Do submucous myoma characteristics affect fertility and menstrual outcomes in patients underwent hysteroscopic myomectomy?

Submucous myomas may be associated with menorrhagia, infertility and dysmenorrhea. The aim of this study was to determine the long term effects of submucousal myoma resection on menorrhagia and infertility; also to detect whether the type, size, and location of myoma affect the surgical success. Totally 98 women referred to hysteroscopy for symptomatic submucousal fibroids [menorrhagia [n=51] and infertility [n=47]] between 2005- 2010 were enrolled in this historical cohort study Pregnancy rates and menstrual improvement rates were compared according to myoma characteristics [size, type and location]. After a mean postoperative period of 23 +/- 10 months in 51 patients with excessive bleeding, 13 had recurrent menorrhagia [25%]. In Other 38 patients excessive bleeding was improved [75%]. The improvement rates by location and myoma type: lower segment 100%, fundus 92%, and corpus 63%; type 0] 70%, type 1] 78%, type 2] 80%. The mean sizes of myoma in recurred and improved patients were 23.33 mm and 29.88 mm respectively. 28 of 47 infertile women spontaneously experienced thirty pregnancies [60%]. Pregnancy rates according to myoma location and type: lower segment 50%, fundus 57%, and corpus 80%; type 0] 75%, type 1] 62%, type 2] 50%. The mean myoma size in patients who became pregnant was 30.38 mm; in patients who did not conceive was 29.95 mm. The myoma eharacetesitics do not affect improvement rates after hysteroseopie_myomectomy in patients with unexplained infertility or excessive uterine bleeding

Fertility sparing surgery on placenta invasion anomalies and placenta previa

Abnormal placental invasion has increased parallel with persistent rise in Caesarean delivery. Management relies on accurate diagnosis and delivery should be planned at an institution with appropriate expertise and resources for managing this condition. We present a case of a placenta invasion anomaly which is the major risk factors of peripartum deaths. In this case we try to explain our approach which reduces unnecessary hysterectomy rates. In order to avoid postpartum hemorrhage and hysterectomy protocols, our approach which consists bilateral hypogastric arterial ligation, Bakri balloon tamponade and if necessary methotrexate therapy can be applied successfully