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Menstrual-Cycle-Related Disorders
Published in Jane M. Ussher, Joan C. Chrisler, Janette Perz, Routledge International Handbook of Women’s Sexual and Reproductive Health, 2019
Nancy Fugate Woods, Nancy J. Kenney
Assessment of PCOS ovarian morphology requires transvaginal ultrasonography to identify 12 or more follicles that measure 2–9 mm in diameter in each ovary or increased ovarian volume in the absence of a dominant follicle (>10 mm). In adolescents, diagnosis of PCOS is based on clinical and/or biochemical evidence of hyperandrogenism in the presence of infrequent menses; a pelvic exam and vaginal ultrasonography are not required for those who are not yet sexually active.
The Infertility Workup
Published in Steven R. Bayer, Michael M. Alper, Alan S. Penzias, The Boston IVF Handbook of Infertility, 2017
The safest, least invasive, and most cost-effective imaging modality routinely employed to visualize and examine the pelvic anatomy is vaginal ultrasonography. Both 2-D and occasionally 3-D images are required to evaluate for suspected abnormalities within the uterus and ovaries. Uterine leiomyomas and polyps as well as ovarian cysts and masses can be easily observed, characterized, and even followed over time. Although uterine anomalies account for only 5% of all causes of infertility, they are more often associated with recurrent pregnancy loss and miscarriage. The best time to perform the vaginal ultrasound is during the first 4 days of the menstrual cycle. At this time, the endometrium is thin and both ovaries are resting and no cysts or follicles larger than 10 mm in diameter should be noticed. Any variation from normal should prompt an investigation to identify the underlying pathologic process and determine if treatment is required.
Primary Postpartum Haemorrhage
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
A high paravaginal haematoma, which is above the levator ani muscles, is rarer in comparison to an infralevator haematoma, but it could be significantly more dangerous to the woman. Moreover, there could be different presentations. A clue to the diagnosis would be a disparity in the visible blood loss associated with trauma to the upper vagina or the cervix and the clinical state of the postpartum woman. In some cases, it may be possible to feel a nontender, boggy mass protruding into the upper portion of the vaginal canal and causing vaginal or rectal pain and exhibiting pressure symptoms (Figure 14.8B). Sometimes, the haematoma may not be detectable externally. Combined abdominal and vaginal ultrasonography helps in its diagnosis. If it is detected immediately or a few hours after delivery, then it requires emergency laparotomy. It is a very dangerous condition that is often burdensome to manage. The principles of management are the same as for an infralevator haematoma. However, identification of an active bleeding point is even more troublesome, and the application of haemostatic sutures to the bed of the haematoma is also more demanding on account of engorged venous plexuses and the need to prevent injury to the ureters. Ligation of the internal iliac arteries (described in Chapter 18) or pelvic arterial embolisation may be required. Insertion of a tight vaginal pack prior to the laparotomy, tight packing of the pelvis after evacuating the blood clots and achieving haemostasis as much as possible, and reinforcing the vaginal pack after the laparotomy, are measures that could be adopted in these difficult cases. If the woman presents late with no deterioration of her clinical condition, then conservative management is possible.
Combined proteomics and transcriptomics identifies serpin family C member 1 associated protein as a biomarker of endometriosis
Published in Annals of Medicine, 2023
Xiao-yan Li, Xi Wang, Zhi-yue Gu, Ting-ting Sun, Jin-hua Leng, Qi Yu
It was determined that a total of n = 7 women who had EM, and n = 7 women who were deemed to be clear of EM at surgery, had biopsies taken. Each patient had a single endometrial biopsy during their menstrual cycle. Vaginal ultrasonography was used to keep tabs on the cycle (Aloka-1000, UST-985 transvaginal probe; Aloka Co. Ltd., Tokyo, Japan). Ultrasound monitoring began on the ninth day of the menstrual cycle for these women. Follicular diameter of 14–15 mm necessitated the use of an LH urine test. The biopsy was taken on an open day LH + 7, which was determined by measuring the LH levels in the urine. Sterilized endometrial samples were taken from the uterus using SAP-1 endometrial harvesting instruments (Saipujiuzhou, Beijing, China). Each sample was split into two equal parts and then glued together. After haematoxylin–eosin staining and immunohistochemistry, samples for histological dating were fixed in formalin and turned into wax under uniform circumstances in similar laboratory. This study used Noyes et al. to code and date all biopsies based on histopathology. Liquid nitrogen was used to keep the RNA test specimens cool [15].
Antithyroid antibodies may predict serum beta HCG levels and biochemical pregnancy losses in euthyroid women with IVF single embryo transfer
Published in Gynecological Endocrinology, 2021
Kagan Gungor, Nur Dokuzeylul Gungor
Gonadotropin stimulation was started by applying 225 IU rFSH on the second or third day of the menstrual cycle. Serial vaginal ultrasonography was used to monitor ovarian response. In order to prevent premature luteinisation, 0.25 μg GnRH (Cetrotide 250 μg, Merck Serono, Jordan, Turkey) antagonist was added daily when the leading follicle reached a diameter of 14 mm. When the mean diameter of two or three leading follicles reached 18 mm or more, recombinant human chorionic gonadotropin (rHCG) (Ovitrelle 250 μg, Merck Serono, Jordan, Turkey) was used to trigger ovulation. Approximately 34–36 h after the rHCG injection the oocytes were harvested transvaginally under general anesthesia. ICSI was then performed 3–4 h later. A single blastocyst transfer was done at the fifth day after oocyte pickup in all cases. For the luteal phase support, 90 mg progesterone (Crinone 8%vaginal gel, Merck Serono, Jordan, Turkey, BID) was used transvaginally in all patients. Early-stage pregnancy serum β-HCG level were checked to identify pregnancy after 14 days from oocyte pickup. Miscarriage defined as the spontaneous loss of an intra-uterine pregnancy prior to 22 completed weeks of gestational age [8].
Comparison of oral dydrogesterone and vaginal micronized progesterone for luteal phase support in intrauterine insemination
Published in Gynecological Endocrinology, 2020
Mustafa Taş, Semih Zeki Uludag, Mustafa Ercan Aygen, Yılmaz Sahin
After obtaining a detailed medical history, patients without any of the exclusion criteria were enrolled. Ovarian stimulation was carried out using 75 IU recombinant FSH (Puregon®, Organon) aiming for 1–2 follicles of at least 16 mm diameter. Ovarian response was evaluated with transvaginal ultrasound at the 8th day of stimulation and either with 250 µgr recombinant human choriogonadotrophin (rhCG) (Ovitrelle, Merck) was administered if the diameter of the dominant follicle was > 18 mm. Insemination with processed semen (0.2–0.5 ml) was performed following 36 h of HCG injection. Dydrogesterone oral (Duphaston® 10 mg tablet, Eczacıbaşı) 3 x 10 mg/day or vaginal micronized progesterone capsule (Progestan® 200 mg soft capsule, Kocak Farma) 3 x 200 mg/day were used for luteal support. Luteal phase support was initiated on the day of insemination and was continued until the 8th week in those with a positive pregnancy test result. Luteo-placental shift is considered to be completed up to 8 weeks [13]. Luteal support was stopped if pregnancy tests were negative. Biochemical pregnancy was established when pregnancy test result was positive with >20 mIU/ml HCG levels, 12 days after insemination. Clinical pregnancy was defined as the presence of fetal cardiac activity on vaginal ultrasonography 4 or 5 weeks after insemination. The groups were compared with respect to treatment outcomes. Clinical pregnancy and live birth were the primary outcome measures of the present study.