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Alternative Imaging Techniques for Endometriosis: Magnetic Resonance Imaging
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Flora Daley, Amreen Shakur, Susan J. Freeman
Rectovaginal endometriosis is retroperitoneal, sited below the peritoneal reflection in the pouch of Douglas. The rectovaginal septum endometriotic deposits are divided into 3 subgroups: rectovaginal septum (type I), posterior vaginal fornix wall (type II) and hourglass lesions involving posterior vaginal fornix and anterior rectal muscularis (type III) (30). Type I lesions are the least common, accounting for 10% of rectovaginal disease, and are seen as low signal intensity lesions on T1WI and T2WI. Type III lesions tend to be larger volume solid deposits involving the posterior vaginal fornix and anterior rectal serosa and muscularis layers (30) (Figure 4.8). Type III lesions are intermediate to low signal intensity on T2WI, representing prominent fibromuscular hyperplasia around ectopic endometrial glands, often measuring more than 30 mm. Type II lesions are a midway point between these two lesions and tend to be smaller lesions involving only the posterior vaginal fornix. Depending upon the proportion of internal blood products, type II and III lesions may demonstrate foci of high signal intensity of T1WI.
Prelabor rupture of the membranes
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Roberto Romero, Lami Yeo, Francesca Gotsch, Eleazar Soto, Sonia S. Hassan, Juan Pedro Kusanovic, Ray Bahado-Singh
Lung maturity can be assessed from the amniotic fluid obtained by amniocentesis or from the vaginal pool. The latter has the advantage of being less invasive and more feasible in patients with oligohydramnios. Amniotic fluid from the vaginal pool can be collected in three ways: (i) from the posterior vaginal fornix by sterile speculum examination, (ii) in a clean bedpan maintained under the patient, or (iii) by the use of obstetric perineal pads left in place for 12 to 24 hours to ensure saturation (192–195). The success rate in obtaining fluid within 48 hours with these noninvasive techniques ranges from 54% to 100% (194,195). Using a pad to detect PG, Estol et al. found a sensitivity of 88%, specificity of 76%, positive predictive value of 34%, and negative predictive value of 98% (196). Lewis et al. investigated the value of a rapid antibody agglutination method (Amniostat FLM) to detect PG in vaginal pool samples (197). Of 201 patients between 26 and 36 weeks of gestation, 36 had positive PG, and none of the infants born to these mothers developed RDS. PG was detectable only after 30 weeks of gestation.
Laparoscopic Hysterectomy in the Setting of Large Fibroids
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
When the myoma screw is used as a manipulator, the vaginal vault can be opened in any of the following ways:To open the vault, the uterosacral ligament should be incised exactly at the point of insertion at the cervicovaginal junction and the vault is opened laterally. One should be careful not to cut into the cervix.Sometimes, with the above method, we may find it difficult to open the vault. In that case, it is useful to place a sponge on a holder in the vagina and push the lateral vaginal fornix. Incising laparoscopically from inside the abdomen over the resulting bulge helps to easily open the vaginal vault.The third option is to place a reusable vaginal delineator tube, which helps to outline the cervicovaginal junction circumferentially. These types of vaginal tube prevent the loss of pneumoperitoneum.
Prediction of preterm delivery in threatened preterm labour with short cervical length
Published in Journal of Obstetrics and Gynaecology, 2022
Kübra Hamzaoğlu, Ebru Alıcı Davutoğlu, Huri Bulut, Riza Madazli
The initial evaluation included a thorough physical examination, obstetrical ultrasound, external cardiotocography, daily body temperature, basal haematological and biochemical blood sample profile, and routine urine culture. Gestational age was determined using the last menstrual period and crown-rump length measurement in the first trimester. Ultrasonographic assessments of CL, UCA and MT were performed on admission using the Toshiba Xario ultrasound machine (Toshiba Medical Systems Corporation, Tokyo, Japan) with 6.0 MHz transvaginal and 2–5 MHz transabdominal transducers. Transvaginal probe was placed in the anterior vaginal fornix, and CL was measured between the internal and external cervical os as previously defined (Tsoi et al. 2003). The UCA was measured from the triangular region between the anterior lower uterine segment and the cervical canal. The angle between the line drawn along the endocervical canal and the line drawn along the anterior uterine lower segment was measured. Transabdominal ultrasonographic measurement of the MT was performed from the fundal wall. The myometrium was defined as a layer of homogeneous echogenicity from the serosal surface to the decidua. Vascular channels above the myometrium or behind the placenta and wall segments with focal or transient thickening were not included in the measurement
The Manchester operation – is it time for it to return to our surgical armamentarium in the twenty-first century?
Published in Journal of Obstetrics and Gynaecology, 2022
Ronen S. Gold, Hadar Amir, Yoav Baruch, David Gordon, Mordechai Shimonov, Asnat Groutz
The present study comprised of patients with true cervical elongation. None of the patients had uterine prolapse. Results show that Manchester operation is an effective treatment for symptomatic long uterine cervix. The surgery is short and without any significant intraoperative and early postoperative complications. Subjectively, the vast majority of patients (85.9%) were very satisfied with the surgery and its results. The main reason for dissatisfaction from the surgery was persistent OAB symptoms. Therefore, in our opinion, it is important to repeatedly emphasise to women undergoing surgery that OAB complaints will not be resolved by the operation. Nevertheless, four patients had significant late postoperative complications that required surgical intervention: hematometra, pyometra, vesicovaginal fistula and small intestine evisceration through the posterior vaginal fornix. Clearly, the hematometra and pyometra were due to cervical stenosis following amputation of the uterine cervix. In order to decrease the chance of cervical stenosis, proper cervical dilatation with Hegar uterine dilators up to 8.5 French should be performed at the beginning of Manchester operation, and the patency of the cervical canal should be ensured at the end of the operation.
The ins and outs of drug-releasing vaginal rings: a literature review of expulsions and removals
Published in Expert Opinion on Drug Delivery, 2020
Peter Boyd, Ruth Merkatz, Bruce Variano, R. Karl Malcolm
The vagina is an elastic muscular canal that connects the uterine cervix to the skin. The proximal end (entrance) of the vaginal canal is the vulva and the distal end of the canal (internally) is the vaginal fornix. The part of the uterus known as the uterine cervix protrudes into the vaginal canal. Since the vaginal canal is elastic, it can usually stretch to easily accommodate the insertion of the ring device. The insertion guidelines for both marketed and investigational vaginal rings invariably require the women to squeeze the ring into a figure-of-eight shape using the thumb and index finger and to manually insert the ring as high as possible in the vaginal canal; the upper third portion is wider than the lower portions of the vaginal (Table 2, Figure 4). In this location, the ring should settle into place, feel comfortable during use, and expulsions are less likely [82,83]. There is no danger that a vaginal ring can be pushed into the uterus since the cervical canal is much too narrow (<8 mm) for ring passage in non-pregnant women [84]. The ring is generally retained in the upper segment of the vaginal canal around the cervix (the vaginal vault) where it can be easily retrieved by finger insertion (Figure 4).