Characterization and treatment of lochia
Miranda A. Farage, Howard I. Maibach in The Vulva, 2017
Asherman syndrome or intrauterine adhesions (IUAs) is the partial or complete obliteration of the uterine cavity by adherence of the uterine walls, leading to menstrual abnormalities (amenorrhea or hypomenorrhea), infertility, and habitual abortion (55). Any event that damages the endometrium can lead to the development of IUAs. The major cause is damage to the basilar layer of the endometrium after curettage. In a review of 1856 women with IUAs, pregnancy was a predisposing factor in 91% (55,56). Of these, 67% had undergone curettage because of induced or spontaneous abortion, and 22% because of PPH. Symptoms of IUAs vary according to the extent of the disease and are usually one of the following: infertility, including sterility; repeated and habitual abortion; complications of late pregnancy such as premature labor, placenta previa, or placenta accrete; or menstrual disorders such as amenorrhea, hypomenorrhea, dysmenorrhea, or menometrorrhagia (55).
Test Paper 4
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike in Get Through, 2017
Uterine dehiscence is characterised by incomplete rupture of the uterine wall, usually involving the endometrium and myometrium but with an intact overlying serosal layer. Uterine dehiscence is a very difficult imaging diagnosis. The presence of a bladder flap haematoma greater than 5 cm and larger pelvic haematomas should be considered abnormal and highly suspicious for uterine dehiscence in the proper clinical setting. MR imaging may be better than CT in checking for uterine dehiscence because of its multiplanar capability and greater soft-tissue contrast, with its ability to help identify an intact serosal layer. Uterine rupture is the most severe potential complication of caesarean delivery and is defined as separation of all layers of the uterine wall, including the serosal layer, with abnormal communication between the uterine cavity and the peritoneal cavity. The presence of gas/blood within the uterine defect extending from the endometrial cavity to the extrauterine parametrium in association with haemoperitoneum increases the likelihood of rupture in the appropriate clinical setting.
How Long Does it Take Uterine Scar(s) to Heal?
John C. Petrozza in Uterine Fibroids, 2020
Intrauterine adhesions, also known as Asherman's syndrome, are defined as the presence of adhesions inside the uterine cavity and/or endocervix. Clinical manifestations include amenorrhea, hypomenorrhea, recurrent pregnancy loss, infertility and abnormal placentation. Conforti et al. reviewed the risk factors associated with Asherman's syndrome and identified curettage after miscarriage to have the highest incidence of Asherman's syndrome [25]. Extrauterine adhesions following abdominal myomectomies may similarly cause problems with fertility as well as pain. There are many anti-adhesion adjuvants but there is no one accepted standard of care, and careful surgical technique is highly recommended.
Early versus late hysteroscopic resection after high-intensity focused ultrasound for retained placenta accreta
Published in International Journal of Hyperthermia, 2021
Sili He, Min Xue, Jianfa Jiang
In the early group, the first hysteroscopic procedure was done at a mean interval of 2.7 ± 1.4 days after HIFU ablation, while in the late group, the interval was 34.7 ± 15.0 days (p < .001) (Table 3). The largest diameter of the retained placenta accreta before the hysteroscopic procedure in the late group was significantly smaller than in the early group (p < .001). The mean uterine cavity depth in the late group (10.1 ± 1.7 cm) was significantly less than that in the early group (11.0 ± 1.5 cm) (p = .03). In the early group, 18 patients (45%) achieved complete resection of retained placenta accreta after the first procedure, and 22 patients (55%) did so after the second procedure, without any serious adverse events. Compared with the early group, the rate of complete removal of the retained placenta accreta after one hysteroscopic procedure was significantly higher in the late group (73.9%) (p = .03). The estimated blood loss in most patients in the early group (30/40) was less than 100 ml. The estimated blood loss of the remaining 10 patients was more than 100 ml, and two patients lost 400 and 500 ml. In the late group, the estimated blood loss of most patients (21/23) was less than 100 ml, and only two patients lost 100 ml. There was no difference between the groups regarding the estimated blood loss (p = .11). Intraoperative complications (including uterine perforation, cervical injury, and air embolism) were not reported in either group.
Second look hysteroscopy following hysteroscopic septum resection improves reproductive outcomes in patients undergoing ICSI
Published in Journal of Obstetrics and Gynaecology, 2022
Bulat Aytek Sık, Ozkan Ozdamar, Ozan Ozolcay, Alper Sismanoglu, Yilda Arzu Aba, Serkan Oral, Mehmet Koc
Septate uterus is a congenital anatomic defect arising from a resorption failure of the tissue connection between bilateral Mullerian ducts during embryogenesis. Septum represents the most common anomaly of uterus, accounting for 35% of all identified uterine anomalies (Hassan et al. 2010). According to the new classification system, proposed in 2013 by European Society of Human Reproduction and Embryology (ESHRE) and European Society for Gynaecological Endoscopy (ESGE), septate uterus is defined as an internal indentation extending >50% of myometrial wall thickness that divides uterine cavity without any restrictions to the length of the septum (Grimbizis et al. 2013). On the other hand, American Society for Reproductive Medicine (ASRM), in 2016, recommended considering a uterus as septate when there is both an indentation depth >15 mm and an indentation angle <90° (ASRM 2016).
Six-month recovery needed after dilation and curettage (D and C) for reproductive outcomes in frozen embryo transfer
Published in Journal of Obstetrics and Gynaecology, 2018
Kemal Ozgur, Hasan Bulut, Murat Berkkanoglu, Faruk O. Basegmez, Kevin Coetzee
Intrauterine surgical interventions, such as D and C, are also known to result in the development of adhesions (i.e. fibrosis bridges or the adhesions between the opposite myometrial surfaces that distort the uterine cavity) and in extreme cases Asherman syndrome; both of which have been confirmed to result in refractory endometria, with a reduced reproductive function (Taylor and Gomel 2008; Garcia-Velasco et al. 2016). A cause-and-effect that was corroborated in the present study, as only one of the six patients with histories of adhesions achieved a LB. Moreover, intrauterine adhesions might not have contributed significantly to the reduced reproductive outcomes observed in the present study, as the incidence of adhesion was low in both of the study sub-groups (≈8.5%). In addition, there was no significant adhesion formation observed at any of the TVS examinations performed prior to the second FET; and while the adhesions are permanent manifestations, the reduction in the reproductive outcomes observed was transient.
Related Knowledge Centers
- Uterus
- Fallopian Tube
- Cervical Canal