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Article in Chinese | WPRIM | ID: wpr-931131


Objective:To investigate the predictive value of serum anti-Mullerian hormone (AMH) combined with transvaginal color Doppler ultrasonography (vaginal color ultrasound) for ovarian reserve function in infertility patients.Methods:A total of 105 infertility patients diagnosed and treated in Dezhou People′s Hospital from January 2018 to October 2020 were selected as study subjects. Among them, 32 patients with less than 5 eggs obtained after the first treatment (low ovarian response) were included in group A, and 73 patients with 5 to 15 eggs obtained (normal ovarian response) were included in group B. Serum AMH levels were measured, antral follicle count (AFC), ovarian volume (OV), and ovarian stromal peak diastolic systolic velocity (PSV) were recorded by vaginal ultrasound. The levels of above index in A, B groups, patients aged > 35 years old, and those aged ≤35 years old were compared. Moreover, the correlation among serum AMH level and aged, ultrasonic parameters were analyzed. The efficacy of serum AMH level and AFC, OV and PSV in predicting low ovarian response was analyzed by receiver operating characteristic (ROC) curve.Results:The levels of serum AMH, AFC, OV and PSV in group A were lower than those in group B: (0.69 ± 0.28) μg/L vs. (1.43 ± 0.44) μg/L, (8.52 ± 2.29) eggs vs. (11.15 ± 2.56) eggs, (3.12 ± 0.70) cm 3 vs. (4.50 ± 1.31) cm 3, (8.80 ± 2.14) cm/s vs. (15.80 ± 4.43) cm/s, the differences were statistically significant ( P<0.05). The levels of serum AMH, AFC, OV and PSV in aged > 35 years old group were lower than those in aged ≤35 years old group: (0.64 ± 0.20) g/L vs. (1.71 ± 0.46) μg/L, (8.35 ± 2.68) eggs vs. (12.17 ± 2.79) eggs, (3.05 ± 0.78) cm 3 vs. (5.02 ± 1.26) cm 3, (9.01 ± 3.04) cm/s vs. (17.90 ± 4.19) cm/s, the differences were statistically significant ( P<0.05). Serum AMH level was negatively correlated with age ( r = -0.317, P<0.05), and positively correlated with AFC, OV and PSV ( r = 0.288, 0.326, 0.370, P<0.05). The sensitivity and specificity for the evaluation of low ovarian response by AMH+AFC+OV+PSV were 96.90% and 100.00% respectively. Conclusions:The sensitivity and specificity of serum AMH combined with vaginal color ultrasound for the evaluation of ovarian reserve function in infertility patients are both high.

Article in English | WPRIM | ID: wpr-928245


Atypical polypoid adenomyoma (APA) is an uncommon type of polypoid characterized by fibroid stroma and endometrial glands. It occurs mostly in premenopausal women and rarely in postmenopausal women with irregular vaginal bleeding. In our current case, a 76-year-old woman presented with irregular vaginal bleeding. The final pathological diagnosis of the mass was APA. APA is not easy to diagnose before surgery. On the one hand, there was no obvious particularity in imaging features and clinical features, especially for uncomfortably identifying endometrial cancer. On the other hand, APA has a pedicle, attaching to any part of the uterine cavity, which can cause pseudocoel between the mass with the uterine cavity wall. So, when it comes to getting the pathological tissue in the absence of hysteroscopy, it is easy to access to the pseudocoel and obtain endometrial tissue rather than the pathological tissue of the mass. Therefore, preoperative imaging examination is of great significance diagnosis way of thinking to clinicians for APA. In the meantime, pathological tissue of APA can be obtained by hysteroscopy in visual conditions.

Adenomyoma/pathology , Aged , Female , Humans , Hysteroscopy , Magnetic Resonance Imaging , Pregnancy , Uterine Hemorrhage , Uterine Neoplasms/diagnostic imaging
Med. j. Zambia ; 49(2): 176-184, 2022. tables
Article in English | AIM | ID: biblio-1402660


ntroduction: The acceptability and willingness to undergo Transvaginal Sonography by the patients havegeneratedmixedreactionsindifferenthealthcare settings. There is little that is known aboutZimbabweanwomen'sperceptionsandwillingness to undergo Transvaginal Sonography and there are no specific guidelines to guide its use. Aim:To evaluate the perception and willingness to undergo Transvaginal Sonography among women attending Obstetrics and Gynaecology clinic at SallyMugabeCentralHospitalinHarare, Zimbabwe.Methods:Across-sectionalsurveyusingastructured questionnaire was conducted between 1 and 30 June 2022. Atotal of 170 women attending the obstetrics and gynaecology clinic at Sally MugabeCentralHospitalwereselectedbyconsecutive sampling to participate in the study.Results:The majority of women (81.76%) had no previous TVS experience, with an equally large proportion (60.84%) not having seen a TVS probe before. Most of the women would prefer female sonographers (85.37%) to conduct the examination. In addition, about 58% of the participants concurred that a chaperone should be present. Less than half of the females (47.93%) were eager to have a TVS done on them. Equally, just 45% of the females said they would encourage others to have a TVS scan. The difference in willingness to undergo a TVS study stratified by employment status was statistically significant (chi-square 7.26, p = 0.03). Conclusion: Our study findings revealed that a large proportion of females had no previous TVS experience, with an equally large proportion not having seen a TVS probe before. Only a sizeable proportion of women were willing to accept TVS provided it is conducted by female sonographers and or in the presence of a chaperone. The findings underscoretheimportanceofeducationandawareness of the benefits of TVS in terms of diagnosis on maternal health outcomes, in the Zimbabwean population.

Humans , Perception , Central Supply, Hospital , Women , Obstetrics and Gynecology Department, Hospital , Ultrasonography
Rev. chil. obstet. ginecol. (En línea) ; 86(5): 492-496, oct. 2021. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388687


Resumen El sangrado uterino posmenopáusico se define como aquel sangrado que ocurre después del cese definitivo de la menstruación en la etapa reproductiva de la mujer como consecuencia de la claudicación biológica de los ovarios, o como un sangrado no esperado en mujeres con terapia de reposición hormonal sistémica de la menopausia. Representa el 5% de las consultas ginecológicas y, si bien su origen suele ser por causas benignas, puede requerir una evaluación minuciosa para descartar patologías malignas del endometrio. El objetivo de este trabajo es establecer un flujograma diagnóstico basado en la evidencia para la evaluación de las pacientes con sangrado uterino posmenopáusico.

Abstract Postmenopausal uterine bleeding is defined as the bleeding that occurs after the last menstruation due to loss of ovarian function, or a non-scheduled bleeding in patients with hormonal therapy. It represents 5% of the gynecologic visits, and even though its origin is often benign, it requires a thorough evaluation to discard malignant diseases. The objective of these review is to propose a diagnostic algorithm based on the available evidence for the evaluation of patients with postmenopausal uterine bleeding.

Humans , Female , Uterine Hemorrhage/diagnosis , Postmenopause , Algorithms , Diagnostic Techniques, Obstetrical and Gynecological
Rev. bras. ginecol. obstet ; 43(7): 530-534, July 2021. tab
Article in English | LILACS | ID: biblio-1347245


Abstract Objective To evaluate the accuracy of transvaginal ultrasound in the diagnosis of intrauterine lesions, using hysteroscopy as the gold standard. Methods This was a prospective observational study with 307 patients. All patients underwent hysteroscopy after a previous transvaginal ultrasound to compare the results. The hysteroscopy was performed by experienced examiners, and transvaginal ultrasounds were performed in various public and private services, which is reflective of routine healthcare practices in obstetrics and gynecology. The sensitivity, specificity, and accuracy of the transvaginal ultrasound were calculated using hysteroscopy as the gold standard. The level of agreement between the two exams was calculated using the Kappa test. Results Themean age was 56.55±12.3 years. For endometrial polyps, we observed a sensitivity of 39.8%, specificity of 72.7%, accuracy of 52.8%, and Kappa index of 0.11 (p=0.025). For fibroids, the sensitivity was 46.7%, specificity was 95.0%, accuracy was 87.9%, and Kappa index was 0.46 (p<0.001). For endometrial thickening, the sensitivity was 68.7%, specificity was 41.7%, accuracy was 47.6%, and Kappa index was 0.06 (p=0.126). For endometrial atrophy, we found a sensitivity of 6.7%, specificity of 99.3%, accuracy of 90.2%, and Kappa index of 0.10 (p=0.006). For the other findings, the sensitivity was 15.6%, specificity was 99.6%, accuracy was 87.3%, and Kappa index was 0.23 (P<0.001). Conclusion Our study demonstrated a low level of accuracy of transvaginal ultrasound for the diagnosis of endometrial lesions, when performed by a non-experienced professional. Thus, it is important to consider the use of hysteroscopy to avoid unnecessary and inappropriate treatments.

Resumo Objetivo Avaliar a acurácia do ultrassom transvaginal para o diagnóstico de lesões intrauterinas, tendo a histeroscopia como padrão de referência. Métodos Foi realizado um estudo observacional prospectivo em 307 pacientes, submetidas à histeroscopia após ultrassonografia prévia para comparação dos resultados. A histeroscopia foi realizada por duas médicas com experiência, e os exames de ultrassom foram realizados em diversas fontes, públicas ou privadas, como ocorre no cotidiano da assistência à saúde em nosso meio. Foram avaliados sensibilidade, especificidade e acurácia, tendo a histeroscopia como padrão-ouro. O nível de concordância foi avaliado pelo teste de Kappa. Resultados A idade média foi de 56,55±12,3 anos. Os resultados para pólipo endometrial foram: sensibilidade 39.8%, especificidade 72,7%, acurácia de 52,8%, e índice Kappa 0,11 (p=0,025). Para mioma, sensibilidade 46,7%, especificidade 95,0%, acurácia 87,9%, e índice Kappa 0,46 (p<0,001). Para espessamento endometrial, sensibilidade 68,7%, especificidade 41,7%, acurácia 47,6%, e índice Kappa de 0,06 (p=0,126). Para atrofia, sensibilidade 6,7%, especificidade 99,3%, acurácia 90,2%, e índice Kappa 0,10 (p=0,006). Para outros achados, sensibilidade 15,6%, especificidade 99,6%, acurácia 87,3%, e índice Kappa 0,23 (p<0,001). Conclusão Nosso estudo demonstrou baixo nível de acurácia da ultrassonografia transvaginal para o diagnóstico de lesões endometriais, quando realizada por profissional não experiente. Assim, é importante considerar o uso da histeroscopia para evitar tratamentos desnecessários e inadequados.

Humans , Female , Pregnancy , Adult , Aged , Polyps , Uterine Diseases/pathology , Uterine Diseases/diagnostic imaging , Uterine Neoplasms/pathology , Leiomyoma/pathology , Hysteroscopy , Ultrasonography , Sensitivity and Specificity , Endometrium/pathology , Middle Aged
Rev. bras. ginecol. obstet ; 43(4): 264-274, Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1280040


Abstract Pretermbirth (PTB) is a major obstetric problem associated with high rates of neonatal morbidity and mortality. The prevalence of PTB has not changed in the last decade; thus, the establishment of a screening test and effective treatment are warranted. Transvaginal ultrasoundmeasurement of the cervical length (TUCL) has been proposed as an effective method to screen pregnant women at a higher risk of experiencing PTB. Objective To evaluate the applicability and usefulness of second-trimester TUCL to predict PTB in a cohort of Portuguese pregnant women. Methods Retrospective cross-sectional cohort study including all singleton pregnant women who performed their second-trimester ultrasound (between weeks 18 and 22þ6 days) from January 2013 to October 2017 at Centro Hospitalar Universitário São João. Results Our cohort included 4,481 women. The prevalence of spontaneous PTB was of 4.0%, with 0.7% occurring before the 34th week of gestation. The mean TUCL was of 33.8mm,and percentiles 3, 5 and 10 corresponded toTUCLs of 25.0mm, 27.0mmand 29.0mmrespectively. The multiple logistic regression analysis, including maternal age, previous PTB and cervical surgery showed a significant negative association between TUCL and PTB, with an odds ratio (OR) of 0.92 (95% confidence interval [95%CI]: 0.90-0.95; p<0.001). The use of a TUCL of 20mm is the best cut-off, when compared with the 25-mm cut-off, improving the prediction of risk. Conclusion The present study showed an inverse association between TUCL and PTB, and that the inclusion of other risk factors like maternal age, previous PTB and cervical surgery can improve the screening algorithm. Furthermore, it emphasizes that the TUCL cut-off that defines short cervix can differ according to the population.

Resumo O parto pré-termo (PPT) é uma grande complicação obstétrica que se associa a elevadas taxas de morbimortalidade neonatal. A sua prevalência não tem alterado na última década, sendo esencial determinar uma forma de rastreio e tratamento eficaz. A medição ecográfica transvaginal do comprimento cervical tem sido proposta como um método eficaz de rastreio das grávidas com risco aumentado de PPT. Objetivo Avaliar a aplicabilidade e utilidade da medição ecográfica transvaginal do comprimento cervical na previsão de PPT numa amostra de grávidas portuguesas. Método Estudo de coorte retrospectivo incluindo todas as grávidas com gestação unifetal que realizaram ecografia do 2° trimestre (de 18 a 22semanasþ6 dias) no Centro Hospitalar Universitário de São João entre janeiro de 2013 e outubro de 2017. Resultados A nossa amostra incluiu 4.481 mulheres. A prevalência de PPT espontâneo foi de 4,0%, sendo que 0,7% ocorreu antes das 34 semanas de gestação. A média do comprimento cervical por ecografia transvaginal foi 33,8mm, e os percentis 3, 5 e 10 da amostra corresponderam a comprimentos cervicais de 25,0mm, 27,0mm e 29,0mm, respetivamente. A regressão logística múltipla, que incluiu a idade materna, PPT anterior e antecedentes de conização, demonstrou uma associação estatisticamente significativa entre o comprimento cervical e o risco de PPT, com um risco relativo de 0,92 (intervalo de confiança de 95% [IC95%]: 0.90-0.95; p<0.001). A utilização de um valor de referência de comprimento cervical de 20mm, quando comparado com o valor de referência de 25 mm, melhora a previsão do risco de PPT. Conclusão Este estudo demostra uma associação entre o comprimento cervical avaliado por ecografia tranasvaginal e o risco de PPT, e salienta que a inclusão de outros fatores de risco, como idade materna, PPT anterior e antecedentes de conização podem melhorar o algoritmo de rastreio. Realça ainda que o valor de comprimento cervical utilizado para definir "colo curto" varia de acordo com a população em estudo.

Humans , Female , Pregnancy , Adult , Cervix Uteri/diagnostic imaging , Premature Birth , Cervical Length Measurement , Portugal , Pregnancy Trimester, Second , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Maternal Age , Tertiary Care Centers
J. coloproctol. (Rio J., Impr.) ; 41(1): 47-51, Jan.-Mar. 2021.
Article in English | LILACS | ID: biblio-1286966


Abstract Objective The literature on the safety and long-term sequelae of transrectal and transvaginal drainage of pelvic abscesses is limited. We evaluated the outcomes and safety of pelvic abscess drainage by interventional radiology at our institution. Methods After obtaining institutional review board approval, we retrospectively evaluated the outcomes of transrectal and transvaginal pelvic abscesses drainage using computed tomography, endorectal ultrasound, and or fluoroscopy. Results The study included 26 patients, with an age range of 24 to 88 years old, out of whom 53.8% were men. A total of 46.1% of the participants were African Americans and 26.9% were Caucasians. The average body mass index was 28.4 (range: 15.6 to 41.9). The most common etiology was penetrating abdominal injury (27%), followed by appendectomy (23%), diverticular disease (11.5%), anastomotic leak (11.5%), and disorders of gynecological causes (11.5%). The mean abscess diameter was 6.3 cm (range: 3.3 to 10.0 cm). Transrectal drainage was performed in all except one patient who had a transvaginal drainage. Transrectal ultrasound was used for drainage in 92.3% cases, and fluoroscopy was used as an additional imaging modality in 75% of the cases. An 8- or 10-Fr pigtail catheter was used in>80% of the patients. Drains were removed between 2 and 7 days in 92.3% of the cases. The average follow-up was 30.4 months (range: 1 to 107 months), and no long-term complications were reported. Only one patient required subsequent operative intervention for an anastomotic leak. Conclusions Pelvic abscess drainage by transrectal route using radiological guidance is a safe and effective procedure.

Resumo Objetivo A literatura sobre a segurança e as sequelas no longo prazo da drenagem transretal e transvaginal do abscesso pélvico é limitada. Avaliamos os resultados e a segurança da drenagem do abscesso pélvico por radiologia intervencionista em nossa instituição. Métodos Após obter a aprovação do conselho de revisão institucional, avaliamos retrospectivamente os resultados da drenagem de abscessos pélvicos transretais e transvaginais por meio de tomografia computadorizada, ultrassom endorretal, e/ou fluoroscopia. Resultados Participaram do estudo 26 pacientes, com faixa etária de 24 a 88 anos, dos quais 53,8% eram homens. Um total de 46,1% eram afro-descendentes, e 26,9% eram brancos. O índice de massa corporal médio foi de 28,4 (gama: 15,6 a 41,9). A etiologia mais comum foi lesão abdominal penetrante (27%), seguida de apendicectomia (23%), doença diverticular (11,5%), fístula anastomótica (11,5%) e distúrbios de causas ginecológicas (11,5%). O diâmetro médio do abscesso foi de 6,3 cm(gama: 3,3 a 10,0 cm). A drenagem transretal foi realizada em todos os pacientes, com exceção de uma, que foi submetida a uma drenagem transvaginal. A ultrassonografia transretal foi utilizada para drenagem em 92,3% dos casos, e a fluoroscopia como modalidade adicional de imagem, em 75% dos casos. Um catéter duplo J de 8 ou 10 Fr foi usado em>80% dos pacientes. Os drenos foram retirados entre 2 e 7 dias em 92,3% dos casos. O acompanhamentomédio foi de 30,4meses (gama: 1 a 107 meses), e nenhuma complicação de longo prazo foi relatada. Apenas um paciente necessitou de intervenção cirúrgica subsequente para um vazamento anastomótico. Conclusão A drenagem do abscesso pélvico por via transretal com orientação radiológica é um procedimento seguro e eficaz.

Humans , Male , Female , Pelvis/physiopathology , Rectum/diagnostic imaging , Vagina/diagnostic imaging , Drainage/methods , Pelvic Infection/etiology , Abscess/diagnostic imaging
Article in Chinese | WPRIM | ID: wpr-910136


Objective:To explore the relationship between different gestational weeks of transvaginal ultrasound-guided fetal reduction and abortion in patients with multiple pregnancies after embryo transfer, and to seek the best gestational age for fetal reduction.Methods:The datas of 486 pregnant women with multiple pregnancies after embryo transfer in the Second Hospital of Hebei Medical University from January 2012 to December 2020 were retrospectively analyzed. The relationship between gestational weeks of fetal reduction and abortion rate was analyzed by curve fitting, threshold effect and multivariate logistic regression analysis.Results:After adjusting for age, infertility type, infertility years, number of births, abortion times, body mass index(BMI), various infertility and sterility factors, endometrial thickness on the day of transformation, monozygotic twins and reduction methods, when the gestational age was less than 8.43 weeks, the abortion rate increased significantly with the increase of reduction gestational age, and the abortion rate increased by 221% ( OR=3.21, 95% CI=1.47-6.99, P=0.003 3). When the gestational age of reduction ≥8.43 weeks, the abortion rate tended to be stable and did not increase ( OR=0.81, 95% CI=0.54-1.22, P=0.317 7); meanwhile, in stratified analysis, the OR value of the BMI ≥24 kg/m 2 was 12.38, and that of BMI <24kg/m 2 was 1.91, P=0.053 9. Conclusions:There is a non-linear relationship between gestational age and abortion rate of ultrasound-guided multiple pregnancy reduction in patients with embryo transfer. The abortion rate increases significantly with the increase of gestational age before 8.43 weeks of gestation. It is recommended to carry out the operation as early as possible before 8 weeks of pregnancy. The effect of BMI on the abortion rate of patients with fetal reduction needs further study.

Article in Chinese | WPRIM | ID: wpr-921556


Objective To observe the patients after transvaginal mesh(TVM)implantation surgery by using transperineal ultrasound(TPUS),compare the diagnosis of pelvic organ prolapse(POP)by TPUS and clinical examination[according to the Pelvic Organ Prolapse Quantification(POP-Q)system published by the International Continence Society],and to explore the role of ultrasound in postoperative evaluation as well as the high-risk factors of post-surgery POP recurrence. Methods This is a retrospective study based on the POP-Q records and TPUS data sets of patients within 6 months after TVM surgery during September 2013 and November 2019.The diagnostic results of TPUS and POP-Q were compared.The incidences of hiatal ballooning and levator avulsion were separately compared between the TPUS group and the control group. Results A total of 147 patients were enrolled.The Kappa values between TPUS and POP-Q in the diagnosis of anterior and posterior compartment POP were 0.268(

Humans , Pelvic Floor/diagnostic imaging , Pelvic Organ Prolapse/diagnostic imaging , Retrospective Studies , Surgical Mesh/adverse effects , Ultrasonography
Journal of Chinese Physician ; (12): 1786-1790,1794, 2021.
Article in Chinese | WPRIM | ID: wpr-931996


Objective:To compare the efficacy of three different surgical methods in the treatment of patients with pelvic organ prolapse (POP)-Q grade Ⅱ-Ⅲ uterine prolapse (UP).Methods:The clinical data of 100 patients with pelvic organ prolapse quantitative (POP-Q) grade Ⅱ-Ⅲ UP treated in the First Affiliated Hospital of Medical College of Shihezi University from November 2015 to April 2019 were analyzed retrospectively. According to the operation method, they were divided into vaginal total hysterectomy group (TVH group, n=46), laparoscopic total hysterectomy + vaginal stump Y-patch sacral fixation group (LSC group, n=34) and transabdominal total hysterectomy + vaginal stump abdominal transverse fascia and round ligament suspension group (AFS group, n=20). The age, body mass index, delivery times, operation time and intraoperative bleeding of the three groups were compared. POP-Q scale, visual analogue scale (VAS) and Pelvic Floor Impact Questionnaire (PFIQ-7) were used to evaluate the objective cure, subjective satisfaction, preoperative and postoperative quality of life, and the recurrence rate of postoperative prolapse was compared. Results:Among the three groups, the TVH group had the shortest operation time and the LSC group had the least intraoperative blood loss ( P<0.05). The postoperative PFIQ-7 score improved the quality of life in the AFS group significantly better than the other two groups ( P<0.05). The postoperative POP-Q indicator points of the three groups were significantly improved than before ( P<0.05). Postoperative prolapse recurred in 8 cases (17.4%) in TVH group, 3 cases (8.8%) in LSC group and 1 case (5.0%) in AFS group, with no significant difference in recurrence rate among the three groups ( P>0.05). Conclusions:These three surgical treatments are all safe and effective for the treatment of moderate to severe uterine prolapse. Various factors should be considered comprehensively to develop individualized surgical plans for patients.

Article in Chinese | WPRIM | ID: wpr-942235


OBJECTIVE@#To analyze the prognostic factors affecting the failure of transvaginal repair of vesicovaginal fistula (VVF).@*METHODS@#A retrospective nested case-control study was conducted. A total of 15 patients who underwent unsuccessful transvaginal vesicovaginal fistula repair in the Department of Urology, Peking University First Hospital from January 2014 to December 2020 were enrolled as the case group. A total of 60 patients receiving transvaginal vesicovaginal fistula repair by the same surgeon within the same time range, were selected as the control group. The age, body mass index (BMI), etiology of vesicovaginal fistula, associated genitourinary malformation, frequency of repair, characteristics of fistula, surgical procedure, postoperative recovery and other factors were compared between the case group and the control group, and the influencing factors of failure were analyzed.@*RESULTS@#The BMI of the case group was (26.3±3.9) kg/m2, the diameter of vaginal fistula was (1.5±0.8) cm, and the operative time of transvaginal repair was (111.8±19.8) min. The proportion of the patients with genitourinary malformations was 4/15, the proportion of the patients with multiple vaginal repairs was 13/15, the proportion of the patients with concurrent ureteral reimplantation was 6/15, and the proportion of the patients with postoperative fever was 5/15. In the control group, the BMI was (23.9±3.0) kg/m2, the diameter of vaginal fistula was (0.8±0.5) cm, the operative time of transvaginal repair was (99.9±19.7) min, the rate of associated genitourinary malformation was 2/60, the rate of multiple transvaginal repair was 18/60, the rate of concurrent ureteral reimplantation was 5/60, and no postoperative fever was found. Compared with the control group, the case group had higher BMI (P=0.013), bigger vaginal fistula (P=0.002), longer time of operation (P=0.027), higher proportion of genitourinary malformations (P=0.013), higher proportion of repeated transvaginal repair (P < 0.001), higher proportion of ureter reimplantation (P=0.006), and higher proportion of postoperative fever (P < 0.001). Multivariate analysis showed that fistula diameter ≥1 cm (OR=10.45, 95%CI=1.90-57.56, P=0.007) and repeated transvaginal repair (OR=16.97, 95%CI=3.17-90.91, P=0.001) were independent prognostic factors for VVF failure in transvaginal repair.@*CONCLUSION@#Fistula diameter ≥1 cm and repeated transvaginal repair are independent prognostic factors of failure in transvaginal repair.

Case-Control Studies , Female , Gynecologic Surgical Procedures , Humans , Prognosis , Retrospective Studies , Treatment Outcome , Vesicovaginal Fistula/surgery
Clinics ; 76: e2981, 2021. tab, graf
Article in English | LILACS | ID: biblio-1286092


OBJECTIVE: To evaluate the association of two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound (TVUS) findings with adenomyosis symptoms. METHODS: This prospective study conducted between January and December 2018 enrolled 78 women aged 18 to 40 years with abnormal uterine bleeding (AUB), infertility, and/or pelvic pain. All patients underwent 2D and 3D TVUS. Signs of adenomyosis on TVUS were identified according to the consensus of the Morphological Uterus Sonographic Assessment group. RESULTS: The prevalence of adenomyosis on TVUS was 55.12%. Patients with adenomyosis were older (p=0.002) and had more dysmenorrhea, AUB, and endometriosis than those without adenomyosis. When comparing the presence of symptoms with each adenomyosis feature, on 2D TVUS, severe dyspareunia was significantly associated with the presence of a poorly defined junctional zone (JZ) (p=0.023) and on 3D TVUS, patients with AUB had a more irregular (p=0.003), poorly defined (p=0.028), and interrupted JZ (p=0.011). After logistic regression analysis, signs of adenomyosis on TVUS remained significantly associated only with age over 30 years (OR: 1.2; 95% CI: 1.0-1.2) and AUB (OR: 7.65; 95% CI: 2-29). Patients with diffuse adenomyosis were older and presented with more infertility and AUB than patients with focal or no adenomyosis. CONCLUSION: The findings of adenomyosis by 2D and 3D TVUS showed association with age and AUB. 3D TVUS alterations in the JZ were associated with AUB and dyspareunia. Diffuse adenomyosis was associated with older age, a greater prevalence of infertility, and AUB.

Humans , Female , Adult , Aged , Uterine Diseases/epidemiology , Uterine Diseases/diagnostic imaging , Endometriosis , Adenomyosis/diagnostic imaging , Prospective Studies , Ultrasonography
J. coloproctol. (Rio J., Impr.) ; 40(4): 345-351, Oct.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1143172


ABSTRACT Introduction: Currently, problems such as constipation due to outlet obstruction, rectal/vaginal prolapse and fecal and urinary incontinence have become increasingly more frequent because of the population aging process, with great impact on the quality of life. Objective: To describe a technique for surgical repair of middle/posterior pelvic floor compartments and extra-mucosal rectal wall treatment by transperineal and vaginal approach, using native tissues and present the results in twenty patients submitted to this surgical technique. Method: Patients with symptoms secondary to middle/posterior pelvic floor descent and anatomical changes confirmed by proctological exam and pelvic MRI defecography. Results were evaluated through the Agachan constipation score, using pre- and post-operative questionnaires. Results: Immediate repair of rectocele and musculature, with prompt improvement of constipation, sustained by 42 months. There were no severe complications in the postoperative period. Conclusion: This is an effective technique, with adequate anatomic repair, improvement of constipation scores and with low risk.

RESUMO Introdução: Problemas como constipação intestinal por obstrução de saída, prolapsos retal/vaginal e incontinências fecal e urinária são cada vez mais frequentes pelo envelhecimento populacional, com grande impacto na qualidade de vida. Objetivo: Descrever técnica para correção do compartimento médio/posterior do assoalho pélvico e tratamento extramucoso da parede retal, por vias perineal e vaginal, utilizando tecidos nativos. Apresentar os resultados da cirurgia em 20 pacientes submetidas à técnica. Método: Pacientes com sintomas secundários ao descenso de assoalho pélvico médio/posterior, submetidas à propedêutica - exame proctológico e defecografia por RNM de pelve que confirmaram as alterações anatômicas. A avaliação dos resultados foi feita com questionários no pré e pós-operatório, com a utilização do escore de Agachan para constipação intestinal. Resultado: Correção imediata da retocele e da musculatura, com melhora imediata da constipação intestinal, sustentada ao longo de 42 meses. Sem complicações graves no pós-operatório. Conclusão: Técnica eficaz, com correção anatômica adequada, associada a melhora significativa dos escores de constipação e de baixo risco.

Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Pelvic Floor/abnormalities , Pelvic Organ Prolapse/surgery , Pelvic Floor Disorders/surgery
Article | IMSEAR | ID: sea-208081


Background: Caesarean scar defect (CSD), also called isthmocele or niche is a long-term complication, which can be asymptomatic or can give rise to chronic pelvic pain, dyspareunia and postmenstrual spotting. The objective of this study was to assess the association of CSD with clinical symptoms, position of the uterus and the number of caesarean sections.Methods: This was a prospective observational study done at a tertiary care teaching hospital from January 2019 to December 2019. The study included women with history of previous one or more caesarean sections with demonstrable CSD on transvaginal ultrasound. Various scar dimensions noted were width and depth of the scar. A deficiency ratio was calculated as a ratio of residual myometrium at the scar to the adjacent myometrium.Univariate analysis was done to assess the relationship of clinical symptoms with the defect parameters and number of previous caesarean sections. Multiple logistic regression analysis was done to find out the association between symptoms and number of previous caesarean sections with the scar defect dimensions.Results: The width, depth and deficiency ratio of the CSD were significantly higher in study subjects with a greater number of caesarean sections. Retroflexed uteri had larger CSD. There was no association of clinical features with the defect dimensions and the position of the uterus.Conclusions: CSD dimensions and deficiency ratio correlate with the number of previous caesarean sections and the position of the uterus. There was no association of clinical symptoms with the defect parameters.

Article | IMSEAR | ID: sea-207935


Background: Different diagnostic tools are available to evaluate endometrial lesion such as hysteroscopy, sonohysterography and transvaginal ultrasound. The present study aimed to determine the diagnostic value of saline infusion sonohystrography (SIS) in diagnosis of intrauterine lesions in women with postmenopausal bleeding (PMB).Methods: This cross-sectional study recruited 100 married women with chief complain of PMB referred to gynecologic clinics at the Zenana hospital, Jaipur from March 2019 to February 2020. All participants were in the post-menopausal period that showed abnormal endometrial thickness (>4 mm) or endometrial focal lesions through transvaginal ultrasound. Participants underwent SIS, hysteroscopy plus endometrial biopsy in order. The gold standard was the histopathology of endometrial specimen reported by pathologist.Results: Mean age of women was 57.14 years. It is evident that sensitivity, specificity, positive predictive value and negative predictive value of SIS for the diagnosis of endometrial atrophy was 79.16%, 100%, 100% and 83.87% respectively which is higher than that of hysteroscopy and equivalent to histopathology. SIS and hysteroscopy are equally efficient in diagnosing endometrial polyp and submucous fibroid. And are better than histopathology. Histopathology is better than SIS and hysteroscopy for the diagnosis of endometrial proliferation.Conclusions: Findings show that, SIS probably is a proper method for detecting endometrial focal lesion including polyps and myomas. Future studies may help to define further advantages of this procedure.

Article | IMSEAR | ID: sea-207865


Background: Postmenopausal bleeding (PMB)accounts for 5% of gynecology visit. All with unexpected uterine bleeding should be evaluated for endometrial carcinoma since this potentially lethal disease is the cause of bleeding in approximately 10 percent patients (range 1 to 25 percent, depending upon risk factors). The aim of the study was to evaluate endometrial causes of postmenopausal bleeding (PMB) with it's correlation with endometrial thickness (ET)and hysteroscopy findings and endometrial tissue histopathology.Methods: A total 50 consecutive cases of PMB fulfilling the inclusion and exclusion criteria and giving informed consent were selected. Each patient was subjected to transvaginal sonography (TVS) in which uterus, adnexa and endometrial thickness (ET) was assessed. Then hysteroscopy and/or dilation and curettage was scheduled at subsequent visit. Endometrial sample was sent for histopathological examination. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy was calculated for ET by TVS and hysteroscopy findings, considering histopathological diagnosis as the gold standard.Results: Most common endometrial cause of PMB was atrophic endometrium (44%). The other causes were endometrial carcinoma (18%), endometrial hyperplasia (18%), endometrial polyp (12%), endometritis (4%), and leiomyoma (4%). The diagnostic accuracy of ET by TVS at a cut-off point of 5 mm was 94% with sensitivity 89.3%, specificity 100%, PPV 100% and NPV 88%. The diagnostic accuracy of hysteroscopy was 98% with sensitivity 96.4%, specificity 100%, PPV 100% and NPV 95.7%.Conclusions: Being relatively cheap, easily accessible, non-invasive, TVS with ET measurement should first line investigation in the evaluation of women with postmenopausal bleeding with suspected endometrial pathology. Although hysteroscopy is more specific and sensitive, in poor resource settings it should be limited to cases with ill-defined endometrial lining, recurrent/ persistent bleeding and cases with endometrial thickness greater than 5 mm irrespective of endometrial echotexture.

Article | IMSEAR | ID: sea-212256


Background: Uterine fibroids constitute a substantial bulk of patients presenting to Gynaecology department. Many newer imaging modalities have evolved for their correct evaluation, but in a developing country like India, ultrasound is still being used as a screening as well as diagnostic modality. So, this study was done to compare ultrasound and magnetic resonance imaging for evaluation of uterine fibroids in terms of their sensitivity, specificity Trans vaginal  and positive predictive value using Histopathology as a gold standard so as to improvise on current clinical practices in this country.Methods: An ethically approved prospective study was done upon 50 patients with suspected uterine masses at SMS Hospital Jaipur. All included patients underwent Trans vaginal Ultrasound (TVS) and Magnetic resonance imaging (MRI) and were accordingly treated surgically. Histopathology report was traced postoperatively. Data was collected and subjected to various statistical tests including Cohen’s kappa.Results: Most of the patients were <50 years and presented with complains of pain abdomen. Among total 50 cases, the sensitivity of TVS and MRI was 44% and 92%, specificity was 96% and 88%, PPV was 91.67% and 88.46%, NPV was 63.16% and 91.67% respectively, kappa was 0.40 and 0.80 i.e. agreement between TVS and MRI v/s HPE was 40% and 80% respectively. The diagonal agreement between transvaginal USG and MRI, was 63%.Conclusions: TVS is a good screening modality but MRI is definitely better for proper characterization and localization of fibroids enabling clinicians to select the most appropriate management in everyday clinical practice.

Article | IMSEAR | ID: sea-207814


Caesarean scar ectopic involves an abnormal implantation of the embryo within the myometrium of previous caesarean scar. It is a rare and serious entity involving maternal complication like abnormal placentation, hemorrhage or death due to uterine rupture. Authors present a case report of 32 years old female diagnosed as a case of caesarean scar ectopic pregnancy on TVS and MRI and managed conservatively by USG guided D and C.

Medisan ; 24(3)mayo.-jun. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1125116


Introducción: La papilomatosis respiratoria recurrente es una enfermedad infrecuente de la vía aérea que afecta a niños y adultos, causada por el papilomavirus. Objetivo: Caracterizar niños con papilomatosis respiratoria recurrente desde los puntos de vista clínico, epidemiológico y terapéutico, así como evaluar su evolución a corto y mediano plazos. Métodos: Se realizó una investigación observacional, longitudinal y prospectiva de 40 niños con papilomatosis respiratoria recurrente, atendidos en el Servicio de Otorrinolaringología del Hospital Infantil Docente Sur Dr. Antonio María Béguez César de Santiago de Cuba, desde enero del 2010 hasta diciembre del 2016. Resultados: Los pacientes incluidos en el estudio representaron 3,2 % del total de los ingresos. Predominó el sexo masculino (60,0 %); el promedio de edad fue de 8,6 ± 4 años. Existió asociación estadística entre la localización anatómica de las lesiones y el sexo masculino; sin embargo, no hubo dicha asociación con la edad. Las localizaciones orofaríngea (50,0 %) y laríngea (42,5 %) fueron las de mayor observancia. El parto transvaginal se asoció con el mayor número de pacientes que presentaron la citada afección (85,0 %) y el tratamiento con exéresis e interferón se asoció a la evolución satisfactoria en 95,8 % de los afectados. Conclusiones: Las características clínicas y epidemiologias de los pacientes con papilomatosis respiratoria recurrente de esta casuística no difieren del contexto epidemiológico mundial, siendo una entidad de observación poco frecuente, pero no rara en los servicios de pediatría.

Introduction n The recurrent respiratory papillomatosis is an uncommon disease of the airways that affects children and adults, caused by the papillomavirus. Objective: To characterize children with recurrent respiratory papillomatosis from the clinical, epidemiologic and therapeutic points of view, as well as to evaluate their clinical course at short and mid terms. Methods: An observational, longitudinal and prospective investigation of 40 children with recurrent respiratory papillomatosis was carried out, they were assisted in the Otolaryngology Service of Dr. Antonio María Béguez Cesar Teaching Southern Children Hospital in Santiago de Cuba, from January, 2010 to December, 2016. Results: The patients included in the study represented 3.2 % of the total of admissions. The male sex prevailed (60.0 %); the average age was 8.6 ± 4 years. Statistical association existed between the anatomical localization of the lesions and the male sex; however, there was no such association with the age. The oropharyngeal (50.0 %) and laryngeal (42.5 %) localizations were those of more observance. The transvaginal childbirth was associated with the higher number of patients that presented the mentioned disorder (85.0 %) and the treatment with exeresis and Interferon was associated with the satisfactory clinical course in 95.8 % of those affected. Conclusions: The clinical and epidemiological characteristics of patients with recurrent respiratory papillomatosis of this case material don't differ from the world epidemiological context, being an unusual observation entity, but not strange in the pediatrics services.

Papilloma , Respiration Disorders , Child , Respiratory Tract Infections/epidemiology
Article | IMSEAR | ID: sea-207673


Background: The objectives of the study was to establish the role of histopathological diagnosis of uterine endometrial lesions in patients of AUB at perimenopausal age and to correlate the transvaginal sonographic (TVS) finding with histopathological examination.Methods: This prospective observational study was carried out over 1 and 1/2 years in the two apex level teaching hospitals in eastern India. A total of 197 women in the age group of 40-49 years and ≥50 years (up to 55 years) who presented with abnormal uterine bleeding were included in the study. After selecting the patient with eligibility criteria in the OPD, detailed clinical history, systemic and gynecological examinations and investigations were done as per proforma. TVS study of endometrial pattern and thickness was measured followed by dilatation and curettage (D and C) and HPE of the endometrial curetting was done.Results: Menorrhagia (44.67%) was the most common clinical finding. Mean endometrial thickness measured by TVS was 7.04±2.11 mm in proliferative phase and 10.25±1.27 mm in the secretory phase. Proliferative endometrium (37.06%) was the most frequent finding in HPE followed by secretory endometrium (20.3%). Hyperplasia of endometrium was noted in 27 cases (100%) at 12-15 mm of endometrial thickness on TVS whereas endometrial hyperplasia with and without atypia and endometrial carcinoma was noted in 25 cases (92.59%) at the same thickness of 12-15 mm of uterine endometrium on HPE. Endometrial hyperplasia and polyp both had sensitivity of 84.21% and 71.43% respectively on TVS as compared with histopathology.Conclusions: Increased endometrial thickness and echo pattern by TVS correlated well with abnormal endometrial tissue histopathology in perimenopausal women with AUB.