Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 117
Rev. bras. ginecol. obstet ; 43(4): 311-316, Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1280049


Abstract A cesarean scar pregnancy (CSP) is a scary and life-threatening complication of cesarean section (CS). Nevertheless, the incidence of CS is constantly growing. The CSP incidence is 0,15% of pregnancies after CS which represents 6,1% of all ectopic pregnancies in women with condition after CS. Therefore, it should be more present in the clinical daily routine. From mild nonspecific symptoms to hypovolemic shock, diagnosis and therapy must be performed quickly. With the progressive growth of the scar pregnancy, a uterine rupture involves the risk of severe bleeding, and an emergency hysterectomy could be necessary. Prolongation of pregnancy has been successful only in a few cases.We report 11 cases from our hospital in the past 10 years. In the discussion, treatment options of this complication with an increasing incidence, which is associated with serious morbidity and mortality, are presented based on the current literature. Treatment options include drug therapy, but also surgical or combined procedures with radiological intervention.

Humans , Female , Pregnancy , Adult , Young Adult , Pregnancy, Ectopic/diagnosis , Pregnancy, Ectopic/therapy , Cesarean Section/adverse effects , Cicatrix/complications , Uterine Hemorrhage/etiology , Uterine Rupture/etiology , Abortifacient Agents, Nonsteroidal/therapeutic use , Methotrexate/therapeutic use , Risk Factors , Pregnancy, High-Risk , Dilatation and Curettage , Hysterectomy
Rev. bras. ginecol. obstet ; 43(4): 323-328, Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1280047


Abstract Complete hydatidiform mole (CHM) is a rare type of pregnancy, in which 15 to 20% of the cases may develop into gestational trophoblastic neoplasia (GTN). The diagnostic of GTN must be done as early as possible through weekly surveillance of serum hCG after uterine evacuation.We report the case of 23-year-old primigravida, with CHM but without surveillance of hCG after uterine evacuation. Two months later, the patient presented to the emergency with vaginal bleeding and was referred to the Centro de Doenças Trofoblásticas do Hospital São Paulo. She was diagnosed with high risk GTN stage/score III:7 as per The International Federation of Gynecology and Obstetrics/World Health Organization (FIGO/WHO). The sonographic examination revealed enlarged uterus with a heterogeneous mass constituted of multiple large vessels invading and causing disarrangement of the myometrium. The patient evolved with progressive worsening of vaginal bleeding after chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen. She underwent blood transfusion and embolization of uterine arteries due to severe vaginal hemorrhage episodes, with complete control of bleeding. The hCG reached a negative value after the third cycle, and there was a complete regression of the anomalous vascularization of the uterus as well as full recovery of the uterine anatomy. The treatment in a reference center was essential for the appropriate management, especially regarding the uterine arteries embolization trough percutaneous femoral

Resumo Mola hidatiforme completa (MHC) é um tipo raro de gravidez, na qual 15 a 20% dos casos podem desenvolver neoplasia trofoblástica gestacional (NTG). O diagnóstico de NTG deve ser feito o mais cedo possível, pelo monitoramento semanal do hCG sérico após esvaziamento uterino. Relatamos o caso de uma paciente primigesta, de 23 anos de idade, com MHC, sem vigilância de hCG após esvaziamento uterino. Dois meses depois, a paciente compareceu na emergência com sangramento vaginal, sendo encaminhada ao Centro de Doenças Trofoblásticas do Hospital São Paulo, onde foi diagnosticada com NTG de alto risco, estádio e score de risco III:7 de acordo com a The International Federation of Gynecology and Obstetrics/Organização Mundial de Saúde (FIGO/OMS). O exame ultrassonográfico revelou útero aumentado com uma massa heterogênea constituída pormúltiplos vasos volumosos invadindo e desestruturando o miométrio. A paciente evoluiu com piora progressiva do sangramento vaginal após quimioterapia com o regime etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO). Ela foi submetida a transfusão de sangue e embolização das artérias uterinas devido aos episódios graves de hemorragia vaginal, com completo controle do sangramento. O hCG atingiu valor negativo após o terceiro ciclo, havendo regressão completa da vascularização uterina anômala, assim como recuperação da anatomia uterina. O tratamento em um centro de referência permitiu o manejo adequado, principalmente no que se refere à embolização das artérias uterinas através da punção percutânea da artéria femoral, que foi crucial para evitar a histerectomia, permitindo a cura da NTG e a manutenção da vida reprodutiva.

Humans , Female , Pregnancy , Young Adult , Arteriovenous Malformations/complications , Uterine Hemorrhage/therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Gestational Trophoblastic Disease/complications , Gestational Trophoblastic Disease/drug therapy , Embolization, Therapeutic , Uterine Hemorrhage/etiology , Uterine Hemorrhage/diagnostic imaging , Vincristine/therapeutic use , Methotrexate/therapeutic use , Ultrasonography, Prenatal , Pregnancy, High-Risk , Cyclophosphamide/therapeutic use , Dactinomycin/therapeutic use , Gestational Trophoblastic Disease/diagnostic imaging , Etoposide/therapeutic use , Uterine Artery
Autops. Case Rep ; 10(3): e2020144, 2020. graf
Article in English | LILACS | ID: biblio-1131832


Arteriovenous malformation (AVM) is a rare lesion in the uterus, which can lead to abnormal uterine bleeding. While AVM has been described in other organs in the literature, there is a paucity of pathology reports of the AVM in uterus. On gross examination, the uterus was markedly enlarged and partly distorted with a pedunculated solid mass, which on the cut surface showed multiple well-circumscribed hemorrhagic cysts ranging from 0.1 to 4.0 cm in size. Microscopically, they were malformed dilated vascular structures containing organized thrombi. We present this case of uterine AVM with gross and microscopic findings, which can serve as a crucial reminder for pathologists to keep in the differential diagnoses as a potential cause of abnormal uterine bleeding.

Humans , Female , Pregnancy , Middle Aged , Arteriovenous Malformations/pathology , Uterine Hemorrhage/etiology , Uterus/injuries , Cysts/etiology , Diagnosis, Differential
Rev. bras. ginecol. obstet ; 41(4): 264-267, Apr. 2019. graf
Article in English | LILACS | ID: biblio-1013603


Abstract Background Most endometrial cancers (75%) are diagnosed in early stages (stages I and II), in which abnormal uterine bleeding is the most frequent clinical sign.When the diagnosis is performed in stage IV, the most common sites of metastasis are the lungs, liver and bones. Central nervous system (CNS)metastasis is a rare condition. The aim of this study is to describe a case of uterine papillary serous adenocarcinoma of the endometrium that progressed to brain and bone metastases. Case Report We present the case of a 56-year-old woman with abnormal uterine bleeding and endometrial thickened echo (1.8 cm). A hysteroscopy with biopsy was performed, which identified poor differentiated serous adenocarcinoma of the endometrium. A total abdominal hysterectomy, with pelvic and para-aortic lymphadenectomy, was performed. Analysis of the surgical specimen revealed a grade III uterine papillary serous adenocarcinoma. Adjuvant radio/chemotherapy (carboplatin and paclitaxel-six cycles) was indicated. Sixteen months after the surgery, the patient began to complain of headaches. Brain magnetic resonance imaging demonstrated an expansile mass in the right parietal lobe, suggesting a secondary hematogenous implant subsequently confirmed by biopsy. She underwent surgery for treatment of brain metastasis, followed by radiotherapy. She died 12 months after the brain metastasis diagnosis due to disease progression. Conclusion Uterine papillary serous adenocarcinoma of the endometrium has a low propensity to metastasize to the brain. To the best of our knowledge, this is the fifth documented case of uterine papillary serous adenocarcinoma of the endometrium with metastasis to the CNS.

Resumo Fundamentos A maioria dos cânceres de endométrio (75%) é diagnosticada em estágios iniciais (estágios I e II), nos quais o sangramento uterino anormal é o sinalclínico mais frequente. Quando o diagnóstico é realizado no estágio IV, os locais mais comuns de metástase são os pulmões, o fígado e os ossos. A metástase para o sistema nervoso central (SNC) é uma condição rara. O objetivo deste estudo é descrever um caso de adenocarcinoma seroso-papilífero do endométrio que progrediu para metástases cerebral e óssea. Relato de Caso Apresentamos o caso de uma mulher de 56 anos com sangramento uterino anormal e eco endometrial espessado (1,8 cm). Foi realizada histeroscopia com biópsia que identificou adenocarcinoma seroso-papilífero pouco diferenciado do endométrio. Uma histerectomia abdominal total, com linfadenectomia pélvica e para-aórtica, foi realizada. A análise da peça cirúrgica revelou adenocarcinoma seroso-papilífero do endométrio grau III. Radioterapia adjuvante/quimioterapia (carboplatina e paclitaxel- seis ciclos) foi indicada.Dezesseismeses após a cirurgia, a paciente começou a se queixar de dores de cabeça. A ressonância magnética cerebral demonstrou uma massa expansiva no lobo parietal direito, sugerindo um implante hematogênico secundário posteriormente confirmado por biópsia. A paciente foi submetida a cirurgia para tratamento de metástase cerebral, seguida de radioterapia. A paciente morreu 12 meses após o diagnóstico de metástase cerebral devido à progressão da doença. Conclusão O adenocarcinoma seroso-papilífero do endométrio tem uma baixa propensão a metastizar para o cérebro. Até onde sabemos, este é o quinto caso documentado de adenocacinoma seroso-papilífero do endométrio com metástase para o SNC.

Humans , Female , Brain Neoplasms/diagnosis , Endometrial Neoplasms/pathology , Cystadenocarcinoma, Serous/diagnosis , Uterine Hemorrhage/etiology , Brain Neoplasms/secondary , Brain Neoplasms/therapy , Endometrial Neoplasms/complications , Endometrial Neoplasms/diagnosis , Endometrial Neoplasms/therapy , Fatal Outcome , Cystadenocarcinoma, Serous/complications , Cystadenocarcinoma, Serous/secondary , Cystadenocarcinoma, Serous/therapy , Combined Modality Therapy , Diagnosis, Differential , Hysterectomy , Middle Aged
Rev. chil. endocrinol. diabetes ; 12(1): 26-28, 2019. ilus
Article in Spanish | LILACS | ID: biblio-982035


La definición de sangrado ginecológico anormal durante terapia hormonal de la menopausia es aquel sangrado no programado durante el uso de la terapia. Este artículo es un pauteo que describe: 1) cuándo diagnosticar unsangrado anormal, ya que difiere según el tipo de esquema hormonal utilizado; 2) eldiagnóstico diferencial del origen del sangrado anormal; 3) los métodos de evaluación para diagnosticar el origen del sangrado. Se destacan los aspectos principales para el diagnóstico diferencial entre patología orgánica versus disrupción endometrial debida al tratamiento hormonal. Además, se describen los ajustes posibles para resolver el sangrado cuando éste se debe a disrupción del endometrio.

Abnormal bleeding related to menopausal hormone therapy is defined as unscheduled bleeding during the use of the therapy. This article outlines when to diagnose an abnormal bleeding -as this differs according to the type of hormonal scheme used-, the differential diagnosis of the origin of abnormal bleeding, and the methods of evaluation to assess the origin of the bleeding. The main aspects are highlighted on the differentiation of organic pathology versus disruption of the endometrium due to treatment. Also, treatment adjustments to resolve bleeding when it is due to disruption of the endometrium are outlined.

Humans , Female , Uterine Hemorrhage/etiology , Menopause , Estrogen Replacement Therapy/adverse effects , Estrogen Receptor Modulators/adverse effects , Norpregnenes/adverse effects , Polyps/complications , Polyps/diagnosis , Endometrial Neoplasms/complications , Endometrial Neoplasms/diagnosis , Estrogen Receptor Modulators/therapeutic use , Diagnosis, Differential , Endometrial Hyperplasia/complications , Endometrial Hyperplasia/diagnosis , Endometrium/diagnostic imaging , Metrorrhagia/etiology , Norpregnenes/therapeutic use
Rev. Soc. Bras. Med. Trop ; 52: e20180425, 2019. graf
Article in English | LILACS | ID: biblio-1003129


Abstract This study describes the isolation of a leech following the presentation of unusual vaginal bleeding. Vaginal bleeding in children due to a leech bite is very rare. This is the first report of severe bleeding in a virgin 14-year-old girl from Mashhad, Iran due to the presence of a leech in the vagina.

Humans , Animals , Female , Adolescent , Uterine Hemorrhage/etiology , Vagina/injuries , Insect Bites and Stings/complications , Leeches
Rev. bras. ginecol. obstet ; 39(7): 358-368, July 2017. tab, graf
Article in English | LILACS | ID: biblio-898881


Abstract Abnormal uterine bleeding is a frequent condition in Gynecology. It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. In cases of acute and severe bleeding, women may need urgent treatment with volumetric replacement and prescription of hemostatic substances. In some specific cases with more intense and prolonged bleeding, surgical treatment may be necessary. The objective of this chapter is to describe the main evidence on the treatment of women with abnormaluterinebleeding, both acuteand chronic.Didactically,thetreatmentoptions were based on the current International Federation of Gynecology and Obstetrics (FIGO) classification system (PALM-COEIN). The etiologies of PALM-COEIN are: uterine Polyp (P), Adenomyosis (A), Leiomyoma (L), precursor and Malignant lesions of the uterine body (M), Coagulopathies (C), Ovulatory dysfunction (O), Endometrial dysfunction (E), Iatrogenic (I), and Not yet classified (N). The articles were selected according to the recommendation grades of the PubMed, Cochrane and Embase databases, and those in which the main objective was the reduction of uterine menstrual bleeding were included. Only studies written in English were included. All editorial or complete papers that were not consistent with abnormal uterine bleeding, or studies in animal models, were excluded. The main objective of the treatment is the reduction of menstrual flow and morbidity and the improvement of quality of life. It is important to emphasize that the treatment in the acute phase aims to hemodynamically stabilize the patient and stop excessive bleeding, while the treatment in the chronic phase is based on correcting menstrual dysfunction according to its etiology and clinical manifestations. The treatment may be surgical or pharmacological, and thelatterisbasedmainlyonhormonaltherapy,anti-inflammatorydrugsandantifibrinolytics.

Resumo O sangramento uterino anormal é uma afecção frequente que pode afetar negativamente aspectos físicos, emocionais, sexuais e profissionais, piorando a qualidade de vida das mulheres. Nos casos de sangramento intenso e agudo, as mulheres podem necessitar de tratamento de urgência, com reposição volumétrica e substâncias hemostáticas. Há situações que necessitam de tratamento prolongado, e ainda situações em que o tratamento cirúrgico pode ser necessário. O objetivo deste estudo é descrever as principais evidências sobre o tratamento das mulheres com sangramento uterino anormal, tanto na fase aguda quanto na crônica. A apresentação do tratamento foi baseada no sistema de classificação (PALM-COEIN, na sigla em inglês) da Federação Internacional de Ginecologia e Obstetrícia (FIGO). As etiologias do PALMCOEIN são: Pólipo uterino (P), Adenomiose (A), Leiomiomia (L), lesões precursoras e Malignas do corpo uterino (M), Coagulopatias (C), distúrbios da Ovulação (O), disfunção Endometrial (E), Iatrogênicas (I), e não classificadas nos itens anteriores (N). Os artigos foram selecionados conforme os graus de recomendação das bases de dados PubMed, Cochrane e Embase que tivessem como objetivo o tratamento do sangramento uterino anormal em mulheres. Somente artigos escritos em inglês foram incluídos. Todos os editoriais ou papers completos que não tratassem de sangramento uterino anormal, ou estudos baseados em modelos animais, foram excluídos. O tratamento tem como objetivo a redução do fluxo menstrual, reduzindo morbidade e melhorando a qualidade de vida. O tratamento na fase aguda visa estabilizar hemodinamicamente a paciente e estancar o sangramento excessivo, enquanto a terapia da fase crônica é baseada na correção da disfunção menstrual, conforme sua etiologia ou conforme a manifestação clínica. O tratamento pode ser cirúrgico ou medicamentoso, sendo o segundo baseado principalmente em fármacos hormonais, anti-inflamatórios ou antifibrinolíticos.

Humans , Female , Uterine Hemorrhage/therapy , Uterine Hemorrhage/etiology
Article in Spanish | LILACS | ID: lil-783350


la genitorragia en pacientes prepuberales es siempre anormal, por lo que requiere estudio. Objetivo: presentar el caso clínico de una paciente prepuberal con genitorragia y revisar en la literatura los diagnósticos diferenciales. Caso clínico: paciente de 10 años con historia de 3 meses de genitorragia sin otros síntomas. Al examen físico mamas Tanner I, vello púbico Tanner II. Genitales externos sin lesiones, himen anular, rojo y delgado. Se descartó pubertad precoz. Se insertó una tórula húmeda en la vagina que dio salida a un trozo de papel higiénico y vello púbico. Después del procedimiento no ha presentado nuevos episodios de sangrado. Conclusión: la genitorragia es un signo alarmante, pero la mayoría de las veces las causas son benignas. En este caso la causa del sangrado fue un cuerpo extraño. Se recomienda derivar a ginecólogo infanto juvenil para evaluación exhaustiva...

Vaginal bleeding in prepubescent girls is always abnormal and needs evaluation. Objective: to present a clinical case and discuss differential diagnosis. Case report: A 10 years old girl with 3 months of vaginal bleeding and no other symptoms. Her breast exam is Tanner stage 1. Her pubic hair is Tanner stage 2, external genitalia were normal; her hymen was red, thin and annular. Precocious puberty was ruled out. By inserting a small sterile catheter into the vagina a piece of pubic hair and toilet paper were easily removed, after that all symptoms resolved. Conclusion: Vaginal bleeding in prepubertal children is an alarming symptom. Our patient vaginal bleeding was due to a vaginal foreign body one of the most common causes. It is recommended that all patients must be referred to a pediatric gynecologist in order to be exhaustively evaluated...

Humans , Female , Child , Foreign Bodies/complications , Uterine Hemorrhage/diagnosis , Uterine Hemorrhage/etiology , Diagnosis, Differential , Puberty, Precocious/diagnosis , Vulvovaginitis/etiology
Article in English | IMSEAR | ID: sea-157582


Antepartum bleeding of unknown origin (ABUO) seems to be one of the most common causes of bleeding in third trimester of pregnancy, but has not been studied well. Objective : The present study was aimed to study the incidence, management strategies and the perinatal outcome in cases of ABUO. Methods : Cases diagnosed as ABUO and managed at the rural referral hospital over last 5 years were analyzed. The diagnosis of ABUO was by exclusion of placental abruption, placenta previa and possible causes of bleeding in the lower genital tract by clinical and ultrasonographic examination. Results : The incidence of ABUO was 0.60 % of births. Of all cases of antepartum haemorrage 18.1% were of teenage and of ABUO10.3% cases were of teenage cases compared to overall 5% cases teenage. Perinatal Mortality Rate (PMR) in cases of ABUO was 237, significantly higher than overall PMR of 66 (p value <0.001) during the study period. Preterm births were the most common cause of perinatal mortality in ABUO. Conclusion : Women with ABUO may not need special interventions, but when ABUO occurs preterm births and perinatal loss increase ,so deaths due to prematurity need to be prevented.

Adolescent , Adult , Female , Fetal Death , Gravidity , Humans , Placenta Previa/complications , Pregnancy Complications , Pregnancy Outcome , Uterine Hemorrhage/etiology , Uterine Hemorrhage/therapy , Young Adult
Article in Portuguese | LILACS | ID: biblio-882853


O sangramento vaginal anormal é um sintoma frequente das pacientes que procuram a emergência. Podemos atribuir esse sangramento tanto às doenças do trato genital inferior, quanto do superior. As hipóteses diagnósticas para este sintoma variam de acordo com a faixa etária em que ocorre. Neste trabalho, revisamos os principais diagnósticos e tratamentos relacionados ao sangramento vaginal anormal conforme a idade.

Abnormal vaginal bleeding is a common symptom of patients visiting the emergency room. Diseases either in the lower or in the upper genital tract can cause this disorder. The possible diagnoses for this symptom vary with the age at which it occurs. In this paper, we review the diagnostics and treatments of this condition related to the patient age at which it occurs.

Uterine Hemorrhage/etiology , Uterine Hemorrhage/therapy , Emergency Medical Services
Lima; s.n; 2013. 48 p. tab, graf.
Thesis in Spanish | LIPECS, LILACS, LIPECS | ID: biblio-1113114


Introducción: La hemorragia uterina anormal es la alteración ginecológica más frecuente en las mujeres en edad reproductiva, siendo el pólipo endometrial una de sus causas y para su diagnóstico se dispone del ultrasonido transvaginal, la histeroscopía y la histerosonografia, quien en los últimos estudios reporta una sensibilidad y especificidad altas estableciéndolo como un buen método. Nuestro objetivo es conocer la prevalencia de pólipos endometriales y estimar el valor diagnóstico de la HSG en el INMP, la cual al ser operador dependiente es necesario conocerla en nuestra institución. Materiales y Métodos: Estudio descriptivo transversal. La muestra son las pacientes que acuden al consultorio externo del Servicio de Ginecología, cuyo motivo de consulta sea el de HUA, en el INMP en el período de Enero 2009 a Diciembre del 2011. Los criterios de inclusión: pacientes no gestantes con estudios de ultrasonido TV e HSG en el INMP, y que luego de realizarse ambos estudios tengan un estudio anatomopatológico. La información se procesará en forma electrónica con el programa estadístico SPSS versión 20.0 y Epidat 3.1. Se elaborará las tablas de contingencia y se identificará las relaciones de dependencia entre las variables cualitativas mediante el Test de Chi cuadrado de Pearson. Se calculará la S, E, VPP y VPN del ultrasonido TV y de la HSG, y la correlación respectiva. Resultados: Entre Enero 2009 y Diciembre 2011, en la Consulta Externa del Servicio de Ginecología del INMP, se atendieron 1726 mujeres con HUA, y hubieron 180 casos confirmados de pólipo endometrial, siendo la prevalencia estimada de 10.4 por ciento. La Ecografia TV para el diagnóstico de Pólipo Endometrial tiene una S: 68 por ciento, E: 62.5 por ciento, VPP: 73.9 por ciento, VPN: 55.5 por ciento; y la HSG, S: 88.0 por ciento, E: 68.5 por ciento, VPP: 81.5 por ciento, VPN: 78.6 por ciento. Conclusión: La HSG tiene mejor valor diagnóstico en comparación con la ecografía TV, sin embargo la correlación...

Introduction: Abnormal uterine bleeding is the most common gynecological disorder in women of reproductive age, endometrial polyp is one of its causes and its diagnosis is available transvaginal ultrasound, hysteroscopy and sonohysterography, who in recent studies report a high sensitivity and specificity establishing it as a good method. Our goal is to determine the prevalence of endometrial polyps and estimate the diagnostic value of the HSG in the INMP, which is operator-dependent and is required to know at our institution. Materials and Methods: A cross-sectional study. The sample comprised patients attending the outpatient clinic of the Department of Gynecology; the reason for the visit is that ofAUB in INMP in the period from January 2009 to December 2011. Inclusion criteria: non-pregnant patients with ultrasound scans and SHG in INMP, and then carried out two studies have a pathological study. The information is processed electronically with SPSS version 20.0 and Epidat 3.1. Be developed contingency tables and identify the dependency relationships between qualitative variables using the chi-square test of Pearson. We calculate the S, E, PPV and NPV of TV ultrasound and SHG, and their respective correlation. Results: Between January 2009 and December 2011, in the outpatient of the INMP Gynecology Service, 1726 women were treated with AUB, and there were 180 confirmed cases of endometrial polyp, with the estimated prevalence of 10.4 per cent. The TV ultrasound for diagnosis of Endometrial polyp has S: 68 per cent, E: 62.5 per cent, PPV 73.9 per cent, NPV: 55.5 per cent and the SHG, S: 88.0 per cent, E: 68.7 per cent, PPV: 81.5 per cent, VPN: 78.6 per cent. Conclusion: The SHG has better diagnostic value compared with ultrasonography TV; however the correlation with the final outcome is moderate. A larger sample is needed to establish more meaningful results.

Female , Humans , Adult , Middle Aged , Uterine Diseases , Uterine Hemorrhage/etiology , Hysteroscopy , Polyps , Uterus/ultrastructure , Observational Study , Cross-Sectional Studies
Gac. méd. Caracas ; 120(3): 213-217, jul.-sept. 2012. ilus
Article in Spanish | LILACS | ID: lil-706244


La embolización de líquido amniótico es una de las condiciones más infrecuentes pero desvastadora que puede presentarse en embarazadas. La prevalencia se ha reportado de 1 en 80.000, con un alto índice de mortalidad (86%). El diagnóstico esta basado en uno o más de los 4 signos clínicos: colapso cardiovascular, dificultad respiratoria, coma y/o convulsiones y coagulopatía. Coagulación intravascular diseminada puede ocasionar pérdida visual bilateral en el grupo de sobrevivientes, por oclusión del sistema arterial retiniano u coroideo. Los sintomas visuales se presentan usualmente después del desarrollo de síntomas sistémicos; sin embargo, en el caso clínico que se expone a continuación la manifestación visual ocurrió simultaneamente con el desarrollo de las sistémicas. Por tanto, la pérdida visual bilateral en el contexto de los signos clínicos sistémicos expuestos, debe alertar al obstetra sobre la posibilidad de embolización de liquido amniótico.

Amniotic fluid embolism is one of the most devastating and infrequent condition known in pregnant women. The prevalence has been reportd as a 1 in 80.000 deliveries with high mortality rate, almost 86%. The diagnosis is based on one or more of the four symptoms and signs: cardiovascular collapse, respiratory distress, coma/seizures and/or coagulopathy. Disseminated intravascular coagulopathy can cause bilateral visual loss in the group of survivors by occlusion of the retinal artery and/or the choroid system. The visual manifestations appear usually after the development of systemic symptoms, but in the clinical case described below the visual symptoms occurred simultaneously to the development of systemic manifestations. Therefore, bilateral visual loss in the context of the systemic clinical signs exposed, should alert the obstetrician about the possibility of embolization of amniotic fluid.

Humans , Adult , Female , Pregnancy , Disseminated Intravascular Coagulation/etiology , Seizures/etiology , Adrenal Cortex Hormones/therapeutic use , Embolism, Amniotic Fluid/etiology , Embolism, Amniotic Fluid/mortality , Retinal Artery Occlusion/complications , Pregnancy Complications/etiology , Uterine Hemorrhage/etiology , Vision Disorders/etiology
Indian J Pathol Microbiol ; 2012 Jul-Sept 55(3): 377-378
Article in English | IMSEAR | ID: sea-142273


Schistosomiasis still represents a major threat to women's health in many developing countries. The frequency in developed countries is increasing among immigrants and tourists who have a history of freshwater exposure in endemic areas. This is a case of 43-year-old immunocompetent Egyptian woman presented by abnormal vaginal bleeding. The gynecological examination revealed an endocervical polyp measuring 3 x 2 x 1 cm. Polypectomy was done. Histopathological examination revealed several granulomas containing viable eggs of Schistosoma hematobium. Schistosomiasis is rarely presented with endocervical polyp. In developing countries, schistosomiasis may be considered in differential diagnosis of patient with endocervical polyp.

Adult , Animals , Egypt , Female , Histocytochemistry , Humans , Polyps/pathology , Polyps/surgery , Schistosoma haematobium/isolation & purification , Schistosomiasis haematobia/diagnosis , Schistosomiasis haematobia/pathology , Schistosomiasis haematobia/surgery , Uterine Hemorrhage/etiology , Uterus/pathology , Uterus/surgery
Einstein (Säo Paulo) ; 10(1): 53-56, jan.-mar. 2012. ilus
Article in English, Portuguese | LILACS | ID: lil-621509


Objective: To identify uterine hysteroscopic findings among patients with prior cesarean section and whom had post-menstrual bleeding spotting type. Methods: We conducted a descriptive and prospective study between June 2008 and December 2009 involving women admitted to our clinic in Ji-Paraná (RO), Brazil, and who complained of prolonged genital bleeding after menstrual period. A total of 20 women with the simultaneous following characteristics were selected: at least one prior cesarean section, aged between 18 and 45 years, no use of hormonal contraceptives, and no history of uterine surgery that could change the cavity anatomy. All participants underwent a hysteroscopic examination. Results: During hysteroscopy, in 90% of the patients, the presence of a cesarean section scar was observed in the last third of the cervix. This scarring causes an anomaly in the uterine cavity anatomy, characterized by the viewing of an enlargement followed by a retraction of the anterior wall, which affords the presence of a pseudocavity with depth and lumen narrowing in variable degrees. Two patients did not present the pseudocavity. Conclusion: Pseudocavities in cesarean section scar are usually found in hysteroscopic examination of patients with prior cesarean section and abnormal uterine spotting.

Objetivo: Identificar os achados histeroscópicos uterino em grupo de pacientes com operação cesariana anterior e sangramento pós-menstrual tipo escape. Métodos: Foi realizado um estudo descritivo e prospectivo, com mulheres que compareceram em consultório em Ji-Paraná (RO), entre junho de 2008 e dezembro de 2009, com queixa de sangramento genital prolongado tipo escape após período menstrual. Destas, foram selecionadas 20 mulheres que apresentavam, simultaneamente, as seguintes características: ao menos uma cesárea prévia; idade entre 18 e 45 anos; sem uso de método anticoncepcional hormonal; e ausência de qualquer outra cirurgia uterina capaz de alterar a anatomia da cavidade. As pacientes selecionadas foram submetidas a exame histeroscópico. Resultados: À histeroscopia, em 90% das pacientes, observou-se, no terço final do colo, a presença da cicatriz de cesárea. Essa cicatriz causa, no interior da cavidade uterina, uma anomalia em sua anatomia, caracterizada pela visualização, na parede anterior, de uma dilatação seguida de retração, que proporciona a presença de pseudocavidade com profundidade e oclusão da luz em graus variáveis. Já em duas pacientes, não foi detectada a pseudocavidade. Conclusão: A pseudocavidade na cicatriz da cesariana é o achado mais freqüente à observação histeroscópica em pacientes com cesárea prévia e sangramento uterino anormal pós-menstrual tipo escape.

Humans , Female , Adolescent , Adult , Middle Aged , Young Adult , Cesarean Section , Diverticulum/diagnosis , Hysteroscopy , Postoperative Complications/diagnosis , Uterine Diseases/diagnosis , Uterine Hemorrhage/diagnosis , Cicatrix/complications , Cicatrix/diagnosis , Cicatrix/pathology , Diverticulum/complications , Diverticulum/epidemiology , Endometrial Neoplasms/complications , Endometrial Neoplasms/diagnosis , Leiomyoma/complications , Leiomyoma/diagnosis , Polyps/complications , Polyps/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Prospective Studies , Uterine Cervical Diseases/complications , Uterine Cervical Diseases/diagnosis , Uterine Cervical Diseases/epidemiology , Uterine Diseases/complications , Uterine Diseases/epidemiology , Uterine Hemorrhage/epidemiology , Uterine Hemorrhage/etiology , Uterine Neoplasms/complications , Uterine Neoplasms/diagnosis
Article in English | IMSEAR | ID: sea-143466


Uterus is the most unique reproductive organ in humans. Rupture uterus is a hazardous complication of pregnancy and labour, and carries high risk both to the mother and the foetus. Uterine rupture during third trimester of pregnancy is a rare complication but if there is rupture and not suspect with in time may have fatal out come for the mother, foetus or both. In this modern medical era, prenatal check-up, advanced non invasive diagnostic facilities and subsequent treatment does not produce such life threatening complication. Rupture uterus cases are observed due to either carelessness of the patient or negligence of the doctor. Three cases of rupture uterus are discussed in this paper of full term pregnancy, had complete antenatal visits with all investigations including ultrasonography and attended the hospital well in time before death. Most cases of rupture uterus are preventable with good ante-natal and intra-partum care, and proper identification of high-risk cases.

Adult , Female , Fetal Death , Humans , Malpractice , Pregnancy , Prenatal Care , Uterine Hemorrhage/etiology , Uterine Rupture/complications , Uterine Rupture/etiology , Uterine Rupture/mortality
Bahrain Medical Bulletin. 2011; 33 (4): 195-198
in English | IMEMR | ID: emr-144000


Abnormal uterine bleeding is a challenging gynecological problem caused by various endometrial pathologies. The present study aims to identify the pattern of histopathological diagnoses encountered in women of various age groups presenting with abnormal uterine bleeding. A retrospective age specific comparative analysis. Department of Pathology. Two thousand two hundred ninety-five endometrial samples from women presenting with abnormal uterine bleeding from January 1995 to June 2008 were retrieved and analyzed. The commonest histopathological diagnosis was secretory endometrium 571 [24.9%], followed by proliferative endometrium 498 [21.7%], endometrial polyp 227 [9.9%], disordered proliferative endometrium 200 [8.7%], simple cystic hyperplasia 160 [7%], chronic endometritis 134 [5.8%], inactive endometrium 126 [5.5%], atrophic endometrium 70 [3.1%], uterine malignancies 41 [1.8%], complex hyperplasia without atypia 33 [1.4%] and finally complex hyperplasia with atypia 15 [0.7%]. Two hundred twenty [9.6%] revealed no endometrial tissue and were considered insufficient for diagnosis. Uterine malignancies and complex hyperplasia with atypia were more common in the age group of 52 years and older, 3.3% and 1.2% respectively. The present study revealed that secretory and proliferative endometrium are the most common endometrial histopathological patterns identified in endometrial samples obtained for abnormal uterine bleeding in our region

Humans , Female , Uterine Hemorrhage/etiology , Endometrium/pathology
Medical Journal of the Islamic Republic of Iran. 2011; 25 (3): 131-135
in English | IMEMR | ID: emr-146531


CuT380A intra uterine device Intra Uterine Device [IUD] is used in the health system of Iran. The most important and frequent side effects of the lUDs are hypermenorrhea and polymenorrhea. In Iran, iron supplement are not prescribed for the IUD users and there are no documents indicating their iron reservation status. This study was performed to determine the iron status in Gorganian IUD users. This historical cohort study was performed on 100 IUD users [exposed group] and 100 non-IUD users [non-exposed group] in the Golestan province in north east of Iran in 2008. To evaluate the iron status hemoglobin and ferritin levels were measured. Data was analyzed by SPSS 13 by using Chi square and Independent T-test. A p-value less than 0.05 were considered as statistically significant. Hgb less than 10.5 was seen in 5% and 6% of IUD users and non-IUD users respectively which was not statistically significant [OR: 1.43, 95% CI: 0.39-5.25]. Low Ferretin Level [less than 15] was seen in 53% of IUD users and in 35% of non-IUD users which was statistically significant [OR: 2.35, 95% CI: 1.28-4.29] Duration of menstrual period in the two groups was statistically significant [7.5 +/- 2.4 vs. 6.4 +/- 1.8, p= 0.005] but interval of menstruation [days] was not statistically significant [26.7 +/- 4.7 vs. 28 +/- 11.2, p> 0.05]. On the basis of the results obtained we suggest either routine iron supplementation following application of IUD, or use of the hormone releasing IUD as an alternative for copper lUDs

Humans , Female , Uterine Hemorrhage/etiology , Menorrhagia/etiology , Menstruation Disturbances , Women , Surveys and Questionnaires , Contraception/methods , Intrauterine Devices, Medicated , Contraceptive Agents , Cohort Studies , Evaluation Studies as Topic
EMHJ-Eastern Mediterranean Health Journal. 2011; 17 (7): 582-586
in English | IMEMR | ID: emr-159085


Postmenopausal bleeding represents one of the most common reasons for referral to gynaecological services. A retrospective review was made of the hospital records of 482 women presenting with postmenopausal bleeding to a referral hospital in Amman Jordan. Histopathological reports and patients' records were reviewed and different causes of bleeding were identified and related to patients' age. Adenocarcinoma was responsible for 9% of cases, and hyperplasia for 11%. Atrophy of the endometrium was the most common finding [52% of women], followed by hyperplasia [with and without atypia] [11%] and carcinoma [9%]. The risk of cancer increased with increasing age while the incidence of bleeding decreased with age. Other pathology was reported as the main finding in 11 cases [2%] with postmenopausal bleeding. These preliminary data are the first reports from Jordan of histopathological findings in this group of patients, and a larger study is required to establish national figures

Humans , Female , Aged, 80 and over , Adult , Middle Aged , Aged , Postmenopause , Uterine Hemorrhage/etiology , Retrospective Studies , Endometrium/pathology , Age Factors , Uterine Neoplasms