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Abstract Isthmocele is a discontinuation of the myometrium at the uterine scar site in a patient with a previous cesarian section (CS). The cause of isthmocele appears to be multifactorial. Poor surgical technique, low incision location, uterine retroflection, obesity, smoking, inadequate healing of scars, and maternal age are possible related factors. Most patients with this condition are asymptomatic. However, women can present with postmenstrual bleeding, pelvic pain, subfertility, dysmenorrhea, infertility, and scar abscess. Brazil has one of the world s highest cesarean section rates. One of the consequences of the rising rate of CS is the isthmocele, an emerging female health problem. Here we report a case of mucinous cystadenoma arising in a uterine isthmocele, a complication, as far as we could investigate, not yet described in the literature.
Resumo Istmocele é a descontinuidade do miométrio no local da cicatriz uterina em paciente com cesariana anterior. A causa da istmocele parece ser multifatorial. Má técnica cirúrgica, baixa localização da incisão, retroflexão uterina, obesidade, tabagismo, cicatrização inadequada de cicatrizes e idade materna são possíveis fatores relacionados. A maioria dos pacientes com esta condição é assintomática. No entanto, as mulheres podem apresentar sangramento pós-menstrual, dor pélvica, subfertilidade, dismenorreia, infertilidade e abscesso cicatricial. O Brasil tem uma das maiores taxas de cesariana do mundo. Uma das consequências da taxa crescente de cesarianas é a istmocele, um problema emergente de saúde feminina. Aqui relatamos um caso de cistoadenoma mucinoso originado em uma istmocele uterina, uma complicação ainda não descrita, até onde pudemos investigar.
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Humans , Female , Middle Aged , Uterus/injuries , Cystadenoma, MucinousABSTRACT
Objective:To explore the clinical value of laparoscopic reversible uterine artery occlusion in the treatment of cesarean section scar pregnancy.Methods:A total of 112 patients who were hospitalized in our hospital from Sep. 2018 to Jun. 2020 in the First Affiliated Hospital of Bengbu Medical College and diagnosed with type II and type III cesarean section scars were selected. The patients were divided into groups according to the randomization method, the control group ( n=58) and the study group ( n=54) . The control group used uterine artery embolization combined with laparoscopic removal of pregnancy and uterine scar repair, while the study group used laparoscopic reversible uterine artery occlusion, pregnancy removal surgery and uterine scar repair surgery. The clinical treatment effects of the two groups of patients were compared. Results:The intraoperative blood loss of the control group (21.26±9.64) ml was significantly less than that of the study group (75.25±8.25) ml ( P<0.05) ; the treatment success rate of the study group was 98.15% (53/54) , which was significantly higher than the control group 86.21% (50/58) ( P<0.05) ; the time of vaginal bleeding in the study group (7.26±0.94) d, postoperative menstrual regain time (31.25±1.26) d, and hospital stay (3.14±0.25) d were significantly less than those in the control group ( (9.54±0.94) 0.86) d, (47.25±2.15) d, (9.26±0.94) d) ] ( P<0.05) ; 24 h β-hCG level and β-hCG negative time study group [ (1015.11±325.05) IU/L, (14.25±3.21) d] was significantly less than the control group [ (2654.25±284.25) IU/L, (27.16±5.14) d] ( P<0.05) ; there was no difference in the scores of the modified SF-36 scale before treatment between the two groups ( P>0.05) . The modified SF-36 scale score (63.22±4.25) of the study group after treatment was significantly higher than that of the control group (55.25±3.83) ( P<0.05) . Conclusions:Laparoscopic reversible uterine artery occlusion is effective in treating cesarean section scar pregnancy. After treatment, the β-hCG level of the patient is significantly reduced and the quality of life is significantly improved.
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A gestação ectópica em cicatriz de cesariana prévia é um evento iatrogênico raro, que vem crescendo junto com o aumento das taxas de cesariana. Ela não exi- be manifestação clínica específica, o que dificulta o diagnóstico e não apresenta tratamento preconizado, embora esteja associada a grandes complicações obsté- tricas como hemorragia incoercível, acretismo placentário e rotura uterina. Dessa forma, o presente artigo relata três casos clínicos em que diferentes tratamentos foram propostos, objetivando discutir algumas possibilidades terapêuticas como a aspiração manual intrauterina (AMIU) associada com o uso de metotrexato, lapa- roscopia e laparotomia, comparando os resultados encontrados.(AU)
Ectopic cesarean scar pregnancy is a rare iatrogenic event, which has been increase with growing in the percentage of cesarean delivery. It does not exhibit specific cli- nical manifestation, making diagnosis difficult and does not have yet recommended treatment, although is associated with major obstetrics complication such incoer- cible hemorrhage, abnormally invasive placenta and uterine rupture. Therefore, the present article reports three clinical cases witch different types of management, ai- ming discuss some possibilities such intrauterine manual aspiration after systemic methotrexate, laparoscopy or laparotomy surgical, comparing results.(AU)
Subject(s)
Humans , Female , Pregnancy , Pregnancy, Ectopic/surgery , Cesarean Section/adverse effects , Suction , Cicatrix , Video-Assisted Surgery , LaparotomyABSTRACT
Background: Rupture uterus is a life-threatening obstetric emergency associated with high perinatal mortality. This study aims to find out the common factors associated with this catastrophic condition so as to help in decreasing the incidence of this condition in this study set-up. The objective of this study was to determine incidence, socio-demographic factors, etiology, types of presentation, patterns of management and maternal and fetal outcome in cases of rupture uterus presenting in this study hospital in one year.Methods: In this retrospective study 40 cases of ruptured uterus admitted in the hospital between January to December 2016 were analyzed. Detailed history of relevant socio-demographic factors, prior obstetric and surgical history, clinical findings, nature of management done, fetal and maternal outcome were thoroughly analyzed from the record.Results: A total 40 cases of ruptured uterus during this one-year period out of total 1220 deliveries constituted an incidence of 3%. The commonest age group is 25-30 years (47%). Majority of patients of rupture uterus were those with previous scarred uterus trying for vaginal delivery in hands of dais, untrained birth attendants and midwives. Repair was possible in the majority of cases. There were no maternal deaths but fetal mortality was 92.5%.Conclusions: Proper antenatal care, transportation facilities, good counseling of patients with history of previous uterine surgery for institutional delivery can help in reducing the incidence of rupture uterus in developing countries like India. Prompt surgical intervention can help in reducing the maternal morbidity and mortality associated with rupture uterus.
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Background: Nowadays, cesarean sections are increasing consistently. Repeat cesarean sections are performed for a large percentage and associated with a higher rate of surgical complications and Long-term morbidities. The trial of labor after cesarean offers an alternative choice. This study carried out to assess the maternal and fetal outcome and to evaluate various parameters as a predictor of success of TOLAC.Methods: This prospective observational study conducted on 150 pregnant women with one previous LSCS who delivered at Mahatma Gandhi hospital, from January 2017 to July 2018. Patient having a singleton pregnancy, cephalic presentation, adequate pelvis size with spontaneous onset of labor were included. Cases were monitored carefully during the labor. Emergency LSCS was done if any indication appeared.Results: 78% of cases delivered safely by the vaginal birth and 22% of cases had an emergency repeat cesarean section (EmRCS). Favorable Bishop Score, active stage of labor and prior vaginal delivery were associated with higher success rate. One (0.66%) case of uterine scar rupture and 2 (1.33%) cases of scar dehiscence noted. No maternal mortality observed. Perinatal mortality occurred in 2 cases (1.33%).Conclusions: Present study shows that appropriate clinical settings and the properly selected group of patients can make the TOLAC safe and effective.
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Se describe el caso de un embarazo ectópico de localización inusual sobre la serosa uterina, en una paciente con resección cornual previa por dos ectópicos consecutivos en dicha zona. De probable implantación abdominal primaria y sin evidencia de comunicación endometrial, fue resuelto con resección del tejido trofoblástico por vía laparoscópica.
The case of an ectopic pregnancy with unusual location on the uterine serosa in a patient with cornual resection after two consecutive ectopic pregnancies in that area is reported. It probably had a primary abdominal implantation without endometrial communication, and was treated with trophoblastic resection by laparoscopy.
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Objective To investigate the significance of laparoscopic hysterectomy combined with MTX and mifepristone in the treatment of uterine scar pregnancy. Methods 86 patients with uterine scar pregnancy from July 2015 to May 2017 in our hospital were selected as the subjects, were randomly divided into control group and experimental group, each group of 43 cases. The control group was treated with MTX and mifepristone, intramuscular injection of 50 mg/m2 methotrexate, mifepristone orally, 3 times a day. The patients in the experimental group received laparoscopic monitoring, combined with MTX and mifepristone treatment. The hospitalization time, cure rate and vaginal bleeding time of the experimental group and the control group were compared and analyzed. Results The success rate of the experimental group was 100.00%, which was significantly higher than that of the control group (72.42%), and the difference was statistically significant (P<0.05). The vaginal bleeding time in the experimental group was (20.87±6.54) days, significantly shorter than the control group, and the number of days was (34.20±10.89) days, with statistical difference (P<0.05). In the experimental group, the time required for the decrease of beta -HCG to normal was (26.90±9.21), and the time required for the decrease of beta-HCG to normal in the control group was (45.66±10.29), with statistical difference (P<0.05). Conclusion Laparoscopic monitoring uterine aspiration combined with Methotrexate and mifepristone in the treatment of uterine scar pregnancy ideal clinical curative effect, can significantly improve patients' clinical symptoms, high success rate, and faster recovery, high safety.
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Objective To investigate the significance of laparoscopic hysterectomy combined with MTX and mifepristone in the treatment of uterine scar pregnancy. Methods 86 patients with uterine scar pregnancy from July 2015 to May 2017 in our hospital were selected as the subjects, were randomly divided into control group and experimental group, each group of 43 cases. The control group was treated with MTX and mifepristone, intramuscular injection of 50 mg/m2 methotrexate, mifepristone orally, 3 times a day. The patients in the experimental group received laparoscopic monitoring, combined with MTX and mifepristone treatment. The hospitalization time, cure rate and vaginal bleeding time of the experimental group and the control group were compared and analyzed. Results The success rate of the experimental group was 100.00%, which was significantly higher than that of the control group (72.42%), and the difference was statistically significant (P<0.05). The vaginal bleeding time in the experimental group was (20.87±6.54) days, significantly shorter than the control group, and the number of days was (34.20±10.89) days, with statistical difference (P<0.05). In the experimental group, the time required for the decrease of beta -HCG to normal was (26.90±9.21), and the time required for the decrease of beta-HCG to normal in the control group was (45.66±10.29), with statistical difference (P<0.05). Conclusion Laparoscopic monitoring uterine aspiration combined with Methotrexate and mifepristone in the treatment of uterine scar pregnancy ideal clinical curative effect, can significantly improve patients' clinical symptoms, high success rate, and faster recovery, high safety.
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Spontaneous complete chorioamniotic membrane separation (CMS) without invasive fetal procedure is extremely rare and associated with adverse perinatal outcomes. A woman with complete CMS which was detected at the 21 weeks' gestation. She did not take any fetal invasive procedures before the diagnosis. At 27 weeks' gestation, an emergency Caesarean section was performed because of fetal distress. The defect of the uterine muscle was detected on the fundus. The baby has grown well without any morbidity. This is the first reported case of complete CMS relative to uterine scar. And we suggest that the pregnancy can be maintained successfully if there is no fetal abnormality when complete CMS is detected on ultrasound.
Subject(s)
Animals , Female , Humans , Mice , Pregnancy , Cesarean Section , Cicatrix , Diagnosis , Emergencies , Fetal Distress , Live Birth , Membranes , Myometrium , UltrasonographyABSTRACT
Objective To study the related factors of hemorrhage of uterine scar again after cesarean section,available for peer exchange.Methods A retrospective analysis of clinical data of 650 patients with scar uterus again cesarean section patients,analysis of postoperative hemorrhage patients,the causes of bleeding.They were divided into placental group (n =6),incision dehiscence group (n =7),uterine atony group (n =17)according to the causes of hemorrhage,and related factors of postoperative bleeding were analyzed.Results The bleeding volume of the placental group in operation[(2 500 ±500)mL]was higher than the uterine atony group[(1 300 ±400)mL] and the incision dehiscence group[(700 ±200)mL].The bleeding volume of the uterine atony group was higher than the incision dehiscence group (t =10.29,5.56,4.33,all P <0.05).The bleeding volume of the uterine atony group after operation[(100.09 ±36.45)mL]was higher than the placental group[(90.71 ±20.31)mL]and the uterine atony group[(81.23 ±30.34)mL].The bleeding volume of the placental group after operation were higher than the uterine atony group (t =3.94,3.02,2.78,all P <0.05).4 cases of hysterectomy,3 cases of conservative surgery in placental group.1 case of hysterectomy,16 cases of conservative surgery in uterine atony group.7 cases conservative surgery in incision dehiscence group.Conclusion placental factors,uterine atony,incision dehiscence all can lead to scar uterus again cesarean section hemorrhage.We should also strengthen the clinical prevention work,and actively take relevant measures,reduce postoperative bleeding risk,to ensure the safety of the mother and infant.
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OBJECTIVE:To investigate the efficacy and safety of methotrexate (MTX),Mifepristone combined with Huayu xiaozheng decoction in the treatment of uterine scar pregnancy. METHODS:86 patients with uterine scar pregnancy were randomly divided into control group(43 cases)and observation group(43 cases). Control group orally received 50 mg ultrasound-guided lo-cal injections of MTX,once a day+50 mg Mifepristone tablet,twice a day;observation group additionally received 100 ml Huayu xiaozheng decoction,twice a day with warm temperature. The treatment course for both groups was 15 d. Clinical efficacy,HCG levels,mass diameter before and after 7,14 and 28 d of treatment,and the incidence of adverse reactions in 2 groups were ob-served. RESULTS:The total effective rate in observation group was significantly higher than control group,the difference was sta-tistically significant(P0.05). CONCLUSIONS:Ultra-sound-guided local injections of MTX combined with Huayu xiaozheng decoction shows good efficacy and safety in the treatment of uterine scar pregnancy.
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Objective To investigate the clinical manifestation and inspection method about abnormal uter-ine bleeding due to cesarean section scar diverticulum.Methods retrospective analysis of 156 abnormal uterine bleeding cases due to cesarean section scar diverticulum.Analysis the relevance ratio,the starting time of clinical symptom,related influencing factors,the information of examine and misdiagnose.Results there are 12 cases cesare-an section scar diverticulum in 2010;30 cases in 2011;26 cases in 2012;37 cases in 2013;51 cases in 2014.The starting time of clinical symptom is 1 ~6 month pose menstrual in 48 cases;6 months to 2 years pose menstrual in 89 cases,2 years later pose menstrual in 19 cases.98 cases don′t have evidential abnormality even through many times ultrasonograph.43 patients subjected diagnosis curettage.The uterine bleeding time obviously longer comparing retro-position of uterus with anteposition and msposition of uterus.Conclusion the morbidity of abnormal uterine bleeding cases due to cesarean section scar diverticulum is low,but the rate of misdiagnosis and missed diagnosis is little high-er.We need to elevate the rate of diagnosis,and to research the preservation and magagement gradually.
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Objective To compare effect of trichosanthin and methotrexate in the treatment of uterine scar pregnancy by a multi-center study. Methods 90 uterine scar pregnancy patients were selected from department of obstetrics and gynecology,in xinyang central hospital,the second affiliated hospital of zhengzhou university,zhumadian central hospital,using random number table divided into 2 groups.The control group of 45 cases were treated by methotrexate,gluteal muscle injection,50 mg one time,and took mifepristone 50 mg,two times a day,a week for a course of treatment;45 cases in the experimental group,were treated with trichosanthin,intramuscular injection of 1.2 mg/time,two times a day,and oral administration of bloven,0.6 g/d,a week for a course of treatment.The end of a course of treatment,2 groups of patients before and after treatment were compared of the serum progesterone level,β-HCG,side reactions after treatment.Results After treatment,progesterone levels were significantly reduced,and the experimental group levels were lower than the control group obviously,the difference has statistical significance(P<0.05).Serum -HCG level after the treatment significantly reduced,and the experimental group in serum -HCG levels were significantly lower,with statistical difference (P <0.05 ). Comparison of adverse reaction of the patients,the experimental group was obviously lower than control group,with statistically significant difference (P<0.05).Conclusion For the treatment of uterine scar pregnancy,trichosanthin and methotrexate have certain effect,but trichosanthin could lower serum progesterone,β-HCG levels more significantly than methotrexate,trichosanthin group side reaction rate is low.
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Objective To investigate the clinical value of uterine artery embolization on the treatment of cesarean scar pregnancy(CSP).Methods Clinical data of 112 cases of CSP patient underwent uterine artery embolization in Ningbo Women and Children's Hospital from January to December 2012 were enrolled for retrospectively analysis.Results All 112 patients underwent transvaginal ultrasound examination before admitted to hospital and among them 101 cases were diagnosed as CSP and 11 cases were suspected of CSP.Ninety-four cases were checked by magnetic resonance imaging (MRI) to measure the muscular thickness of uterine scar and the size of pregnant bursa.All patients received bilateral uterine artery embolization successfully,50-100 mg Methotrexat (MTX) were injected into uterine artery during this procedure.After uterine artery embolization,95 cases received curettage under ultrasound guidance,while 17 cases received curettage under hysteroscopy.All patients recovered as schedule.During the follow-up,no serious complication was found.Conclusion The use of uterine artery embolization in the treatment of CSP is safe and effective,and it can preserve patients' fertile ability.It is worthy recommended in the clinical application.
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OBJETIVO: Avaliar as repercussões da cicatriz uterina na dopplervelocimetria das artérias uterinas, entre 26 e 32 semanas, em gestantes primíparas com uma cesariana prévia, considerando quando esta foi realizada fora (cesárea eletiva) ou durante o trabalho de parto. MATERIAIS E MÉTODOS: Estudo prospectivo transversal em 45 gestantes, divididas em três grupos: 17 gestantes com cicatriz prévia resultante de cesariana eletiva (grupo A); 14 gestantes com uma cicatriz prévia oriunda de cesariana executada em trabalho de parto (grupo B); 14 gestantes cujo único parto anterior foi realizado por via vaginal (grupo C). A dopplervelocimetria das artérias uterinas foi realizada pela via abdominal. Foram calculados as médias, medianas e desvios-padrão (DP) para cada grupo em estudo. Em relação ao índice de pulsatilidade, a comparação dos grupos foi conduzida pelo teste não paramétrico de Kruskal-Wallis. RESULTADOS: Os valores médios do índice de pulsatilidade no grupo A variaram de 0,60 a 1,60 (média: 0,90; DP: 0,29), no grupo B, de 0,53 a 1,43 (média: 0,87; DP: 0,24), e no grupo C, de 0,65 a 1,65 (média: 1,01; DP: 0,37); p = 0,6329. CONCLUSÃO: Não houve repercussões da cicatriz de cesariana prévia na dopplervelocimetria das artérias uterinas avaliadas de 26 a 32 semanas de gestação.
OBJECTIVE: To evaluate the possible repercussions of the previous cesarean scar at uterine arteries Doppler velocimetry between the 26th and 32nd gestational weeks. MATERIALS AND METHODS: Prospective cross-sectional study including 45 women between 11 and 14 weeks of gestation, divided into three groups: 17 pregnant women with uterine scar resulting from a previous elective cesarean section (group A); 14 with uterine scar resulting from a previous cesarean section performed during labor (group B); and 14 pregnant women with a single previous vaginal delivery (group C). Uterine arteries Doppler velocimetry was performed with transabdominal approach. Means, medians and standard deviation (SD) were calculated for each group in the study. The groups comparison regarding pulsatility index was performed with the non-parametric Kruskal-Wallis test. RESULTS: In group A, the pulsatility index ranged from 0.60 to 1.60 (mean: 0.90; SD: 0.29), in group B, from 0.53 to 1.43 (mean: 0.87; SD: 0.24), and in group C, from 0.65 to 1.65 (mean: 1.01; SD: 0.37); with p = 0.6329. CONCLUSION: No repercussion of previous cesarean scar was observed at uterine arteries Doppler velocimetry performed in the period between the 26th and 32nd gestational weeks.
Subject(s)
Humans , Female , Pregnancy , Cesarean Section , Cicatrix , Placenta Previa , Placental Circulation , Placental Insufficiency , Pregnancy, Ectopic , Uterine Artery , Labor, Obstetric , Pregnancy , Ultrasonography, DopplerABSTRACT
Nineteen cases of rupture of the uterus following cesarean section, representing a ten-year period (July 1945 to June 1955) and observed at the charity obstetrical ward, P.G.H., are presented herein. During this period, there were 85 cases of rupture of the uterus from various causes out of 47,078 deliveries. Therefore, 22.3% of all uterine rupture cases were postcesarean rupturesAnalysis of our data strikingly demonstrates the relative safety of the lower segment scar for mother and baby in contrast to the comparative danger to the infant particularly, of the classical scar. Out of the 19 cases presented, 15 had previous classical cesarean section and 4 had low cervical cesarean section. Twelve of the classical scar ruptures were complete. There were 2 maternal deaths due to shock and hemorrhage from previous classical section and 12 fetal deaths due to anoxia. There was one maternal death due to hypostatic pneumonia and sepsis following incomplete rupture of the lower segment; and one fetal death from complete rupture. The knowledge gathered from a reuter of these cases is enumerated and certain recommendation made. (Summary)