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Intrauterine devices
Published in Sarah Bekaert, Alison White, Integrated Contraceptive and Sexual Healthcare, 2018
Sarah Bekaert, Alison White, Kathy French, Kevin Miles
Introduce the uterine sound through the cervical canal into the uterine cavity until it reaches the fundus. After determining the direction and length of the cervical canal and the uterine cavity, prepare Nova T380 for insertion.
The intrauterine device (IUD)
Published in Suzanne Everett, Handbook of Contraception and Sexual Health, 2020
Insertion of an IUD is performed by a ‘non-touch technique’ so a clean pair of gloves should be used following bimanual examination. A sterile speculum is inserted into the vagina and the cervix is located; this is cleaned with sterile cotton wool and antiseptic solution. A uterine sound is inserted into the uterus via the cervical canal to measure the length, direction and patency of the uterus. This may cause cramp-like period pains which should diminish when the uterine sound is removed. The cervix may be stabilised by Allis forceps or a tenaculum so that the IUD may be inserted more easily; these may cause some discomfort as the cervix is very sensitive. Next the IUD is inserted through the cervical canal into the uterus. The threads of the IUD are shortened once it is in position and are tucked up behind the cervix. If there are any problems with an insertion, then your client should be referred to a specialist in IUDs. Following insertion, you should encourage your client to lie down and rest. Analgesia may be required for period pains. Sanitary towels should be used initially to reduce the risk of infection and because tampons may catch on the IUD threads which have not yet softened. Tampons may be used with the next menstrual period. Your client may experience bleeding initially. This is a good time to remind her of any initial problems and when to return, for example if she experiences a change in her normal vaginal discharge or persistent abdominal pain. You should teach your client how to check her IUD threads and encourage her to perform this after each menstrual period. It is helpful to show your client a picture of the type of IUD she has fitted, and how long it should remain in situ. Up-to-date written information should be given along with relevant telephone numbers of where to get help if needed. The IUD is effective immediately, so no additional contraception is required. An IUD procedure takes usually ten minutes.
Gynaecology
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
Access to the uterine cavity, whether for biopsy (curettage), examination (hysteroscopy), or operative intervention, such as termination of pregnancy or endometrial ablation, requires dilatation of the cervix. The steps involved in a simple ‘D&C’ operation are: A vaginal speculum is inserted to expose the cervix and the anterior lip is grasped with a vulsellum (grasping forceps), drawing the cervix downwards into the vagina and straightening the endocervical canal, so as to make the passage of instruments safer.A uterine sound is passed to measure the length of the cavity. Great care must be taken not to create a false passage or to perforate the fundus of the uterus with this relatively sharp instrument. This step is strictly contraindicated in pregnancy; when terminating a pregnancy the size of the uterus is estimated by bimanual palpation, not by a metal sound.The cervix is then dilated by the passage of graduated metal rods (Hegar dilators), each 0.5 mm greater in diameter than its predecessor. The operator must never pass the dilator further than the known length of the cavity. The extent of dilatation depends on the operation to be performed. For diagnostic procedures it is seldom necessary to dilate the cervix >7 or 8 mm, but for termination of pregnancy the extent of dilatation depends on the size of the fetus to be evacuated. If the cervix is to be dilated >10 mm, some preoperative preparation, either with prostaglandins or a hygroscopic dilator, is essential to prevent damage.Examination of the uterine cavity may indicate minor pathology, such as a polyp, which can be simply avulsed.For diagnostic purposes, a blunt spoon (curette) is used to scrape off the outer lining of the endometrium.
Laparoscopy-assisted suprapubic salpingectomy ‘Kaya technic’ - a low-cost treatment of ectopic pregnancy
Published in Journal of Obstetrics and Gynaecology, 2019
Cihan Kaya, Ismail Alay, Ecem Eren, Ozlem Helvacioglu
In the LASS group, the pneumoperitoneum was created with a Veress needle using carbon dioxide and the pressure was kept at 12 mmHg. The operation table was kept in the Trendelenburg position. A 2 cm trans-umbilical incision was performed and a 10 mm reusable umbilical optical trocar was inserted for endoscopic visualisation (Karl Storz, Tuttlingen, Germany) of the abdominal cavity. A uterine sound was then inserted as a uterine manipulator in all cases to provide an adequate exposure of the pelvic organs. A 10 mm trocar was inserted ≈3 cm above the symphysis pubis in the midline. The free blood or coagulum was aspirated with a conventional aspirator used for open surgical procedures after the removal of the suprapubic trocar as necessary. The pelvis was inspected and irrigated to confirm the diagnosis of tubal pregnancy if there was no adequate visualisation. A 10 mm reusable laparoscopic Babcock grasper (Karl Storz, Tuttlingen, Germany) introduced through the suprapubic port to pull the tube with the ectopic foci outside the abdomen simultaneously after the abdominal pressure was decreased, desuflation was obtained, and the patient was laid in the supine position. The tube was fixed using Heaney tissue forceps used for open surgeries outside the abdomen and the damaged or active bleeding tube was excised and sutured with a 2-0 absorbable suture. After bleeding was controlled, the adnexal remnant was moved back into the abdominal cavity. The trocars were then withdrawn, the umbilical and suprapubic fascia were closed with a 2-0 absorbable suture, and the skin was closed with a 2-0 Vicryl Rapide suture (Vicryl, Ethicon, Somerville, NJ, USA). (Figures 1–3)
Safety and effectiveness of laparoscopic sacrocolpopexy as the treatment of choice for pelvic organ prolapse
Published in Arab Journal of Urology, 2019
Sherif Mourad, Hisham El Shawaf, Ahmed Farouk, Hisham Abdel Maged, Amr Noweir, Bruno Deval
All procedures were performed under general anaesthesia with the patient in supine Trendelenburg position. A uterine sound is placed in the uterus to manipulate the uterus and four transperitoneal ports (one 5-mm port, one 12-mm, and two 10-mm ports) are used (Figure 1). The first step is dissecting the sacral promontory and exposing the anterior longitudinal ligament (blue thread) and vein. A 2/0 polypropylene (Prolene®; Ethicon Inc., Somerville, NJ, USA) suture is taken transversely in the anterior longitudinal ligament (Figure 2). Then dissection of the right retroperitoneal tissue with incision of the peritoneum to enter the recto-uterine pouch and right uterosacral ligament. The posterior vaginal wall is stretched and pushed upwards by the malleable retractor and dissected carefully for ~6–8 cm downwards (Figure 3). Incision of the anterior peritoneum is done. Complete dissection of the anterior vaginal wall from the empty bladder is done with a malleable retractor stretching the anterior vaginal wall. Fixation of the posterior mesh (polypropylene mesh ~3 × 15 cm) is done using four to six 2/0 polyglactin 910 (Vicryl®; Ethicon Inc.) sutures to the posterior vaginal wall in front of the rectum (white arrow head) and right adnexa (Figure 4). The anterior mesh is divided incompletely into two limbs (right and left), leaving a common stem of ~5–6 cm. The anterior mesh common stem is fixed to the anterior vaginal wall with four to six sutures (Figure 5). The right limb of anterior mesh is passed through the right broad ligament and past the left limb of the anterior mesh through the left broad ligament. The two meshes are anchored on the sacral promontory using a tacking device (AbsorbaTack™; Medtronic, Minneapolis, MN, USA) (Figure 6). Reperitonalisation over the anterior mesh, posterior mesh and sacral promontory is done to avoid the risk of bowel adhesions and complications (Figure 7). We evaluated operative outcomes including: intraoperative complications, blood transfusion, associated surgical procedures, use of tacking device on the promontory, number of anterior and posterior meshes used, and operative time.