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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.
Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Fibroid torsion is uncommon and is associated with pedunculated subserosal fibroids. It can present with pain; however uterine artery embolisation does not predispose to this and the most likely diagnosis in this case remains post-embolisation syndrome.
Endometriosis
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Ceana Nezhat, Pavan Ananth, Dahlia Admon
Spontaneous hemoperitoneum is another way endometriosis can present as a surgical emergency. Although this is more commonly due to a ruptured endometriotic cyst, Fiadjoe et al. present a case of endometriosis eroding through the uterine artery and resulting in massive pelvic hemorrhage [5].
The impact on Anti-Mullerian Hormone (AMH), uterine fibroid size and uterine artery patency following Uterine Fibroid Embolization (UFE) with a resorbable embolic agent
Published in Human Fertility, 2022
Nigel Hacking, Ganesh Vigneswaran, Drew Maclean, Timothy Bryant, Sameer Umranikar, Ying Cheong, Sachin Modi
The long-term implications of UFE are not well understood and there is speculation regarding the detrimental effect of UFE on fertility (Chrisman et al., 2000; Gupta et al., 2014; Karlsen et al., 2018). Theoretically, there are two main potential methods through which UFE could adversely impact on fertility. Firstly, there is the potential risk of non-target embolization (particles reaching the ovarian vessels) leading to ischaemia of the ovarian cortex, causing reduction in Anti Mullerian Hormone (AMH) secreting antral and pre-antral follicles (Broekmans et al., 2008; Hascalik et al., 2004). Whilst indirect measures of ovarian reserve such as FSH, oestradiol and ovarian volume do not show a significant effect post embolization (Broer et al., 2014), there have been conflicting data on the impact of UFE on ovarian reserve biomarkers such as AMH (McLucas et al., 2016). Secondly, there is a potential detrimental impact of UFE on fertility secondary to the occlusion of the uterine artery. Surgical occlusion of the uterine artery or endovascular embolization of the artery has been associated with a lower rate of live births (Goldberg et al., 2004; Holub, 2008; Holub et al., 2008). Therefore, if patency of the uterine artery can be maintained post-embolization, this bears a theoretical fertility benefit. However, no studies have directly examined if differential uterine artery patency rates post-embolization have resulted in a differential live birth rate.
Lateral closure of the uterine artery prior to laparoscopic hysterectomy: a systematic review
Published in Journal of Obstetrics and Gynaecology, 2022
Vibeke Kramer Lysdal, Grigorios Karampas, Martin Rudnicki
Through time, various methods to approach and occlude the uterine arteries have been described. One of the most-commonly used methods is the anterior approach which involves opening of the anterior broad ligament over the paravesical area where the internal iliac artery can be identified and followed until the uterine artery is crossing the ureter (Sinha et al. 2008; Einarsson and Suzuki 2009). In what it is called the ‘reverse hysterectomy’ (Litta et al. 2013), the procedure starts by opening the vesicouterine fold and incision of the pubocervical fascia via the round ligament to identify ureter. The uterine artery is identified where crossing the ureter on the posterior layer of the broad ligament, also known as Litta’s triangle. The recommended site of closure of the uterine artery is lateral to crossing the ureter (Litta et al. 2013). Finally, several authors have described a lateral approach through a peritoneal incision lateral to the ovarian vessels (Pan et al. 2008; Sinha et al. 2008; Poojari et al. 2014; Kale et al. 2015). By the lateral approach to the uterine artery, the operator is forced to identify the location of ureters. This approach starts by the opening of the peritoneum from the round ligament and along the infundibulopelvic ligament, then identifying the ureter, which is followed to the crossing of the uterine artery. The uterine artery is occluded lateral to the ureter at its origin. This procedure has been shown to reduce risks of bleeding and ureteral injuries (Pan et al. 2008; Sinha et al. 2008; Poojari et al. 2014; Kale et al. 2015).
Laparoscopic temporary bilateral uterine artery occlusion – a successful pregnancy outcome of heterotopic intrauterine and cervical pregnancy
Published in Journal of Obstetrics and Gynaecology, 2021
Lanying Jin, Limei Ji, Mingjun Shao, Min Hu
The patients were taken in the Trendelenburg position, after general anaesthesia. Under a direct laparoscopic vision, we noted that the uterus was enlarged as being bigger than pregnant for two months (Figure 1(a)). Titanium clips were used to occlude the bilateral uterine arteries at the beginning of the procedure (Figure 1(b,c)). The clips were easy to apply and easy to remove. The structure of the titanium clip was similar to a non-invasive forceps and caused less damage to vessels compared with other clips. The uterine artery was located via the anterior leaf of the broad ligament. A resection of CP was performed without any complications (Figure 1(d,e)). The bleeding surface of the cervix was repaired with 3–0 absorbable suture. After confirmation of haemostasis, the reflow of both uterine arteries was accomplished by removing the titanium clip. The clip partial is performed according to the approach as described in our previous paper (Shao et al. 2013; Ji et al. 2018). Finally, the peritoneum was closed with 3–0 absorbable suture. The operative time was 60 min, the uterine artery occlusion time was 15 min and the estimated blood loss volume was 100 mL.