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Specific Management of PPH
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Uterine artery ligature: It is done at the level of the internal os at the lateral wall of the uterus. The uterine vessels start ascending at that level. A deep bite, including the lower lateral wall to occlude the uterine artery, is the safest and quickest procedure. One need not necessarily skeletonise the uterine artery to ligate it. Either absorbable sutures like catgut or delayed absorbable polyglactin are used for uterine artery ligation. The uterine branch of the ovarian artery is ligated at the cornual end below the fallopian tube, with a suture passed to include a part of the adjoining uterine wall. This O’Leary ligature occludes the uterine branch coming down from the ovarian vessels via the mesosalpinx.
Ovarian cyst and tumors
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Bryan J. Dicken, Deborah F. Billmire
With large tumors, the leaves of the mesovarium are widely splayed and the Fallopian tube may be draped over the mass. The peritoneum of the mesovarium is incised in an avascular plane between the tube and ovary with cautery dissection. This maneuver will expose the vascular pedicle of the ovary. If the tumor is large, the venous plexus is often engorged and the pedicle may need to be taken in stepwise fashion with pairs of clamps, division of the tissue, and ligation. The assistant should maintain manual compression of the pedicle as the dissection proceeds (Figure 81.7). If the tube is adherent, it may be taken in continuity with the ovary. Caution should be taken to clearly identify the ureter before proceeding with division of the mesosalpinx.
Ectopic Pregnancy: Extrauterine Pregnancy and Pregnancy of Unknown Location
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Caution is advised during surgery because of the anatomic blood supply to the tube (Figure 2.9). Anastomoses are caused by bilateral arterial inflow and bilateral venous outflow. One is from the uterine artery and vein and the other from the ovarian artery and vein. Vasopressin may be injected into the mesosalpinx prior to the incision in order to reduce intraoperative bleeding. This provides a better view during surgery. A salpingotomy is performed with a longitudinal incision of 1 to 2 cm on the contralateral mesenterial site of maximum bulging (Figure 2.10A). If the lumen is opened over the entire length of the incision, the gestational sac usually bulges out (Figure 2.10B) and can be evacuated by aspiration or taken with a grasper (Figure 2.10C). It is important to remove the entire pregnancy tissue as well as surrounding coagulations with minimum trauma (Figure 2.10D). Forceps, vacuum, or aqua dissection may be used. Residual tissue may be squeezed out either in the direction of the ampulla of the uterine tube or the incision. The site of implantation should be extensively irrigated. The fluid should be drained on both sides (ie, the salpingotomy end and the fimbria). Minor bleeding is normal and should cease spontaneously.
Prognostic value of hysterosalpingography after salpingostomy in patients with hydrosalpinx
Published in Journal of Obstetrics and Gynaecology, 2023
Wen-Xi Yao, Du-Zhou Zheng, Wei-Feng Liu, Mi-Mi Zhou, Li Liu, Ming-Jin Cai
Salpingostomy is distal tubal plastic surgery to manage hydrosalpinx using scissors, electrosurgery or laser (Gomel and Wang 1994), with the aim of preserving the fallopian tubes and allowing the patient to attempt natural conception. During surgery, the distal tube is incised and opened in the avascular area, and the newly created ostium is sutured back to the mesosalpinx (Ng and Cheong 2019). However, pregnancy rates and outcomes in various reports differ (Gomel 2015). It is admitted that pregnancy rate and outcome are associated with patient age, tubal stage, adhesion stage, the operative technique used and infection by Chlamydia (Audebert and Pouly 2014). In addition, scholars have found that most natural pregnancies after salpingostomy in patients with hydrosalpinx occur within 18 months (Chu et al.2015).
Lipomesosalpinx: differential diagnosis of a fat-containing adnexal mass
Published in Journal of Obstetrics and Gynaecology, 2022
L. Sellars, A. Matthews, M. Dobson, R. Mohamed
An unusual appearance of the left mesosalpinx was also noted. It appeared swollen and enlarged throughout its length with yellow fatty looking deposits between the leaflets of the broad ligament, and the ovary was separate to it (see Figure 1). The finding was unilateral, with a normal appearance of the contralateral mesosalpinx and adnexa. In view of the uncertain aetiology of the mesosalpinx lesion a further MRI scan was performed postoperatively to aid diagnosis and management. This demonstrated a smaller area of persisting fat-intensity signal in the left adnexa measuring 65 × 33 mm. This had a ‘bubbly’ or multi-loculated appearance with low signal internal septations. Fat-suppression sequences showed uniform signal ‘drop out’, confirming this was a fatty lesion. This was reported as residual teratoma.
Evaluation of the correlation between insulin like factor 3, polycystic ovary syndrome, and ovarian maldescent
Published in Gynecological Endocrinology, 2018
A significant positive correlation was found between INSL3 values and the ovarian volume and its included follicular number. Abnormally located polycystic ovaries in the study group were all outside the true pelvic cavity, adherent to the lateral abdominal wall in both lumbar regions. The tubes were also suspended beside the abnormally situated ovaries, and their mesosalpinx were almost absent in most cases; to make the tubes completely retroperitoneal. Abnormal uterine anomalies were available in 15 cases; between bicornuate uterus, septate and subseptate uterus, which had been diagnosed with the routine hysteroscopy performed in the same session (Figure 8).