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Molecular Diagnosis of Endometrial Receptivity
Published in Carlos Simón, Carmen Rubio, Handbook of Genetic Diagnostic Technologies in Reproductive Medicine, 2022
Maria Ruiz-Alonso, Diana Valbuena, Carlos Simón
To perform an ERA test, a small endometrial biopsy must be taken from the uterine fundus using a pipelle catheter (Cornier Devices, CCD Laboratories, Paris, France) or similar device. This requires a piece of tissue around 70 mg. In difficult cases, where the cervix impedes entrance of the biopsy catheter, an endometrial sample can be obtained by vigorous aspiration with the transfer catheter.
Primary Postpartum Haemorrhage
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
Fundal massage, which is the first step in managing uterine atony, should be applied with circular movements of the left hand on the fundus of the uterus. Only gentle rubbing is needed to initiate uterine contractions. Vigorous rubbing is unnecessary and could possibly even be counterproductive. Blood clots within the lower uterine segment, the cervical canal and in the vagina should be simultaneously removed with the index and middle fingers of the right hand in the vagina (Figure 14.1). If these blood clots are not removed, then the uterus would not be able to contract adequately, in spite of high and repeated doses of uterotonics. It is important to identify the uterine fundus carefully in obese women because a roll of abdominal fat may be mistaken for the uterus. A two-handed technique of applying fundal massage is also described.
Laparoscopic Hysterectomy in the Setting of Large Fibroids
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Trocar positioning is the first and most important step for laparoscopic surgery. Correct trocar positioning provides a sufficient view of the operation field and adequate range of motion for instruments, facilitating the surgery. Generally, the higher the primary trocar is, the better the visualisation of the operative field. The distance between the primary trocar and the uterine fundus should be at least 5 to 8 cm to allow an adequate view and space for operation during uterine manipulation, without interference by masses. Thus, the primary trocar should be placed at least at the midpoint between the umbilicus and the xiphoid process (Lee–Huang point) [1], Palmer’s point, or a point above the umbilicus (in the) midline or in the left upper quadrant, depending on the size of the uterus. As for ancillary trocars, the numbers and positions vary, depending on the uterine size, location of fibroids, and complexity of the surgery.
Clinical efficacy of myometrial and endometrial microwave ablation in the treatment of patients with adenomyosis who had anemia
Published in International Journal of Hyperthermia, 2022
Zuolin Li, Xiaolian Li, Min Lin, Sihua Qiu, Liangqin Wang, Liping Lai, Xuefen Luo, Zunyu Mo, Gang Dong, Guorong Lyu, Shuiping Li
Endometrial histopathology of patients with adenomyosis after MEA treatment revealed significantly higher endometrial tubal metaplasia (TM) than in normal menstrual cycles. ER and PR expression were significantly low after MEA, implying that increased TM and a lack of expression of ER and PR in the endometrium following MEA may impact recurrence [19]. However, in this study, the endometrial ablation range of the MEWA intima was only one-third of the endometrium, which not only reduced the degree of TM in the intima, avoided the lack of ER and PR expression, and reduced the possibility of recurrent bleeding, but also had the advantage of avoiding patient anxiety that would arise from amenorrhea due to excessive ablation of the endometrium. Since the endometrium at the uterine fundus was more likely to invade the myometrium [24], one-third of the endometrium near the uterine fundus was selected for ablation in this study.
Comprehensive overview of the venous disorder known as pelvic congestion syndrome
Published in Annals of Medicine, 2022
Kamil Bałabuszek, Michał Toborek, Radosław Pietura
Venography still remains the gold standard for diagnosis of PCS. Since it is an invasive examination it should be reserved for patients who had prior non-invasive imaging, while interventional therapy is planned [60,69,81]. Selective ovarian and iliac catheter venography can be performed under local anaesthesia. Another way of venographic diagnostics is the direct injection of contrast to the uterine fundus through a needle inserted into the myometrium and evaluating venous flow under fluoroscopy [80]. Evaluation can be based on Beard’s criteria, which consists of three components: maximum diameter of the ovarian vein (<5mm considered normal, 5–8 mm moderate, >8mm severe), time to the disappearance of contrast material (0, 20, and 40 s), and degree of congestion (normal when veins are small and straight, moderate when tortuous and severe if veins are highly tortuous and wide). Each component is scored from 1 to 3 and the final sum of 5 or more is considered to fulfil the diagnostic criteria, which are believed to have 91% sensitivity and 89% specificity [82].
Myomectomy during pregnancy; diagnostical dilemmas: two case reports and a systematic review of the literature
Published in Journal of Obstetrics and Gynaecology, 2022
Michail Diakosavvas, Kyveli Angelou, Zacharias Fasoulakis, Nikolaos Kathopoulis, Dimitris Zacharakis, Nikolaos Blontzos, Panos Antsaklis, Dimitrios Haidopoulos, George Daskalakis, Alexandros Rodolakis, Marianna Theodora
Secondarily, this study gathered current data of myomectomies performed during pregnancy, including the characteristics and diagnosis of the myomas of pregnant women, the surgical details and complications, along with the outcomes of these gestations. Overall, the analysis of cases published in international literature, suggests that surgical removal of myomas during pregnancy can be considered safe, given certain indications and considerations (Fanfani et al. 2010). Our review, including the cases of the present study, comprises of 71 women undergoing excision of fibroids during pregnancy, between 8th and 26th week of gestation. The surgical operation performed, was via laparotomy in 60 cases, 10 via laparoscopy and one through the vaginal route. The vast majority of the myomas removed, concerned subserosal and/or pedunculated fibroids in the uterine fundus unresponsive to the primary conservative management. Regarding the case of the submucous fibroid removed vaginally, it concerned a semipedunculated posterior cervical myoma with a thick base and closed cervical os. Due to the inability of removing the myoma via twisting and clamping, an incision was made on its surface and the nucleus was extracted, before suturing the cervical concavity. Fortunately, postoperatively no cervical funnelling or short cervix was discovered, and the pregnancy continued uneventfully, resulting in a spontaneous vaginal delivery (Obara et al. 2014).