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Uterine Anomalies and Recurrent Pregnancy Loss
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
Daniel S. Seidman, Mordechai Goldenberg
Although no randomized controlled studies are available, observational studies have reported impressive results following incision of a septum in patients with recurrent miscarriage [45,53]. Fedele et al. [44] studied the reproductive outcome in 102 patients with a complete (n = 23) or partial septate uterus (n = 79) and infertility or recurrent miscarriage. Following hysteroscopic metroplasty the cumulative pregnancy and birth rates at 36 months were 89% and 75%, respectively, in the septate uterus group and 80% and 67% in the subseptate uterus group. Dalal et al. [45], reported on 72 women with unexplained primary infertility who underwent hysteroscopic septal resection. Thirty-three women (45.8%) conceived within one year of surgery. Only four women (12%) miscarried, and only five (15%) had preterm delivery. Sugiura-Ogasawara [39] published a comparative cohort study on 109 women with two or more miscarriages who underwent septotomy (hysteroscopic or by open surgery) and compared the live birth rates to 15 women who did not undergo surgery. Although the study was underpowered to show a statistically significant effect, there was a 20% benefit from surgery (81% live births after surgery compared to 61.5% without surgery) [39]. However, hysteroscopic metroplasty is associated with a substantial and as yet non-quantified increased risk of uterine rupture during subsequent pregnancies [46–48]. Uterine perforation and/or the use of electrosurgery increase this risk but are not considered independent risk factors [47].
Operative gynaecology
Published in Andrea Akkad, Marwan Habiba, Justin Konje, David Taylor, EMQs in Obstetrics and Gynaecology, 2017
Andrea Akkad, Marwan Habiba, Justin Konje, David Taylor
Uterine perforation, particularly in a pregnant uterus, is a serious complication. It can lead to substantial haemorrhage requiring a hysterectomy, but also other organs such as bowel can be injured, in particular where a suction curette is being used for the uterine evacuation. Typical clues would be difficult dilation of the cervix, failure to obtain tissues on curettage and insertion of the curette to a depth beyond the expected size of the uterine cavity. Laparoscopy/ laparotomy to inspect the damage and deal with any injuries is required.
X-Ray and Computed Tomography
Published in William Y. Song, Kari Tanderup, Bradley R. Pieters, Emerging Technologies in Brachytherapy, 2017
Martin T. King, Michael J. Zelefsky
For cervical brachytherapy treatment planning after applicator insertion, x-ray imaging is limited due to its inability to accurately image either the cervix or the surrounding organs. CT imaging has fundamentally changed brachytherapy treatment planning, since the cervix, bladder, and rectum can be delineated for each individual patient. Dose volume histogram (DVH) analysis has shown that CT-based planning allows for better target coverage and conformality than prescription to Point A (Shin et al., 2006). Furthermore, International Commission on Radiation Units and Measurements (ICRU) bladder and rectal points may underestimate maximal bladder and rectal doses (Pelloski et al., 2005). Recently, a prospective multicenter study demonstrated that patients who underwent 3D-based dosimetry, predominantly with CT, had improved local control and decreased toxicity compared to those who were treated with two-dimensional (2D) techniques (Charra-Brunaud et al., 2012). An added benefit is that CT-based imaging allows for the detection of uterine perforation, which is a serious complication often not easily appreciated on conventional x-ray (Barnes et al., 2007).
Safety and efficacy of microwave endometrial ablation for patients with previous uterine surgery: a pilot study
Published in Journal of Obstetrics and Gynaecology, 2022
Aki Maebayashi, Nobuki Hayashi, Saki Kamata, Toshihiro Sugi, Takahiro Nakajima, Masaji Nagaishi, Kei Kawana
Microwave endometrial ablation (MEA) is a second-generation endometrial ablation modality utilising fixed-frequency microwaves. The microwave heats and destroys the base layer of the lining of the endometrium and endometrial glands at a temperature of 60 °C or higher (Nakayama et al. 2011). MEA has been used to treat hypermenorrhea since the 1990s (Sharp et al. 1995; Jamieson et al. 2002). The characteristics of MEA include fewer complications, higher response rates, and greater therapeutic efficacy than total hysterectomy (Sharp et al. 1995; Cooper KG et al. 1999; Cooper JM et al. 2004). On the other hand, a few serious complications have been reported, including uterine perforation and intestinal injury. The presence of sites of myometrial thinning has been suggested as a cause of such injury. To avoid this issue, preoperative imaging and intraoperative ultrasounds are recommended (Kanaoka et al. 2005; Nakayama et al. 2011).
Outcomes of surgical hysteroscopy: 25 years of observational study
Published in Journal of Obstetrics and Gynaecology, 2022
Anna Vilà Famada, Ramon Cos Plans, Laura Costa Canals, Mireia Rojas Torrijos, Agueda Rodríguez Vicente, Albert Bainac Albadalejo
Complications differed depending on surgery type but, overall, the combined category of mechanical complications was the most common, making up 52.2% of all complications (broken down by individual complication type, these were 23% with cervical tear, 13.7% with uterine perforation, 8.6% with false cervical route, 4% with vaginal tear and 2.9% with false endometrial route). These mechanical injuries were produced with different instruments, mostly by Hegar uterine dilators (58%), the hysteroscope itself (24%), electricity (15%) or Foerster forceps (3%). Only 11 patients required surgery to treat their complication. Ten diagnostic-therapeutic laparoscopies were performed to treat uterine perforations and in one patient laparotomy was necessary (surgery performed in the early years of operative hysteroscopy in our hospital).
Intrauterine device penetrating the anterior urinary bladder wall discovered during caesarean section: a case report
Published in Journal of Obstetrics and Gynaecology, 2020
Goda Jievaltienė, Dominyka Surgontaitė, Rosita Aniulienė, Donatas Venskutonis
An early diagnosis of IUD migration is important to avoid further tissue or organ damage and adhesion formation. In analysed studies, migrated IUDs were detected during transabdominal, transvaginal ultrasound examinations or pelvic radiography (Eli et al. 2015; Niu et al. 2015; Uçar et al. 2017). In the described clinical case, the patient was diagnosed with class III obesity, therefore, excessive adipose tissue could have made the visualisation of the IUD near impossible. The right technique when inserting IUD in the uterus is another important factor, as the perforation can occur during insertion. In situations like these, pain and vaginal bleeding can be present (Mascarenhas et al. 2012). In this case, there were no signs of urethral or uterine perforation, but it cannot be guaranteed that it did not happen during the insertion, as it would be clearer why the IUD was found in the anterior urinary bladder wall. More importantly, IUD’s location was specified by ultrasound after the insertion.