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Alternative Modes of Tissue Coagulation and Removal
Published in Sujoy K. Guba, Bioengineering in Reproductive Medicine, 2020
Following treatment necrosis of tissue in the affected zone takes place and then normal tissue growth ensues. Hemorrhage and cervical stenosis are not common but there is profuse discharge for 2 to 3 weeks following treatment and repeat therapy may be required to obtain complete healing. Another limitation of the method is that the depth of biologic effect cannot be readily controlled as possible with laser techniques.
The GP eye view of the symptoms and signs
Published in Ruth Chambers, Fertility Problems, 2018
Look for: obesity (e.g. Body Mass Index >30) or abnormalities in the pelvic examination to give clues to the cause of subfertility, such as vaginal infection or pain indicating endometriosis or pelvic inflammatory disease. Previous treatment for abnormal smears may have caused cervical stenosis. Bimanual examination may reveal an ovarian cyst or fibroids. Hirsuitism and/or acne may be the clue to the presence of polycystic ovarian syndrome. Galactorrhoea will suggest the probability of hyperprolactinaemia.
Screening for cervical cancer by Pap tests
Published in Norman J. Temple, Andrew Thompson, Excessive Medical Spending, 2018
Andrew Thompson, Norman J. Temple
A report of a study designed to find a means to improve on the accuracy of the Pap test describes some other consequences.7Current management often includes colposcopy-directed biopsy to confirm the severity of the disease, and cervical ablation [removal by electrophysical means such as laser surgery] or excision of even low grade or equivocal lesions … to prevent progression … The cost of these services and subsequent overtreatment is considerable. Medical complications of treatment are rare, but include cervical incompetence, secondary infertility, infection, and cervical stenosis [narrowing of the cervical neck]. Furthermore, emotional concerns regarding referral and treatment for persistent viral infections and “precancerous conditions” are sometimes substantial.
Hysteroscopy in postmenopause: from diagnosis to the management of intrauterine pathologies
Published in Climacteric, 2020
R. Fagioli, A. Vitagliano, J. Carugno, G. Castellano, M. C. De Angelis, A. Di Spiezio Sardo
The most important factors for the success of diagnostic hysteroscopy are adequate instrumentation and a proper technical approach. The Royal College of Obstetrics and Gynaecology (RCOG) guidelines16 recommend the use of miniaturized hysteroscopes (2.7 mm with a 3–3.5 mm diameter of the external sheaths) for outpatient diagnostic hysteroscopy, as they significantly reduce patient discomfort. Accordingly, Giorda et al. found that the use of a 3.5-mm-diameter hysteroscope was associated with lower pain compared to a 5-mm instrument, specifically in postmenopausal women17. The operator should cautiously insert the hysteroscope into the vagina and drive the instrument to the posterior fornix until the external cervical os is clearly visualized. This technique, known as vaginoscopy, or the ‘no touch technique’, allows the atraumatic insertion of the hysteroscope into the external cervical os, without the aid of a speculum or tenaculum. This method reduces patient discomfort, allowing completion of the procedure also in cases of severe vaginal atrophy and in most cases of cervical stenosis18,19.
Obstetric complications as a challenge after radical trachelectomy: a review of the literature
Published in Journal of Obstetrics and Gynaecology, 2019
Amalia Sanchez-Migallon, Victor Lago, Luis Matute, Santiago Domingo
Current studies report successful pregnancy rates that range from 40% to 80% in patients after RT. In a case series of 125 patients with cervical cancer who underwent VRT, 58 patients (46.4%) achieved 106 pregnancies (Plante et al. 2011). Similar pregnancy rates were reported in patients undergoing ART, laparoscopic or robotic approach. Approximately 55% of patients will require assisted reproduction techniques, which is important to consider at the time of preoperative counselling (Hauerberg et al. 2015). The miscarriage rates after RT are high in the first and second trimester, reaching 20% and 3%, respectively (Plante et al. 2011; Hauerberg et al. 2015). The risk of miscarriage and preterm delivery are higher in women that do not undergo prophylactic cerclage, reaching up to 13% for abortion and 27% for preterm delivery (Brownfoot et al. 2013). However, multiple studies have associated having a prophylactic cervical cerclage with an increased risk of developing cervical stenosis, which is one of the main causes of infertility in this population. In a recent systematic review, Li et al. (2015) reported a cervical stenosis rate of 10.5% among 1547 women who had undergone RT; 3% of those patients did not have a cerclage and 8.6% underwent a cervical cerclage. The authors suggest that the use of anti-stenosis tools could reduce the occurrence of cervical stenosis after cerclage (Shepherd and Milliken 2008).
High field structural MRI in the management of degenerative cervical myelopathy
Published in British Journal of Neurosurgery, 2018
Dan Wright, Sean Martin, Erlick AC Pereira, Yazhuo Kong, Irene Tracey, Thomas Cadoux-Hudson
One of the earliest descriptions of the condition was by Mair and Druckman who described a physical dysfunction secondary to extrinsic compression of the cord and its vascular supply by degenerative disease of the cervical spine. The compression of vascular structures, both arterial and venous, was thought to play a role.6 It continues to be one of the most common spinal cord disorders, with one cadaveric study estimating cervical stenosis to be present in 6.8% of people at 50 years and in 9% of those over 70 years.7 The natural history however, is uncertain: for some there is stepwise decline, for others there are long periods of quiescence, and a small group see clinical improvement.