligamentous axis, leading to compromised blood flow, potential necrosis, and infertility if untreated. Recurrent ovarian torsion is rare and under-researched and poses a unique challenge due to risk of compromising ovarian reserve. There is the absence of standardised management guidelines for prevention and long term management. Literature suggests recurrence rates may be reduced with oophoropexy, but technique and patient selection remain debated. While oophoropexy is a recognised surgical option, variability in technique yields inconsistent outcomes.
This case report presents a rare case of recurrent ovarian torsion in a nulliparous woman, outlines the clinical decision-making process, and demonstrates successful prevention of further torsion using laparoscopic oophoropexy.

Methods:
A 37-year-old nulliparous woman presented with recurrent left ovarian torsion. She initially underwent laparoscopic detorsion of the left ovary. A second torsion occurred 2 months later, necessitating diagnostic laparoscopy, drainage of a left ovarian cyst, and repeat detorsion.
Given the recurrence, a pelvic ultrasound was performed in three months to assess for recurrence of ovarian cyst. The scan revealed a normal left ovary and a right exophytic ovarian cyst measuring 42x40x27mm. After discussion and counselling regarding risks and benefits, the patient opted for laparoscopic left oophoropexy to prevent further episodes.
A laparoscopic oophoropexy was performed using the “hot dog in a bun” technique. This method involves positioning the fallopian tube between the utero-ovarian ligament and mesosalpinx, effectively stabilising the ovary while preserving tubal function.
Results:
The procedure was uneventful with no intraoperative or postoperative complications. The patient recovered well and was discharged with advice to follow up in six months for a pelvic ultrasound to assess ovarian position and function. At time of writing, no further episodes of torsion have been reported.

Conclusion:
This case demonstrates successful management of recurrent ovarian torsion in a reproductive-aged woman through laparoscopic oophoropexy. It highlights the importance of prompt recognition and surgical intervention in ovarian torsion, considering prophylactic oophoropexy in patients with recurrence and choosing a fixation technique that preserves fertility potential.
Given the lack of formal guidelines for recurrent torsion, this case adds valuable insight to a limited evidence base. Further studies are needed to evaluate long-term outcomes, recurrence rates, and optimal techniques for oophoropexy in similar patients.

Name (Presenters)
Yousef Alebrahim

Grade
ST4

Hospital
St Mary’s Hospital, Manchester

Authors
Yousef Alebrahim, Abdullah Shahzad, Daxina Bhatt, Navneet Kaur, Elizabeth Mann, Lamiya Mohiyiddeen

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Research

Abstract (400 words maximum)

Immune dysregulation in Asherman syndrome

Objectives: Asherman syndrome (AS) is a challenging diagnosis for women experiencing subfertility. Definitive treatment with hysteroscopic adhesiolysis is complicated by a significantly high recurrence rate of intrauterine adhesions. As immune mechanisms drive fibrosis in other tissues, we investigated whether immune dysregulation underlies AS.

Methods: Blood and endometrial biopsies were obtained from women aged 18-43. AS was diagnosed at hysteroscopy, with follow-up samples obtained 6-12 weeks post-adhesiolysis. Controls were women with a normal uterine cavity or previous successful pregnancy. Serum biomarkers were measured using Luminex multiplex immunoassays (R&D Systems) in controls (n=40) and AS (n=10). Flow cytometry was used to phenotype endometrial immune cells. Imaging mass cytometry (HyperionTM) was used to investigate the spatial landscape of endometrial immune and stromal cells using control (n=5) and AS samples taken at diagnosis (n=6) and follow-up (n=6).

Results: Serum analysis identified significant differences in proliferation markers (IGFBP-1), adhesion molecules (NCAM-1, CD62L), extracellular matrix regulators (MMP-9) and pro-inflammatory cytokines (IL-1α, IL-12 p70). Flow cytometry showed high numbers of monocytes in AS patients that sustained post-adhesiolysis, indicating ongoing immune dysfunction despite macroscopic resolution of fibrosis. Imaging mass cytometry demonstrated reduced type 1 collagen deposition and increase in cell-cycle marker Ki67 post-adhesiolysis, indicating endometrial proliferation and restoration of tissue structure. High numbers of B cells (CD20+) were observed in AS patients. Post-adhesiolysis, B cells formed clusters with CD8+ T cells, developing B cell follicles.

Conclusions: AS is characterised by persistent immune dysregulation, particularly involving monocytes and B cells. These findings suggest that immune pathways may drive adhesion recurrence and represent targets for new immunomodulatory therapies.

POSTER PRESENTATIONS

Name (Presenters)
Jiexin Cao

Grade
Clinical Research Fellow

Hospital
St Mary’s Hospital

Authors
Jennifer C Davies, Rachel L Hawkins, Lee Malcomson, Lorna McWilliams, Emma J Crosbie

Select
Research

Abstract (400 words maximum)

Barriers to cervical screening and the potential for self-sampling methods to improve screening uptake in people from ethnically diverse backgrounds living in the UK: the Alternative CErvical Screening (ACES) Diversity study

Introduction
People from ethnically diverse backgrounds are less likely to attend cervical screening in the UK. Self-sampling may overcome some of the barriers experienced. This study aimed to understand the barriers and explore the potential for vaginal and urine self-sampling to improve cervical screening uptake among people from ethnically diverse backgrounds living in the UK.
Methods
A survey was co-created with community groups in Greater Manchester, UK and distributed through community partners and via social media using online and paper versions, targeted to maximise recruitment from ethnically diverse groups. People over 18 years and invited for cervical screening now or in the future were eligible to participate. Data were collected via the Qualtrics platform and analysed using descriptive statistics.
Results
A total of 629 completed surveys were analysed, 450 (71.5%) of which were from participants from African (n=91, 20%), Chinese (n=69, 15.2%), Indian (n=69 ,15.2%), Pakistani (n=49, 10.8%), Mixed (n=52, 11.6%), Caribbean (n=21, 4.6%), Eastern European (19, 4.2%), Arabic (n=11, 2.4%), or other ethnically diverse backgrounds (n=71, 15.8%) and 173 were White British. Emotional barriers, including worry about discomfort/pain (n=165, 36.7%) and lack of a female practitioner (n=133, 29.6%) were major barriers to routine cervical screening for participants from ethnically diverse backgrounds. By contrast, practical barriers, such as difficulty finding a good time for screening, were most important barriers for White British participants (n=75, 43.3%). For future screening, 157/343 (45.8%) preferred self-sampling, especially poor attenders to routine screening, across all ethnic groups. More ethnically diverse participants felt confident about taking a urine self-sample than a vaginal self-sample for future cervical screening (375/450; 82.2% vs 271/450; 59.8%).
Conclusion
People from ethnically diverse backgrounds in the UK face specific barriers to cervical screening. Self-sampling may be an acceptable alternative to these populations, with urine self-sampling having broadest appeal.

Name (Presenters)
Jiexin Cao

Grade
Clinical Research Fellow

Hospital
St Mary’s Hospital

Authors
Jennifer C Davies, Suzanne Carter, Alex Sargent, Phil AJ Crosbie, Emma J Crosbie

Select
Research

Abstract (400 words maximum)

Urine human papillomavirus (HPV) testing as a strategy for cervical screening in high-risk older women The Alternative CErvical Screening (ACES) 65+ study

Background:
In the UK, an arbitrary age cut-off of 65 years is used for routine cervical screening, despite mortality rate increases exponentially from 70 years old. Non-attenders of screening and current/ex-smokers from socioeconomically deprived backgrounds are at greatest risk. Speculum examination is poorly tolerated in this age group, but urine HPV testing is less invasive with similar sensitivity for cervical pre-cancer detection (CIN2+) compared to routine screening. Our aim was to establish the acceptability of urine HPV testing for cervical screening over 65-year-olds attending community-based lung cancer screening.
Methods:
People attending community-based targeted lung health checks in Greater Manchester, UK who were 65 years or older with a cervix were invited to provide a urine sample using the Colli-Pee®, a specialised first void urine collection device, for high-risk HPV testing using Roche Cobas 8800. Participants whose urine tested HPV positive were offered a clinician-collected cervical sample for HPV and cytology testing. Colposcopy was performed on those with abnormal cervical samples. A questionnaire was used to ascertain acceptability of urine sampling for cervical screening.
Results:
A total of 2320 urine samples were tested for HPV. Two hundred and five (8.8%) tested urine HPV positive, of whom 160 (78.0%) provided cervical samples, and 66 (41.3%) of these had positive findings. To date, colposcopy has been performed on 56 (2.4%) participants with 9 (0.4%) CIN2+ lesions detected so far. Urine self-sampling had high acceptability, with 1987 (91.4%) participants confident about using the Colli-Pee® device.
Conclusion:
The 0.4% CIN2+ rate is comparable to that of women over 50 years of age (0.5%) in the UK cervical screening programme. This suggests that the upper age limit for routine cervical screening warrants re-evaluation. Urine self-sampling was acceptable and could encourage screening uptake in high-risk individuals accessing healthcare for another indication.

Name (Presenters)
Hagar Salem

Grade
FY2

Hospital
Liverpool Women’s Hospital

Authors
Hagar Salem, Amr Malawany, Mohammed Sunoqrot, Alaa Abusido, Mohamed Okba

Select
Audit

Abstract (400 words maximum)

Depth of Myometrial Invasion and Lymphovascular Space Invasion as Predictors of Nodal Metastasis in Endometrial Cancer.

Introduction/Background
Accurate prediction of nodal metastasis is essential for optimizing the extent of lymphadenectomy and guiding adjuvant treatment in endometrial cancer. Lympho-vascular space invasion (LVSI) and the depth of myometrial invasion are recognised pathological risk factors for nodal metastasis. Both factors form key components of the ESGO/ESTRO/ESP risk stratification systems for endometrial cancer; however, their relative predictive value is uncertain. This study aimed to determine which factor correlates more strongly with nodal metastasis.

Methodology
Patients who underwent hysterectomy for endometrial cancer between 2022 and 2025, at Liverpool Women’s Hospital, were retrospectively identified from pathology records (465 patients). Histology reports were reviewed for depth of myometrial invasion, presence and extent of lymphovascular space invasion (LVSI), and nodal status. LVSI was graded as none, focal, or substantial. Cases without complete histological data were excluded. Associations between these pathological variables and nodal metastasis were analysed using Fisher’s exact test, with statistical significance defined as p < 0.05.

Results
173 patients had nodal assessment. Nodal metastases were identified in 34 of 173 patients (19.7%). Increasing LVSI grade correlated strongly with nodal positivity (Fisher’s exact p= 0.0004; trend p = 0.0008). Cases with any LVSI demonstrated a significantly higher rate of nodal involvement compared with those without LVSI (31.4% vs 8.2%; p= 0.0003).
Deeper myometrial invasion also predicted nodal metastasis (Fisher’s exact p= 0.022; trend p= 0.0059), with ≥50% invasion showing significantly greater nodal positivity than <50% or none (32% vs 11%; p= 0.012).

Conclusion
Both LVSI and depth of myometrial invasion were independently associated with lymph-node metastasis in this surgically staged cohort. LVSI demonstrated the stronger correlation and should remain a pivotal factor in pathological risk stratification. These findings support their continued integration into ESGO/ESTRO/ESP algorithms and may inform the selection of patients for sentinel node assessment or extended lymphadenectomy.

Name (Presenters)
Dr Mohamed Hemdan

Grade
Senior clinical fellow

Hospital
Manchester Foundation Trust

Authors
Hemdan M, Shelleh A, Yan A, Murdeshwar A.

Select
Research

Abstract (400 words maximum)

Presence of Endometriosis in the Appendix: A Retrospective Review of Appendicectomy Specimens in Females of Childbearing Age

Objectives:
To determine whether appendicectomy specimens from females of childbearing age who underwent surgery for abdominal pain demonstrated histological evidence of endometriosis within the appendix.

Methods:
A retrospective review was conducted of intra-operative findings and histopathology reports from females aged 18–50 who underwent appendicectomy for abdominal pain over a six-month period in 2024. Electronic medical records were examined to collect data on operative indications, histological outcomes, and any previous history of endometriosis. A total of 180 appendicectomy cases were included in the analysis.

Results:
All 180 appendicectomies were performed for new-onset abdominal pain, most commonly due to suspected acute appendicitis. Histopathological review confirmed acute appendicitis in the majority of cases. Importantly, no cases demonstrated endometriosis within the appendix on histological examination, including those with a prior diagnosis of endometriosis.

Conclusions:
Within this cohort, appendicectomy for abdominal pain was predominantly performed for acute appendicitis, with histological confirmation in most cases. No instances of appendiceal endometriosis were identified. This raises the question of whether pathologists in local practice routinely assess appendiceal specimens for endometriosis and whether specific histological criteria or heightened awareness are required to detect such findings. Further investigation into local pathological practices and the frequency of appendiceal involvement in patients undergoing surgery for known endometriosis would be valuable to clarify the true incidence and clinical significance of this phenomenon.

Name (Presenters)
Emmanuella Adu-Peprah

Grade
ST3

Hospital
North Manchester General Hospital

Authors
Dr Emmanuella Adu-Peprah, Dr Pratyusha Chaudhuri, Dr Evlyn James

Select
Case Report

Abstract (400 words maximum)

The curious case of an ovarian ectopic pregnancy

Objectives:
Ovarian ectopic pregnancies are rare, accounting for 0.5–1% of all ectopic pregnancies. They can often present diagnostic challenges, as they can be difficult to distinguish from corpus luteal cysts, tubal ectopic pregnancies adherent to the ovary, a second corpus luteum, or other ovarian pathologies. This case highlights the challenges in diagnosing and managing an ovarian ectopic pregnancy.
Case Report:
A 33-year-old woman, gravida 2 para 1 (one normal vaginal delivery), presented to the emergency department after a private scan suggested a possible ectopic pregnancy. She was asymptomatic at presentation, with gestation estimated at 6 weeks and 2 days based on her last menstrual period. Her admission β-hCG was 16,858 IU/L. A subsequent scan showed a suspected right-sided ectopic pregnancy with no yolk sac or fetal pole and no free fluid.
She was consented for diagnostic laparoscopy and possible excision of ectopic pregnancy. Intraoperatively, a 4 × 3 cm haemorrhagic cystic mass was noted on the right ovary, raising uncertainty between a corpus luteum or an ovarian ectopic pregnancy. A decision was made by multiple consultants to preserve the ovary, and a plan was made to monitor β-hCG levels.
Given the ongoing diagnostic uncertainty, a second opinion was sought from a consultant with early pregnancy expertise. Upon reviewing ultrasound and intraoperative images. The management options he advised included either re-laparoscopy for excision or methotrexate administration with inpatient monitoring until day 7 to ensure safety and monitor treatment effect. The patient remained asymptomatic and preferred to avoid oophorectomy. Serial β-hCG results were: 16,858 IU/L (5th April 2025), 10,827 IU/L (7th April), and 8,842 IU/L (8th April).
On 8th April, as the β-hCG remained above the methotrexate treatment threshold, she was consented for a second laparoscopy. She underwent laparoscopic excision of the right ovarian ectopic pregnancy and was discharged the following day. Histopathological examination confirmed the diagnosis.
Discussion:
Preoperative diagnosis of ovarian ectopic pregnancy is often difficult. The increased vascularity associated with pregnancy and the proximity of the ectopically implanted trophoblast to ovarian and uterine vessels pose a significant risk of massive, life-threatening haemorrhage. Although medical management with methotrexate may be considered in haemodynamically stable patients, evidence of its success is limited, particularly without laparoscopic confirmation. Definitive treatment is successful with laparoscopic excision.

Conclusion:
Ovarian ectopic pregnancies are typically diagnosed intraoperatively and confirmed histologically. Early recognition and multidisciplinary management is essential to minimise morbidity and preserve ovarian function.

Name (Presenters)
Aisha Anwar

Grade
ST5

Hospital
Liverpool Women’s Hospital

Authors
Aisha Anwar, Lewis Nancarrow, Nicola Tempest

Select
Research

Abstract (400 words maximum)

Transvaginal vs Transabdominal Ultrasound-Guided Embryo Transfer: Does Catheter Echogenicity Matter?

Objective:
In vitro fertilisation (IVF) involves ovarian stimulation, egg retrieval, fertilisation, and embryo transfer (ET). Despite advancements, success rates remain modest, with only ~25% of women achieving a live birth after their first ET, often causing considerable distress. While laboratory techniques have progressed, ET—the final and crucial step—has seen limited innovation. Across the UK, practice varies in catheter type and ultrasound guidance, most commonly transabdominal (TAUSG) or transvaginal (TVUSG). This study aimed to evaluate whether ultrasound method and catheter echogenicity influence pregnancy outcomes following ET.

Methods:
We retrospectively analysed all ETs performed by a single practitioner between March–December 2024 (n = 145), including both fresh and frozen embryo transfer (FET) cycles. Three approaches were compared: (1) TVUSG ET, (2) TAUSG ET with an echogenic catheter tip, and (3) TAUSG ET with a non-echogenic catheter. ETs performed without ultrasound guidance were excluded. The primary outcome was a positive pregnancy detection test (PDT). Statistical analysis was performed using chi-square with post-hoc testing.

Results:
Of 145 ETs (90 FET, 55 fresh; mean age 34.6 ± 4.5 years), a significant association was observed between ET approach and PDT outcome, χ²(2, N = 145) = 7.95, p = .019. Post-hoc analysis showed TAUSG ET with a non-echogenic catheter had a significantly lower pregnancy rate compared with both TVUSG ET and TAUSG ET with an echogenic catheter. No significant difference was found between TVUSG ET and TAUSG ET with an echogenic catheter.

Conclusions:
The ET approach significantly influences pregnancy outcomes. TAUSG ET using a non-echogenic catheter was associated with reduced success, whereas TVUSG ET and TAUSG ET with an echogenic catheter appeared comparable and more effective. Prospective studies assessing clinical pregnancy and live birth rates are required to confirm and expand upon these findings.

Name (Presenters)
Mohamed Hemdan

Grade
Senior Locally Employed Doctor in O&G

Hospital
Wythenshawe Hospital

Authors
Mohamed Hemdan, Rohit Arora, Weihong Ma

Select
Case Report

Abstract (400 words maximum)

An Exceptionally Rare Ovarian Lymphangioma Mimicking a Dermoid Cyst Recurrence: A Case Report

Authors:
Mohamed Hemdan¹, Rohit Arora², Weihong Ma³
¹Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester, UK
²Department of Gynaecology, Manchester University NHS Foundation Trust, Manchester, UK
³Department of Histopathology, Manchester University NHS Foundation Trust, Manchester, UK

Background
Ovarian lymphangioma is an exceptionally rare benign tumour derived from lymphatic vessels, with only a few cases reported worldwide. The imaging features are nonspecific and often resemble those of common adnexal lesions. Therefore, a definitive preoperative diagnosis is difficult, making histopathological confirmation essential. Surgical excision, either by cystectomy or oophorectomy, is the treatment of choice, with a favourable prognosis when excised completely. However, because of the rarity of this condition, there are no established evidence-based recommendations for postoperative surveillance, and follow-up is usually tailored to the individual after multidisciplinary review. We report a unique case of an ovarian lymphangioma coexisting with a haemorrhagic corpus luteal cyst, initially mistaken for a recurrent dermoid cyst after laparoscopic cystectomy.

Case Presentation:
A woman in her 30s presented with pelvic pain and menorrhagia one year after laparoscopic right ovarian cystectomy for a mature teratoma. Ultrasound demonstrated a hyperechoic, solid-appearing cystic lesion within the right ovary containing small cystic spaces and no Doppler vascularity, suggesting dermoid cyst recurrence. Tumour markers were within normal limits. The patient underwent laparoscopic right salpingo-oophorectomy. Macroscopically, the ovary contained a cystic structure measuring 32 × 25 mm with focal haemorrhage. Microscopy revealed a haemorrhagic corpus luteal cyst coexisting with multiple back-to-back thin-walled vascular channels lined by bland endothelium, positive for CD34 and focally for D2-40 (podoplanin), confirming a benign lymphangioma. Recovery was uneventful, and annual pelvic ultrasound for two years was advised following multidisciplinary review.

Discussion:
Ovarian lymphangioma is an extremely rare benign tumour, with pathogenesis thought to be either congenital or acquired. Congenital theories suggest entrapment of lymphatic channels during embryogenesis, while acquired mechanisms include lymphatic obstruction secondary to infection, inflammation, trauma, or prior surgery. In this case, development one year after laparoscopic cystectomy supports an acquired or reactive origin, likely from surgical disruption of local lymphatic vessels leading to stasis and endothelial proliferation. Histologically, lymphangiomas comprise thin-walled vascular channels lined by bland endothelium and demonstrate positivity for D2-40 and CD34, confirming lymphatic differentiation. In imaging, they present as multiloculated cystic lesions resembling dermoid cysts or cystadenomas, making histopathology the diagnostic gold standard. Surgical excision by cystectomy or oophorectomy remains curative, with an excellent prognosis and minimal recurrence risk. Given the absence of standardised surveillance protocols, follow-up should be individualised. In this patient, annual pelvic ultrasound for two years was recommended following multidisciplinary review, reflecting best practice for rare benign ovarian tumours.

Conclusion:
Ovarian lymphangioma is an exceptionally rare benign tumour that may mimic common adnexal cystic lesions, creating diagnostic challenges. Diagnosis relies on histopathological and immunohistochemical confirmation, particularly D2-40 staining. Complete excision is curative, with recurrence being exceedingly uncommon. Multidisciplinary review ensures appropriate follow-up, and greater clinical awareness can prevent misdiagnosis and optimise management of similar cases.

Name (Presenters)
Zaibun Khan

Grade
ST6

Hospital
St Mary’s hospital

Authors
Zaibun Nisa Khan, Navneet Kaur, Ciaran Barclay, Kingshuk Majumder, Edmond Edi-Osagie & Kenneth Ma.

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Research

Abstract (400 words maximum)

Laparoscopic transabdominal cerclage, A tertiary hospital experience from 2010.

Introduction:
Transabdominal cerclage (TAC) is an established management option for women with recurrent second-trimester pregnancy loss or extreme preterm birth, particularly when vaginal cerclage has failed or is anatomically unsuitable. Compared to vaginal cerclage, TAC offers superior protection against early preterm birth and fetal loss. The laparoscopic approach has demonstrated equivalent efficacy to open TAC with the additional benefits of reduced postoperative pain, shorter recovery, and fewer complications. This study presents a 15-year tertiary hospital experience with laparoscopic transabdominal cerclage (LAC), evaluating perioperative and obstetric outcomes.

Methods:
A retrospective analysis was conducted on all women who underwent LAC at a tertiary referral centre between January 2010 and January 2025. Data were collected on demographics, surgical outcomes, complications, and obstetric outcomes for women with at least 12 months of follow-up after surgery. Descriptive statistics were used for analysis.

Results:
A total of 51 LAC procedures were performed, including four during pregnancy. The median age was 35 years (range 22–42) and median BMI 29 (range 22–43). Indications included previous second-trimester loss (41/51), history of cervical surgery with short cervix (8/51), failed elective vaginal cerclage (20/51), failed rescue cerclage (4/51), and cervix unsuitable for vaginal cerclage (8/51).
Median operative time was 84 minutes. Blood loss was <100 mL in 76% of cases, with two patients (4%) exceeding 300 mL. Ninety percent of women were discharged within 24 hours. There were two intraoperative complications but neither resulted in any adverse outcomes.
Of 44 women eligible for obstetric outcome analysis, 30 (68%) conceived. Three experienced early miscarriage and one pregnancy was terminated for fetal chromosomal abnormality. Among the remaining 26 pregnancies; 25 (96%) resulted in birth at or above 34 week’s gestation with 22 (88%) delivering above 37 weeks. One pregnancy (4%) was complicated by preterm rupture of membranes and chorioamnionitis at 21 weeks.
Of the four LACs performed during pregnancy (9–16 weeks), three women delivered at term and one ongoing pregnancy reached 28 weeks at the time of reporting.

Conclusion:
Laparoscopic transabdominal cerclage is a safe and effective intervention for women with cervical insufficiency where vaginal cerclage is unsuitable or has failed. The high term delivery rate (88%) and absence of major surgical complications demonstrate favourable maternal and perinatal outcomes comparable to international standards, supporting the continued use of LAC within tertiary endoscopic units.

Name (Presenters)
Naila Iftikhar

Grade
ST7

Hospital
Royal Bolton Hospital

Authors
Naila Iftikhar:Royal Bolton Hospital.Guillame Antem:University of Manchester,Kenn Lim:Salford Royal Hospital

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Case Report

Abstract (400 words maximum)

Primary Uterine Non-Hodgkin B-cell Lymphoma Presenting with Postpartum Bleeding: Successful Management with Chemotherapy and Adjuvant Robotic Hysterectomy – A Rare Case Report.

Burkitt lymphoma is a highly aggressive B-cell non-Hodgkin lymphoma known for its rapid growth rate. Burkitt lymphoma of the endometrium is an extremely rare occurrence. When it arises primarily in the endometrium ,it presents a unique clinical challenge due to its rarity and the potential for misdiagnosis with more common gynaecological conditions. Due to the rarity, there are no standard treatment guidelines for primary endometrial Burkitt lymphoma. Due to the aggressive nature the intensive chemotherapy needs to be commenced immediately.This case report aims to highlight the diagnostic challenges and successful management of this rare entity with chemotherapy and adjuvant hysterectomy.

Methods:
A 31 years old lady presented to the gynaecology department with history of ongoing heavy bleeding 6 weeks after normal vaginal delivery. She was commenced on Tranexamic acid and norethisterone which did not help much.An ultrasound scan was
performed which was suggestive of retained products of conception.She underwent
hysteroscopic guided surgical evacuation of retained products.. Histological analysis of the evacuated tissue unexpectedly revealed primary endometrial high-grade B-cell Non
Hodgkin lymphoma, likely Burkitt lymphoma.Following the diagnosis, an urgent referral was made to Haematology .CT scan at diagnosis showed the disease to be confined to the uterus with bulky disease. Her haemoglobin had dropped to 77.The significant risk of bleeding or potential uterine rupture with the initial cycle of chemotherapy was discussed with the patient given the rapid rate of growth of the tumour and rapid
breakdown.She tolerated her chemotherapy really well and after 2 – 3 weeks the excessive bleeding lessened and the pelvic mass shrunk considerably in size.The post treatment PET scan showed a complete remission and a normal sized uterus. As she had completed her family she was keen to have a hysterectomy instead of a radiotherapy to avoid radiotherapy associated side effects.Her case was discussed in the MDT and an MRI was performed for surgical planning. She underwent robotic hysterectomy with conservation of the ovaries in the oncology centre.

Results:

The patient achieved complete remission after chemotherapy. The subsequent robotic hysterectomy with ovarian conservation was performed successfully. Postoperative recovery was uneventful, and the patient remains under regular haematological follow-up with no evidence of disease recurrence.

Conclusion:
This case underscores the diagnostic pitfalls of primary endometrial B-cell lymphoma, where initial presentation and even endoscopic findings can be misleading, mimicking common gynaecological issues like postpartum complications. Successful management with chemotherapy followed by adjuvant robotic hysterectomy with ovarian preservation demonstrates a potential treatment strategy for this rare malignancy.This
case emphasizies the importance of thorough histological evaluation of
endometrial samples obtained during gynaecological procedures.

Name (Presenters)
Zara Cotton

Grade
ST4

Hospital
St Mary’s Hospital, Manchester

Authors
Z Cotton, T Manias, K Ma

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Research

Abstract (400 words maximum)

Learning from Rarity: A Case Series Analysis of Interstitial Pregnancy Management in a Tertiary Referral Centre

Z Cotton (ST4), T Manias (Cons), K Ma (Cons)

Objectives
Interstitial pregnancies (IP) are those that develop within the interstitial portion of the fallopian tube and accounts for 2% of all ectopic pregnancies. These pregnancies carry a high risk of uterine rupture, catastrophic haemorrhage, and maternal mortality.
Current evidence to guide optimal diagnosis and management remains limited. This retrospective study evaluates the diagnostic pathways, management approaches and clinical outcomes at a tertiary referral centre.

Methods
Cases of IP were prospectively identified over a sever-year period at a tertiary referral centre. Data was retrospectively analysed using electronic patient records including review of demographics, diagnostic pathways, management strategies and associated complications.

Results
Twenty-six cases of IP were identified over a seven-year period. Patient age ranged from 22 to 47 years (median 34), BMI 21 to 42 (median 30.5), and parity 0 to 3 (median 1). The median gestational age was 6+4 weeks gestation (range from 4+0 to 16+6 weeks). 21/26 were symptomatic of pain at presentation, with a mean serum hCG at presentation of 25 819 iu/l (range from 1222 to 290 823 iu/l).
14/26 had no recognisable risk factors for IP; defined as previous ectopic pregnancy, previous tubal surgery, previous pelvic infection, and assisted conception.
Diagnosis was made pre-operatively by ultrasound in 20/26 cases and incidentally at laparoscopy in 6/26 cases. 16/26 were initially identified by sonographers, with 9/16 requiring confirmation by expert consultant scan. 4/20 cases were diagnosed by consultants only. 6/20 were diagnosed by 3D sonographic visualisation.
11/26 cases had a live interstitial ectopic pregnancy, a higher proportion than published literature suggests. Of the 6 diagnosed at Laparoscopy, 3 were incorrectly diagnosed as tubal ectopics by ultrasound.
Management strategies comprised conservative (1/26), medical (3/26), and surgical interventions (22/26).
All medical management involved the use of systemic methotrexate with resolution within 36-51 days. 1/4 cases of medical management results in surgical management 4 days later due to signs of rupture.
Surgical management involved either cornuectomy (12/22) or cornuostomy (10/22). 3/22 cases required conversion to laparotomy, and 4/26 cases were ruptured at time of surgery. The estimated blood loss ranged from minimal to 1700 mls (median 100 mls).
There were 3 cases of recurrence across the seven-year period.

Conclusion
This retrospective case series highlights the diagnostic challenges for interstitial pregnancies even within a tertiary referral centre. 13 out of 26 cases required specialist sonographic assessment by gynaecology consultants, underscoring the need for expertise and prevalence of 3D ultrasound scanning.
While there is no national guidance or large studies to inform the choice between cornuectomy and cornuostomy, this dataset supports cornuosotmy as a safe and more conservative approach which preserves normal anatomy and reduces loss of myometrium.

Name (Presenters)
Eleanor Jones

Grade
ST5

Hospital
Saint Mary’s

Authors
Eleanor Jones, Gail Busby

Select
Quality Improvement

Abstract (400 words maximum)

The acceptability of outpatient hysteroscopy for women who self-select this mode of analgesia

Objectives:
Hysteroscopy, a diagnostic procedure used to visually examine the endometrium, is commonly used to investigate abnormal bleeding. It can be performed either without analgesia, with local anaesthesia, under sedation or under spinal or general anaesthetic (GA). Patient-reported pain scores vary considerably. A significant proportion of patients find it extremely painful. Our objective was to survey patients who had undergone outpatient hysteroscopy to gain insights into the acceptability of the procedure and measures that can improve this.

Methods:
We conducted a retrospective survey of consecutive patients who underwent outpatient hysteroscopy by an experienced operator in the private sector. Surveys were sent to patients by administrative staff and the results analysed after the first 50 were returned.

Results:
Of the 50 women who responded to the survey, 92% reported having received either written information, an information video or both. 90% felt that they knew what to expect from the procedure and 90% took painkillers beforehand. All women felt that they were offered an opportunity to discuss pain relief options, and all felt involved in the decisions regarding their care. The operator’s normal practice is to offer all patients different pain relief options, including GA, and 86% of patients recalled being offered the option of having the procedure under GA. Additional measures including heat packs and Entonox were also offered. Mean pain scores were 5.34 (range 0-10). 30% of women reported a pain score between 7 and 10, which is better than patient reported national data. When asked if they were to need a repeat hysteroscopy how they would choose to have the procedure performed, 66% stated they would choose outpatient (the same again), 18% stated they would choose conscious sedation, 2% stated they would choose spinal anaesthetic and 14% stated general anaesthetic.

Conclusions:
Acceptability of outpatient hysteroscopy was overall good and higher than the national average. All women were well informed prior to the procedure and were given complete choice on their mode of analgesia, including the option of GA. Good patient education and self-selection of their mode of analgesia are vital for the optimisation of the patient experience at outpatient hysteroscopy.

Name (Presenters)
Jovariah Aziz

Grade
Senior Clinical fellow

Hospital
Wythenshawe

Authors
Jovariah Aziz, Aneeqa Ashraf, Akanksha Sood, Sujata Gupta

Select
Case Report

Abstract (400 words maximum)

Echoes of a Cyst: An Unusual Recurrent Presentation in a Young Female

Objectives:
Recurrent symptomatic large benign ovarian cysts, such as mucinous cystadenomas, present a significant challenge in young females, especially when repeated surgeries are required. This case highlights the complexities of managing such cases while preserving fertility and minimizing ovarian damage.
Methods:
This report details the case of a young nulliparous female who underwent seven laparoscopic procedures for symptomatic mucinous cystadenomas over the course of 2 years, out of which the last three were done as emergency procedures for suspected ovarian torsion. Bilateral cyst recurrences persisted, leading to egg preservation and a subsequent left salpingo-oophorectomy after discussion with a multidisciplinary gynaecology oncology team.
Results:
The most recent laparoscopic procedure took place in May, following which she was seen in the Consultant clinic where she expressed aim to conceive naturally as advised by fertility team. Her follow-up appointment is scheduled in six months with interval pelvic ultrasound. Despite repeated surgeries, the patient continues to face management challenges with recurrent presentations in emergency gyne unit with pelvic pain.
Conclusion:
This case emphasizes the importance of considering age, parity, and the impact of ovarian removal on fertility when planning surgeries for recurrent ovarian cysts. Recurrent cysts and multiple surgeries, particularly in a young woman, raise concerns about premature menopause and its physical and mental health implications. Multidisciplinary management and individualized care are essential in navigating these complex cases.

Name (Presenters)
Eleanor Jones

Grade
ST5

Hospital
Saint Mary’s Hospital, Manchester

Authors
Eleanor R Jones, Helena O’Flynn, Kelechi Njoku, Chloe E Barr Suzanne Carter, Emma J Crosbie

Select
Research

Abstract (400 words maximum)

Risk factors for endometrial cancer in women presenting to secondary care with postmenopausal bleeding

Objectives:
Postmenopausal bleeding (PMB), the red flag symptom for endometrial cancer, is a common reason for urgent gynaecological review. A recent upsurge in urgent referrals and changing population demographics mean that predictors of endometrial cancer amongst symptomatic women may be different from those reported in the literature. Identifying the risk factors associated with endometrial cancer in women with PMB is essential to improve early diagnosis. Our aim was to characterise predictive associations for known risk factors and to identify potential new clinical features associated with endometrial cancer.

Methods:
Data from the DETECT study were collected on participant demographics, previously reported risk factors, presenting symptoms and signs, urinalysis results, and transvaginal scan results. The odds ratio (OR) and 95% confidence intervals (CI) were estimated using univariable logistic regression for endometrial cancer and atypical endometrial hyperplasia (AEH). The effect of suspected confounders was considered using multivariable logistic regression analysis. Findings were compared for Bokhman Type I and II cancers. Predictive values were calculated for the most significant variables.

Results:
In total, 1864 postmenopausal women were included in the study, of whom 99 (5.3%) had endometrial cancer and 27 (1.4%) AEH. Endometrial cancer was more likely with advancing age [OR 1.11 per one year increase in age (95% CI 1.09-1.14), p value <0.001], particularly for Bokhman Type II cancers [OR 1.15 per one year increase (95% CI 1.12-1.18), p <0.001], and with higher BMIs [OR 1.03 per 1kg/m2 increase in body mass index (BMI) (95% CI 1.01-1.06), p=0.010], particularly for Bokhman Type I cancers [OR 1.06 per 1kg/m2 increase (95% CI 1.03-1.09), p<0.001]. Recurrent vaginal bleeding gave an OR of 6.00 (95% CI 3.26-11.05) for endometrial cancer. Age, BMI, recurrent vaginal bleeding [OR 6.42 (95% CI 3.41-12.08), p<0.001] and older age at menopause [OR 1.07 per one year increase (95% CI 1.02-1.12), p=0.006] remained strongly associated with endometrial cancer on multivariable analysis, whilst ever use of hormone replacement therapy [OR 0.54 (95% CI 0.32-0.92), p=0.023] was strongly protective. Abnormal urinalysis, particularly haematuria, predicted endometrial cancer with an OR of 5.42 (95% CI 3.53-8.32, p<0.001).

Discussion:
The prevalence of endometrial cancer in women referred to secondary care with PMB is lower than expected from previous studies. Established risk factors, as well as haematuria, were strongly predictive of endometrial cancer in our cohort. Additional triage strategies to reduce the burden of invasive diagnostics on patients and the healthcare system are needed and could incorporate these findings.

Name (Presenters)
Maya Whittaker

Grade
ST3

Hospital
St Mary’s Hospital

Authors
Maya Whittaker, Eleanor R. Jones, Suzanne Carter, Helena O’Flynn, Chloe E. Barr, Kelechi Njoku, Emma J. Crosbie

Select
Research

Abstract (400 words maximum)

The diagnostic pathway in practice for detection of endometrial cancer in a prospective cohort of women presenting with postmenopausal bleeding

Objectives
Post-menopausal bleeding (PMB) is an indication for urgent referral to exclude endometrial cancer. We aim to describe the diagnostic pathway for PMB in practice and explore adherence to national guidelines for investigations performed following referral to a gynaecologist.

Methods
We conducted a multicentre cross-sectional study of 1,864 women with PMB, recruited across Greater Manchester between 2018–2021. Diagnostic investigations attempted were compared to concurrent British Gynaecological Cancer Society (BGCS) guidelines. These recommend hysteroscopy for an endometrial thickness (ET) ≥4mm, endometrial irregularity or presentation with recurrent PMB; pipelle biopsy for a regular endometrium with ET≥4mm; and no further investigation if ET <4mm.

Results
There were 99 (5.3%) women with endometrial cancer. Among 898 (48.2%) women with hysteroscopy attempted, 738 (82.2%) were completed. Endometrial biopsies were attempted in 1,138 (61.1%) women, including 54 (4.7%) failed, 62 (5.4%) insufficient and 176 (17.2%) inadequate biopsies. There were 13 (4.5%) cases of endometrial cancer among those with an inconclusive biopsy. The diagnostic accuracies of ultrasound (43.7%), hysteroscopy (90.9%) and endometrial biopsy (99.4%) varied and increased when used in combination.

Overall, 1,013 (56.6%) women had guideline-concordant care following ultrasound. Among the 1,791 (96.8%) women with a conclusive ultrasound scan, 1,439 (80.4%) required further investigation, but only 708 (49.2%) had these as recommended by BGCS. 47 (13.4%) women who could have been discharged underwent further investigation.

Among 797 (42.8%) women who underwent all three investigation modalities, 195 (24.5%) accessed these in a single ‘one-stop’ appointment. 774 (41.5%) women attended more than one appointment and 352 (18.9%) women had investigations repeated.

Conclusions
We found a high burden of investigations on women presenting with PMB, with just 56.6% receiving guideline-concordant care. Increasing pressures on cancer exclusion pathways and patient dissatisfaction with invasive diagnostic tools necessitates innovation in risk stratification to ensure timely diagnosis and treatment of people with endometrial cancer.

Name (Presenters)
Ammar Rafiq

Grade
ST7

Hospital
University Hospitals of North Midlands NHS Trust

Authors
Ammar Rafiq, Ahmed Salama, Mohamed Elsheikh, Ayesha Mahmud, Nitish Raut, Gourab Misra

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Research

Abstract (400 words maximum)

Assessment of the Impact of dedicated hands simulation course on laparoscopic skills of gynaecological resident doctors

Objective:
There is a recognized need for systematic training interventions to ensure gynae trainees in the UK acquire proficiency and safety in minimally invasive procedures. This study aimed to assess the impact of a dedicated intensive hands-on laparoscopic course on the improvement of laparoscopic key skills of the gynaecology resident doctors.

Methods:
A dedicated laparoscopic training course was conducted over the course of two days for gynaecology resident doctors. The course included more than 10 hours of hands-on sessions, where two participants were mentored by one faculty member on a lap trainer. Exercises included hand-eye coordination, suturing, knot-tying techniques, myomectomy, and salpingectomy models using energy devices. The effectiveness of this intervention was evaluated via pre- and post-course self-assessment scores across a comprehensive set of 19 core laparoscopic competencies covering four major domains, i-e hand-eye coordination, needle handling, suturing & knot tying.

Results:
Across all domains, mean scores improved significantly post intervention, with average total score rising from 2.35 (pre-course) to 3.67 (post-course)- a 26% average improvement.
Notable increase was seen in, knoy tying (+31.3%), suturing technique (+29.7%), needle handling (+28%) with individual skill elements improved between 12 to 34%. No skill domains declined after the intervention.

Conclusion:
Participation in the laparoscopic course led to a consistent and meaningful improvement in self-assessed laparoscopic surgical skills among participants. The structured intervention positively impacted core technical abilities necessary for safe and effective practice. These results support the incorporation of such courses into routine UK gynae training pathways to enhance surgical competence and patient safety.

Name (Presenters)
Chevonne Risbrooke

Grade
ST2

Hospital
George Eliot Hospital

Authors
Risbrooke C, Elgharably, A. Subramaniem, A.

Select
Audit

Abstract (400 words maximum)

Uterine Artery Embolisation-  Effect on fibroid reduction and re-intervention rate 4-6 years post-procedure. A retrospective case series at New Cross Hospital UK
Uterine artery embolisation (UAE) effect on fibroid reduction and re-intervention rate

Objectives
• To determine the % reduction of uterine fibroids post-UAE.
• To quantify the re-intervention rate by repeat UAE or surgical intervention after 4-6 year follow-up.

Methods
• Electronic records of patients who underwent UAE in 2017 and 2018 were accessed for retrospective data collection.
• Data on patient demographics (age, ethnicity, parity), date of the UAE procedure and MRI reports before UAE and after UAE were collected.
• Follow-up clinic records 4-6 years post-UAE were accessed to determine whether any re-intervention by UAE or surgical intervention, either hysterectomy or myomectomy, were undertaken.

Results
49 patients were initially included in the data sample. After screening, 4 patients were excluded as 1 patient underwent UAE for adenomyosis, 2 patients were lost to follow-up and 1 patient was a duplicate record as they had a repeat UAE later in the same year. 45 patients were included in the final data analysis. The age range of the patients included were between 30-60 years. 44% of patients were Black, 36% White, 13% Asian and 7% Other ethnicities. 24% of patients were nulliparous and 62% parous. Parity was not recorded for 6 patients. The median time of admission post procedure was 1 day.
Of the 45 patients in the sample, 32 had MRI reports which described the diameter of the largest fibroid before UAE and after UAE. The mean percentage reduction of the largest uterine fibroid at 3-months was 11.2%, 4-6 months was 13.6% and >6-months was 21%. Overall, the 4 to 6-year re-intervention rate was 18%. The surgical reintervention rate, comprising 5 hysterectomies was 11%. No patients underwent myomectomies after UAE. The re-intervention rate for repeat UAE was 7%.
Conclusions
UAE achieves a reduction in fibroid size within the first 3-months following UAE and shows further reduction effects beyond 6-months post-procedure. The re-intervention rate for UAE may be 18% within 4-to-6-year period. Therefore, the clinical benefits of fibroid reduction and symptom reduction may be considered for patients whose medical management has failed or have a preference for non-surgical uterine sparing intervention.

Name (Presenters)
Mohammad Saaed ElFarran

Grade
Senior Registrar

Hospital
Old St. Mary’s Hospital

Authors
Mohammad Saaed ElFarran, Raj Mathur, Karolina Palinksa-Rudzka

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Case Report

Abstract (400 words maximum)

Mature Oocyte Retrival Without Exogenous Trigger

Mature oocyte retrieval without an exogenous trigger during random-start stimulation in a very early intrauterine pregnancy: a case report
Abstract
Random-start controlled ovarian stimulation (RS-COS) facilitates timely fertility preservation in patients who must expedite oncological treatment. Early pregnancy, below the detection threshold at baseline, may subsequently alter pituitary–ovarian dynamics, complicate trigger strategy, and heighten the risk of ovarian hyperstimulation syndrome (OHSS) We describe a para 1, 32-year-old patient with inflammatory breast cancer (grade 3, T4N2M0, ER/PR-negative, HER2 3+, Ki-67 60%) who underwent luteal-phase RS-COS using a GnRH-antagonist protocol with human menopausal gonadotrophin (hMG) 300 IU daily. A serum pregnancy test three days before stimulation was negative. On stimulation day 10, an intrauterine gestational sac was identified and serum β-hCG measured 2,563 IU/L, rising to 5,973 IU/L on day 12. In view of high OHSS risk in the context of an ongoing very early pregnancy, no exogenous trigger (hCG or GnRH-agonist) was administered. Nine metaphase-II oocytes were retrieved and vitrified; no clinical OHSS occurred. At baseline the pregnancy was below detection thresholds, and the patient did not disclose a possibility of conception
This case supports a biologically plausible mechanism for MII acquisition: sustained occupancy of the luteinising hormone/choriogonadotrophin receptor (LHCGR) by endogenous early pregnancy hCG, including hyperglycosylated isoforms, whose longer half-life and more durable signalling than pituitary LH induce meiotic resumption and cumulus expansion in responsive follicles. This uncommon scenario illustrates that endogenous early-pregnancy hCG can, in an exceptional circumstance, make an exogenous trigger unnecessary.
No clinical OHSS was observed under prophylaxis and surveillance, and, to our knowledge, there are no previous published reports of multiple MII oocyte retrieval without an exogenous trigger during RS-COS.

Name (Presenters)
Batool Al-wahdano

Grade
ST4 Registrar and ACF in Gyn-oncology

Hospital
Saint Mary’s Hospital

Authors
Batool Al-wahdani and Lauren O’Connelle

Select
Audit

Abstract (400 words maximum)

Evaluating the Use of Hysteroscopy vs Pipelle Biopsy in Patients with Endometrial Thickness 4–10 mm: A Retrospective Audit from a Menstrual Disorders Clinic

Background:
Women with abnormal uterine bleeding and a transvaginal ultrasound (TVS)-reported endometrial thickness (ET) between 4–10 mm are commonly referred for hysteroscopy, despite limited evidence on when it is most appropriate. This audit aimed to evaluate current management practices and assess whether outpatient Pipelle biopsy may be a sufficient first-line alternative in selected patients.

Methods:
A retrospective audit was conducted on patients attending the Menstrual Disorders Clinic at Leigh Infirmary between July and September 2024. Of 159 patients reviewed, 56 with an ET of 4–10 mm on TVS were included. Data were collected on presenting complaints, ultrasound findings, procedures performed (hysteroscopy or Pipelle), and histopathology results.

Results:
• A total of 46 patients (82.1%) underwent hysteroscopy, of whom 35 (76.1%) had a biopsy and 11 (23.9%) did not.
• Histology in the hysteroscopy + biopsy group showed: 80% benign, 8.6% insufficient, and 11.4% abnormal results.
• Only one case of malignancy was detected, which was associated with suspicious ultrasound findings.
• 10 patients (17.9%) underwent Pipelle biopsy alone—all had benign results with normal ultrasound features.

Conclusion:
The majority of patients with ET 4–10 mm had benign findings, and all patients with normal ultrasound features who underwent Pipelle biopsy alone had adequate and reassuring results. This suggests that in patients with normal TVS appearances, Pipelle biopsy may be an appropriate and less invasive first-line investigation. A more selective use of hysteroscopy could improve patient experience and resource allocation.

Name (Presenters)
Lakshmi Jayagovarthanan

Grade
Specialty Doctor in obstetrics and Gynaecology

Hospital
Saint Marys Hospital, Oxford Road campus

Authors
Lakshmi Jayagovarthanan , Nikolaos Tsampras

Select
Case Report

Abstract (400 words maximum)

Resistant Ovary Syndrome in IVF: A Case Report 

Objective:

To report a rare case of possible resistant ovarian syndrome in IVF to highlight the risk of misdiagnosis as premature ovarian insufficiency

Method:

Analysis of clinical history and investigations done during the IVF cycle.

Results:

A 36-year-old woman was referred to our IVF department with a two-year history of primary subfertility. She had previously used the oral contraceptive pill for six years to regularize her menstrual cycles and discontinued it when she started trying to conceive. Following cessation, her cycles were regular for approximately six months, after which she developed oligomenorrhea, characterized by infrequent episodes of sporadic bleeding and spotting every 3–4 months. She was otherwise fit and well, with no significant past medical history or comorbidities.

Initial evaluation in the primary care setting, performed one year prior to referral, revealed an elevated FSH level of 25.6 IU/L with an AMH of 4.4 pmol/L. On presentation to our department, her baseline AMH was 15.9 pmol/L. A repeat hormone profile on day 2 of her menstrual cycle showed FSH 23.9 IU/L and LH 37.8 IU/L, with normal prolactin, thyroid function, and HbA1c levels. Pelvic ultrasound demonstrated a total antral follicle count of 17 with a thin endometrium. Diagnostic hysteroscopy was done, excluding intrauterine adhesions. Antibody screening identified raised thyroid peroxidase antibody levels.

The above findings were consistent with resistant ovary syndrome (ROS). However, confirmatory genetic testing was not available within the NHS. The patient was counseled extensively regarding her diagnosis and management options, including conventional IVF and IVF with donor oocytes. She opted to attempt conventional IVF. Controlled Ovarian stimulation was done with maximal doses of gonadotrophins in combination with empirical corticosteroid therapy for 20 days; however, no ovarian response was observed, and the cycle was subsequently cancelled. The patient was referred to the menopause clinic for hormone replacement therapy (HRT) and IVF with donor oocytes.

Conclusion:

Resistant ovarian syndrome is a rare endocrine syndrome where patients typically present with oligomenorrhoea or amenorrhea, sub fertility, and raised endogenous gonadotrophin levels. They can be easily misdiagnosed as premature ovarian insufficiency if not correlated with anti mullerian hormone levels and antral follicle count. These patients also exhibit typically poor response to controlled ovarian stimulation and IVF donor eggs is advised.