Natural history of endometriosis in pregnancy: ultrasound study of morphology of deep endometriosis and ovarian endometrioma
ABSTRACT Objective To assess the morphological appearance of deep endometriosis and ovarian endometrioma in pregnancy using pelvic ultrasound examination. Methods This was a prospective observational cohort study conducted over 3 years at University College London Hospital, which is a tertiary level...
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| Published in: | Ultrasound in obstetrics & gynecology Vol. 62; no. 4; pp. 585 - 593 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Chichester, UK
John Wiley & Sons, Ltd
01.10.2023
Wiley Subscription Services, Inc |
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| ISSN: | 0960-7692, 1469-0705, 1469-0705 |
| Online Access: | Get full text |
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| Abstract | ABSTRACT
Objective
To assess the morphological appearance of deep endometriosis and ovarian endometrioma in pregnancy using pelvic ultrasound examination.
Methods
This was a prospective observational cohort study conducted over 3 years at University College London Hospital, which is a tertiary level referral unit for early pregnancy complications and an accredited endometriosis center. All women who participated provided written consent and were invited for surveillance ultrasound examination at the time of their routine scans in pregnancy. All scans were performed by a single operator to eliminate interobserver variability. The change in size of ovarian endometrioma and nodules was reported as change in their mean diameter. Ovarian endometrioma with irregular thick inner walls, hyperechoic papillary projections and/or high vascularity and hyperechoic nodules with moderate to high vascularity were reported as decidualized.
Results
Sixty‐five women with a live, normally sited pregnancy and concomitant ultrasound features of deep and/or ovarian endometriosis were included in the study. The median age of the study population was 34 (range, 23–44) years, and the median gestational age at presentation was 7 + 6 (range, 3 + 6 to 18 + 0) weeks. From the cohort, 47/65 (72%) were nulliparous, 48/65 (74%) had a previous diagnosis of endometriosis and 19/65 (29%) conceived via in‐vitro fertilization. There were 10/65 (15% (95% CI, 7–24%)) women with ovarian endometrioma alone, 28/65 (43% (95% CI, 31–55%)) with endometriotic nodules alone and the remaining 27/65 (42% (95% CI, 30–54%)) had both. Of the women with ovarian endometrioma who underwent follow‐up, 29/34 (85% (95% CI, 73–97%)) experienced cyst regression, 2/34 (6% (95% CI, 0–14%)) experienced cyst growth, and in 3/34 (9% (95% CI, 0.0–18%)) women, cyst size was unchanged. In 10/34 (29% (95% CI, 14–45%)), there was complete resolution of all cysts. Of the women with nodules who underwent follow‐up, 43/51 (84% (95% CI, 74–94%)) experienced nodule regression, 2/51 (4% (95% CI, 0–9%)) experienced nodule growth and, in 6/51 (12% (95% CI, 3–21%)) women, nodule size was unchanged. In 4/51 (8% (95% CI, 0–15%)) women, there was complete resolution of all nodules. In 5/37 (14% (95% CI, 3–25%)) women who attended postnatal follow‐up, complete resolution of all endometriotic lesions occurred during pregnancy. In 10/34 (29% (95% CI, 14–45%)) women with ovarian endometrioma and 27/51 (53% (95% CI, 39–67%)) women with nodules, a pattern of growth was observed in the first and second trimesters, followed by regression later in pregnancy. Features of decidualization were observed in 17/34 (50% (95% CI, 33–67%)) women with ovarian endometrioma, most commonly in the first trimester, and in 25/51 (49% (95% CI, 35–63%)) women with nodules, most commonly in the second trimester.
Conclusions
For the majority of women, despite features of decidualization being common in the first and second trimesters, ovarian endometrioma and deep nodules regress during pregnancy. Morphological changes of endometriosis in pregnancy are difficult to differentiate from characteristics of malignant lesions. Better understanding of the appearance of endometriosis in pregnancy is vital to minimize intervention and help counsel women regarding their condition. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. |
|---|---|
| AbstractList | To assess the morphological appearance of deep endometriosis and ovarian endometrioma in pregnancy using pelvic ultrasound examination.OBJECTIVETo assess the morphological appearance of deep endometriosis and ovarian endometrioma in pregnancy using pelvic ultrasound examination.This was a prospective observational cohort study conducted over 3 years at University College London Hospital, which is a tertiary level referral unit for early pregnancy complications and an accredited endometriosis center. All women who participated provided written consent and were invited for surveillance ultrasound examination at the time of their routine scans in pregnancy. All scans were performed by a single operator to eliminate interobserver variability. The change in size of ovarian endometrioma and nodules was reported as change in their mean diameter. Ovarian endometrioma with irregular thick inner walls, hyperechoic papillary projections and/or high vascularity and hyperechoic nodules with moderate to high vascularity were reported as decidualized.METHODSThis was a prospective observational cohort study conducted over 3 years at University College London Hospital, which is a tertiary level referral unit for early pregnancy complications and an accredited endometriosis center. All women who participated provided written consent and were invited for surveillance ultrasound examination at the time of their routine scans in pregnancy. All scans were performed by a single operator to eliminate interobserver variability. The change in size of ovarian endometrioma and nodules was reported as change in their mean diameter. Ovarian endometrioma with irregular thick inner walls, hyperechoic papillary projections and/or high vascularity and hyperechoic nodules with moderate to high vascularity were reported as decidualized.Sixty-five women with a live, normally sited pregnancy and concomitant ultrasound features of deep and/or ovarian endometriosis were included in the study. The median age of the study population was 34 (range, 23-44) years, and the median gestational age at presentation was 7 + 6 (range, 3 + 6 to 18 + 0) weeks. From the cohort, 47/65 (72%) were nulliparous, 48/65 (74%) had a previous diagnosis of endometriosis and 19/65 (29%) conceived via in-vitro fertilization. There were 10/65 (15% (95% CI, 7-24%)) women with ovarian endometrioma alone, 28/65 (43% (95% CI, 31-55%)) with endometriotic nodules alone and the remaining 27/65 (42% (95% CI, 30-54%)) had both. Of the women with ovarian endometrioma who underwent follow-up, 29/34 (85% (95% CI, 73-97%)) experienced cyst regression, 2/34 (6% (95% CI, 0-14%)) experienced cyst growth, and in 3/34 (9% (95% CI, 0.0-18%)) women, cyst size was unchanged. In 10/34 (29% (95% CI, 14-45%)), there was complete resolution of all cysts. Of the women with nodules who underwent follow-up, 43/51 (84% (95% CI, 74-94%)) experienced nodule regression, 2/51 (4% (95% CI, 0-9%)) experienced nodule growth and, in 6/51 (12% (95% CI, 3-21%)) women, nodule size was unchanged. In 4/51 (8% (95% CI, 0-15%)) women, there was complete resolution of all nodules. In 5/37 (14% (95% CI, 3-25%)) women who attended postnatal follow-up, complete resolution of all endometriotic lesions occurred during pregnancy. In 10/34 (29% (95% CI, 14-45%)) women with ovarian endometrioma and 27/51 (53% (95% CI, 39-67%)) women with nodules, a pattern of growth was observed in the first and second trimesters, followed by regression later in pregnancy. Features of decidualization were observed in 17/34 (50% (95% CI, 33-67%)) women with ovarian endometrioma, most commonly in the first trimester, and in 25/51 (49% (95% CI, 35-63%)) women with nodules, most commonly in the second trimester.RESULTSSixty-five women with a live, normally sited pregnancy and concomitant ultrasound features of deep and/or ovarian endometriosis were included in the study. The median age of the study population was 34 (range, 23-44) years, and the median gestational age at presentation was 7 + 6 (range, 3 + 6 to 18 + 0) weeks. From the cohort, 47/65 (72%) were nulliparous, 48/65 (74%) had a previous diagnosis of endometriosis and 19/65 (29%) conceived via in-vitro fertilization. There were 10/65 (15% (95% CI, 7-24%)) women with ovarian endometrioma alone, 28/65 (43% (95% CI, 31-55%)) with endometriotic nodules alone and the remaining 27/65 (42% (95% CI, 30-54%)) had both. Of the women with ovarian endometrioma who underwent follow-up, 29/34 (85% (95% CI, 73-97%)) experienced cyst regression, 2/34 (6% (95% CI, 0-14%)) experienced cyst growth, and in 3/34 (9% (95% CI, 0.0-18%)) women, cyst size was unchanged. In 10/34 (29% (95% CI, 14-45%)), there was complete resolution of all cysts. Of the women with nodules who underwent follow-up, 43/51 (84% (95% CI, 74-94%)) experienced nodule regression, 2/51 (4% (95% CI, 0-9%)) experienced nodule growth and, in 6/51 (12% (95% CI, 3-21%)) women, nodule size was unchanged. In 4/51 (8% (95% CI, 0-15%)) women, there was complete resolution of all nodules. In 5/37 (14% (95% CI, 3-25%)) women who attended postnatal follow-up, complete resolution of all endometriotic lesions occurred during pregnancy. In 10/34 (29% (95% CI, 14-45%)) women with ovarian endometrioma and 27/51 (53% (95% CI, 39-67%)) women with nodules, a pattern of growth was observed in the first and second trimesters, followed by regression later in pregnancy. Features of decidualization were observed in 17/34 (50% (95% CI, 33-67%)) women with ovarian endometrioma, most commonly in the first trimester, and in 25/51 (49% (95% CI, 35-63%)) women with nodules, most commonly in the second trimester.For the majority of women, despite features of decidualization being common in the first and second trimesters, ovarian endometrioma and deep nodules regress during pregnancy. Morphological changes of endometriosis in pregnancy are difficult to differentiate from characteristics of malignant lesions. Better understanding of the appearance of endometriosis in pregnancy is vital to minimize intervention and help counsel women regarding their condition. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.CONCLUSIONSFor the majority of women, despite features of decidualization being common in the first and second trimesters, ovarian endometrioma and deep nodules regress during pregnancy. Morphological changes of endometriosis in pregnancy are difficult to differentiate from characteristics of malignant lesions. Better understanding of the appearance of endometriosis in pregnancy is vital to minimize intervention and help counsel women regarding their condition. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. ABSTRACT Objective To assess the morphological appearance of deep endometriosis and ovarian endometrioma in pregnancy using pelvic ultrasound examination. Methods This was a prospective observational cohort study conducted over 3 years at University College London Hospital, which is a tertiary level referral unit for early pregnancy complications and an accredited endometriosis center. All women who participated provided written consent and were invited for surveillance ultrasound examination at the time of their routine scans in pregnancy. All scans were performed by a single operator to eliminate interobserver variability. The change in size of ovarian endometrioma and nodules was reported as change in their mean diameter. Ovarian endometrioma with irregular thick inner walls, hyperechoic papillary projections and/or high vascularity and hyperechoic nodules with moderate to high vascularity were reported as decidualized. Results Sixty‐five women with a live, normally sited pregnancy and concomitant ultrasound features of deep and/or ovarian endometriosis were included in the study. The median age of the study population was 34 (range, 23–44) years, and the median gestational age at presentation was 7 + 6 (range, 3 + 6 to 18 + 0) weeks. From the cohort, 47/65 (72%) were nulliparous, 48/65 (74%) had a previous diagnosis of endometriosis and 19/65 (29%) conceived via in‐vitro fertilization. There were 10/65 (15% (95% CI, 7–24%)) women with ovarian endometrioma alone, 28/65 (43% (95% CI, 31–55%)) with endometriotic nodules alone and the remaining 27/65 (42% (95% CI, 30–54%)) had both. Of the women with ovarian endometrioma who underwent follow‐up, 29/34 (85% (95% CI, 73–97%)) experienced cyst regression, 2/34 (6% (95% CI, 0–14%)) experienced cyst growth, and in 3/34 (9% (95% CI, 0.0–18%)) women, cyst size was unchanged. In 10/34 (29% (95% CI, 14–45%)), there was complete resolution of all cysts. Of the women with nodules who underwent follow‐up, 43/51 (84% (95% CI, 74–94%)) experienced nodule regression, 2/51 (4% (95% CI, 0–9%)) experienced nodule growth and, in 6/51 (12% (95% CI, 3–21%)) women, nodule size was unchanged. In 4/51 (8% (95% CI, 0–15%)) women, there was complete resolution of all nodules. In 5/37 (14% (95% CI, 3–25%)) women who attended postnatal follow‐up, complete resolution of all endometriotic lesions occurred during pregnancy. In 10/34 (29% (95% CI, 14–45%)) women with ovarian endometrioma and 27/51 (53% (95% CI, 39–67%)) women with nodules, a pattern of growth was observed in the first and second trimesters, followed by regression later in pregnancy. Features of decidualization were observed in 17/34 (50% (95% CI, 33–67%)) women with ovarian endometrioma, most commonly in the first trimester, and in 25/51 (49% (95% CI, 35–63%)) women with nodules, most commonly in the second trimester. Conclusions For the majority of women, despite features of decidualization being common in the first and second trimesters, ovarian endometrioma and deep nodules regress during pregnancy. Morphological changes of endometriosis in pregnancy are difficult to differentiate from characteristics of malignant lesions. Better understanding of the appearance of endometriosis in pregnancy is vital to minimize intervention and help counsel women regarding their condition. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. To assess the morphological appearance of deep endometriosis and ovarian endometrioma in pregnancy using pelvic ultrasound examination METHODS: This was a prospective observational cohort study conducted over three years at a single centre. We included 65 women with a live normally-sited pregnancy and concomitant ultrasound feature of deep and/or ovarian endometriosis. The study was conducted at University College London Hospital, which is a tertiary level referral unit for early pregnancy complications and an accredited Endometriosis Centre. All women who participated provided written consent and were invited for surveillance ultrasound examinations at the time of their routine scans in pregnancy. All scans were performed by a single operator to minimise interobserver error. The change in size of endometrioma and nodules were reported as change in their mean diameter. Endometrioma with irregular thick inner walls, hyperechoic papillary projections and/or high vascularity and hyperechoic nodules with moderate to high vascularity were reported as decidualized. Sixty five women were included in the study. Their median age was 34 years (23-44), and the gestation at presentation was 7+6 weeks (3+6 to 18+0). 47/65 (72%) were nulliparous, 48/65 (74%) had a background of endometriosis and 19/65 (29%) conceived following IVF. There were 10/65 (15%, 95% CI 7-24) women with endometrioma alone, 28/65 (43%, 95% CI 31-55) with nodules alone and the remaining 27/65 (42%, 95% CI 30-54) had both. 29/34 (85%, 95% CI 73-97) women with endometrioma experienced cyst regression, 2/34 (6%, 95% CI 0 - 14) experienced cyst growth and in 10/34 (29%, 95% CI 14-45) there was complete resolution of all cysts. 43/51 (84%, 95% CI 74-94) women with nodules experienced nodule regression, 2/51 (4%, 95% CI 0 - 9) experienced nodule growth and in 4/51 (8%, 95% CI 0-15) there was complete resolution of all nodules. 5/37 (14%, 95% CI 3 - 25) women who attended postnatal follow-up, experienced complete resolution of all endometriotic lesions during pregnancy. In 10/34 (29%, 95% CI 14-45) women with endometrioma and 27/51 (53%, 95% CI 39-67) with nodules, a pattern of growth was observed in the first and second trimesters, which preceded regression later in pregnancy. Features of decidualization were observed in 17/34 (50%, 95% CI 33 - 67) women with endometrioma, most commonly observed in the 1st trimester, and 25/51 (49%, 95% CI 35 - 63) women with nodules, most commonly observed in the 2 trimester. For the majority of women, despite features of decidualization being common in the first and second trimesters, endometrioma and deep nodules will regress during pregnancy. Morphological changes of endometriosis in pregnancy are difficult to differentiate from characteristics of malignant lesions. Better understanding of the appearance of endometriosis in pregnancy is vital to minimise intervention and help counsel women regarding the significance of their condition. This article is protected by copyright. All rights reserved. Objective To assess the morphological appearance of deep endometriosis and ovarian endometrioma in pregnancy using pelvic ultrasound examination. Methods This was a prospective observational cohort study conducted over 3 years at University College London Hospital, which is a tertiary level referral unit for early pregnancy complications and an accredited endometriosis center. All women who participated provided written consent and were invited for surveillance ultrasound examination at the time of their routine scans in pregnancy. All scans were performed by a single operator to eliminate interobserver variability. The change in size of ovarian endometrioma and nodules was reported as change in their mean diameter. Ovarian endometrioma with irregular thick inner walls, hyperechoic papillary projections and/or high vascularity and hyperechoic nodules with moderate to high vascularity were reported as decidualized. Results Sixty‐five women with a live, normally sited pregnancy and concomitant ultrasound features of deep and/or ovarian endometriosis were included in the study. The median age of the study population was 34 (range, 23–44) years, and the median gestational age at presentation was 7 + 6 (range, 3 + 6 to 18 + 0) weeks. From the cohort, 47/65 (72%) were nulliparous, 48/65 (74%) had a previous diagnosis of endometriosis and 19/65 (29%) conceived via in‐vitro fertilization. There were 10/65 (15% (95% CI, 7–24%)) women with ovarian endometrioma alone, 28/65 (43% (95% CI, 31–55%)) with endometriotic nodules alone and the remaining 27/65 (42% (95% CI, 30–54%)) had both. Of the women with ovarian endometrioma who underwent follow‐up, 29/34 (85% (95% CI, 73–97%)) experienced cyst regression, 2/34 (6% (95% CI, 0–14%)) experienced cyst growth, and in 3/34 (9% (95% CI, 0.0–18%)) women, cyst size was unchanged. In 10/34 (29% (95% CI, 14–45%)), there was complete resolution of all cysts. Of the women with nodules who underwent follow‐up, 43/51 (84% (95% CI, 74–94%)) experienced nodule regression, 2/51 (4% (95% CI, 0–9%)) experienced nodule growth and, in 6/51 (12% (95% CI, 3–21%)) women, nodule size was unchanged. In 4/51 (8% (95% CI, 0–15%)) women, there was complete resolution of all nodules. In 5/37 (14% (95% CI, 3–25%)) women who attended postnatal follow‐up, complete resolution of all endometriotic lesions occurred during pregnancy. In 10/34 (29% (95% CI, 14–45%)) women with ovarian endometrioma and 27/51 (53% (95% CI, 39–67%)) women with nodules, a pattern of growth was observed in the first and second trimesters, followed by regression later in pregnancy. Features of decidualization were observed in 17/34 (50% (95% CI, 33–67%)) women with ovarian endometrioma, most commonly in the first trimester, and in 25/51 (49% (95% CI, 35–63%)) women with nodules, most commonly in the second trimester. Conclusions For the majority of women, despite features of decidualization being common in the first and second trimesters, ovarian endometrioma and deep nodules regress during pregnancy. Morphological changes of endometriosis in pregnancy are difficult to differentiate from characteristics of malignant lesions. Better understanding of the appearance of endometriosis in pregnancy is vital to minimize intervention and help counsel women regarding their condition. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. |
| Author | Bean, E. Naftalin, J. Jurkovic, D. Knez, J. Casagrandi, D. Setty, T. Tetteh, A. |
| Author_xml | – sequence: 1 givenname: E. orcidid: 0000-0003-0264-2966 surname: Bean fullname: Bean, E. email: elisabeth.bean@nhs.net organization: University College London – sequence: 2 givenname: J. orcidid: 0000-0003-3543-5920 surname: Knez fullname: Knez, J. organization: University Medical Center Maribor, Clinic for Gynecology – sequence: 3 givenname: T. surname: Setty fullname: Setty, T. organization: University College London – sequence: 4 givenname: A. surname: Tetteh fullname: Tetteh, A. organization: University College London – sequence: 5 givenname: D. surname: Casagrandi fullname: Casagrandi, D. organization: University College London – sequence: 6 givenname: J. orcidid: 0000-0002-9358-1291 surname: Naftalin fullname: Naftalin, J. organization: University College London – sequence: 7 givenname: D. orcidid: 0000-0001-6487-5736 surname: Jurkovic fullname: Jurkovic, D. organization: University College London |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/37448233$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1002_uog_27607 crossref_primary_10_1007_s00404_024_07927_y crossref_primary_10_1016_j_heliyon_2024_e41543 crossref_primary_10_1007_s13669_025_00424_2 crossref_primary_10_1093_hropen_hoae036 crossref_primary_10_1093_humrep_deaf090 crossref_primary_10_1016_j_bpobgyn_2023_102450 crossref_primary_10_1016_j_bpobgyn_2025_102643 crossref_primary_10_1097_GCO_0000000000001036 crossref_primary_10_1016_j_fertnstert_2024_08_355 crossref_primary_10_1002_uog_27707 |
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| ContentType | Journal Article |
| Copyright | 2023 The Authors. published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. This article is protected by copyright. All rights reserved. 2023. This work is published under Creative Commons Attribution – Non-Commercial License~http://creativecommons.org/licenses/by-nc/3.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. |
| Copyright_xml | – notice: 2023 The Authors. published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. – notice: This article is protected by copyright. All rights reserved. – notice: 2023. This work is published under Creative Commons Attribution – Non-Commercial License~http://creativecommons.org/licenses/by-nc/3.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. – notice: 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. |
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| Keywords | Pregnancy Endometriosis Ultrasound Endometrioma Decidualization |
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To assess the morphological appearance of deep endometriosis and ovarian endometrioma in pregnancy using pelvic ultrasound examination.... To assess the morphological appearance of deep endometriosis and ovarian endometrioma in pregnancy using pelvic ultrasound examination METHODS: This was a... Objective To assess the morphological appearance of deep endometriosis and ovarian endometrioma in pregnancy using pelvic ultrasound examination. Methods This... To assess the morphological appearance of deep endometriosis and ovarian endometrioma in pregnancy using pelvic ultrasound examination.OBJECTIVETo assess the... |
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| SubjectTerms | Complications Cysts decidualization endometrioma Endometriosis Fertilization Gestational age Gynecology Lesions Morphology Nodules Observational studies Obstetrics Ovaries Population studies Pregnancy Pregnancy complications Regression Ultrasonic imaging Ultrasonic testing Ultrasound |
| Title | Natural history of endometriosis in pregnancy: ultrasound study of morphology of deep endometriosis and ovarian endometrioma |
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