Retained Products of Conception (RPOC) occur in 1 % of cases. Clinical features of 41 women diagnosed of RPOC by hysteroscopy, to establish the best time-lapse of an expectant management after an office hysteroscopy avoiding an operative hysteroscopy to permit a spontaneous expulsion, were analyzed. There were no differences between patients who suffered a spontaneous expulsion or those in whom a persistence of RPOC was observed at time of surgical removal in terms of age, gravidity, prior uterine surgeries, uterine alterations, type and time of pregnancy termination and ultrasonographic characteristics. There was a higher rate of spontaneous expulsion after 4 weeks from the office hysteroscopy compared with those where the surgical removal was performed up to 4 weeks after the diagnosis (p-value 0.011).
Appendicectomy is associated with increased pregnancy rateFerstman Duran
1) This study examined whether appendicectomy or appendicitis is associated with reduced subsequent fertility using a large validated database.
2) The study included nearly 30,000 women who underwent appendicectomy and compared their pregnancy rates to matched controls.
3) The results showed that women who had appendicectomy had higher rates of pregnancy than matched controls, with an adjusted hazard ratio of 1.20. Appendicectomy was associated with increased subsequent fertility.
Hysteroscopic endometrial resection in the management of abnormal uterine ble...Dr. Aisha M Elbareg
This document summarizes a study that investigated the efficacy of hysteroscopic endometrial resection (HER) in treating abnormal uterine bleeding (AUB) among Libyan women. The study found that HER was an effective treatment, achieving a 92.8% success rate in reducing symptoms after 2 years of follow up among the 70 women who completed the study. Younger age (<40 years), thicker endometrium (>7mm), larger uterine size, and the presence of fibroids were found to be factors associated with treatment failure. The study concludes that HER is an effective procedure for AUB, especially in women over age 40 without an enlarged uterus or fibroids.
This document analyzes histomorphologic changes in placentas from pregnancies complicated by hypertension. Placentas from 50 normal pregnancies and 50 pregnancies with hypertension were examined. Microscopic analysis found significantly increased villous abnormalities in placentas from pregnancies with hypertension, including higher rates of syncytial knots, decreased vasculo-syncytial membranes, more fibrinoid necrosis, thicker basement membranes, and more villous stromal fibrosis. These findings suggest reduced blood flow in the placenta among pregnancies with hypertension, which can impact fetal and maternal health.
This research article studied the impact of performing routine hysteroscopy (examination of the uterus) prior to intrauterine insemination (IUI) on pregnancy rates. 180 infertile women undergoing IUI were divided into two groups: one group received hysteroscopy before IUI to check for any uterine abnormalities, while the other group did not receive hysteroscopy. Hysteroscopy found uterine abnormalities in 41% of women. Pregnancy rates were significantly higher in the group that received hysteroscopy before IUI (46.25%) compared to the group without hysteroscopy (25%). The study concluded that performing hysteroscopy before IUI improves chances of conception by allowing detection and
This randomized controlled trial studied three surgical techniques used in caesarean sections to determine their effects on maternal infectious morbidity: 1) Single vs double layer closure of the uterine incision, 2) Closure vs non-closure of the pelvic peritoneum, and 3) Liberal vs restricted use of a subrectus sheath drain. The trial recruited 3033 women undergoing their first caesarean section. It found no significant differences in maternal infectious morbidity between any of the surgical technique pairs studied. The results have implications for changing current guidance on peritoneum closure.
This document summarizes a study comparing the efficacy, safety and acceptability of medical abortion in women with previously scarred uteruses and non-scarred uteruses. The study included 75 women with previous cesarean sections and 75 women without cesarean sections who were given mifepristone followed by misoprostol. The success rate for complete abortion was 88% for those with scarred uteruses and 89.3% for those without, showing no significant difference. Adverse effects and incomplete abortions were also similar between the groups. The study concluded that medical abortion is an effective, safe and acceptable option for early termination of pregnancy in women with previous uterine scarring.
The document provides definitions and background information related to fertility, infertility, and subfertility. It discusses statistics on natural conception rates and causes of infertility. Common risk factors for infertility are outlined for both males and females. Evaluation of an infertile couple involves obtaining a detailed medical history and conducting physical exams. Standard investigations and tests are described, including semen analysis, ovulation documentation, hormonal assays, and imaging like hysterosalpingography. Complications associated with these diagnostic tests and treatments for infertility are summarized.
This study retrospectively analyzed 65 cases of unusual ectopic pregnancies out of 1000 total ectopic pregnancy cases over a 10-year period. The study found that ovarian pregnancies were associated with intrauterine device placement and pelvic inflammatory diseases. Extratubal ectopic pregnancies like those in the ovaries, cervix, and abdomen presented more serious symptoms and had higher misdiagnosis rates than tubal pregnancies. Most unusual ectopic pregnancies required surgery for treatment, though some early cervical and corneal pregnancies were treated with conservative methods like mifepristone and methotrexate or curettage.
Appendicectomy is associated with increased pregnancy rateFerstman Duran
1) This study examined whether appendicectomy or appendicitis is associated with reduced subsequent fertility using a large validated database.
2) The study included nearly 30,000 women who underwent appendicectomy and compared their pregnancy rates to matched controls.
3) The results showed that women who had appendicectomy had higher rates of pregnancy than matched controls, with an adjusted hazard ratio of 1.20. Appendicectomy was associated with increased subsequent fertility.
Hysteroscopic endometrial resection in the management of abnormal uterine ble...Dr. Aisha M Elbareg
This document summarizes a study that investigated the efficacy of hysteroscopic endometrial resection (HER) in treating abnormal uterine bleeding (AUB) among Libyan women. The study found that HER was an effective treatment, achieving a 92.8% success rate in reducing symptoms after 2 years of follow up among the 70 women who completed the study. Younger age (<40 years), thicker endometrium (>7mm), larger uterine size, and the presence of fibroids were found to be factors associated with treatment failure. The study concludes that HER is an effective procedure for AUB, especially in women over age 40 without an enlarged uterus or fibroids.
This document analyzes histomorphologic changes in placentas from pregnancies complicated by hypertension. Placentas from 50 normal pregnancies and 50 pregnancies with hypertension were examined. Microscopic analysis found significantly increased villous abnormalities in placentas from pregnancies with hypertension, including higher rates of syncytial knots, decreased vasculo-syncytial membranes, more fibrinoid necrosis, thicker basement membranes, and more villous stromal fibrosis. These findings suggest reduced blood flow in the placenta among pregnancies with hypertension, which can impact fetal and maternal health.
This research article studied the impact of performing routine hysteroscopy (examination of the uterus) prior to intrauterine insemination (IUI) on pregnancy rates. 180 infertile women undergoing IUI were divided into two groups: one group received hysteroscopy before IUI to check for any uterine abnormalities, while the other group did not receive hysteroscopy. Hysteroscopy found uterine abnormalities in 41% of women. Pregnancy rates were significantly higher in the group that received hysteroscopy before IUI (46.25%) compared to the group without hysteroscopy (25%). The study concluded that performing hysteroscopy before IUI improves chances of conception by allowing detection and
This randomized controlled trial studied three surgical techniques used in caesarean sections to determine their effects on maternal infectious morbidity: 1) Single vs double layer closure of the uterine incision, 2) Closure vs non-closure of the pelvic peritoneum, and 3) Liberal vs restricted use of a subrectus sheath drain. The trial recruited 3033 women undergoing their first caesarean section. It found no significant differences in maternal infectious morbidity between any of the surgical technique pairs studied. The results have implications for changing current guidance on peritoneum closure.
This document summarizes a study comparing the efficacy, safety and acceptability of medical abortion in women with previously scarred uteruses and non-scarred uteruses. The study included 75 women with previous cesarean sections and 75 women without cesarean sections who were given mifepristone followed by misoprostol. The success rate for complete abortion was 88% for those with scarred uteruses and 89.3% for those without, showing no significant difference. Adverse effects and incomplete abortions were also similar between the groups. The study concluded that medical abortion is an effective, safe and acceptable option for early termination of pregnancy in women with previous uterine scarring.
The document provides definitions and background information related to fertility, infertility, and subfertility. It discusses statistics on natural conception rates and causes of infertility. Common risk factors for infertility are outlined for both males and females. Evaluation of an infertile couple involves obtaining a detailed medical history and conducting physical exams. Standard investigations and tests are described, including semen analysis, ovulation documentation, hormonal assays, and imaging like hysterosalpingography. Complications associated with these diagnostic tests and treatments for infertility are summarized.
This study retrospectively analyzed 65 cases of unusual ectopic pregnancies out of 1000 total ectopic pregnancy cases over a 10-year period. The study found that ovarian pregnancies were associated with intrauterine device placement and pelvic inflammatory diseases. Extratubal ectopic pregnancies like those in the ovaries, cervix, and abdomen presented more serious symptoms and had higher misdiagnosis rates than tubal pregnancies. Most unusual ectopic pregnancies required surgery for treatment, though some early cervical and corneal pregnancies were treated with conservative methods like mifepristone and methotrexate or curettage.
Abstract—3D ultrasound (3-dimensional sonography) when combined with sonosalpingography, it provides detailed information regarding internal and external contours of the uterus, without the need for radiation contrast material or surgical intervention. This study was done because of the need of such diagnostic modality that is highly accurate as well as least invasive. A descriptive study was conducted on 50 infertile females to assess the diagnostic value of 3-dimensional SHG in reference of diagnostic hystero-laproscopy (DHL) assuming as gold standard. It was found that sensitivity of 3-dimensional SHG reasons of tubal patency, ovarian pathology and uterine cavity was found 97.6%, 90.91% and 71.43% respectively. And diagnostic accuracy of 3-dimensional SHG in reference of DHL for tubal patency, ovarian pathology and for uterine cavity was found 96%, 92% and 96% respectively. So it can be concluded from present study that 3-Dimensional sonohysterography is an efficient tool to assess women with infertility. Its sensitivity, specificity, and diagnostic accuracy is comparable to hysterolaproscopy.
This document summarizes uterine transplantation (UTx), a potential treatment for women with absolute uterine factor infertility who cannot carry a pregnancy due to the absence or dysfunction of a uterus. UTx involves transplanting a donated uterus into the recipient, which allows for pregnancy and childbirth experiences. Over 70 UTx procedures have been performed worldwide resulting in over 23 live births. While UTx offers an alternative to adoption and surrogacy, it involves significant risks like multiple surgeries and lifelong immunosuppression to prevent transplant rejection. Long-term studies are still needed to fully understand the risks and benefits of UTx.
A Case of Abdominal Pregnancy, Primary vs Secondary – Radiological Workupiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
In this manuscript we show the successful laparoscopical treatment of a ruptured cornual ectopic pregnancy. In many settings this condition is treated by open approach due to the advanced skills required to control bleeding. This is a case report with the aim of showing images of the procedure, how to easily prevent bleeding and the management of it.
The document discusses the use of hysteroscopy in evaluating and treating infertility. It provides evidence-based guidelines on when hysteroscopy is recommended and not recommended in infertility workup. It also reviews evidence on techniques for diagnostic and operative hysteroscopy, including indications, preparation, distension media, findings, and treatment of various intrauterine issues like polyps, fibroids, adhesions that may cause infertility. Complications are also discussed.
The Diagnostic Value of Saline Infusion Sonohysterography Versus Hysteroscopy...Ahmed Mowafy
This study evaluated the diagnostic value of saline infusion sonohysterography (SIS) compared to hysteroscopy for detecting uterine abnormalities in 161 women with infertility or recurrent pregnancy loss. SIS had slightly lower sensitivity and specificity than hysteroscopy, particularly for detecting intrauterine adhesions and congenital anomalies. However, SIS has advantages of being non-invasive, cheaper, faster, and more comfortable for patients compared to hysteroscopy. While hysteroscopy remains the gold standard, SIS is an effective initial screening tool for evaluating the uterine cavity.
The Diagnostic value of saline infusion sonohysterography and hysteroscopy in...Ahmed Mowafy
Hysteroscopy is more sensitive and has a higher negative predictive value than saline infusion sonohysterography (SIS) in detecting intracavitary abnormalities, according to a study comparing the two techniques. The study of 80 women found hysteroscopy had a sensitivity of 96.3% versus 89.3% for SIS. Hysteroscopy also had a higher negative predictive value of 92.3% compared to 76.9% for SIS. However, SIS has advantages of being non-invasive, cheaper, faster, and less discomfortable for patients. Both techniques had few complications, with bleeding being most common for SIS. The study concludes hysteroscopy is superior for diagnosis but S
The document discusses plans to establish a uro-gynecology and pelvic floor disorders center at Al Zahra Hospital in Dubai. It outlines that currently there are no dedicated uro-gynecology centers or subspecialist consultants in the UAE. The proposed center would be led by a dual-accredited uro-gynecology consultant and would provide specialized clinics and treatments for a wide range of conditions using evidence-based care pathways. It would establish the gold standard for care of conditions like incontinence and prolapse across the UAE. The center aims to set up robust governance, education, and data collection to help more women.
IVF is stressful and expensive and there is a continued need to improve outcome using all information technology available to improve outcomes , meet expectations and review management.
This document summarizes guidelines on the optimal use of infertility diagnostic tests and treatments from 2000. It discusses the role of laparoscopy in fertility investigation and treatment. Key points include:
- Laparoscopy is the gold standard for diagnosing tubal pathology, endometriosis, adhesions and other intra-abdominal causes of infertility.
- Diagnostic laparoscopy alters treatment decisions in 25% of patients who would have otherwise been treated with IUI based on an HSG or semen analysis alone.
- For mild-moderate endometriosis, laparoscopic surgery may improve pregnancy rates compared to diagnostic laparoscopy only, though further randomized trials are needed.
- For
This document provides information about Prof. Narendra Malhotra, including his professional qualifications and positions held. It lists that he is a practicing obstetrician gynecologist in Agra with special interests in high risk obstetrics, ultrasound, laparoscopy, infertility and genetics. It also provides information about Malhotra Nursing & Maternity Home Pvt. Ltd. and Global Rainbow Health Care in Agra.
This document discusses fetal endoscopic surgery, including the indications and anesthetic management. It describes several fetal conditions that may benefit from fetoscopic intervention, including twin-twin transfusion syndrome (TTTS), twin reversed arterial perfusion sequence (TRAP), and bladder outlet obstruction from conditions like posterior urethral valves. For TTTS and TRAP sequence, fetoscopic techniques like selective fetoscopic laser photocoagulation of placental vessels and umbilical cord ligation are discussed as alternatives to open fetal surgery or other treatments. The document also reviews maternal and fetal considerations for anesthesia during these procedures.
This document provides an outline of the contents of a course book for a gynecology course. It includes:
1. An introduction with the course coordinator and list of teachers.
2. An outline of the course contents including 33 topics that will be covered over the lectures, readings, and clinical sessions.
3. A syllabus with details on 7 sample topics that will be covered, including learning objectives and references.
The document provides a comprehensive overview of the structure and key elements of the gynecology course.
Endometriosis is known to have a remarkably negative effect on the Quality of Life of the women. Surgery is considered when medical therapy is unsuccessful or in the setting of infertility. A high recurrence rate is reported in advanced stages of endometriosis. Thus, Complete excision and prevention of recurrence is particularly important.
— This study was conducted to find out if AFI ≤ 5 cms has any clinical significance in identifying the subsequent fetal distress & associated maternal & perinatal outcomes, in pregnancies beyond 37 weeks. Methodology: This is a prospective case control study done from July 2010 to July 2012 (24 months) at Dr Vasantrao Pawar Medical College, Hospital and Research Center. Adgaon, Nashik. It study the pregnancy outcome comparison of 58 Anenatal Cases(ANCs)as Study Group with diangosis of oligohydramnios (AFI ≤ 5 cms) by ultrasound after 37 completed weeks of gestation w e r e compared with 58 ANCs (Control Group) with no oligohydramnios (AFI > 5 cms). These two groups were matched for other variables like age, parity, gestational age and any pregnancy complication. Results: There was significant difference between two groups. Hypertension and Preeclampsia were found significantly more in ANCs with oligohydramnios. FHR deceleration was also significantly higher in women with oligohydramnios. Women require LSCS were also significantly more in women with oligohydramnios. Newborn borned by women with oligohydramnios had significantly more chances to admit in NICU than in newborn born by women without oligohydramnios. Conclusion: It can be concluded from this study that women with oligohydramnios poor pregancy outcomes. Determination of AFI can be used as an adjunct to other fetal surveillance methods. Determination of AFI can be used as valuable screening test for predicting fetal distress in labour, requiring caesarean section.
Dr. Brahmana Askandar is the head of the Oncology Division at the Department of Obstetrics and Gynecology at Unair Medical School Hospital in Surabaya. He received his medical degree from Unair Medical School and completed fellowships in gynecologic surgery, endoscopy, and gynecologic oncology in Hungary, India, and the Netherlands. He currently serves as the head of the Oncology Division and chair of the Surabaya branch of the Indonesian Society of Obstetrics and Gynecology.
Diagnosis and classification of tubal factor infertilitySanjay Makwana
This document discusses tubal factor infertility (TFI), including causes such as damage from injury or pelvic inflammatory disease. It evaluates various diagnostic tests for TFI like hysterosalpingography (HSG), laparoscopy, and chlamydial antibody testing. Treatment options discussed include expectant management, antibiotics, tubal surgery like cannulation or anastomosis, and IVF. The evidence for different approaches is limited, with no randomized controlled trials directly comparing treatments. The conclusion is that IVF is generally the best treatment for older patients or more severe TFI, while surgery may be considered for milder cases or proximal tubal obstruction.
This document discusses the role of tubal patency tests and tubal surgery in the era of assisted reproductive techniques. It reviews evidence on various tubal patency tests like laparoscopy, hysterosalpingogram, hysterosalpingo contrast sonography, and their advantages and limitations. While laparoscopy is considered the gold standard, it requires general anesthesia and carries surgical risks. Hysterosalpingogram is widely available but less accurate and exposes patients to radiation. Hysterosalpingo contrast sonography provides images without radiation but may be limited in some patients. The document concludes that in vitro fertilization has largely replaced tubal surgery as it offers better success rates and can be done on an out
1. Tubal anastomosis or IVF-ET must be considered based on factors like age, tubal damage extent, cost, and patient preference.
2. IVF-ET has a higher per-cycle success rate while tubal anastomosis has a higher cumulative success rate and may be more cost-effective.
3. Both have risks and neither is clearly superior, so options should be discussed individually to help couples feel they explored all options.
Tubal factor and fertility by Dr.GayathiriMorris Jawahar
This document discusses tubal factor infertility, which is caused by diseases, obstructions, damage or other factors that impede the passage of eggs through the fallopian tubes. Common causes include pelvic inflammatory disease, endometriosis, ectopic pregnancy and previous tubal surgery or ligation. Diagnostic tests include hysterosalpingogram, sonohysterography and laparoscopy. Treatment depends on the location and severity of the blockage, and may include tubal surgery such as recanalization or salpingostomy, or IVF for more severe cases or sterilization reversals. Management of hydrosalpinges often involves drainage, salpingectomy or proximal tubal occlusion prior to IVF
This document summarizes spontaneous and recurrent abortion, including etiology, diagnosis, and treatment. It discusses risk factors like maternal age and chromosomal abnormalities. Diagnosis involves history, exam, ultrasound, and hCG levels. Treatment depends on severity but may include manual vacuum aspiration, medications, or expectant management. It also covers ectopic pregnancy, noting risk factors and clinical signs like abdominal pain and bleeding. Diagnosis involves ultrasound and hCG levels. Treatment is typically surgical or medical with methotrexate depending on stability and hCG levels.
Transfusion and Postoperative Outcome in Pediatric Abdominal Surgeryasclepiuspdfs
Background: Intraoperative and post-operative morbimortality factors are multiple in pediatric patients. Studies in pediatric cardiac surgery and intensive care patients have identified transfusion as one independent factor among others. This study was undertaken to investigate whether transfusion was an independent factor of morbimortality in pediatric abdominal surgical patients. Objectives: The objective of the study is to identify morbimortality risk factors in intraoperatively transfused and not transfused pediatric abdominal surgical patients. Design: This was a retrospective observational descriptive pediatric cohort study. Setting: Monocentric pediatric tertiary center, Necker–Enfants Malades University Hospital, Paris, from January 1, 2014, to May 17, 2017. Patients: 193 patients with a median age of 27.5 months (1.0–100.5) were included in the study. Inclusion criteria were the presence or the absence of transfusion in the intraoperative period in abdominal surgery patients. Exclusion criterion was transfusion in the post-operative period until discharge from hospital and non-abdominal surgical patients.
Abstract—3D ultrasound (3-dimensional sonography) when combined with sonosalpingography, it provides detailed information regarding internal and external contours of the uterus, without the need for radiation contrast material or surgical intervention. This study was done because of the need of such diagnostic modality that is highly accurate as well as least invasive. A descriptive study was conducted on 50 infertile females to assess the diagnostic value of 3-dimensional SHG in reference of diagnostic hystero-laproscopy (DHL) assuming as gold standard. It was found that sensitivity of 3-dimensional SHG reasons of tubal patency, ovarian pathology and uterine cavity was found 97.6%, 90.91% and 71.43% respectively. And diagnostic accuracy of 3-dimensional SHG in reference of DHL for tubal patency, ovarian pathology and for uterine cavity was found 96%, 92% and 96% respectively. So it can be concluded from present study that 3-Dimensional sonohysterography is an efficient tool to assess women with infertility. Its sensitivity, specificity, and diagnostic accuracy is comparable to hysterolaproscopy.
This document summarizes uterine transplantation (UTx), a potential treatment for women with absolute uterine factor infertility who cannot carry a pregnancy due to the absence or dysfunction of a uterus. UTx involves transplanting a donated uterus into the recipient, which allows for pregnancy and childbirth experiences. Over 70 UTx procedures have been performed worldwide resulting in over 23 live births. While UTx offers an alternative to adoption and surrogacy, it involves significant risks like multiple surgeries and lifelong immunosuppression to prevent transplant rejection. Long-term studies are still needed to fully understand the risks and benefits of UTx.
A Case of Abdominal Pregnancy, Primary vs Secondary – Radiological Workupiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
In this manuscript we show the successful laparoscopical treatment of a ruptured cornual ectopic pregnancy. In many settings this condition is treated by open approach due to the advanced skills required to control bleeding. This is a case report with the aim of showing images of the procedure, how to easily prevent bleeding and the management of it.
The document discusses the use of hysteroscopy in evaluating and treating infertility. It provides evidence-based guidelines on when hysteroscopy is recommended and not recommended in infertility workup. It also reviews evidence on techniques for diagnostic and operative hysteroscopy, including indications, preparation, distension media, findings, and treatment of various intrauterine issues like polyps, fibroids, adhesions that may cause infertility. Complications are also discussed.
The Diagnostic Value of Saline Infusion Sonohysterography Versus Hysteroscopy...Ahmed Mowafy
This study evaluated the diagnostic value of saline infusion sonohysterography (SIS) compared to hysteroscopy for detecting uterine abnormalities in 161 women with infertility or recurrent pregnancy loss. SIS had slightly lower sensitivity and specificity than hysteroscopy, particularly for detecting intrauterine adhesions and congenital anomalies. However, SIS has advantages of being non-invasive, cheaper, faster, and more comfortable for patients compared to hysteroscopy. While hysteroscopy remains the gold standard, SIS is an effective initial screening tool for evaluating the uterine cavity.
The Diagnostic value of saline infusion sonohysterography and hysteroscopy in...Ahmed Mowafy
Hysteroscopy is more sensitive and has a higher negative predictive value than saline infusion sonohysterography (SIS) in detecting intracavitary abnormalities, according to a study comparing the two techniques. The study of 80 women found hysteroscopy had a sensitivity of 96.3% versus 89.3% for SIS. Hysteroscopy also had a higher negative predictive value of 92.3% compared to 76.9% for SIS. However, SIS has advantages of being non-invasive, cheaper, faster, and less discomfortable for patients. Both techniques had few complications, with bleeding being most common for SIS. The study concludes hysteroscopy is superior for diagnosis but S
The document discusses plans to establish a uro-gynecology and pelvic floor disorders center at Al Zahra Hospital in Dubai. It outlines that currently there are no dedicated uro-gynecology centers or subspecialist consultants in the UAE. The proposed center would be led by a dual-accredited uro-gynecology consultant and would provide specialized clinics and treatments for a wide range of conditions using evidence-based care pathways. It would establish the gold standard for care of conditions like incontinence and prolapse across the UAE. The center aims to set up robust governance, education, and data collection to help more women.
IVF is stressful and expensive and there is a continued need to improve outcome using all information technology available to improve outcomes , meet expectations and review management.
This document summarizes guidelines on the optimal use of infertility diagnostic tests and treatments from 2000. It discusses the role of laparoscopy in fertility investigation and treatment. Key points include:
- Laparoscopy is the gold standard for diagnosing tubal pathology, endometriosis, adhesions and other intra-abdominal causes of infertility.
- Diagnostic laparoscopy alters treatment decisions in 25% of patients who would have otherwise been treated with IUI based on an HSG or semen analysis alone.
- For mild-moderate endometriosis, laparoscopic surgery may improve pregnancy rates compared to diagnostic laparoscopy only, though further randomized trials are needed.
- For
This document provides information about Prof. Narendra Malhotra, including his professional qualifications and positions held. It lists that he is a practicing obstetrician gynecologist in Agra with special interests in high risk obstetrics, ultrasound, laparoscopy, infertility and genetics. It also provides information about Malhotra Nursing & Maternity Home Pvt. Ltd. and Global Rainbow Health Care in Agra.
This document discusses fetal endoscopic surgery, including the indications and anesthetic management. It describes several fetal conditions that may benefit from fetoscopic intervention, including twin-twin transfusion syndrome (TTTS), twin reversed arterial perfusion sequence (TRAP), and bladder outlet obstruction from conditions like posterior urethral valves. For TTTS and TRAP sequence, fetoscopic techniques like selective fetoscopic laser photocoagulation of placental vessels and umbilical cord ligation are discussed as alternatives to open fetal surgery or other treatments. The document also reviews maternal and fetal considerations for anesthesia during these procedures.
This document provides an outline of the contents of a course book for a gynecology course. It includes:
1. An introduction with the course coordinator and list of teachers.
2. An outline of the course contents including 33 topics that will be covered over the lectures, readings, and clinical sessions.
3. A syllabus with details on 7 sample topics that will be covered, including learning objectives and references.
The document provides a comprehensive overview of the structure and key elements of the gynecology course.
Endometriosis is known to have a remarkably negative effect on the Quality of Life of the women. Surgery is considered when medical therapy is unsuccessful or in the setting of infertility. A high recurrence rate is reported in advanced stages of endometriosis. Thus, Complete excision and prevention of recurrence is particularly important.
— This study was conducted to find out if AFI ≤ 5 cms has any clinical significance in identifying the subsequent fetal distress & associated maternal & perinatal outcomes, in pregnancies beyond 37 weeks. Methodology: This is a prospective case control study done from July 2010 to July 2012 (24 months) at Dr Vasantrao Pawar Medical College, Hospital and Research Center. Adgaon, Nashik. It study the pregnancy outcome comparison of 58 Anenatal Cases(ANCs)as Study Group with diangosis of oligohydramnios (AFI ≤ 5 cms) by ultrasound after 37 completed weeks of gestation w e r e compared with 58 ANCs (Control Group) with no oligohydramnios (AFI > 5 cms). These two groups were matched for other variables like age, parity, gestational age and any pregnancy complication. Results: There was significant difference between two groups. Hypertension and Preeclampsia were found significantly more in ANCs with oligohydramnios. FHR deceleration was also significantly higher in women with oligohydramnios. Women require LSCS were also significantly more in women with oligohydramnios. Newborn borned by women with oligohydramnios had significantly more chances to admit in NICU than in newborn born by women without oligohydramnios. Conclusion: It can be concluded from this study that women with oligohydramnios poor pregancy outcomes. Determination of AFI can be used as an adjunct to other fetal surveillance methods. Determination of AFI can be used as valuable screening test for predicting fetal distress in labour, requiring caesarean section.
Dr. Brahmana Askandar is the head of the Oncology Division at the Department of Obstetrics and Gynecology at Unair Medical School Hospital in Surabaya. He received his medical degree from Unair Medical School and completed fellowships in gynecologic surgery, endoscopy, and gynecologic oncology in Hungary, India, and the Netherlands. He currently serves as the head of the Oncology Division and chair of the Surabaya branch of the Indonesian Society of Obstetrics and Gynecology.
Diagnosis and classification of tubal factor infertilitySanjay Makwana
This document discusses tubal factor infertility (TFI), including causes such as damage from injury or pelvic inflammatory disease. It evaluates various diagnostic tests for TFI like hysterosalpingography (HSG), laparoscopy, and chlamydial antibody testing. Treatment options discussed include expectant management, antibiotics, tubal surgery like cannulation or anastomosis, and IVF. The evidence for different approaches is limited, with no randomized controlled trials directly comparing treatments. The conclusion is that IVF is generally the best treatment for older patients or more severe TFI, while surgery may be considered for milder cases or proximal tubal obstruction.
This document discusses the role of tubal patency tests and tubal surgery in the era of assisted reproductive techniques. It reviews evidence on various tubal patency tests like laparoscopy, hysterosalpingogram, hysterosalpingo contrast sonography, and their advantages and limitations. While laparoscopy is considered the gold standard, it requires general anesthesia and carries surgical risks. Hysterosalpingogram is widely available but less accurate and exposes patients to radiation. Hysterosalpingo contrast sonography provides images without radiation but may be limited in some patients. The document concludes that in vitro fertilization has largely replaced tubal surgery as it offers better success rates and can be done on an out
1. Tubal anastomosis or IVF-ET must be considered based on factors like age, tubal damage extent, cost, and patient preference.
2. IVF-ET has a higher per-cycle success rate while tubal anastomosis has a higher cumulative success rate and may be more cost-effective.
3. Both have risks and neither is clearly superior, so options should be discussed individually to help couples feel they explored all options.
Tubal factor and fertility by Dr.GayathiriMorris Jawahar
This document discusses tubal factor infertility, which is caused by diseases, obstructions, damage or other factors that impede the passage of eggs through the fallopian tubes. Common causes include pelvic inflammatory disease, endometriosis, ectopic pregnancy and previous tubal surgery or ligation. Diagnostic tests include hysterosalpingogram, sonohysterography and laparoscopy. Treatment depends on the location and severity of the blockage, and may include tubal surgery such as recanalization or salpingostomy, or IVF for more severe cases or sterilization reversals. Management of hydrosalpinges often involves drainage, salpingectomy or proximal tubal occlusion prior to IVF
This document summarizes spontaneous and recurrent abortion, including etiology, diagnosis, and treatment. It discusses risk factors like maternal age and chromosomal abnormalities. Diagnosis involves history, exam, ultrasound, and hCG levels. Treatment depends on severity but may include manual vacuum aspiration, medications, or expectant management. It also covers ectopic pregnancy, noting risk factors and clinical signs like abdominal pain and bleeding. Diagnosis involves ultrasound and hCG levels. Treatment is typically surgical or medical with methotrexate depending on stability and hCG levels.
Transfusion and Postoperative Outcome in Pediatric Abdominal Surgeryasclepiuspdfs
Background: Intraoperative and post-operative morbimortality factors are multiple in pediatric patients. Studies in pediatric cardiac surgery and intensive care patients have identified transfusion as one independent factor among others. This study was undertaken to investigate whether transfusion was an independent factor of morbimortality in pediatric abdominal surgical patients. Objectives: The objective of the study is to identify morbimortality risk factors in intraoperatively transfused and not transfused pediatric abdominal surgical patients. Design: This was a retrospective observational descriptive pediatric cohort study. Setting: Monocentric pediatric tertiary center, Necker–Enfants Malades University Hospital, Paris, from January 1, 2014, to May 17, 2017. Patients: 193 patients with a median age of 27.5 months (1.0–100.5) were included in the study. Inclusion criteria were the presence or the absence of transfusion in the intraoperative period in abdominal surgery patients. Exclusion criterion was transfusion in the post-operative period until discharge from hospital and non-abdominal surgical patients.
This document summarizes a study that evaluated the effectiveness of hysteroscopic transcervical resection of uterine septum (HTCRS) in improving reproductive outcomes for women with infertility or recurrent miscarriages. The study included 210 women in Libya who underwent HTCRS. Results found that after the procedure, 57.3% of patients who were trying to get pregnant achieved pregnancy within one year. Miscarriage rates and preterm birth rates were reduced compared to before the procedure. The procedure was concluded to be safe and effective in managing infertility and recurrent miscarriage by increasing pregnancy rates and live birth rates while decreasing miscarriage risks.
An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in the fallopian tubes. Damage to the fallopian tubes from infections or other causes is a major risk factor. Clinical presentation includes abdominal pain, delayed or abnormal vaginal bleeding. Diagnosis involves testing hCG levels in blood and ultrasound imaging. Treatment options are medical, using methotrexate, or surgical, typically laparoscopic surgery. Methotrexate can be used for stable patients with unruptured ectopic pregnancies.
Ultrasonographic Cervical Length Measurement at 10-14- and 20-24-weeks’ Gesta...AI Publications
Preterm labor is a regular occurrence in pregnancy; an estimated 15 million babies are born prematurely each year, with the number increasing. This was a prospective study of pregnant women who came to the Maternity Teaching Hospital in Erbil, Kurdistan Province, Iraq, for an outpatient clinic. On a manageable sample of 150 singleton pregnancies. In this study, one hundred fifty singleton asymptomatic pregnancies encountered the inclusion criteria during the study period, 69 primi gravid, 81 multi gravid. The correlation between the cervical length at 20–24 weeks and preterm delivery was moderately poor (r =0.715), and this correlation was highly significant (P < 0.001). In another word, a better correlation was found between preterm delivery and cervical length at 20–24 weeks than at 10–14 weeks in the prediction of preterm delivery. This study also points towards the importance of serial ultrasound scans to detect those who are at higher risk. There was no statistically significant effect of age, parity. Finally, the findings revealed that trans vaginal ultrasound is more accurate at 20-24weeks than 10-14weeks gestation for prediction of preterm labor, it can be used routinely to prevent preterm birth.
This study compared the effects of epidural analgesia and patient-controlled analgesia on patients undergoing laparoscopic right colectomy or low anterior resection. The study found that:
1) Epidural analgesia was associated with faster return of bowel function by 1 day in patients undergoing low anterior resection, but not in patients undergoing right colectomy.
2) Epidural analgesia provided significantly better pain control compared to patient-controlled analgesia for both right colectomy and low anterior resection patients.
3) However, epidural analgesia alone was inadequate for pain control in 28% of patients, who required the addition of patient-controlled analgesia.
Use of laparoscopy in the management of abdominal trauma a center experiencewael mansy
This study evaluated the use of laparoscopy in managing 65 patients with abdominal trauma at Zagazig University from 2011-2014. For patients who were hemodynamically stable, laparoscopy was considered for diagnosis and treatment. The results showed that laparoscopy avoided laparotomy in 81.5% of cases. Therapeutic laparoscopy was effective in repairing injuries like stomach penetrations, liver lacerations, diaphragmatic injuries, and splenic lacerations. The study demonstrates that laparoscopy can be performed safely and effectively in stable patients with abdominal trauma to reduce unnecessary laparotomies.
This document discusses sonographic criteria for uterine curettage when endometrial neoplasia is suspected. Eight premenopausal and perimenopausal women underwent transvaginal ultrasounds and uterine curettage due to abnormal bleeding or discharge. Histopathology found hyperplasia in polycystic ovary syndrome patients and cancer in a patient on tamoxifen therapy. Key ultrasound findings associated with hyperplasia or cancer included thick irregular endometrium, ill-defined endometrial-myometrial junction, intrauterine fluid collections, adnexal masses, and cystic endometrial areas. The document concludes that endometrial stripe abnormalities on ultrasound, in addition to thickness, are important
Uterine prolapse (also called descensus or procidentia) means the uterus has descended from its normal position in the pelvis farther down into the vagina.Cervicopexy is fertility conserving surgical management of prolapse.
Obstetrical Ultrasound Examination and Biochemical Markers as Contemporary To...Rustem Celami
- Obstetrical ultrasound examination and biochemical markers are contemporary tools used in Albania to assess fetal anomalies.
- Nuchal translucency measurements over 3mm and abnormal biochemical markers indicate an increased risk of structural fetal abnormalities.
- Abnormalities like increased nuchal translucency and cystic hygroma can be detected during first trimester ultrasound screening.
Robot-assisted versus open radical hysterectomy: A multi-institutional experi...flasco_org
This study compared outcomes of 491 early-stage cervical cancer patients who underwent either robot-assisted radical hysterectomy (RRH, n=259) or open radical hysterectomy (ORH, n=232) across three institutions. The study found that patients who received RRH had significantly less estimated blood loss, shorter hospital stays, and fewer intra-operative complications compared to ORH patients. Disease recurrence and survival rates were similar between the two groups. Overall, RRH resulted in improved clinical outcomes for early-stage cervical cancer patients compared to ORH.
Heterotopic pregnancy is defined by the presence of an intrauterine pregnancy and an ectopic pregnancy in any location, mostly in
the uterine tubes. It is a rare obstetric pathology. However, in recent years its incidence has increased due to assisted reproduction
treatments. His diagnosis remains a challenge. Ultrasound is the
most important tool in its diagnosis and early identification. Laparoscopy remains the definitive method of extrauterine pregnancy.
We present the case of a 39-year-old patient, with a gestation of 6
weeks by date of last menstrual period, with a diagnosis of heterotopic pregnancy, where the extrauterine pregnancy is located in
the uterine tube.
Colour Doppler ultrasound in controlled ovarian stimulation with Intrauterine...Apollo Hospitals
To assess the endometrial receptivity in terms of endometrial thickness and vascularity and to assess the
potential relationship between perifollicular vascularity following ovulation inducing drugs and outcome in intrauterine insemination (IUI) using the Doppler ultrasonography.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A Retrospective Analysis of Complications of Pelvic Exenteration - A Single I...Premier Publishers
To analyse complications in patients who underwent pelvic exenteration procedures performed in our, between January 2013 – December 2018. A retrospective analysis of the baseline characteristics, surgical outcomes, complication rates of 51 patients who had undergone pelvic exenteration procedures between January 2013 and December 2018 was made. The results analysed using chi-square test. Of the 51 patients, 38 were operated for primary malignancy and 13 underwent exenteration for recurrences. Seventeen patients were operated by laparoscopy whereas the rest underwent open procedures. The diagnosis for which exenteration had been done included cancers of cervix (37), urinary bladder (5), rectum (4), urethra (1), vagina (3), and ovary (1). Bleeding was the most common complication encountered. Hypokalaemia, surgical site infections, urine leak and sepsis were seen in early post-operative period. The morbidity rate (major) was 33.3% and the mortality rate was 5.8% in our centre. The late outcome was inadequately evaluated as most patients lost follow-up. Pelvic exenteration is the only surgical option available for advanced pelvic malignancies and the morbidity pattern differs based on diagnosis, extent of resection and the type of diversion procedure. In a high-volume centre, the morbidity and mortality rates are acceptable compared with international standards.
This patient is a 30-year-old female who presented with vaginal spotting during her first trimester of pregnancy. An ultrasound was ordered which did not show an intrauterine or ectopic pregnancy. The patient's beta-hCG level was measured at 1056. At follow-up two days later, the patient's symptoms had resolved but her beta-hCG had risen to 1465. A repeat ultrasound now showed a right tubal ectopic pregnancy, so the patient underwent a laparoscopic right salpingectomy to remove the ectopic pregnancy from her fallopian tube.
Hysteroscopy in management of AUB in women with intact hymen by Associate Pro...Dr. Aisha M Elbareg
Hysteroscopy is generally considered the gold standard for evaluating the uterine cavity but poses challenges for virgins due to concerns about hymen damage. This study evaluated the role and safety of hysteroscopy in diagnosing and treating abnormal uterine bleeding in 17 unmarried patients with intact hymens. Hysteroscopies were successfully performed on all patients without hymen or cervical injury. Common findings included polyps and thickened endometrium. Symptoms were relieved in most patients with no reported complications. This study demonstrates hysteroscopy can be a reliable, safe, and effective option for managing uterine issues in women with intact hymens while avoiding hymenal trauma.
Focused reproductive endocrinology and infertility (2019) guidelineVõ Tá Sơn
Focused reproductive endocrinology and infertility (2019) image library, guideline,
Hình ảnh học siêu âm trong nội tiết sinh sản và vô sinh,
AIUM 2019,
Bs Võ Tá Sơn,
This document outlines a thesis submitted for an MD degree in oncosurgery. The thesis aims to compare the diagnostic accuracy of Pipelle endometrial sampling to dilatation and curettage (D&C) in patients with abnormal uterine bleeding. It also aims to assess if hysteroscopy guidance improves biopsy sampling. The study will involve 200 patients divided into two groups - one undergoing hysteroscopy before biopsy and the other direct biopsy. Both groups will undergo Pipelle sampling and D&C, with samples sent for histopathology analysis. The results will compare diagnostic sensitivity and sample adequacy between groups.
Similar to International Journal of Reproductive Medicine & Gynecology (20)
A 5-year old boy, with an established diagnosis of a topic
dermatitis, previously treated by topical corticosteroids and emollient cream with a good improvement, developed widespread papules on his legs, hands and forearm that appeared 5 months ago.
Methods: Retrospectively, the file records of the patients who underwent sleeve gastrectomy were examined. Demographic features, Body Mass Index (BMI), the mouth opening, Mallampati score, thyromental distance, sternomental distance, neck circumference measurements and videolaryngoscopic examination results were recorded Results: In a total of 140 consecutive patients (58 male, 82 female) were included in the study. The mean age of the study participants was 35.40 ± 9.78 and the mean BMI of the patients was 44.33 ± 7.52 kg/m2
. The mean mouth opening of the patients was 4.82 ± 0.54 cm
and the mean neck circumference was 43.52 ± 4.66 cm. The mean thyromental distance was 8.02 ± 1.00 cm and the mean sternomental distance was16.58 ± 1.53 cm. Difficult intubation was determined in 8 (5.7%) patients. In logistic regression analysis, age (p : 0.446), gender (p : 0.371), BMI (p : 0.947), snoring (p : 0.567), sleep apnea (p : 0.218), mouth opening (p : 0.687), thyromental distance (p :0.557), sternomental (p : 0.596) and neck circumference (p : 0.838) were not the independent predictors of difficult intubation. However, Mallampati score (p : 0.001) and preoperative direct laryngoscopy findings (p : 0.037) performed in outpatient clinic were the significant
predictors of difficult intubation. Interestingly, all patients with grade 4 laryngoscopy findings had difficult intubation.
Introduction: Laparoscopic surgery has been performed in Mexico since 1989, but no reports about training tendencies exist. We conducted a national survey in 2015, and here we report the results concerning training characteristics during the surgical residence of the respondents. Materials and Methods: A prospective study was conducted through a survey questioning demographic data, laparoscopic training during pre and post surgical residency and other of areas of laparoscopic practice. The sample was calculated and survey piloted before
application. Special interest in this report was placed on type and quality of training received. Data are reported in percentages.
Heterotopic Ossification (HO) is defined as pathological bone formation at locations where bone normally does not exist. The
presence of HO has been found to be a rare complication after stroke in several studies, whereas there are only sporadic references relating HO to Cerebral Palsy (CP) and few for CP and stroke. No effective treatment for HO has yet been found, whereas the cellular and molecular mechanisms have not been completely understood. Therefore, increased awareness among physicians is required, as a challenge for early diagnosis and treatment. A case of a male patient with CP, who developed HO on the paretichip joint following an ischemic stroke is presented.
Objectives: To assess the practice of food hygiene and safety, and its associated factors among street food vendors in urban areas of Shashemane, West Arsi Zone, Oromia Ethiopia, 2019.
Methods: Cross-sectional study design was applied from December 28, 2019 to January 27, 2020. Data was collected from 120 food handlers, which were selected by purposive sampling techniques. Information was gathered from interview and field observation by conducting food safety survey and using questionnaires via face to face interview. The collected data was entered using Epi Data 3.1 and finally, it was analyzed using SPSS VERSION 20.
A Division I football player experienced acute posterior leg pain while playing. An ultrasound examination revealed an unusual injury - a complete rupture of the plantaris tendon mid-substance. This type of isolated plantaris tendon injury has rarely been reported. Ultrasound was useful for diagnosis and guided rehabilitation by monitoring healing over time. The athlete was able to return to full competition within 3 weeks through a progressive rehabilitation program focused on restoring range of motion and strength. This case suggests isolated plantaris tendon injuries may allow for faster return to play than other potential causes of posterior leg pain.
Type 1 Diabetes (T1D), is a severe disease, representing 5-10% of all reported cases of diabetes worldwide. Fulminant Type 1 Diabetes Mellitus (FT1D) is a subtype of type 1 diabetes mellitus that is largely characterized by the abrupt onset of Diabetic Ketoacidosis (DKA) and severe hyperglycemia without insulin defi ciency. Viral infections have been hypothesized to play a major role in the pathogenesis of Fulminant Type 1 Diabetes Mellitus (FT1D) through the complete and rapid destruction of pancreatic beta cells. Coxsackie viral infection has been detected in islets of 50% of the pancreatic tissue recovered from recent-onset Type 1 Diabetes (T1D) patients. In this report we have highlighted a case where the patient developed a Group B Coxsackie virus infection culminating in the development of Fulminant Type 1 Diabetes Mellitus (FT1D).
Methods: Cercariae are released by infected water snails. To determine the occurrence of cercariae-emitting snails in SchleswigHolstein, 155 public bathing places were visited and searched for fresh water snails. Family and genus of the collected snails were determined and the snails were examined for the shedding of cercariae, using a standard method and a newly developed method.
Objective: To generate preliminary information about of enteroviruses and Enterovirus 71 (EV71) in patients with aseptic meningitis in Khartoum State, Sudan.
Method: Cerebrospinal fluid specimens were collected from 89 aseptic meningitis patients from different Khartoum Hospitals
(Mohammed Alamin Hamid Hospital, Soba Teaching Hospital, Omdurman Military Hospital, Alban Gadeed Teaching Hospital and Police Hospital) within February to May 2015. Among these 89 patients, 43 (48%) were males and 46 (52%) were females. The patient’s age ranged between 1 day and 30 years old. The collected specimens were assayed to detect enteroviruses and EV71 RNA using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) technique
Femoral hernias, comprise 2% to 4% of all hernias in the inguinal region, and occur most commonly in women. Th ey present typically with a mass below the level of the inguinal ligament. The sac may contain preperitoneal fat, omentum, small bowel, or other structures and have a high rate of incarceration and strangulation due to the small size of the hernia neck orifice, requiring emergency surgery. We present the case of a 54-year-old female patient with intestinal occlusion due to incarcerated femoral hernia, repaired by laparoscopic approach, that gave the patient the opportunity to attend her daughter’s wedding the same day.
Small Supernumerary Marker Chromosome (sSMC) is a rare genetic condition marked by the presence of an extra chromosome to the 46 human chromosomes. This case report describes a 4 year old child with SSMC on the 46th chromosome. The child presented with delayed speech and language development, seizures and mild developmental delay. Speech and Language evaluation was carried out and management options are discussed.
A catheter is a thin tube made from medical grade materials that serve a broad range of functions, but mainly catheters are medical devices that can be inserted in the body to treat disease or perform surgical procedures. Catheters have been inserted into body cavities, ducts, or vessels to allow for drainage, administration of therapeutic fluids or gases, operational access for surgery. Catheters help perform tasks in various systems such as cardiovascular, urological, gastrointestinal, neurovascular, and ophthalmic systems. A dataset of 12 patients with varying “weights” and “heights” was recorded along with the lengths of their catheter tubes. This data set was found from two revered statistical textbooks on linear regression and the Department of Scientific Computing at Florida State University. This data set was not able to be linked to any particular clinical or experimental research studies, but the data set can be used to help catheter manufacturers and medical professionals better decide on what particular catheter lengths to use for patients knowing only their height & weight. These research insights could be helpful to healthcare professionals that have patients with incomplete or no healthcare records
to decide what catheter length to use. The main investigative inquiry that needed to be answered was how does patient weight & height influence catheter length together and separately? We conducted linear regression and other statistical analysis procedures in R program & Microsoft Excel and discovered that this data exhibited a quality called multi collinearity. With multi collinearity, all predictors (2 or more
independent variables) are not significant in an all encompassing linear aggression, but the predictors might be significant in their own individual linear regressions. Individual linear regression analyses were conducted for both patient height & weight to see how much they both contribute to varying catheter length. Patient weight was found to be more impatful than patient height in relationship to catheter length, even though height and weight are a classical example of multi collinearity predictors.
Bovine mastitis has a negative impact through economic losses in the dairy sector across the globe. A cross sectional study was carried out from September 2015 to July 2016 to determine the prevalence of bovine mastitis, associated risk factors and isolation of major causative bacteria in lactating dairy cows in selected districts of central highland of Ethiopia. A total of 304 lactating cows selected randomly from five districts were screened by California Mastitis Test (CMT) for subclinical mastitis. Based on CMT result and clinical examination, over all prevalence of mastitis at cow level was 70.62% (214/304).
Two hundred fourteen milk samples collected from CMT positive cows were cultured for isolation of major causative bacteria. From 214 milk samples,187 were culture positive and the most prevalent isolates were Staphylococcus aureus 42.25% (79/187) followed by Streptococcus agalactiae 14.43%
(27/187). Other bacterial isolates were included Coagulase Negative Staphylococcus species 12.83% (24/187), Streptococcus dysgalactiae 5.88% (11/187), Escherichia coli 13.38% (25/187) and Entrococcus feacalis 11.23% (21/187) were also isolated. Moreover, age, parity number, visible teat abnormalities,husbandry practice, barn fl oor status and milking hygiene were considered as risk factors for the occurrence of bovine mastitis and they were found significantly associated with the occurrence of mastitis (p < 0.05). The findings of this study warrants the need for strategic approach including dairy extension that focus on enhancing dairy farmers’ awareness and practice of hygienic milking, regular screening for subclinical mastitis, dry cow therapy and culling of chronically infected cows.
A 36-year-old female developed right upper quadrant pain and nausea after taking the herbal supplement kratom for two weeks to manage back pain. Laboratory tests showed elevated liver enzymes. A liver biopsy ruled out other causes and determined she had drug-induced liver injury from kratom use. Her symptoms and liver enzymes gradually returned to normal over six weeks after stopping kratom. The case report discusses kratom's potential for hepatotoxicity and advises clinicians to consider its effects on patient health.
The assessment, diagnosis and treatment of critically ill patients is extremely challenging. Patients often deteriorate whilst being
reviewed and their rapidly changing pathophysiology barrages healthcare professionals with new data. Furthermore, comprehensive assessments must be postponed until the patient has been stabilised. So, important data and interventions are often missed in the heat of the moment. In emergency situations, suboptimal management decisions may cause signifi cant morbidity and mortality. Fortunately, standardisation and careful design of documentation (i.e. proformas and checklists) can enhance patient safety. So, I have developed a series of checklist proformas to guide the assessment of critically ill patients. These proformas also promote the systematic recording and presentation of information to facilitate the retrieval of the precise data required for the management for critically ill patients. The proformas have been modifi ed extensively over the last twenty years based on my personal experience and extensive consultation with colleagues in several world-renowned centres of excellence. The proformas were originally developed for use in the intensive therapy unit
or high dependency unit. However, they have been adapted for use by outreach teams reviewing patients admitted outside of critical care areas. The use of these tools can direct eff orts to provide appropriate organ support and provides a framework for diagnostic reasoning.
This review article discusses microvascular and macrovascular disease in systemic hypertension. It summarizes that:
1) Cardiac imaging plays a crucial role in risk stratifying hypertensive patients and identifying management strategies by properly diagnosing microvascular and coronary artery disease.
2) The nitric oxide synthase (eNOS) G298 gene allele may be a marker for microvascular angina in hypertensive patients, as studies have found it to be more prevalent in hypertensive patients with chest pain and reversible myocardial defects but normal coronary arteries.
3) Both structural changes like capillary rarefaction and functional changes like endothelial dysfunction can cause microvascular dysfunction and angina in hypertensive individuals in the absence of
This study characterized dengue infections in Pakistan by analyzing hematological and serological markers in 154 suspected dengue cases and 146 control patients with other febrile illnesses. NS1 antigen was detected in 55% of dengue cases, IgM antibodies in 30%, and both in 15%. Control groups primarily had malaria (71%) and enteric fever (20%). Hematological markers (platelet count, hematocrit, WBC) measured before and after treatment showed significant differences for platelet count and hematocrit but not WBC count between the groups. Analysis of clinical symptoms and serological/hematological markers helps diagnose dengue, assess prognosis, and inform prevention efforts to reduce morbidity, mortality and spread of the disease.
Researchers from Utrecht recently published yet another paper on the use of Magnetic Resonance Imaging (MRI)demonstrating an additional failed attempt to understand the importance of qualitative versus quantitative imaging, and anatomic versus physiologic imaging. Th e implications of this failure here cannot be overstated.
Introduction: Stroke is an even more dramatic major public health problem in young people. Goal of the study: Contribute to the knowledge of strokes in young people. Methodology: This was a retrospective study carried out over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Neurology department of the University Hospital
Center of the Sino-Central African Friendship (CHUSCA) of Bangui.
Background: This report describes a unique case of a patient that developed psychotic symptoms believed to be secondary
to a tentorial meningioma with associated hydrocephalus. These psychotic symptoms subsequently abated with placement of a
ventriculoperitoneal shunt. Case description: 60-year-old female was admitted to an inpatient psychiatric facility on a psychiatric involuntary commitment petition due to progressive paranoia, homicidal ideation and psychosis. The work up showed a calcified six cm tentorial meningioma with associated hydrocephalus. The patient initially rejected treatment but later became amenable to placement of Ventriculoperitoneal Shunt
(VPS).
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
2. SCIRES Literature - Volume 3 Issue 1 - www.scireslit.com Page - 025
International Journal of Reproductive Medicine & Gynecology
INTRODUCTION
Retained Products of Conception (RPOC) are not an unusual
outcome after miscarriage, Termination of Pregnancy (TOP) and
vaginal or caesarean delivery. It is estimated to occur in approximately
1% of cases, although it could be higher in cases of TOP depending on
the treatment regimen [1].
The presence of RPOC can be diagnosed due to short-term
clinical manifestations such as abnormal uterine bleeding, abdominal
pain, fever, dilated cervical canal or secondary amenorrhea; and it
can lead to long-term consequences such as infertility, Intrauterine
Adhesions (IUA) formation or repeated spontaneous miscarriages.
RPOC are suspected in a transvaginal Doppler Ultrasonography
when intracavitary homogeneous or heterogeneous echogenic foci or
endometrial fluid collection with echogenic foci are detected, as well
as the finding of high-velocity, low-resistance flow at colour Doppler
Ultrasonography [2-4].
In terms of management, it has been described an expectant
management and also the use of treatments such as ergotamine or
misoprostol, but RPOC are mainly managed surgically by Dilatation
and Evacuation (D&E) or by hysteroscopic removal [1,5]. Several
studies have reported the comparison between the use of D&E and
hysteroscopy referring to post-operative IUA formation, surgical
complications, rate of incomplete removal and pregnancy outcomes,
as well as the safety and effectiveness of hysteroscopic removal, and
it seems that the latter would be superior compared with D&E [6-
8]. Nevertheless, there is a paucity of studies regarding the best time
to perform the hysteroscopic removal of RPOC after the end of the
pregnancy in order to permit a possible spontaneous expulsion, thus
avoiding complications such as fluid overload, formation of IUA,
uterine bleeding, infection or uterine perforation, as well as those
related to the anaesthesia.
The aim of this study was to analyse the clinical features of
patients affected of RPOC and to establish if a 4-week expectant
management after an office hysteroscopy would permit the chance of a
spontaneous expulsion before performing an operative hysteroscopy,
thus avoiding possible complications related to surgical procedures
during the removal.
MATERIALS AND METHODS
From July 2009 to June 2015 all patients diagnosed of RPOC by an
office hysteroscopy performed in the Hysteroscopic Unit of Hospital
Clinic of Barcelona with a histopathologic study confirmation were
included in this study. They were sent to our unit in case of suspicion
of RPOC beyond one month of the end of pregnancy and in absence of
acute symptoms (defined as heavy uterine bleeding, heavy abdominal
pain or fever), in which cases a D&E was preferred. The present study
was approved by the Ethics Committee from our institution and an
informed consent was obtained from all patients.
After the diagnostic of RPOC an operative hysteroscopy was
indicated. The possibility of a spontaneous expulsion during the
waiting list was explained to the patients and if they accepted, the
surgical procedure was scheduled as a non-high-priority surgery. All
patients underwent preoperative complete blood sample test with
blood cell count and coagulation test. Patients affected of RPOC were
instructed to ask to our unit in case of uterine bleeding, abdominal
pain or fever before the surgical procedure. In the first case, patients
underwent a transvaginal Ultrasonography in order to assess the
persistence or the spontaneous expulsion of RPOC, in which case,
a second-look office hysteroscopy was performed to confirm uterine
vacuity. In case of abdominal pain or fever a D&E under antibiotic
treatment was preferred.
Hysteroscopic transcervical removal of RPOC was performed
undergeneralanaesthesiaandantibioticprophylaxiswasadministered
to all of them. A 26Fr resectoscope (Karl Storz, Tuttlingen, Germany)
assembled to a 4-mm cutting loop was introduced into the uterine
cavity after mechanical cervical dilation with Hegar’s dilators to no.
10. No prostaglandins were used for cervical ripening. The uterine
cavity was distended and irrigated by saline solution and bipolar
energy was used, controlled by an electronic device (Hysteroflator;
Karl Storz, Tuttlingen, Germany) and fluid balance was recorded.
The loop was used mechanically as a curette, avoiding the use of
electrosurgery, which was applied only if necessary due to bleeding
or difficulties in the removal procedure. Tissue obtained was sent
for histopathologic study. Surgery duration, intraoperative and
postoperative complications were recorded. All procedures were
performed by the same medical team.
Thefollowingvariableswererecorded:age,gravidity,prioruterine
surgeries (defined as prior D&E, C-section, operative hysteroscopy or
myomectomy), presence of uterine alterations such as leiomyomatas
and malformations, history of placental retention in the last end of
pregnancy (including incomplete miscarriages, postpartum D&E
or manual revision of uterus after delivery), time of pregnancy
ABSTRACT
Retained Products of Conception (RPOC) occur in 1 % of cases. Clinical features of 41 women diagnosed of RPOC by hysteroscopy,
to establish the best time-lapse of an expectant management after an office hysteroscopy avoiding an operative hysteroscopy to permit
a spontaneous expulsion, were analyzed. There were no differences between patients who suffered a spontaneous expulsion or those
in whom a persistence of RPOC was observed at time of surgical removal in terms of age, gravidity, prior uterine surgeries, uterine
alterations, type and time of pregnancy termination and ultrasonographic characteristics. There was a higher rate of spontaneous
expulsion after 4 weeks from the office hysteroscopy compared with those where the surgical removal was performed up to 4 weeks after
the diagnosis (p-value 0.011).
It might be possible a 4-week delay of the RPOC removal after having performed an office hysteroscopy in order to let the possibility
of a spontaneous expulsion.
Keywords: Retained products of conception; Office hysteroscopy; Operative hysteroscopy; Ultrasonography; Spontaneous
expulsion; Termination of pregnancy
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International Journal of Reproductive Medicine & Gynecology
termination (first or second trimester, preterm and term delivery)
and type of termination (whether it was a spontaneous miscarriage,
or it was managed by medical treatment with misoprostol or D&E,
or in case of preterm and term deliveries, whether they were vaginal
deliveries or C-section), endometrial thickness and characteristics
of colour Doppler flow at ultrasonographic study performed due to
RPOC suspicion. Rate differences between spontaneous expulsion
and persistence of RPOC at operative hysteroscopy up to 4 weeks and
after 4 weeks from the office hysteroscopy were assessed.
Continuous variables were compared using a nonparametric
Mann-Whitney U test and categorical variables were compared using
Chi-square or Fisher exact test, if appropriate. The SPSS version
20.0 software (IBM, Armonk, NY, USA) was used for the statistical
analysis. p-value < 0.05 was considered statistically significant.
RESULTS
Forty-one patients were diagnosed of RPOC by an office
hysteroscopy and a histopathologic study confirmation. The
suspicion of RPOC before the hysteroscopy was reached either by
performing a transvaginal Ultrasonography, with colour Doppler
study if feasible, due to clinical complaints such as vaginal bleeding
after the end of the last pregnancy (miscarriage, TOP, vaginal delivery
or C-section), amenorrhea, abdominal pain or during the follow-
up after a miscarriage or TOP. One patient required D&E under
endovenous antibiotic therapy due to fever after the performance
of an office hysteroscopy. Five patients presented uterine bleeding
after the office hysteroscopy while waiting for the surgical procedure,
a transvaginal ultrasonography was performed and no signs of
RPOC were observed. These patients underwent a second-look office
hysteroscopy, which confirmed uterine vacuity. None of the patients
presented heavy abdominal pain before the surgery.
Finally, 35 patients underwent an operative hysteroscopy for the
removal of RPOC. In six patients no intrauterine findings were found,
so a spontaneous expulsion was assumed. After explaining to these
patients the absence of findings, all of them referred a single episode
of spontaneous bleeding while waiting for the operative hysteroscopy,
not having referred it before the procedure. A hysteroscopic removal
was then performed in 29 patients. Only three patients suffered
surgical complications during the procedure: 1 cervical laceration, 2
heavy uterine bleedings that were solved with intramuscular injection
of ergometrine and intrauterine balloon with Foley catheter during 12
hours. No other complications were registered before, during or after
the procedure. Figure 1 shows the flow of events described above.
Baseline characteristics of the 40 patients affected by RPOC (1
patient out of the 41 underwent a D&E due to fever) either if they
underwent hysteroscopic removal or they suffered a spontaneous
expulsion are shown in Table 1. There were no differences in any of the
variables shown, when compared between women with persistence
of RPOC at the time of operative hysteroscopy and those in whom
uterine vacuity was observed, except for the time lapse from the office
hysteroscopy to the surgical procedure (figure 2 shows time lapse
differences in weeks between patients who suffered a spontaneous
expulsion and those in whom a persistence of RPOC was observed in
the operative hysteroscopy). There was a higher rate of spontaneous
expulsion after 4 weeks from the office hysteroscopy (90.9 %)
compared with the group of patients where the surgical removal was
performed up to 4 weeks after the diagnosis (p-value 0.011).
DISCUSSION
Retained products of conception are a complication described
after miscarriage, TOP or deliveries that have been traditionally
treated by D&E. Nevertheless, in the last few years, several studies
have reported the benefits of performing a hysteroscopic selective
curettage instead of D&E [7,8]. Operative hysteroscopy with a
selective curettage limited to the area affected by RPOC performed
with direct vision could avoid the rest of healthy endometrial surface
from suffering a blind curettage that could lead to inflammation, scar
formation and finally Intrauterine Adhesions (IUA) or Asherman’s
syndromedevelopment[6].Moreover,itpermitstheassessmentofthe
Figure 1: Flow of events of patients with a diagnostic of RPOC by an office
hysteroscopy.
RPOC: Retained Products of Conception, D&E: Dilatation and Evacuation.
Table 1: Differences between cases with removal of RPOC (n = 29) and cases
with spontaneous expulsion (n = 11) in the 40 patients affected by RPOC.
Hysteroscopic
removal of
RPOC (n = 29)
Spontaneous
expulsion
(n = 11)
p-value
Type of pregnancy termination
First trimester - spontaneous
First trimester – medical treatment
First trimester – D&E
Second trimester – spontaneous
Second trimester – medical
treatment
Preterm vaginal delivery
Preterm caesarean-section
Term vaginal delivery
Term caesarean-section
6 (20.7%)
1 (3.4%)
5 (17.2%)
1 (3.4%)
3 (10.3%)
2 (6.9%)
0
9 (31%)
2 (6.9%)
1 (9.1%)
2 (18.2%)
3 (27.3%)
1 (9.1%)
3 (27.3%)
0
0
1 (9.1%)
0
0.298
Age (years)
36 (30-41, 34-
37)
36 (25-42,
31-38)
0.881
Primigravida 11 (37.9%) 3 (27.3%) 0.404
Uterine surgery 10 (34.5%) 4 (36.4%) 0.596
Uterine alterationa
2 (6.9%) 1 (9.1%) 0.630
Placental retention 11 (37.9%) 4 (36.4%) 0.613
Endometrial thickness (mm) 21 (4-64, 16-28)
16 (10-38,
13-26)
0.321
Characteristical flow at colour
Doppler ultrasonography
18 (78.3%) 5 (83.3%) 0.430
Continuous variables are expressed in median (range, 25th
-75th
percentiles)
and were compared using a nonparametric Mann-Whitney U test. Categorical
variables were compared using Chi-square or Fisher exact test, if appropriate.
a
Cases of uterine alterations were a type 2 leiomyomata and an arquate uterus in
case of persistence of RPOC and a type 2 leiomyomata in case of spontaneous
expulsion.
RPOC: Retained Products of Conception; D&E: Dilatation and Evacuation.
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International Journal of Reproductive Medicine & Gynecology
complete removal of RPOC without the need of a second procedure,
which is not uncommon in cases where a D&E is performed. The
surgical technique using the loop of the resectoscope as a curette
limiting the use of electrosurgery would reduce thermal damage
to the endometrium, adding the chance of treating uterine cavity
anomalies if present [7]. Apart from this, it has been hypothesised
that continuous flushing of the uterus with sterile solution during the
hysteroscopy may reduce the risk of local infection and inflammation
processes that could contribute to adhesion formation [5]. When
hysteroscopic removal is performed, it has been described less
incidence of IUA detected by a second-look hysteroscopy and a
tendency to earlier conception [8], although whether there is a higher
conception rate remains unclear [5,6].Operative hysteroscopy in such
cases has been described as a simple, safe an efficient procedure [2], as
well as relatively easy to learn and to perform [6] .
Accordingly to the literature, taking into account the benefits of a
hysteroscopic treatment of RPOC, if there is a paucity of symptoms,
it would be better to postpone the hysteroscopy at least 1 month after
the end of any type of pregnancy, due to the technical difficulty if
performed before, because of the uterus enlargement and cervical
dilation, thus increasing the risk of uterine perforation and leading
to a larger spillage of distension medium, and also due to the higher
risk of infection [6,9]. For this reason, D&E would be the method of
choice for RPOC treatment during the first month, in cases of acute
symptoms such as heavy uterine bleeding, heavy uterine pain, fever,
or suspicion of other pathologies (for example, hydatidiform mole).
Although it seems that the hysteroscopic treatment would be
the best treatment of choice for patients affected by RPOC [7], when
the symptoms related to it are not acute, there is a lack of evidence
regarding the best time to perform the removal of RPOC in order
to permit the chance of a spontaneous expulsion, thus avoiding
complications such as fluid overload, formation of IUA, uterine
bleeding, infection or uterine perforation, as well as those related to
anaesthesia. For this reason, the purpose of our study was to analyse
whether it could be feasible an expectant management of RPOC after
its diagnosis by an office hysteroscopy in order to let a spontaneous
expulsion happen.
It has been compared the role of ultrasonography an hysteroscopy
in the diagnostic of RPOC, showing the former a sensitivity of 86.3%,
a specificity of 89.2% and positive predictive value of 67.9%, and the
latter 77.2%, 92.8% and 73.9%, respectively, with only a significant
difference in sensitivity, suggesting the use of hysteroscopy only as
an operative tool [10]. Nevertheless, in our opinion, after having
assessed the uterine cavity with a transvaginal ultrasonography to
all patients with RPOC suspicion, it would be recommendable to
perform an office hysteroscopy as a diagnostic tool before scheduling
the removal of RPOC in a operating room since it is a safe outpatient
procedure (in our study we only reported one complication: a patient
who underwent fever few days after the procedure), nearly painless
and with a diagnostic accuracy similar to the ultrasonography,
adding some benefits to the patient such as the possibility of a biopsy
in case of diagnostic doubts or suspicion of other pathologies, and
the possible reduction of risk of infection and intrauterine adhesions
formation because of the irrigation. In addition, we hypothesise its
contribution to the spontaneous expulsion of the RPOC due to the
cervical dilation and the irrigation of the intrauterine cavity, without
affecting the endometrial surface. For this reason, we do not consider
a “see and treat” hysteroscopy in cases of RPOC.
All this factors described would undoubtedly contribute to the
reduction of unnecessary surgical procedures according to our data:
from 40 cases where an operative hysteroscopy was scheduled, 27.5%
of them (n = 11) suffered a spontaneous expulsion before the surgical
procedure. We analysed several variables to determine if some
showed a relation with a spontaneous expulsion in order to predict
which patients would benefit of an expectant management and only
the time lapse from the office hysteroscopy to the hysteroscopic
removal of RPOC or the diagnosis of spontaneous expulsion showed
a statistically significant difference, being longer in cases where a
uterine vacuity was observed compared with persistence of RPOC.
Therefore, in cases of RPOC suspicion we suggest, according to
our data, to assess the uterine cavity with an ultrasonography and also
an office hysteroscopy to confirm the diagnostic always after 1 month
of the end of pregnancy. If there are no acute symptoms and patient
accepts an expectant management, a new assessment of the uterine
cavity would be performed after 4 weeks or before in cases of heavy
uterine bleeding. If indicated because of the persistence of RPOC, a
hysteroscopic removal should then be performed.
CONCLUSION
In conclusion, although this is a study with a reduced sample
size due to the low incidence of this pathology, it is the first to our
knowledge where the optimal time to perform the removal of RPOC
in women without acute symptoms is assessed. Our data suggest that
it might be possible a 4-week delay of the RPOC removal after having
performed an office hysteroscopy in order to let the possibility of a
spontaneous expulsion, thus avoiding complications related to the
surgical and anaesthetic procedures, without increasing the risk of
infection. Further prospective studies with larger sample sizes are
necessary in order to assess the absence of complications after an
office hysteroscopy in cases of RPOC suspicion and also to evaluate
the outcomes of offering an expectant management when possible in
terms of spontaneous expulsion rates, possible intrauterine infections
and intrauterine adhesions formation.
IMPACT STATEMENT
What is already known on this subject: Several studies report
that hysteroscopic removal seems better than dilatation and
evacuation, but the best time to perform it in order to permit a
possible spontaneous expulsion has not been established.
Figure 2: Time lapse (weeks) between office and operative hysteroscopy or
diagnostic of spontaneous expulsion in case of patients with spontaneous
expulsion and patients who underwent a hysteroscopic removal of RPOC
(Retained Products of Conception).
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International Journal of Reproductive Medicine & Gynecology
What the results of this study add: In cases of RPOC suspicion
we suggest, to assess the uterine cavity with an ultrasonography and
also an office hysteroscopy to confirm the diagnostic always after 1
month of the end of pregnancy. If there are no acute symptoms and
patient accepts an expectant management, a new assessment of the
uterine cavity would be performed after 4 weeks. If indicated because
of the persistence of RPOC, a hysteroscopic removal should then be
performed.
What the implications are of these findings for clinical
practice and/or further research: It could be feasible an expectant
management of RPOC after its diagnosis by an office hysteroscopy
in order to let a spontaneous expulsion happen, thus avoiding
complications such as fluid overload, formation of intra uterine
adhesions, uterine bleeding, infection or uterine perforation, as well
as those related to anaesthesia.
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