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1.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 50(1): 100815-100815, Ene-Mar. 2023. tab
Artigo em Espanhol | IBECS | ID: ibc-214994

RESUMO

El sangrado uterino anómalo es una consulta frecuente en el ámbito de la ginecología que tiene una gran repercusión física, emocional y social. En la actualidad existen diferentes tratamientos, y el manejo dependerá de cada situación.El tratamiento definitivo es la realización de una histerectomía, que debe ser el último recurso tras haber agotado las alternativas médicas, ya que no está exenta de riesgos. Es importante evaluar las comorbilidades asociadas a cada paciente y siempre que sea posible y factible se debe optar por la cirugía mínimamente invasiva.En los países en vías de desarrollo, la cirugía sigue siendo el tratamiento de primera elección debido a la falta de recursos para optar por las nuevas terapias médicas. Además, el acceso a las técnicas quirúrgicas mínimamente invasivas también está más restringido. El gran desafío es intentar garantizar un acceso equitativo a los recursos y a las mejoras a nivel mundial.(AU)


Abnormal uterine bleeding is a frequent reason for consultation in the field of gynaecology of great physical, emotional, and social impact. There are several current treatment options, and management depends on the clinical scenario.The definitive treatment of abnormal uterine bleeding involves performing a hysterectomy which is not risk free. An exhaustive evaluation of the comorbidities and, whenever feasible, minimally invasive surgery should be performed.In developing countries, surgery remains the first choice for abnormal uterine bleeding treatment due to the lack of resources to access the new medical therapies available. Access to minimally invasive surgical techniques is also more restricted. For this reason, the big challenge is to ensure equal access to resources and improvements around the world.(AU)


Assuntos
Humanos , Feminino , Hemorragia Uterina , Doenças Uterinas , Histerectomia , Procedimentos Cirúrgicos Minimamente Invasivos , Ginecologia , Obstetrícia
2.
Ultrasound Obstet Gynecol ; 53(1): 107-115, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29536581

RESUMO

OBJECTIVE: To generate guidance for detailed uterine niche evaluation by ultrasonography in the non-pregnant woman, using a modified Delphi procedure amongst European experts. METHODS: Twenty gynecological experts were approached through their membership of the European Niche Taskforce. All experts were physicians with extensive experience in niche evaluation in clinical practice and/or authors of niche publications. By means of a modified Delphi procedure, relevant items for niche measurement were determined based on the results of a literature search and recommendations of a focus group of six Dutch experts. It was predetermined that at least three Delphi rounds would be performed (two online questionnaires completed by the expert panel and one group meeting). For it to be declared that consensus had been reached, a consensus rate for each item of at least 70% was predefined. RESULTS: Fifteen experts participated in the Delphi procedure. Consensus was reached for all 42 items on niche evaluation, including definitions, relevance, method of measurement and tips for visualization of the niche. A niche was defined as an indentation at the site of a Cesarean section with a depth of at least 2 mm. Basic measurements, including niche length and depth, residual and adjacent myometrial thickness in the sagittal plane, and niche width in the transverse plane, were considered to be essential. If present, branches should be reported and additional measurements should be made. The use of gel or saline contrast sonography was preferred over standard transvaginal sonography but was not considered mandatory if intrauterine fluid was present. Variation in pressure generated by the transvaginal probe can facilitate imaging, and Doppler imaging can be used to differentiate between a niche and other uterine abnormalities, but neither was considered mandatory. CONCLUSION: Consensus between niche experts was achieved regarding ultrasonographic niche evaluation. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.


Assuntos
Ultrassonografia , Anormalidades Urogenitais/diagnóstico por imagem , Útero/anormalidades , Adulto , Cicatriz/diagnóstico por imagem , Consenso , Técnica Delphi , Feminino , Humanos , Guias de Prática Clínica como Assunto , Útero/diagnóstico por imagem
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