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Cesarean Section Scar Ectopic Pregnancy
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
In cases that progress to the third trimester, the optimal management is still to place the patient on bedrest, and women should be counseled about short- and long-term risks. The myometrial thickness is a good indicator of abnormal or invasive placentation and can be helpful in identifying patients at risk for more severe complications. Deliveries should always be planned in tertiary care centers equipped with anesthesia, blood banking, and the necessary surgical expertise for an emergent hysterectomy if needed as a lifesaving option [18].
A Functional Approach to Gynecologic Pain
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Adenomyosis occurs when the endometrial glands and stroma grow into the uterine musculature. This growth induces hypertrophy and hyperplasia of the surrounding myometrium, and results in an enlarged, globular presentation of the uterus. The clinical result in addition to uterine enlargement is abnormal bleeding and painful menses. Its origin is unknown, but the two major theories are that it either develops de novo from Müllerian rests, or from endomyometrial invagination of the endometrium.14 The uterus with adenomyosis takes a characteristic heterogeneous appearance when imaged by ultrasound.
Broad Ligament Fibroids
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Fibroids are benign, monoclonal smooth muscle tumors of the myometrium and are aggregates of extracellular matrix containing collagen, elastin, proteoglycans, and fibronectins [1]. Forty percent are associated with chromosomal abnormalities like translocation of chromosome 12 and 14, deletion of chromosome 7, and trisomy of chromosome 12 [2, 3]. Although these are benign tumors, the incidence of sarcomas in fibroids is reported to be 0.29 to 0.05% of cases. Hence, diagnosis and proper management are necessities, especially in symptomatic and large fibroids.
Zooming in on the endometrial factor of recurrent implantation failure
Published in Human Fertility, 2022
Chibuzor Ifenatuoha, Babatunde Okewale
The endometrium is a complex, dynamic, and repetitively cycling tissue, lining the uterus that facilitates the implantation of the blastocysts (Kliman & Frankfurter, 2019). It is composed of a functional layer that lies adjacent to the uterine lumen, and a basalis layer, attached to the myometrium. These layers are multicellular, comprising several cell types such as the endometrial stromal cells, immune cells, luminal and glandular epithelial cells, and the vascular cells that make up the spiral arterioles (Hart, 2016; Kobayashi & Behringer, 2003; Roy & Matzuk, 2011). The endometrium is tagged a dynamic tissue because of its unique nature of remodelling during the processes of menstrual repair, proliferation, and differentiation occurring during the menstrual cycle. This process of remodelling is meticulously controlled by the female sex hormones during the menstrual cycle, and it is also pertinent in enabling endometrial receptivity for embryo implantation. However, this requires a precise interaction of molecular and cellular events (Kobayashi & Behringer, 2003; Roy & Matzuk, 2011).
Caesarean section operation is not associated with myometrial hypertrophy–a prospective cohort study
Published in Journal of Obstetrics and Gynaecology, 2022
Ayman A. A. Ewies, Shahin Qadri, Rachna Awasthi, Ulisses Zanetto
A prospective comparative histological study, including benign hysterectomy specimens obtained from premenopausal women, conducted in Sandwell and West Birmingham Hospitals NHS Trust between 1 December 2015 and 31 March 2020. Out of 687 hysterectomies performed for benign indications during the study period, only 52 were included in the analysis following strict exclusion criteria. Myometrial hypertrophy was defined as uterine weight of >120 g and anterior myometrial thickness of >20 mm in the absence of endometrial or myometrial pathology (Traiman et al. 1996). The largest thickness of the uterine wall of each specimen was considered for the analysis. Informed consent was obtained from all women included in this study before the histological assessment of their specimens. The inclusion in the study did not interfere or alter the clinical decision to undergo the hysterectomy. The histological assessment was performed according to the departmental standard operating procedure which is performed routinely on all specimens.
Current approaches to overcome the side effects of GnRH analogs in the treatment of patients with uterine fibroids
Published in Expert Opinion on Drug Safety, 2022
Mohamed Ali, Mohamed Raslan, Michał Ciebiera, Kornelia Zaręba, Ayman Al-Hendy
Uterine fibroids are benign monoclonal neoplasms of the myometrium and represent the most common tumors in women worldwide. Unfortunately, there has been no long-term noninvasive treatment option that exists for these hormone-dependent tumors. Several reported risk factors are involved in UFs pathogenesis, the most important and frequent one being race, specifically, the African American race. Other risk factors include old age; obesity, vitamin D deficiency, pre-menopausal state; non-parity, family history of UFs and frequent consumption of soybean milk. Available hormonal therapies are used to control uterine bleeding and tumor growth based on regulation of estrogen and progesterone levels/effects. However, some of these hormonal therapies have the potential to interfere with endometrial development and implantation and therefore cannot be used while pursuing pregnancy. Initially, oral contraceptive pills were used to stop excessive uterine bleeding for short term considering their cost-effectiveness; however, their effect on tumor size was controversial and limits their long-term use. Similarly, levonorgestrel intrauterine devices have been used but limited with being expelled with tumors, especially submucosal ones.