Malignancy
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
Higher-grade lesions (Ib1–IIa) are usually treated by simple or radical hysterectomy with LN sampling. Cancers presenting at less than 20 weeks’ gestation have traditionally been treated immediately [E]. The hysterectomy can usually be performed with the fetus in situ; however, a hysterotomy, avoiding the lower part of the uterus, can be employed to remove the pregnancy and improve access if necessary. Delaying treatment until after delivery becomes an increasingly favourable option after 20 weeks’ gestation for stage I cancers.26 Nine studies involving 63 patients with stage I cervical cancer have examined the effect of a delay, varying between 1 and 32 weeks. Only one outcome was possibly affected by the delay. However, these studies are clearly non-randomised and the decision to delay should be made with oncologists and neonatologists after careful patient counselling. Steroids should be given to promote fetal lung maturation. Delivery at 32–34 weeks can now be justified with advances in the care of the preterm infant. Caesarean section is normally advised, due to theoretical concerns of haemorrhage from cervical lesions and increased malignant cell dissemination with vaginal delivery [E]. Local recurrence within episiotomy sites is well documented and is associated with a high mortality rate. Radical hysterectomy at the time of caesarean section is associated with greater blood loss, but the rate of other complications is not increased [D].
Antepartum Haemorrhage
Sanjeewa Padumadasa, Malik Goonewardene in Obstetric Emergencies, 2021
Vaginal delivery may sometimes be the most reasonable option to deliver a fetus that is either dead or bearing a lethal abnormality even in the presence of placenta praevia. This is usually done before 24 weeks of gestation after embolisation of internal iliac arteries, foeticide and induction of labour with a high dose vaginal misoprostol regimen. This practice will bypass the need for a hysterotomy, an operation that carries significant maternal morbidity as far as future obstetric performance is concerned. However, hysterotomy may possibly be performed for maternal safety if there is unacceptable bleeding. In countries where fetocide is illegal, women with placenta praevia in the presence of a lethal fetal abnormality are managed similarly as the case of a live viable fetus.
Stem cell therapies for atrophic endometrium and Asherman's syndrome
Carlos Simón, Linda C. Giudice in The Endometrial Factor, 2017
The causes of AS are often iatrogenic. AS occurs most frequently in women with a history of uterine dilation and curettage (D&C), particularly in the context of pregnancy and infection (17,18). Friedler et al. have shown that the risk of the disease was increased with the number of intrauterine procedures (19). Common risk factors include postpartum curettage, followed by cesarean section, myomectomy, hysterotomy, diagnostic curettage, intrauterine device (IUD) insertion, pelvic irradiation, schistosomiasis, and tuberculosis (20–22). Women with a congenital uterine anomaly are at higher risk of IUAs (23,24). Intrauterine synechiae during pregnancy have been identified as “amniotic sheets” or “amniotic folds” visualized by ultrasonography. Amniotic sheets typically do not impact fetal growth and are rarely related to complications (25,26).
Intrauterine Fetal Demise Associated with Vascular Malperfusion and Multiple Uterine Leiomyomata: A Report of Two Cases
Published in Fetal and Pediatric Pathology, 2023
Tess E. K. Cersonsky, Megan Lord, Halit Pinar
The patient was counseled on options for uterine evacuation. Pelvic examination confirmed the presence of a large uterine leiomyoma in the lower uterine segment, and it was unclear if the fetus would be able to pass through the pelvis. A hysterotomy for uterine evacuation would likely require incision into the contractile portion of the uterus. Given the size and location of the leiomyoma, there was also concern for uterine atony following hysterotomy, potentially resulting in hysterectomy. At the time of admission, attempted dilation and evacuation (D&E) in the operating room was not felt to be feasible given the patient’s advanced gestational age. Mildly elevated blood pressures were noted during induction on hospital day 2; serum creatinine and other end-organ laboratory values were normal at this time. The patient was mildly febrile and was started on gentamicin and clindamycin for possible intraamniotic infection.
Unintended hysterotomy extension during caesarean delivery: risk factors and maternal morbidity
Published in Journal of Obstetrics and Gynaecology, 2018
Lauren E. Giugale, Sara Sakamoto, Jonathan Yabes, Shannon L. Dunn, Elizabeth E. Krans
A hysterotomy extension was defined as any documentation of an extension by the surgeon in the operative note. The diagnosis of a hysterotomy extension was at the discretion of the operating physician. The estimated blood loss (EBL) in millilitres (ml) was extracted from the CD operative note. An intraoperative haemorrhage was defined as the 95th percentile for EBL (>1200 ml in our dataset). A change in the haemoglobin was the difference between the preoperative haemoglobin and the lowest postoperative haemoglobin value obtained during the hospitalisation. A clinically significant change in the postoperative haemoglobin was defined as ≥3.7 g/dL (95th percentile for this change). The need for a blood transfusion was defined as any transfusion of packed red blood cells intraoperatively or during the postoperative hospital course. The operative time was defined as the time in minutes from the skin incision to the skin closure. Because of the low frequency of cystotomy, an evaluation for lower urinary tract (LUT) injury was assessed as a composite outcome defined as the backfilling of the bladder, intraoperative cystoscopy or an actual cystotomy repair. Evaluation of the LUT was at the discretion of the surgeon.
Retrospective analysis of indications for termination of pregnancy
Published in Journal of Obstetrics and Gynaecology, 2019
Ozgur Ozyuncu, Gokcen Orgul, Atakan Tanacan, Fatih Aktoz, Naz Guleray, Erdem Fadiloglu, Mehmet Sinan Beksac
The pregnancy terminations were performed by use of misoprostol with/without an oxytocin induction. After the expulsion of the foetus and placenta, any retained product of conception was evacuated by a manual vacuum aspiration or dilatation and curettage. None of the patients underwent a D&E (dilatation and evacuation) directly because of an advanced gestational age (>10 weeks). The route (vaginal or oral), dose and intervals of the misoprostol administration were decided according to the patient’s gestational week, personal obstetrics history and clinical guidelines (Dodd and Crowther 2010; ACOG 2013; RCOG 2015). The misoprostol usage and follow-up were personalised for every patient and the need for additional oxytocin for cervical augmentation was decided based on the patients’ examinations and clinical statuses. A hysterotomy was performed on the patients with a failed induction on their misoprostol administration, or on the patients with three or more prior caesarean sections without any medical attempt. None of the foetuses delivered were alive.
Related Knowledge Centers
- Anemia
- Birth Defect
- Cardiac Arrest
- Dilation & Curettage
- Ectopic Pregnancy
- Uterus
- Preterm Birth
- Resuscitation
- Abortion
- Caesarean Section
- Dilation & Curettage