Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
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Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Invited lecture by Dr Sujoy dasgupta in the Annual Conference of the "Academy of Clinical Embryologists" (ACE) held in October 2021 in "Hybrid mode" (Kolkata and Webinar)
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on Febuary 13,2021 by Dr. Asha Jain
Hysteroscopic procedures are getting refined and with the advent of miniature scopes , doing these procedures in he office is getting better and more comfortable.
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)Sujoy Dasgupta
Dr Sujoy Dasgupta invited to deliver a lecture on "RPL- ESHRE Guideline" in the Annual Conference of RCOG (Royal College of Obstetricians and Gynaecologists) IRC (International Representative Committee) India East held on 20-21 May, 2023
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Invited lecture by Dr Sujoy dasgupta in the Annual Conference of the "Academy of Clinical Embryologists" (ACE) held in October 2021 in "Hybrid mode" (Kolkata and Webinar)
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Hysteroscopic procedures are getting refined and with the advent of miniature scopes , doing these procedures in he office is getting better and more comfortable.
Today, Laparoscopy is an alternative technique for carrying out many operations that have traditionally required an open approach. The benefits of minimal access surgery have been well recorded, including lower post-operative morbidity, shorter duration of hospital stay and a shorter return to work.
Adherent placenta occurs when there is a defect in the decidua basalis, Resulting in an abnormal invasion of the placenta directly into the substance of the uterus
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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2. PREVALENCE
An increase
Rising rate of CS
Better awareness
Diagnostic techniques
ABOUBAKR ELNASHAR
3. Term CSEP is misleading
occur after any myometrial trauma
myomectomy
manual removal of placenta
D&C
IVF.
1 CS:
6% risk of CSEP
ABOUBAKR ELNASHAR
4. PRESENTATION
No symptoms: 37%
Painless vaginal bleeding: 39%
Generalized abdominal pain:25%.
(Rotas et al.2006)
ABOUBAKR ELNASHAR
5. Miscarriage
Vaginal bleeding: usually heavier
US:
gestational sac within either the cervix or lower
uterine segment
no blood flow on Doppler examination,
indicating a detached gestational sac.
Cervical pregnancy
a bulbous region within the cervix
blood flow surrounding the gestational sac
layer of myometrium between the pregnancy and
the bladder.
CSEP
either limited or no myometrium between the
pregnancy and the bladder
cervical canal is empty
ABOUBAKR ELNASHAR
6. PATHOGENESIS
Impaired wound healing
after previous trauma:
myometrial defects: scar at which the blastocyst
implants.
may be secondary to
systemic diseases (DM): poor blood flow
poor tissue quality
inadequate collagen formation
postoperative wound infections
short-interval pregnancy
improper closure
ABOUBAKR ELNASHAR
7. DIAGNOSIS
Positive pregnancy test
TVUS:
1. Empty uterus& cervical canal
2. GS at the hysterotomy site
3. Thin or absent myometrial tissue between bladder
& GS
4. Vascular area noted at the previous cesarean
scar
ABOUBAKR ELNASHAR
9. Types
Type 1 (endogenic)
GS grows inward toward the cervicoisthmus
space
Type 2 (exogenic)
GS grows outward toward the bladder& abd
wall
Determining the type help
counseling on expectant management
optimal medical/surgical approach for
termination.
ABOUBAKR ELNASHAR
11. TREATMENT
≥30 different treatment modalities
Success rate&
Morbidity& mortality
vary with each method
dependent on
patient stability
desire for future fertility.
ABOUBAKR ELNASHAR
12. COUNSELING CONSIDERATIONS
Significant challenges
morbidities
desire for future fertility
lack of consensus on treatment approach
TERMINATION SOON AFTER DIAGNOSIS
Prevents
uterine rupture
placentation abnormalities
invasion into surrounding organs
hge
other complications
DIC, hypovolemic shock& death.
ABOUBAKR ELNASHAR
13. Expectant management:
High likelihood of cesarean hysterectomy
Close surveillance until complete resolution of the
pregnancy is confirmed.
ABOUBAKR ELNASHAR
15. I. EXPECTANT MANAGEMENT
Should not be recommended
as 1st -line TT in most individuals
1.Complications
2. Poor outcomes
High failure rate (44%–91%)
Requiring additional interventions such as
surgery
ABOUBAKR ELNASHAR
16. Complications: ≥50% of patients
1. hysterectomy
2. cesarean hysterectomy
3. preterm delivery
4. uterine rupture
5. future infertility
6. significant hge
(Maheux-Lacroix et al, 2014)
7. Maternal death
Ruptured ectopic pregnancies: 2.7% of
maternal deaths
ABOUBAKR ELNASHAR
17. An option when
patient desires to
let nature take its course
continue the pregnancy.
Should be undertaken only with
1. thoroughly counseled
2. close surveillance& follow-up
3. stable
4. minimal symptoms
5. compliant patients
6. type 1 CSEP
Better outcomes when
no fetal cardiac activity
declining β-hCG..
(Mollo et al, 2014)
ABOUBAKR ELNASHAR
18. II. MEDICAL TREATMENT
Candidates
≤ 8 w
absent fetal cardiac activity
stable
β-hCG ≤5000 to 12,000 mIU/mL
≥ 2-mm thickness between myometrium& bladder.
(Gonzalez , Tulandi,SR 2017)
Additional surgical or medical management
should be considered if the CSEP does not resolve
with the initial MTX treatment.
ABOUBAKR ELNASHAR
19. Methotrexate
Routes of administration
1. Locally
2. Systemic
single-dose: 1 mg/kg or 50 mg/m2 of body
surface area.
2to3 IM (1mg/kg BW or 50 mg/mm2 of surface area) at
an interval of 2 or 3 days over course of a week.
3. US guided local, plus sys MTX:
25mg in GS, 25mg in F placenta, 25mg IM
4. In combination with surgical management.
ABOUBAKR ELNASHAR
20. Success for local MTX if
Myometrial thickness between GS& bladder: ≥
2mm
β-hCG level: low
wide range from ≤5,000 to 10,000 mIU/mL has
been reported.
(Parker et al, 2006)
ABOUBAKR ELNASHAR
21. Pretherapeutic scoring model for treatment
(Dior et al, 2018)
Rates of conversion to surgical treatment
1 2 3
G age(w) ≤6 6-8 ≥8
Abd pain absent present
B HCG (IU) ≤3000 3000-10000 ≥10000
G sac(mm) ≤10 10-25 ≥25
Score 6 7-8 9
Conversion to surgical TT(%) 0 15 44
ABOUBAKR ELNASHAR
22. Success for either local or systemic MTX
similar (50%–66%)
increases moderately when given in more than 1
dose.
(Gonzalez N, Tulandi,SR 2017)
The simultaneous administration of MTX both locally&
systemically
No improve outcomes compared with a multidose
protocol.
(Jurkovic et al, 2003)
ABOUBAKR ELNASHAR
23. Complications
Significant hge
Surgical intervention
Hysterectomy
Need for further intervention is common
(Jurkovic et al, 2003)
Adverse effects: rare
alopecia
pneumonitis
bone marrow suppression
stomatitis
(Mollo et al, 2014)
In severe cases, cirrhosis and hepatic fibrosis
routine laboratory evaluation of hepatic and renal function was
unnecessary in healthy women.
ABOUBAKR ELNASHAR
24. III. UTERINE ARTERY EMBOLIZATION
Not 1st line option
for patients who desire future fertility.
{high failure& complication rates
potential detrimental impact to future fertility}.
Should be undertaken only in those with
arteriovenous malformations or
when there is significant bleeding
(Kanat-Pektas et al, 2016)
ABOUBAKR ELNASHAR
25. IV. SURGICAL
Including
D&C
Direct excision via
abdominal
laparoscopic
hysteroscopic
vaginal approach
Combination approach
Definitive management with hysterectomy.
ABOUBAKR ELNASHAR
26. Choosing the method
1. skill of the surgeon
2. patient presentation
3. desire for future fertility
lack of high-quality studies makes it difficult to
propose evidence-based guidelines.
ABOUBAKR ELNASHAR
27. 1. HYSTEROSCOPY
To remove CSEP either
alone or
with adjuvant medical therapy.
Methods
hysteroscopic removal of tissue
aspiration of GS after medication
injection of MTX or ethanol into the GS.
(Gonzalez N, Tulandi et al, SR, 2017)
Best indicated in
type 1 CSEP.
ABOUBAKR ELNASHAR
28. Success rate:
variable rate
requirement for additional procedures, including
hysterectomy
(Maheux-Lacroix et al, SR, 2017)
Higher in
lower gravidity/parity
fewer prior CS
earlier gestational age at time of procedure.
ABOUBAKR ELNASHAR
29. ASRM, 2016:
hysteroscopy could be used to remove CSEP via
direct visualization or US assistance.
dissection of the CSEP from the uterine wall using
electrosurgery had
high success rate
extremely low complication rate
should be considered safe& effective
Complications: Rare
Fluid overload, electrolyte imbalances, perforation, infection, and hospital
admission.
ABOUBAKR ELNASHAR
30. 2. LAPAROTOMY
Very few data on laparotomy as 1st choice
Performing
myometrial wedge excision
Advantages:
Direct visualization of the lower uterine segment
(Maheux-Lacroix et al, SR, 2017)
Success rate
high
with a low complication rate
myometrium between GS& bladder ≥2 mm.ABOUBAKR ELNASHAR
31. ACOG 2017
Laparotomy:
not considered 1st line treatment
should be avoided for CSEP management if
possible.
1. potential morbidity
bladder/ureter injuries
intraoperative blood loss
wound complications
2. invasive nature
3. longer duration of hospital stay, operating time
4. slower return to normal activity
MIS
should be 1st line if the surgeon is adequately
trained
ABOUBAKR ELNASHAR
32. 3. COLPOTOMY TV approach
Steps:
An anterior colpotomy incision to access the CSEP
Removal&repair of previous scar.
(Maheux-Lacroix et al, SR, 2017)
Many studies supports
use of a TV hysterotomy for
stable patients
who desire future fertility
Advantages:
Morbidity: minimal
Success rates: ≥90%.
Faster resolution of β-hCG when compared with
UAE or hysteroscopic removal +MTX.ABOUBAKR ELNASHAR
33. The least to be utilized compared with hysterotomy
via laparoscopy or laparotomy.?
(Kanat-Pektas et al, 2016)
1. Incomplete visualization of
CSEP
Previous hysterotomy scar±: persistent
embryonic tissue
3. Risks
Infection
bleeding
damage to surrounding structures.
ABOUBAKR ELNASHAR
34. 4. LAPAROSCOPY
Best suited in
type 2 CSEP
(Gonzalez N, Tulandi SR, 2017)
Steps:
Laparoscopic hysterotomy with wedge resection of
the CSEP& previous scar
Temporarily occluding blood supply to the uterus:
decrease blood loss
enable complete resection of the CSEP
ABOUBAKR ELNASHAR
35. It has been encouraged as one of the primary
approache
(Maheux-Lacroix et al SR, 2017)
1. minimally invasive
2. direct visualization of pregnancy
3. removal of the scar
4. success rate: 97%
5. faster resolution of β-hCG
6. long-term outcomes
higher rate of subsequent pregnancies
reduction of CSEP reoccurrence
ABOUBAKR ELNASHAR
36. Risks of laparoscopic surgery
initial entry into the abdomen
perforation of vessels or intestines
trocar site
infection or hernia
Advanced skills
Nessaray
(Birch Petersen et al, 2016)
ABOUBAKR ELNASHAR
37. V. COMBINATION APPROACHES
1. MTX administered in combination with other
interventions
UAE
Hysteroscopic or laparoscopic removal of the ectopic
Suction curettage
Needle aspiration.
(Qiao et al, 2016)
Success rate: ≥80%
Greater with less morbid sequelae than MTX
alone.
MTX + UAE
MTX + hysteroscopic or laparoscopic excision
MTX + needle aspiration
(Birch Petersen et al, SR, 2016) ABOUBAKR ELNASHAR
38. Complications
hge
need for blood transfusion
hysterectomy
laparotomy, have been reported in all of these treatment
protocols
(Gonzalez , Tulandi et al, SR, 2017)
MTX with or without surgical intervention
should not be considered as a primary method of
CSEP termination.?
1. likely need for additional intervention
2. potential for adverse events
(Gonzalez , Tulandi et al, SR, 2017)
ABOUBAKR ELNASHAR
39. MTX with or without D&C or suction curettage
conflicting results when compared with MTX alone.
Some research:
No differences.
(Gonzalez , Tulandi et al, SR, 2017)
RCT:
UAE + curettage Vs. MTX + curettage
Fewer adverse events
blood loss
hospitalization
resolution of β-hCG
(Qiao et al, SR, 2016)ABOUBAKR ELNASHAR
40. 3. Hysteroscopic resection in combination with
UAE, D&C & adjuvant MTX
variable levels of success to accelerate the resolution of
the gestational sac.
ABOUBAKR ELNASHAR
42. There are numerous strategies to treat CSEP,&
currently level I evidence is not available
Level II evidence: any method that removes the
CSEP& previous scar (via transvaginal, laparoscopy, or
laparotomy) is best practice.
high success rate
minimal complications.
hge, hysterectomy, higher rate of preserved fertility.
Level II evidence: supports any minimally invasive
method that removes the pregnancy& scar at once,
such as
hysteroscopic or
laparoscopic hysterotomy.ABOUBAKR ELNASHAR
43. ASRM recommends (level III evidence)
multiple mechanisms can be utilized
D&C
laparoscopy/laparotomy excision, or
local or systemic MTX.
Treatment should fit
Patient
hemodynamic status
desire for future fertility
compliance
CSEP
location
gestational age
Surgeon expertise.
ABOUBAKR ELNASHAR
44. Expectant management
highest of morbid outcomes
Medical management
often requires further treatment with additional
medication or surgery.
high failure& complication rate
not recommended as 1st -line approach.
ABOUBAKR ELNASHAR
45. Different surgical methods
UAE
D& C
surgical removal via vaginal, laparoscopic, or laparotomic
approach; & hysterectomy.
Various levels of success depending on
surgeon skill
patient presentation.
Optimal method should be
as least invasive as possible
pending surgeon ability and patient stability.ABOUBAKR ELNASHAR
46. You can get this lecture and 440
lectures from:
1.My scientific page on Face book:
Aboubakr Elnashar Lectures.
https://www.facebook.com/groups/2277
44884091351/
2.Slide share web site
3.elnashar53@hotmail.com
4.My clinic: Elthwara St. Mansura
ABOUBAKR ELNASHAR