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Retained Placenta
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Ultrasound with or without colour Doppler may be used as an adjunct to clinical examination in order to identify retained placental parts. However, its ability to differentiate between placental parts and blood clots may possibly be low (discussed in Chapter 15). Although manual removal is the fundamental method for removal of the retained placenta, additional suction or sharp curettage may have to be performed in some cases. Excessive or vigorous curettage which can aggravate bleeding or cause uterine perforation and even Asherman’s syndrome, should be avoided. Following the procedure, the placenta must be examined carefully to be able to ensure that it has been removed completely. An exploration of the uterus may have to be performed in order to exclude any retained placental parts, especially in the presence of ongoing bleeding. Trauma to the genital tract should be excluded. An oxytocin infusion (e.g. 20 units in 500 mL of normal saline) should be started to maintain uterine contractions, and broad-spectrum antibiotics (e.g. intravenous cefuroxime and metronidazole) administered to prevent infection. If bleeding continues despite completely removing the placenta, then uterine balloon tamponade (discussed in Chapter 14), and laparotomy followed by uterine compression sutures (discussed in Chapter 17), uterine devascularization (discussed in Chapter 18) and even hysterectomy (discussed in Chapter 19), may have to be performed.
Malignant diseases of the skin
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
Anupam Das, Yasmeen Jabeen Bhat
Treatment: Although spontaneous resolution may occur, this does not happen for many months – and frequently leaves an unsightly scar. For these reasons, therapeutic intervention is usually indicated. Surgical excision or curettage and cautery may be employed. Intralesional methotrexate and prednisolone have also been reported to be effective. Systemic retinoids can be given for multiple lesions.
Cervical Ectopic Pregnancy
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
The most widely used surgical intervention is a hysterectomy (Figure 4.6), which clearly will jeopardize fertility but results in less blood loss and less morbidity; hysterectomy is considered a permanent treatment method when compared to curettage [28, 29]. This method should be used only if conservative medical management is unsuccessful or there are any other contraindications to the agents used for medical management [28, 29]. This method can also be reserved for patients in whom medical management fails and massive hemorrhage develops [29]. If bleeding occurs emergently, consideration can be given to inserting a Foley balloon to tamponade the bleeding vessels within the cervical canal [30]. In addition, a Shirodkar cerclage and/or intracervical vasopressin injection have also been reported as being successful to control hemostasis in these situations [31]. Another surgical intervention that has been studied for the surgical management of cervical ectopic pregnancies is ligation of the uterine artery branches, which is thought to decrease blood flow to the ectopic pregnancy with resultant failure to grow and demise and involution [32]. If curettage is used, this may be followed by injection of methotrexate or potassium chloride into the sac [28]. Hysteroscopic resection of the sac and tissue has also been evaluated as a method, but again, this technique results in morbid hemorrhage if meticulous hemostasis is not achieved [28].
Animal models in intrauterine adhesion research
Published in Journal of Obstetrics and Gynaecology, 2022
Shanshan Liang, Yanlan Huang, Yanfen Xia, Shuang Liang, Qiaoling Wu, Zhifu Zhi
In addition to factors such as surgery, infection, and trauma, low levels of oestradiol after endometrial injury can also lead to the formation of adhesions (Yang et al. 2022). However, a current view also supports using oestrogen before surgery to prevent the formation of adhesions (Zhang et al. 2019). Some studies have shown that oestrogen combined with other treatments can reduce the AFS score, reduce endometrial adhesions, improve the capability of endometrial regeneration, and improve the reproductive outcome of patients with IUA (Cai et al. 2016; Ebrahim et al. 2018). Bazoobandi et al. (2016) increased the intervention conditions with oestrogen on the basis of the above experiments (Bazoobandi et al. 2016). They improved the method of the above model by combining it with the polyoestrous characteristic of rabbits, allowing the uterine endometrium to be restored shortly after the traumatic curettage of the uterus. Under the same experimental conditions as those of Khrouf et al.(2012), lowering the oestrogen level by deletion or fixation of ovarian hormone effects reduced endometrial proliferation. The histological examination of uterine sections showed that curettage was effective in endometrial destruction. These workers thus successfully established an IUA model and proved the potential effects of hormone levels on endometrial structure, regeneration, and fertility after uterine curettage. Their study also provided a model reference for follow-up study with oestrogen and progesterone for preventing adhesions (Khrouf et al. 2012).
Placenta accreta spectrum disorders in the first trimester: a systematic review
Published in Journal of Obstetrics and Gynaecology, 2022
Julieth Alexandra Guzmán López, Luz Ángela Gutiérrez Sánchez, Gabriel David Pinilla-Monsalve, Ilan E. Timor-Tritsch
Currently, it is considered that the increase in PAS disorders is strongly associated with the rise of CDs and a history of placenta previa. Likewise, there are other risk factors for these disorders, including advanced maternal age, prior curettage, submucosal myomas, and the number of pregnancies (Dueñas et al. 2007). This review found 53 cases with risk factors for the development of PAS disorders, being CD the most common. Another frequent finding was vaginal haemorrhage in patients after invasive curettage procedures reported as intermittent or even massive. This is consistent with Wang and colleagues, who depicted 23 published cases of PAS disorders after miscarriage in the first trimester (Wang et al. 2019), 17 of which met the inclusion criteria of the present study and are found herein.
Risk factors of retained products of conception after miscarriage or termination with gemeprost in the second trimester of pregnancy: a retrospective case-controlled study in Japanese population
Published in Journal of Obstetrics and Gynaecology, 2022
Tomoko Noguchi, Michihisa Shiro, Sakiko Nanjo, Mika Mizoguchi, Nami Ota, Yasushi Mabuchi, Shigetaka Yagi, Sawako Minami, Kazuhiko Ino
Surgical curettage after delivery was not routinely performed in our hospital in order to avoid uterine rupture and subsequent intrauterine adhesions. Routine curettage after delivery in the second trimester abortion was not recommended in Royal College of Obstetricians and Gyanecologists (RCOG) guidelines (RCOG 2004). Previous reports (Hooker et al. 2016) indicated that surgical curettage was associated with a higher incidence of uterine adhesion and infertility. Moreover, surgical curettage for RPOC is reported to be associated with an increase risk factor of recurrence in subsequent pregnancies (Smorgick et al. 2018). Capmas et al. reported that hysteroscopic resection of RPOC was an efficient procedure and alternative therapy compared to surgical curettage. In this study, only 7.5% of women who were diagnosed with RPOC and received hysteroscopic resection caused intrauterine adhesion, and 83% of them had subsequent pregnancy (Capmas et al. 2019).