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1.
Int J Surg Case Rep ; 115: 109318, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38306871

ABSTRACT

INTRODUCTION: Episiotomy is a procedure during vaginal delivery to facilitate a safer delivery. However, it can also have complications including hemorrhage, perineal tears, infections, and vaginal hematoma which should be managed and monitored carefully. PRESENTATION OF CASE: A 27-year-old woman with term pregnancy, had a normal vaginal delivery at 39 weeks of gestation, and a large episiotomy was performed due to the estimated neonate weight to prevent shoulder dystocia. She was complicated with a huge pelvic hematoma that was expanded to prerenal space. DISCUSSION: This complication was managed by conservative therapy, including antibiotic therapy, intensive observation of the patient's situation, and follow-up with a CT scan after consulting with a radiologist. The huge hematoma was reduced. CONCLUSION: Noninvasive management and close monitoring for pelvic hematoma due to episiotomy in a low-risk patient are successful; however, consulting with radiologists and experts and a multidisciplinary approach should be considered.

2.
J Med Life ; 16(12): 1740-1744, 2023 Dec.
Article in English | MEDLINE | ID: mdl-38585533

ABSTRACT

Constipation and obstructive bowel disorders are the most common symptoms of prolapse and posterior defects. Prolapse and obstructive defecation disorders are treated using various surgical techniques to repair posterior defects. This study aimed to evaluate the manometry results of patients before and after reconstructive surgery of the posterior compartment. This retrospective cohort study included 40 women with defecation disorders referred to the Imam Khomeini Hospital Complex, an academic center affiliated with Tehran University of Medical Sciences, Tehran, Iran, from 2020 to 2021. Data were collected through medical records and a checklist developed by the researcher before and after surgery. All analyses were performed using SPSS software (version 26), with significance at p<0.05. Forty women with a mean age of 49.47±9.66 years participated in this study. The manometry results showed significant differences in patients before and after surgery in parameters such as maximum resting pressure, push test, constipation, straining during defecation, finger support necessity, sensation of incomplete defecation, dyspareunia, and husband's sexual satisfaction (p<0.001). In addition, all patients had a grade 2 or higher posterior compartment prolapse, which improved in all cases after surgery (p<0.0001). Patients' symptoms significantly improved during the 12-month follow-up after DeLancey level 3 to 1 surgery. This type of surgery proved to be an effective surgical intervention without significant complications in the short-term follow-up.


Subject(s)
Pelvic Organ Prolapse , Humans , Female , Adult , Middle Aged , Pelvic Organ Prolapse/surgery , Retrospective Studies , Iran , Constipation/surgery , Constipation/etiology , Manometry/adverse effects , Treatment Outcome
3.
Int J Surg Case Rep ; 96: 107313, 2022 Jul.
Article in English | MEDLINE | ID: mdl-35716621

ABSTRACT

INTRODUCTION AND IMPORTANCE: Aggressive Angiomyxoma (AA) is an uncommon, locally infiltrative mesenchymal tumor that primarily originates from perineal and pelvic sites of women, particularly in the 4th decade of life with having an emphasized tendency for local recurrence, whereas it has a low tendency to metastasize. Patients often present with nonspecific symptoms such as painless visible mass that might be misdiagnosed with every mass in genital and pelvic sites in reproductive-age women. CASE PRESENTATION: We describe a 31-year-old female presenting with an enlargement on the right labia majora. Ultrasound and magnetic resonance were carried out, and the mass was surgically excised completely and without complication. The diagnosis of AA was made based on characteristic histopathological features. The postoperative follow-up for recurrence is currently being continued. CLINICAL DISCUSSION: Due to its rarity and lack of specificity in clinical and radiological examinations, the pre-operative misdiagnosis rate of AA is rather high. Hence, most cases are diagnosed on histology after initial surgical excision. Surgical management is the gold standard treatment for primary tumors; however, in case of local recurrences, treatment choices range from surgical resection to gonadotropin-releasing hormone (GnRH) agonist for tumors positive for estrogen and progesterone receptors. CONCLUSION: Wide surgical resection is the gold standard treatment of AA; however, exceptions might occur due to the depth of tumor infiltration to adjacent viscera. Therefore, adjunct medical therapies can play a crucial role in treatment. In addition, long-term follow-up is necessary due to the high rate of local recurrences.

4.
J Midlife Health ; 10(2): 57-62, 2019.
Article in English | MEDLINE | ID: mdl-31391753

ABSTRACT

The current evidence regarding the association between vitamin D status and pelvic floor disorder (PFD) are inconclusive. This meta-analysis was aimed to summarize existing data demonstrating the association between Vitamin D status and PFD using published observational studies. All national and international databases including Web of Science, PubMed, Google Scholar, and Scopus were searched up until January 30, 2018, and related published studies retrieved for meta-analysis. The effect sizes of Vitamin D status were presented as standardized mean difference (SMD) with 95% confidence interval (CI), using random-effect models and inverse variance method. The Cochran Q statistic and I 2 tests were used to evaluate the heterogeneity across included studies. Seven studies with 3219 women were included our meta-analysis. There was heterogeneity existing among included studies (I 2 = 96.4%, P < 0.001), so a random-effect model was used. The findings of this meta-analysis revealed that the mean serum Vitamin D levels in women with PFD were significantly lower than healthy women (SMD -0.60; 95% CI, -1.06, -0.13; P = 0.01). This meta-analysis demonstrates lower levels of serum Vitamin D in women with PFD rather than healthy women. Additional prospective studies regarding the association between Vitamin D status and PFD are required to confirm our findings.

5.
Taiwan J Obstet Gynecol ; 48(2): 120-3, 2009 Jun.
Article in English | MEDLINE | ID: mdl-19574171

ABSTRACT

OBJECTIVE: The aim of this study was to compare the effects of the transverse muscle-cutting Maylard incision and the Pfannenstiel incision for hysterectomies, in terms of postoperative complications, pain, and quality of life. MATERIALS AND METHODS: This randomized, double-blind study compared two laparotomy techniques. All hysterectomies were performed for benign conditions. Eighty cases were randomly assigned to receive either Pfannenstiel or Maylard incisions. Measured intraoperative variables included volume of blood loss and duration of surgery. Postoperative variables included abdominal distension, postoperative pain, and quality of life. RESULTS: Postoperative abdominal distension was significantly lower in the Maylard group (p = 0.004). There were no differences in intraoperative characteristics and duration of hospitalization, hemorrhage volume, or duration of surgery between the two groups. CONCLUSION: Hysterectomy performed via the Maylard incision was associated with the use of fewer additional analgesics than hysterectomy performed via the Pfannenstiel incision.


Subject(s)
Hysterectomy/methods , Intraoperative Complications , Postoperative Complications , Adult , Blood Loss, Surgical , Double-Blind Method , Female , Follow-Up Studies , Humans , Length of Stay , Middle Aged , Quality of Life , Surveys and Questionnaires , Urinary Catheterization
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