Retained Intrauterine Sutures for 6 Years.

The most common sutures used for uterine suturing during cesarean section (CS) are vicryl and/or chromic catgut. The sutures' chemistry and polymer morphology alter sutures' performance and absorption. If the sutures used during CS undergo inappropriate hydrolysis and absorption, the retained intrauterine sutures may cause intrauterine inflammations with subsequent abnormal uterine bleeding (AUB) and/or infertility. This report represents a rare case report of retained intrauterine sutures for 6 years after previous CS, which were incised and released from its attachment to the uterine wall using operative hysteroscopy. This report highlights that the retained intrauterine sutures may interfere with sperm transport and implantation and act as a foreign body with subsequent intrauterine inflammation and infertility. In addition, the report highlights the role of a hysteroscopy as the gold standard for uterine cavity assessment in women presented with AUB and/or infertility.

Successful Pregnancy Outcome Immediately after Methotrexate Treatment for Cesarean Section Scar Pregnancy.

A 27-year-old cesarean section scar pregnancy (CSSP) case diagnosed by the vaginal ultrasound which showed gestational sac located in the lower uterine anterior quadrant close to the site of the previous scars (with yolk sac inside) with ß-hCG 15,373 mIU/ml in September 2017 was managed by intramuscular (IM) multidose methotrexate (MTX). The studied woman discharged home when the ß-hCG decreased to 11,630 mIU/ml on the 1st week after the first MTX dose. On the 5th week after the first dose of IM-MTX, the ß-hCG dropped to zero and the gestational sac completely disappeared. She was counseled about the risk of pregnancy in the first 6 months after the MTX and the possibility of the CSSP recurrence. She presented on December 16, 2018, with preterm delivery at 35 weeks' gestation. After delivery, her neonate admitted to the neonatal intensive care unit (NICU) due to mild respiratory distress and discharged from the NICU on the 4th day in good condition. Multi-dose MTX regimen for the treatment of CSSP supported by many authors with follow-up by ß-hCG and vaginal ultrasound. This report highlights the successful outcome immediately after the proper management of CSSP cases.

Sentinel Lymph Nodes in Endometrial Cancer Update 2018.

There are no established data about lymphadenectomy during treatment of endometrial cancers (ECs) and to what extent lymphadenectomy should be performed. In addition, retroperitoneal lymphadenectomy increases the intraoperative and postoperative complications. Sentinel lymph node (SLN) mapping has the lowest costs and highest quality-adjusted survival. SLN is the most cost-effective strategy in the management of low-risk ECs. Women staged with SLN mapping were more likely to receive adjuvant treatment compared with women staged with systemic lymphadenectomy. This review article designed to evaluate the diagnostic accuracy and the methods of SLN detection in ECs.

Successful management of severe preeclampsia major complications: Case report.

Severe preeclampsia (PE) have considerable adverse outcome especially in low-resource countries. A 21-year-old pregnant woman with severe PE and intrauterine fetal death, delivered by cesarean section (CS). The CS complicated by atonic postpartum hemorrhage (PPH). She was transferred by the air ambulance to the tertiary center of West Kazakhstan University-intensive care unit, once she developed anuria. She was carefully monitored after exclusion of maternal sepsis and HELLP (hemolysis, elevated liver enzymes and low platelet) syndrome and she developed postpartum eclampsia and right partial lobe intracranial hemorrhage (ICH). She was managed by multi-disciplinary team with proper and clear management plan and discharged from the hospital on the 20th postpartum day in good general condition. The complications of severe PE need clear multi-disciplinary team management plan to avoid the adverse outcome of the severe PE.

Uterine suspension using I. Abdelazim sacrohysteropexy technique for treatment of uterine prolapse: Case series.

Surgical treatment of uterine prolapse in woman who wishes to preserve her uterus remains a major surgical challenge. This case series describes a new surgical technique for uterine suspension in women who wish to preserve their uteri, using the Mersilene tape as an artificial uterosacral ligament to suspend the uterus to the sacral promontory. Four women with genital prolapse (two with stage 1 uterine prolapse and two with stage 2 uterine prolapse and stage 1 vaginal walls prolapse) who requested a uterine conserving procedure were offered I. Adelazim sacrohysteropexy technique as a new surgical option for treatment of the uterine prolapse. This surgical technique is formed of three basic steps: (1) exposure of the anterior longitudinal ligament over the sacral promontory and exposure of the uterosacral ligaments on the back of the uterine cervix; (2) fixation of the Mersilene tape as Y-shaped artificial uterosacral ligament extended from the sacral promontory to the back of the uterine cervix; and (3) closure of the incised visceral peritoneum over the artificial Y-shaped uterosacral ligament. The mean operative duration of I. Abdelazim sacrohysteropexy technique was 50.5 ± 8.4 min and the mean estimated blood loss was 480 ± 67.8 ml. No intraoperative or postoperative complications or recurrence of the uterine prolapse were recorded in the studied cases. I. Abdelazim sacrohysteropexy technique is an effective uterine suspension technique for treatment of uterine prolapse in women who wish to preserve their uteri, using the Mersilene tape as an artificial uterosacral ligament to suspend the uterus to the sacral promontory.

Cesarean section scar dehiscence during pregnancy: Case reports.

BACKGROUND: The incidence of cesarean section increased worldwide with subsequent increase in the risk of cesarean section scar dehiscence (CSSD). The clinical significance and the management of the CSSD are still unclear. CASE REPORTS: Here, we report two cases of CSSD. A 35-year-old woman, gravida 2, previous CS, due to preterm premature rupture of membranes (PPROM) and breech presentation at 30 weeks, was admitted for elective CS at 38+3d weeks' gestation. During the second elective CS, it was seen that the site of the previous CS scar was very thin along its whole length and the anterior uterine wall was completely deficient, leaving visible bulging fetal membranes and moving baby underneath. A 32-year-old woman, previous three CSs, was admitted as unbooked case without any antenatal records at 29+4d weeks' gestation, triplet pregnancy with preterm labor. She received betamethasone and magnesium sulfate (MgSO4) for fetal lung and fetal brain protection, respectively, followed by emergency CS. During the CS, the previous CSs scars were dehiscent over more than half of its length and the anterior uterine wall was missing leaving visible fetal membranes. The uterine incision of the studied women was repaired in two layers using vicryl 0 interrupted simple stitches for the first layer, followed by interrupted mattress stitches for the second layer. The studied women had uneventful postoperative recovery and were discharged from the hospital after counseling regarding intraoperative findings, uterine incisions repair, and future pregnancies. CONCLUSION: It is useful to assess the lower uterine segment of women with previous CS using the available ultrasound facilities. If the CSSD is diagnosed before the elective CS, the surgeon should prepare himself with the safest uterine incision with least possible complications and the best way of repair of the defective or dehiscent uterine wall.