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Specific Management of PPH
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Uterine artery ligature: It is done at the level of the internal os at the lateral wall of the uterus. The uterine vessels start ascending at that level. A deep bite, including the lower lateral wall to occlude the uterine artery, is the safest and quickest procedure. One need not necessarily skeletonise the uterine artery to ligate it. Either absorbable sutures like catgut or delayed absorbable polyglactin are used for uterine artery ligation. The uterine branch of the ovarian artery is ligated at the cornual end below the fallopian tube, with a suture passed to include a part of the adjoining uterine wall. This O’Leary ligature occludes the uterine branch coming down from the ovarian vessels via the mesosalpinx.
Adnexal/Ovarian Torsion
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Hajra Takala, Mona Omar, Ayman Al-Hendy
The arterial supply of the ovaries derives from the ovarian artery and uterine artery. The ovarian artery passes through the mesovarium; blood from the ovarian arteries runs along the infundibulopelvic ligament; branches from uterine artery run along the UO ligament. The venous drainage of the ovaries forms a pampiniform plexus, which consolidates to form the ovarian vein. On the right side, the ovarian vein drains into the inferior vena cava, whereas on the left, the ovarian vein drains into the left renal vein [1, 2].
How Long Does it Take Uterine Scar(s) to Heal?
Published in John C. Petrozza, Uterine Fibroids, 2020
The uterus is a fibromuscular hollow organ located between the bladder and rectum that consists of an inner layer of mucosa called the endometrium, a thick muscular wall known as the myometrium, and the peritoneal serosa that overlies the outer wall. The blood supply to the uterus arises from the ascending branch of the uterine artery and from the medial or uterine branch of the ovarian artery [1].
The reproductive endocrine feature and conception outcome of women with unknown etiological menstrual cycle (36–45 days) with long follicular phase
Published in Gynecological Endocrinology, 2022
Zhewei Wang, Jiongjiong Yan, Huifen Chen, Laman He, Shaohua Xu
Under normal circumstances, the estrogen level synthesized by the ovary increases with follicular development in the follicular stage. Meanwhile, the blood flow of ovarian artery in the diastolic phase increases gradually and RI decreases. Follicular size and blood perfusion reflect the serum estrogen level [18,19]. Insufficient perfusion of ovarian blood flow on the ovulation side during ovulation may be related to LUFS [20,21]. Generally, only one ovary ovulates in the menstruation cycle, and the level of local estrogen on its side gradually increases but the ovarian artery’s RI decreases and statistically lower than that of the opposite side on ovulation. However, this does not occur in women with follicular dysplasia [22]. Our study found that the rate of ‘RI of the ovarian artery on ovulation side greater than that of the opposite side’ on the day when B-ultrasound indicated the follicle was mature in the LMC group was higher. This result supported another conclusion that these women had higher risk of poor ovulation quality. From the view of theoretical base of TCM, follicle quality and ovarian blood perfusion may interact as both the cause and effect [23]. That is to say, insufficient ovarian blood flow would further hamper the development of follicles. In the study, the outcome of 3 participants who received TCM later indicated one possible solution to long follicular phases, which invites further study.
Angiography and transcatheter arterial embolization for non-variceal gastrointestinal bleeding
Published in Scandinavian Journal of Gastroenterology, 2020
Hai-Yang Lai, Ke-Tong Wu, Yang Liu, Zhao-Fei Zeng, Bo Zhang
With the patient in the supine position, celiac trunk, superior mesenteric, inferior mesenteric, and internal iliac angiography were performed with standard percutaneous transfemoral catheterization using 5 Fr RH (Cook Medical, Bloomington, IN) or Cobra (Terumo, Tokyo, Japan) catheters under local infiltration anesthesia or sedation. Selective angiography was performed in the branches depending on what was known about the localization of the bleeding. For one special case, angiography for an ovarian artery was also performed. Once the causative arteries were confirmed, then superselective catheterization was usually performed as close to the bleeding site as possible using a 2.7 Fr microcatheter (Progreat, Terumo, Tokyo, Japan) or 2.6 Fr microcatheter (ASAHI Corsair), which is inserted coaxially through the macrocatheter.
Partial tubal devascularisation: a novel procedure for tubal conservation in ectopic pregnancy
Published in Journal of Obstetrics and Gynaecology, 2019
Sherif A. Shazly, Ahmed G. Gayar, Ahmed Y. Abdelbadee, Ahmed M. Afifi, Ahmed A. Nassr
A partial tubal devascularisation, a novel procedure, was then performed to control bleeding from the internal surface of the tube. Based on the vascular anatomy, the surgeon should straighten the affected segment using two Babcock forceps at each end of the salpingostomy incision. The two Babcock forceps were held by the assistant, while the surgeon was carrying out the procedure. Two to three simple horizontal sutures were taken (5–7 mm each), at the same level just below the lower border of the tube. The sutures were taken parallel to the salpingostomy incision and extended around 3 mm beyond the incision both medially and laterally, making a line that is continuous along the affected segment. Given the blood supply of the Fallopian tube, these sutures tend to close the small ascending arterioles, coming from the ovarian artery that supplies the bleeding segment of the tube rather than the ligating ovarian vessels or utero-ovarian anastomosis. The tube was left open. The procedure was performed by multiple surgeons in our hospital who subjectively found it as a rapid and effective procedure to stop bleeding from the tube without disrupting the mucosa (Figure 1).