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Adrenocortical carcinoma
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Dushyanthy Arasaratnam, Nadia Barghouthi, Vladimer Bakhutashvili
Given the poor prognosis, it has been suggested that surgical resection be considered first line, regardless of the trimester, and mitotane should be offered, even in tumors limited to the adrenal gland in this population.6,8Complete tumor resection is the most efficient treatment. A laparoscopic or open approach may be used. Open surgery is typically recommended for limited disease as laparoscopic surgery is associated with a higher risk of developing recurrence, tumor rupture, or carcinomatosis.6 In pregnancy, the laparoscopic approach may be preferred due to the advantages of shorter operative time, little interference to the abdominal cavity, and less bleeding. Carbon dioxide pneumoperitoneum which can occur secondary to gas insufflation in laparoscopic surgery can increase blood CO2 partial pressure in pregnant patients and pose a potential threat to the fetus. The enlarged uterus may also pose a challenge in this approach.5
Gynaecology, Fertility and Family Planning
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Zahra Ameen, Kopal Singhal Agarwal, Chawan Baran, Lauren Laws, Maria Garcia de Frutos, Black Benjamin
Rapidly assess the severity of bleeding for haemorrhage or shock and respond appropriately if concerning. Perform a complete gynaecological examination. Arrange a pregnancy test for all women of childbearing age, haemoglobin7 and endometrial biopsy for women aged >40 years or who have risks factors for endometrial cancer.8 Organise pelvic ultrasound, if available, particularly if abnormal pelvic masses or enlarged uterus are noted on physical examination.
Acute abdomen in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Nicole Fearing, William L. Holcomb
Treatment of intestinal obstruction in pregnancy is the same as that for the nonpregnant patient. Clinical management includes prompt correction of fluid and electrolyte deficits, decompression of bowel, relief of obstruction, and resection of nonviable tissue. Prompt fluid resuscitation is especially important in pregnancy, since uterine blood flow depends upon a normal maternal blood volume. If patients are in shock or significantly impaired, a foley catheter may be required to monitor urine output. As fetus mortality is high with bowel obstruction, early surgery is warranted. Adequate operative exposure and thorough inspection of the full length of the bowel should not be compromised. Usually, a midline abdominal laparotomy incision is optimal. In some cases, it may be necessary to empty the uterus to accomplish satisfactory surgical therapy. However, this can most often be avoided (71). As a rule, the treatment of intestinal obstruction is surgical. Selected cases of early sigmoid volvulus have been successfully treated with colonoscopy, long-tube and rectal-tube decompression alone (72). In the case of bowel obstruction, it may not be optimal to attempt a laparoscopic exploration in a pregnant patient. There will be limited exposure due not only to the enlarged uterus but also to the dilated bowel. The bowel may also be friable and easily torn with manipulation causing enterotomies.
A comparison of the pregnancy outcomes between ultrasound-guided high-intensity focused ultrasound ablation and laparoscopic myomectomy for uterine fibroids: a comparative study
Published in International Journal of Hyperthermia, 2020
Guangping Wu, Rong Li, Min He, Yuanfang Pu, Jishu Wang, Jinyun Chen, Hongbo Qi
Inclusion criteria were as follows: (1) women who desire fertility or a pregnancy plan; (2) women who have a regular sexual life and do not use contraception postoperatively; (3) women with symptomatic fibroids confirmed by an imaging examination and with any of the following indications for intervention: (a) enlarged uterus (uterine volume equal to or larger than that at 10 week’s gestation); (b) menorrhagia and/or secondary anemia; (c) pelvic pain, frequent urination, or constipation; (4) women who had fewer than three fibroids with an individual diameter larger than 2 cm, as visualized by pelvic ultrasonography; and (5) women who chose to be treated with USgHIFU ablation and had fibroids clearly detected by ultrasonography. For patients with abdominal surgical scars, the range of the blurred image caused by acoustic attenuation should be <10 mm.
Combined therapeutic effects of HIFU, GnRH-a and LNG-IUS for the treatment of severe adenomyosis
Published in International Journal of Hyperthermia, 2019
Xinhua Yang, Xiaofei Zhang, Bin Lin, Xiao Feng, Aixingzi Aili
Both gonadotropin-releasing hormone agonist (GnRH-a) and the levonorgestrel-releasing intrauterine system (LNG-IUS) are common conservative approaches for women with adenomyosis. GnRH-a alleviates dysmenorrhea and induces amenorrhea by suppressing gonadotropin secretion, which causes restrained ovarian function and is also defined as drug oophorectomy [13]. The major side effects include premenopausal symptoms, bone loss and high relapse rate after medicine withdrawal. The LNS-IUS alleviates dysmenorrhea and hypermenorrhea by releasing progestin derivatives, which results in endometrial decidualization [14]. However, the LNS-IUS is not suitable for women with an enlarged uterus especially a uterus the size of that observed at 3 months of gestation, due to high risk of prolapse or expulsion [15].
The passage of fluid into the peritoneal cavity during hysteroscopy in pre-menopausal and post-menopausal patients
Published in Journal of Obstetrics and Gynaecology, 2018
Janka Palancsai Siftar, Monika Sobocan, Iztok Takac
This prospective clinical study was conducted over an 11-month period at the gynaecological department of a general hospital in Slovenia. Patients with suspected intrauterine pathologies who had been referred to the HSC unit were included in this study. Patients were receiving diagnostic or therapeutic hysteroscopies. The inclusion criteria were patients with intrauterine pathologies referred to the HSC unit. These pathologies included pre- or post-menopausal abnormal bleeding, and suspected pathologies of the uterine cavity – such as the uterine septum, uterine fibroids, uterine cavity adhesions, a suspicious thickening of the endometrium or an intrauterine device removal. Women were excluded if they had contraindications of tubal infertility or previously confirmed abdominal adhesions. The study also excluded women with signs of risk factors such as a uterine fibroid larger than 1 cm or an enlarged uterus of more than 10 cm. This study was conducted after obtaining the approval of the Ethics Committee of the Republic of Slovenia (registration number 120/08/08), and signed consent forms were obtained from all the patients included.