Migration of intrauterine devices (IUCDs) from the uterus can occur, ranging from expulsion to perforation into other organs. Imaging plays an important role in diagnosing migrated IUCDs. The case report describes 4 cases of migrated IUCDs diagnosed by x-ray, ultrasound, CT, and treated by laparotomy, hysteroscopic or cystoscopic removal. Migrated IUCDs can cause complications and their removal is usually recommended even if asymptomatic.
This document discusses adnexal masses in reproductive age women. It provides clinical background and epidemiology of adnexal masses. It discusses ultrasound techniques for evaluating adnexal masses such as 2D ultrasound, Doppler ultrasound, 3D and power Doppler ultrasound. Pattern recognition of benign disease using ultrasound is covered. The document also discusses predicting malignancy using systems like IOTA simple rules and pattern recognition. Characterization of adnexal masses and predicting histopathology and management are key focuses.
The document discusses various uterus sparing techniques for prolapse surgery in young women who desire to preserve fertility and menstrual function. It describes Shirodkar's sling operation, which has been shown to have high rates of normal vaginal delivery and low recurrence rates of prolapse. Laparoscopic sacrohysteropexy is indicated for young women with prolapse as it has better efficacy than vaginal sacrospinous fixation and results in fewer mesh complications compared to sacral colpopexy with hysterectomy. While sacral colpopexy has high success rates, it also carries risks of serious mesh-related complications requiring reoperation years later.
MANAGEMENT OF VAULT PROLAPSE BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the management of vault prolapse, which is the descent of the vaginal cuff after a hysterectomy. It defines vault prolapse and lists risk factors. Conservative management includes pessaries but surgery is often needed. Surgical options include vaginal approaches like sacrospinous ligament fixation or abdominal approaches like sacral colpopexy. The document compares techniques and factors to consider in surgical planning like prolapse severity and patient factors. Prevention techniques like culdoplasty at time of hysterectomy are also discussed.
Cervical cancer is caused by HPV infection and is the leading cause of cancer deaths in many developing countries. HPV is present in over 99% of cervical cancers. Risk factors include young age of first sexual activity, multiple partners, early pregnancy, and smoking. Precancerous lesions usually develop over 10-15 years. Cervical cancer spreads locally through the cervix and vagina, and can metastasize to nearby lymph nodes and distant sites like the lungs and liver. Diagnosis involves identifying dysplastic cervical cells, and treatment depends on the cancer stage.
- Tumor markers are glycoproteins detected by monoclonal antibodies that are produced by tumors or the body's response to cancer.
- Cancer antigen 125 (CA-125) is an important tumor marker used for ovarian cancer screening, diagnosis, treatment monitoring and recurrence detection, though it can be elevated in some non-cancerous conditions.
- For screening, CA-125 levels above 35 U/mL in postmenopausal women or 200 U/mL in premenopausal women should be further evaluated. Monitoring CA-125 after treatment can indicate response or recurrence of ovarian cancer.
Malignant epithelial ovarian tumors account for 90% of ovarian cancers and are the fourth most common cause of cancer death in women. Ovarian cancers are often called "silent killers" as they rarely produce symptoms in early stages. When diagnosed at Stage I, the cure rate is around 90% but drops to 20-25% at Stage III/IV. Screening is recommended for women over 50 or those at high risk due to family history or genetic mutations. Screening involves measuring serum CA125 levels and transvaginal ultrasound but has not been proven to reduce mortality in average risk women.
This document discusses adnexal masses in reproductive age women. It provides clinical background and epidemiology of adnexal masses. It discusses ultrasound techniques for evaluating adnexal masses such as 2D ultrasound, Doppler ultrasound, 3D and power Doppler ultrasound. Pattern recognition of benign disease using ultrasound is covered. The document also discusses predicting malignancy using systems like IOTA simple rules and pattern recognition. Characterization of adnexal masses and predicting histopathology and management are key focuses.
The document discusses various uterus sparing techniques for prolapse surgery in young women who desire to preserve fertility and menstrual function. It describes Shirodkar's sling operation, which has been shown to have high rates of normal vaginal delivery and low recurrence rates of prolapse. Laparoscopic sacrohysteropexy is indicated for young women with prolapse as it has better efficacy than vaginal sacrospinous fixation and results in fewer mesh complications compared to sacral colpopexy with hysterectomy. While sacral colpopexy has high success rates, it also carries risks of serious mesh-related complications requiring reoperation years later.
MANAGEMENT OF VAULT PROLAPSE BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the management of vault prolapse, which is the descent of the vaginal cuff after a hysterectomy. It defines vault prolapse and lists risk factors. Conservative management includes pessaries but surgery is often needed. Surgical options include vaginal approaches like sacrospinous ligament fixation or abdominal approaches like sacral colpopexy. The document compares techniques and factors to consider in surgical planning like prolapse severity and patient factors. Prevention techniques like culdoplasty at time of hysterectomy are also discussed.
Cervical cancer is caused by HPV infection and is the leading cause of cancer deaths in many developing countries. HPV is present in over 99% of cervical cancers. Risk factors include young age of first sexual activity, multiple partners, early pregnancy, and smoking. Precancerous lesions usually develop over 10-15 years. Cervical cancer spreads locally through the cervix and vagina, and can metastasize to nearby lymph nodes and distant sites like the lungs and liver. Diagnosis involves identifying dysplastic cervical cells, and treatment depends on the cancer stage.
- Tumor markers are glycoproteins detected by monoclonal antibodies that are produced by tumors or the body's response to cancer.
- Cancer antigen 125 (CA-125) is an important tumor marker used for ovarian cancer screening, diagnosis, treatment monitoring and recurrence detection, though it can be elevated in some non-cancerous conditions.
- For screening, CA-125 levels above 35 U/mL in postmenopausal women or 200 U/mL in premenopausal women should be further evaluated. Monitoring CA-125 after treatment can indicate response or recurrence of ovarian cancer.
Malignant epithelial ovarian tumors account for 90% of ovarian cancers and are the fourth most common cause of cancer death in women. Ovarian cancers are often called "silent killers" as they rarely produce symptoms in early stages. When diagnosed at Stage I, the cure rate is around 90% but drops to 20-25% at Stage III/IV. Screening is recommended for women over 50 or those at high risk due to family history or genetic mutations. Screening involves measuring serum CA125 levels and transvaginal ultrasound but has not been proven to reduce mortality in average risk women.
This document summarizes a presentation given by Dr. Rajni Singh on vaginal hysterectomy techniques. Key points include:
- Vaginal hysterectomy is the safest and most cost-effective surgical route for conditions like fibroids and abnormal bleeding, with less complications and faster recovery compared to abdominal hysterectomy.
- Evaluation of pelvic support and anatomy is important prior to the surgery.
- Techniques like bladder dissection, use of curved scissors and hemostatic systems like Ligasure can aid in performing a bloodless procedure.
- Post-operative care includes catheter removal after 12 hours and discharge usually within 24-36 hours. Potential complications include vault hematoma, infections and urinary tract injuries
This pilot study examines myomectomy as an alternative to hysterectomy for women who have completed childbearing. The study found that myomectomy is a feasible option that resulted in significant relief of symptoms for most patients, with average blood loss comparable to hysterectomy when using appropriate techniques. The conclusions suggest that a randomized study directly comparing hysterectomy to myomectomy in this patient population is warranted to further evaluate myomectomy as a conservative treatment alternative to hysterectomy.
Cervical insufficiency, also known as cervical incompetence, is a condition where the cervix is unable to retain a pregnancy at term due to a functional or structural defect. It is characterized by painless dilatation of the cervix resulting in premature rupture of membranes and delivery, usually occurring in the second or third trimester. Cervical cerclage procedures aim to surgically suture the cervix closed to prevent premature opening. There are several techniques for cervical cerclage placement depending on the location and indication, including McDonald, Shirodkar, emergency/rescue cerclages, and pessary or balloon alternatives. Cerclage procedures can be done through the vagina or abdomen depending
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.
The document summarizes revisions to the FIGO staging system for endometrial cancer in 2023. Key changes include distinguishing aggressive from non-aggressive histological subtypes and assessing lymphovascular space invasion. The revised system incorporates prognostic molecular markers like POLE mutations and p53 abnormalities. Stage I is now restricted to non-invasive tumors. Stage IA3 includes some ovarian involvement by low-grade endometrial cancer. The revisions aim to better stratify patients by risk to guide treatment decisions.
Cervical and broad ligament fibroids are rare; with incidence of only 2% and 1% respectively.
Cervical fibroid often present with pressure symptoms and often pose surgical difficulties due to its proximity to bladder and rectum.
Broad ligament fibroid though rare , but have the propensity of growing into large adnexal masses and may mimic ovarian malignancy.
(I) The document discusses various types of ovarian tumours including functional cysts, inflammatory cysts, and benign and malignant neoplastic tumours.
(II) Functional cysts include follicular cysts, corpus luteal cysts, and theca lutein cysts which are usually asymptomatic and resolve on their own. Inflammatory cysts include tubo-ovarian abscesses.
(III) Benign neoplastic tumours discussed are serous cystadenoma, mucinous cystadenoma, dermoid cyst, fibroma, thecoma, and Brenner's tumour. Malignant transformations are possible in some tumour types.
This document discusses cervical intraepithelial neoplasia (CIN), a precancerous condition affecting the cervix. It provides a historical background of CIN and describes the grading system used (CIN 1-3). Risk factors for CIN include HPV infection and early sexual activity. CIN results from abnormal cell growth in the cervix due to HPV infection. Progression from CIN to invasive cancer depends on the grade, with higher grades having greater risk. Diagnosis involves Pap testing, colposcopy, and HPV testing.
This document provides information on ovarian tumors, including normal ovarian anatomy and function, differential diagnosis of adnexal masses, classification of ovarian neoplasms, clinical presentation, evaluation, and management of ovarian cysts and masses. Key points include:
- Ovarian cysts are a common finding and are usually benign functional cysts.
- Evaluation involves ultrasound, tumor markers like CA-125 and HE4, and risk of malignancy algorithms.
- Management depends on factors like size, symptoms, and patient age/menopausal status.
- Ovarian neoplasms include functional, inflammatory, and neoplastic tumors and are classified based on histology.
- Borderline ovarian tumors have
Day care obstetrics and gynecology provides inpatient level care to patients on an outpatient basis. It was first established in 1969 in the US and has since expanded globally. Day care allows for monitoring of high-risk pregnancies, infertility procedures, fetal medicine procedures, and gynecological surgeries. Patients are selected based on surgical, medical, and social criteria to ensure safety. Procedures are performed using local anesthesia, IV sedation, or general anesthesia with rapid induction and recovery. Strict discharge criteria involving patient status and availability of a caretaker ensure safe recovery at home.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
This document discusses injuries to the ureter during gynecological surgeries. It provides details on the surgical anatomy of the ureter, risk factors for injury, common sites of injury, grading of injuries, prevention strategies and intraoperative diagnosis. The key points are:
1. The ureter's course makes it susceptible to injury during pelvic surgeries, especially at the pelvic brim.
2. Injuries occur in 0.3-1% of cases and are most common during hysterectomy.
3. Risk factors include large fibroids, adhesions, and prior pelvic surgery.
4. Prevention relies on proper surgical technique including identification and
Internal iliac artery ligation (IIAL) is a technique to control pelvic hemorrhage by ligating the internal iliac arteries. It preserves fertility and can be life-saving when other options risk compromising the patient. IIAL works by reducing blood flow and pressure in the pelvis, allowing clots to form and stop bleeding. The pelvis has extensive collateral circulation, so ligation does not cause ischemia. IIAL is effective for prophylactic or therapeutic control of hemorrhage from the uterus, cervix, or broad ligament. It carries risks if not performed carefully to avoid injuring nearby structures like veins and ureters.
PUBERTY MENORRHAGIA & BLEEDING DISORDERS Made Easy Dr Sharda Jain Lifecare Centre
This document discusses evaluation and treatment of puberty menorrhagia and bleeding disorders. It begins with classifications of abnormal uterine bleeding and an overview of common causes of puberty menorrhagia such as dysfunctional uterine bleeding and bleeding disorders. Evaluation involves a detailed history, physical exam, ultrasound, and lab tests to rule out other causes before screening for bleeding disorders. Common bleeding disorders seen in puberty menorrhagia are von Willebrand disease, platelet function defects, and coagulation factor deficiencies. Treatment depends on the underlying cause but may include combined oral contraceptives, antifibrinolytic agents, plasma concentrates, and managing anemia.
Gestational trophoblastic disease is a heterogeneous group of lesions arising from abnormal placental trophoblast proliferation. It includes premalignant conditions like complete and partial hydatidiform moles, as well as malignant gestational trophoblastic neoplasia (GTN). GTN has varying potential for local invasion and metastasis. While rare, GTN is highly curable even with widespread dissemination. Treatment involves chemotherapy, with single or multi-agent regimens depending on risk factors and disease stage according to the FIGO scoring system. Careful monitoring of beta-hCG levels is important for diagnosis and follow-up.
This document discusses management considerations for pregnancies following previous caesarean sections. It finds that pregnancies after a previous classical/hysterotomy scar carry a higher risk of uterine rupture compared to those with a previous lower segment transverse scar. For classical scars, an elective repeat caesarean is recommended at 38 weeks. Those with a previous lower segment scar can attempt a vaginal birth after caesarean (VBAC) if certain criteria are met, like a prior nonrecurring indication and adequate monitoring resources. Strict monitoring during labour is needed for all previous scar pregnancies to detect any signs of scar rupture.
DNB Obstetrics & gynaecology previous Year Question Papersapollobgslibrary
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
This document discusses gestational trophoblastic disease (GTD), specifically hydatidiform moles. It defines a hydatidiform mole as a pregnancy characterized by vesicular swelling of placental villi, usually with the absence of an intact fetus. Molar pregnancies can be complete or partial based on whether there is a fetus present. Complete moles have no fetus and are diploid, while partial moles may contain defective fetuses and are usually triploid. Symptoms include vaginal bleeding and an enlarged uterus. Diagnosis involves beta-hCG levels and ultrasound showing a "snowstorm" pattern. Treatment is surgical evacuation followed by chemotherapy for high-risk cases to prevent invasive tumors.
accurate assessment of gestational age by certain mensrtual data and clinical examination may have dating discrepancy with the ultrasound. this ppt critically addresses such issues
Case Report Migrated Iucd Causing Unilateral Obstrutive Hydroureteronephrosis...iosrjce
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.
This document summarizes a presentation given by Dr. Rajni Singh on vaginal hysterectomy techniques. Key points include:
- Vaginal hysterectomy is the safest and most cost-effective surgical route for conditions like fibroids and abnormal bleeding, with less complications and faster recovery compared to abdominal hysterectomy.
- Evaluation of pelvic support and anatomy is important prior to the surgery.
- Techniques like bladder dissection, use of curved scissors and hemostatic systems like Ligasure can aid in performing a bloodless procedure.
- Post-operative care includes catheter removal after 12 hours and discharge usually within 24-36 hours. Potential complications include vault hematoma, infections and urinary tract injuries
This pilot study examines myomectomy as an alternative to hysterectomy for women who have completed childbearing. The study found that myomectomy is a feasible option that resulted in significant relief of symptoms for most patients, with average blood loss comparable to hysterectomy when using appropriate techniques. The conclusions suggest that a randomized study directly comparing hysterectomy to myomectomy in this patient population is warranted to further evaluate myomectomy as a conservative treatment alternative to hysterectomy.
Cervical insufficiency, also known as cervical incompetence, is a condition where the cervix is unable to retain a pregnancy at term due to a functional or structural defect. It is characterized by painless dilatation of the cervix resulting in premature rupture of membranes and delivery, usually occurring in the second or third trimester. Cervical cerclage procedures aim to surgically suture the cervix closed to prevent premature opening. There are several techniques for cervical cerclage placement depending on the location and indication, including McDonald, Shirodkar, emergency/rescue cerclages, and pessary or balloon alternatives. Cerclage procedures can be done through the vagina or abdomen depending
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.
The document summarizes revisions to the FIGO staging system for endometrial cancer in 2023. Key changes include distinguishing aggressive from non-aggressive histological subtypes and assessing lymphovascular space invasion. The revised system incorporates prognostic molecular markers like POLE mutations and p53 abnormalities. Stage I is now restricted to non-invasive tumors. Stage IA3 includes some ovarian involvement by low-grade endometrial cancer. The revisions aim to better stratify patients by risk to guide treatment decisions.
Cervical and broad ligament fibroids are rare; with incidence of only 2% and 1% respectively.
Cervical fibroid often present with pressure symptoms and often pose surgical difficulties due to its proximity to bladder and rectum.
Broad ligament fibroid though rare , but have the propensity of growing into large adnexal masses and may mimic ovarian malignancy.
(I) The document discusses various types of ovarian tumours including functional cysts, inflammatory cysts, and benign and malignant neoplastic tumours.
(II) Functional cysts include follicular cysts, corpus luteal cysts, and theca lutein cysts which are usually asymptomatic and resolve on their own. Inflammatory cysts include tubo-ovarian abscesses.
(III) Benign neoplastic tumours discussed are serous cystadenoma, mucinous cystadenoma, dermoid cyst, fibroma, thecoma, and Brenner's tumour. Malignant transformations are possible in some tumour types.
This document discusses cervical intraepithelial neoplasia (CIN), a precancerous condition affecting the cervix. It provides a historical background of CIN and describes the grading system used (CIN 1-3). Risk factors for CIN include HPV infection and early sexual activity. CIN results from abnormal cell growth in the cervix due to HPV infection. Progression from CIN to invasive cancer depends on the grade, with higher grades having greater risk. Diagnosis involves Pap testing, colposcopy, and HPV testing.
This document provides information on ovarian tumors, including normal ovarian anatomy and function, differential diagnosis of adnexal masses, classification of ovarian neoplasms, clinical presentation, evaluation, and management of ovarian cysts and masses. Key points include:
- Ovarian cysts are a common finding and are usually benign functional cysts.
- Evaluation involves ultrasound, tumor markers like CA-125 and HE4, and risk of malignancy algorithms.
- Management depends on factors like size, symptoms, and patient age/menopausal status.
- Ovarian neoplasms include functional, inflammatory, and neoplastic tumors and are classified based on histology.
- Borderline ovarian tumors have
Day care obstetrics and gynecology provides inpatient level care to patients on an outpatient basis. It was first established in 1969 in the US and has since expanded globally. Day care allows for monitoring of high-risk pregnancies, infertility procedures, fetal medicine procedures, and gynecological surgeries. Patients are selected based on surgical, medical, and social criteria to ensure safety. Procedures are performed using local anesthesia, IV sedation, or general anesthesia with rapid induction and recovery. Strict discharge criteria involving patient status and availability of a caretaker ensure safe recovery at home.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
This document discusses injuries to the ureter during gynecological surgeries. It provides details on the surgical anatomy of the ureter, risk factors for injury, common sites of injury, grading of injuries, prevention strategies and intraoperative diagnosis. The key points are:
1. The ureter's course makes it susceptible to injury during pelvic surgeries, especially at the pelvic brim.
2. Injuries occur in 0.3-1% of cases and are most common during hysterectomy.
3. Risk factors include large fibroids, adhesions, and prior pelvic surgery.
4. Prevention relies on proper surgical technique including identification and
Internal iliac artery ligation (IIAL) is a technique to control pelvic hemorrhage by ligating the internal iliac arteries. It preserves fertility and can be life-saving when other options risk compromising the patient. IIAL works by reducing blood flow and pressure in the pelvis, allowing clots to form and stop bleeding. The pelvis has extensive collateral circulation, so ligation does not cause ischemia. IIAL is effective for prophylactic or therapeutic control of hemorrhage from the uterus, cervix, or broad ligament. It carries risks if not performed carefully to avoid injuring nearby structures like veins and ureters.
PUBERTY MENORRHAGIA & BLEEDING DISORDERS Made Easy Dr Sharda Jain Lifecare Centre
This document discusses evaluation and treatment of puberty menorrhagia and bleeding disorders. It begins with classifications of abnormal uterine bleeding and an overview of common causes of puberty menorrhagia such as dysfunctional uterine bleeding and bleeding disorders. Evaluation involves a detailed history, physical exam, ultrasound, and lab tests to rule out other causes before screening for bleeding disorders. Common bleeding disorders seen in puberty menorrhagia are von Willebrand disease, platelet function defects, and coagulation factor deficiencies. Treatment depends on the underlying cause but may include combined oral contraceptives, antifibrinolytic agents, plasma concentrates, and managing anemia.
Gestational trophoblastic disease is a heterogeneous group of lesions arising from abnormal placental trophoblast proliferation. It includes premalignant conditions like complete and partial hydatidiform moles, as well as malignant gestational trophoblastic neoplasia (GTN). GTN has varying potential for local invasion and metastasis. While rare, GTN is highly curable even with widespread dissemination. Treatment involves chemotherapy, with single or multi-agent regimens depending on risk factors and disease stage according to the FIGO scoring system. Careful monitoring of beta-hCG levels is important for diagnosis and follow-up.
This document discusses management considerations for pregnancies following previous caesarean sections. It finds that pregnancies after a previous classical/hysterotomy scar carry a higher risk of uterine rupture compared to those with a previous lower segment transverse scar. For classical scars, an elective repeat caesarean is recommended at 38 weeks. Those with a previous lower segment scar can attempt a vaginal birth after caesarean (VBAC) if certain criteria are met, like a prior nonrecurring indication and adequate monitoring resources. Strict monitoring during labour is needed for all previous scar pregnancies to detect any signs of scar rupture.
DNB Obstetrics & gynaecology previous Year Question Papersapollobgslibrary
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
This document discusses gestational trophoblastic disease (GTD), specifically hydatidiform moles. It defines a hydatidiform mole as a pregnancy characterized by vesicular swelling of placental villi, usually with the absence of an intact fetus. Molar pregnancies can be complete or partial based on whether there is a fetus present. Complete moles have no fetus and are diploid, while partial moles may contain defective fetuses and are usually triploid. Symptoms include vaginal bleeding and an enlarged uterus. Diagnosis involves beta-hCG levels and ultrasound showing a "snowstorm" pattern. Treatment is surgical evacuation followed by chemotherapy for high-risk cases to prevent invasive tumors.
accurate assessment of gestational age by certain mensrtual data and clinical examination may have dating discrepancy with the ultrasound. this ppt critically addresses such issues
Case Report Migrated Iucd Causing Unilateral Obstrutive Hydroureteronephrosis...iosrjce
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 34-year-old woman presented with lower abdominal pain and vaginal bleeding. Ultrasound and MRI revealed an abdominal pregnancy implanted on the mesentery of the sigmoid colon. The patient underwent laparotomy where the 13-week placenta was dissected from the mesentery and abdominal sidewall. Abdominal pregnancy is a rare and serious form of ectopic pregnancy that can be accurately diagnosed using ultrasound and MRI to determine placental location preoperatively.
Endometriosis is a disease restricted usually to the female genital tract. Involvement of the bowel by this disease can lead to a diagnostic dilemma due to the great variation in the symptomatology. Awareness of the pathophysiology, clinical features and diagnostic modalities is of utmost importance to decide the modality of treatment. Hormonal manipulation and surgical resection are the two modalities of treatment. The choice depends upon critical analysis of clinical and radiological findings and the desire to have pregnancy in cases associated with infertility.
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.
A 33-year old female presented with abdominal pain, dysuria, and fever. Ultrasound and X-ray revealed a bladder calculus formed around an intrauterine contraceptive device (IUCD) that had migrated from the uterus into the bladder. Such IUCD migration is a rare but known complication, and the device must be removed to prevent further complications like stone formation. Cystoscopy confirmed the presence of the IUCD within the bladder, which was then removed surgically.
This document discusses various abnormalities of the female urethra. It begins by describing the normal anatomy of the female urethra. It then lists and describes 9 common abnormalities: 1) urethral diverticulum, 2) vaginal leiomyoma, 3) Skene gland abnormalities, 4) Gartner duct abnormalities, 5) vaginal wall cysts, 6) urethral mucosal prolapse, 7) urethral caruncle, 8) periurethral bulking agents, and 9) urethral carcinoma. For each abnormality, it discusses presentation, evaluation, diagnosis, and treatment options.
A case report of cervical ectopic pregnancy misdiagnosed as cervical miscarriageApollo Hospitals
This case report describes a patient who presented with vaginal bleeding after a dilatation and curettage procedure for what was believed to be a cervical miscarriage. Ultrasound revealed remnants of conception in the cervix, indicating a misdiagnosed cervical ectopic pregnancy. The patient underwent cervical evacuation and balloon tamponade to stop bleeding. Cervical ectopic pregnancies are rare but can be misdiagnosed as cervical miscarriages if not considered. Early diagnosis with ultrasound is important to guide treatment and prevent morbidity.
A case report of cervical ectopic pregnancy misdiagnosed as cervical miscarriageApollo Hospitals
A 35-year-old woman presented with vaginal bleeding after a dilatation and curettage procedure to treat a suspected cervical miscarriage. An ultrasound revealed remnants of conception in the cervix, indicating a cervical ectopic pregnancy rather than miscarriage. The patient underwent cervical evacuation and balloon tamponade to stop bleeding. Cervical ectopic pregnancies are rare and often misdiagnosed as miscarriages due to similar symptoms. Early diagnosis using ultrasound is important to guide appropriate treatment and prevent morbidity.
Assessment of Ureteroscopy During Pregnancy.docx4934bk
Ureteroscopy can be performed safely during pregnancy to diagnose and treat ureteral stones. The summary is:
1) Ureteroscopy allows direct visualization of the ureter and extraction or fragmentation of stones without the risks of radiation exposure, as compared to other imaging modalities.
2) In a study of 15 pregnant patients who underwent ureteroscopy, stones were successfully removed or fragmented and all pregnancies resulted in full-term deliveries without complications.
3) Ureteroscopy during pregnancy can be performed safely under sedation rather than general anesthesia using thin ureteroscopes, with close obstetric monitoring.
Diagnostic laparoscopy is a minimally invasive surgical
procedure that allows the visual examination of intraabdominal organs in order to detect any pathology. This
procedure allows the direct visual examination of intraabdominal organs including large surface areas of the
liver, gallbladder, spleen, peritoneum, pelvic organs, and
retroperitoneum. Biopsies, aspiration, and cultures can be
obtained, and laparoscopic ultrasound (US) may be used.
Diagnostic laparoscopy is safe and well tolerated and
can be performed in an outpatient or inpatient setting
under general anesthesia (Fig. 1A). There may also be
unique circumstances where office based diagnostic
laparoscopy may be considered under local anesthesia.
These circumstances should include only procedures where
complications and the need for therapeutic procedures
through the same access are extremely unlikely. Manipulation
and biopsy of the viscera is possible through additional ports.
Diagnostic laparoscopy is the most commonly performed
gynecological procedure today. Its greatest advantage is that
it has replaced exploratory laparotomy.
Diagnostic laparoscopy was first introduced in 1901,
when Kelling, performed a peritoneoscopy in a dog and was
called ‘‘celioscopy’’. A Swedish internist named Jacobaeus is
credited with performing the first diagnostic laparoscopy on
human in 1910. He described its application in patients with
ascites and for the early diagnosis of malignant lesions.
In last 10 years, laparoscopy has made a great difference
to the diagnosis of abdominal acute and chronic pain. It
has evolved as an informative and important method of
diagnosing a wide spectrum of both benign and malignant
diseases. Exploratory laparoscopy also allows tissue
biopsy, culture acquisition, and a variety of therapeutic
interventions. Elective diagnostic laparoscopy refers to the
use of the procedure in chronic intra-abdominal disorders.
Emergency diagnostic laparoscopy is performed in patients
presenting with acute abdomen
Diagnostic laparoscopy allows direct visual examination of intra-abdominal organs through minimally invasive surgery. It can detect pathology, obtain biopsies and cultures, and diagnose conditions like appendicitis, diverticulitis, ovarian cysts, and ectopic pregnancy. Key advantages are that it is safe, well-tolerated, and has replaced more invasive exploratory laparotomy. Diagnostic laparoscopy provides accurate diagnosis of conditions presenting with abdominal pain or ascites, correcting clinical diagnoses in some cases. It allows evaluation of conditions affecting female fertility through examination of pelvic organs and tubal patency assessment.
There is an increasing incidence of cesarean scar defect. This article will discuss and show different and variable sonographic presentations of scar niches and uterine postpartum ultrasonography with vaginal birth after cesarean section that can be confusing and many should be unaware of. This brief review aims to help practitioners to avoid confusion and be aware and acquainted with the different sonographic findings encountered in practice related to cesarean scar. It can lead to uterine rupture I labour, dehiscence in pregnancy and placenta accreta in the future pregnancy, but this is not evidence-based and not even a contraindication for pregnancy. It is neither an indication of repair for the presenting patient nor an indication to screen these patients for such complications. It is treated if associated with infertility or bleeding and not in asymptomatic ones.
1. Midurethral slings are now the gold standard treatment for stress urinary incontinence, replacing pubovaginal slings.
2. Pubovaginal slings are placed at the bladder neck and can be effective for various types of SUI but have higher risks than midurethral slings.
3. Midurethral slings are typically placed at the midurethra using either a retropubic or transobturator approach and have better subjective cure rates than pubovaginal slings.
This document describes a case study of a 48-year-old woman who presented with a large perianal tumor arising from long-standing perianal endometriosis in an episiotomy scar. She underwent wide excision surgery to remove the tumor, which was diagnosed as endometrioid adenocarcinoma. This resulted in a large perineal and perianal defect. The defect was reconstructed immediately using an inferior gluteal artery perforator (IGAP) flap. The IGAP flap provided good functional and aesthetic results for perianal reconstruction after tumor excision. The patient recovered well post-operatively with no complications or tumor recurrence after one year.
Laparoscopic ovarian surgery can be used to manage most ovarian abnormalities. Key steps in laparoscopic ovarian cystectomy include aspirating cyst contents, stripping the cyst capsule from the ovarian cortex, and extracting the capsule. It is important to avoid injury to nearby structures like the ureter and completely remove the cyst to evaluate for early carcinoma. Outcomes are better when the ovary can be preserved through cystectomy rather than full oophorectomy. Teratomas require especially careful removal of all contents to prevent chemical peritonitis.
An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. Transvaginal ultrasound is the primary investigation to diagnose ectopic pregnancies. On ultrasound, ectopic pregnancies may appear as an inhomogeneous adnexal mass, empty extrauterine sac, yolk sac, or pseudosac. Serum hCG levels and ultrasound findings are used to determine management, whether surgical, medical, or expectant. Rare sites of ectopic implantation include the cervix, caesarean scar, interstitial portion of the fallopian tube, and ovaries.
This document discusses three cases of postpartum uterine dehiscence treated conservatively. Each case involved a woman who had undergone a cesarean section and later presented with abdominal pain and vaginal discharge. Ultrasound revealed uterine dehiscence and fluid collections in each case. The women were treated with intravenous and then oral antibiotics and monitored weekly with ultrasound and clinical parameters. In each case, the collections resolved and the dehiscence healed over 1-3 weeks without need for surgery. The document concludes that for uterine dehiscence cases without active bleeding or severe infection, conservative treatment with antibiotics can be an appropriate approach.
Abdominal Wall Endometrioma: A Diagnostic Enigma—A Case Report and Review of ...KETAN VAGHOLKAR
Background. Abdominal wall endometriomas are quite uncommon. They are usually misdiagnosed by both the surgeon and the
gynaecologist. Awareness of the details of this rare condition is therefore essential for prompt diagnosis and adequate treatment.
Introduction. Endometriosis though a condition commonly seen in the pelvic region can also occur at extrapelvic sites giving
rise to a diagnostic dilemma. Abdominal wall endometrioma is one such complex variant of extrapelvic endometriosis with an
incidence of less than 2% following gynaecologic operations. Case Report. A case of abdominal wall endometrioma diagnosed
clinically and treated by wide surgical resection is presented to highlight the importance of clinical evaluation in the diagnosis of
this condition. Discussion. The etiopathogenesis, presentation, investigations, and management are discussed briefly. Conclusion.
Clinical evaluation confirmed by supportive imaging is diagnostic.Wide local excision is the mainstay of treatment.
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.
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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
1. 1
MIGRANT IUCD
ABSTRACT
In a developing country like India where population census is crossing the limits,
contraceptive methods are the necessary measures for the population control.
Intrauterine Contraceptive devices (IUCDs) are the second most commonly used method
of contraception after sterilization. Misplaced IUCDs usually present with the missing
thread and remain asymptomatic in most of the cases.
INTRODUCTION
Intrauterine devices (IUCDs) are a commonly used form of contraception
worldwide. However, migration of the IUCD from its normal position in the
uterine fundus is a frequently encountered complication, varying from uterine
expulsion to displacement into the endometrial canal to uterine perforation.
Different sites of IUCD translocation vary in terms of their clinical significance
and subsequent management, and the urgency of communicating IUCD migration
to the clinician is likewise variable. Expulsion or intrauterine displacement of the
IUCD leads to decreased contraceptive efficacy and should be clearly
communicated, since it warrants IUCD replacement to prevent unplanned
pregnancy. Embedment of the IUCD into the myometrium can usually be
managed in the outpatient clinical setting but occasionally requires hysteroscopic
removal. Complete uterine perforation, in which the IUCD is partially or
completely within the peritoneal cavity, requires surgical management, and timely
and direct communication with the clinician is essential in such cases. Careful
evaluation for intra abdominal complications is also important, since they may
warrant urgent or emergent surgical intervention. The radiologist plays an
important role in the diagnosis of IUCD migration and should be familiar with its
appearance at multiple imaging modalities.
CASE REPORT
CASE 1
A case of P2L2, last child birth 9years back. IUCD inserted in postpartum period.
Now patient came for IUCD removal and sterilisation. Patient is asymptomatic. Referred as
a case of misplaced IUCD to our department. We done a X ray abdomen in our department
which shows radioopaque IUCD in higher abnormal position and orientation within the
pelvis(Fig.1). Following that, Ultra sonogram was performed showing vertical limb of
IUCD piercing the uterus at the fundal region and horizontal limb lies over the outer
surface of uterus(Fig.2 & 3) . Similar findings confirmed by CT(Fig.4). Peroperatively
identification of horizontal limb outside the uterus which was held by artery forceps and
IUCD removed successfully by laparatomy(Fig.5)
2. 2
FIG.2-4: VERTICAL LIMB OF IUCD PIERCING THE UTERUS AT THE FUNDAL REGION AND
HORIZONTAL LIMB LIES OVER THE OUTER SURFACE OF UTERUS
FIG.1: RADIOOPAQUE IUCD
NOTED HIGH IN THE PELVIS
SHOWING ABNORMAL POSITION
AND ORIENTATION
3. 3
FIG.5: PEROPERATIVELYIDENTIFICATION OFHORIZONTALLIMBOUTSIDE THE UTERUS WHICH WASHELD
BY ARTERY FORCEPSAND IUCD REMOVED SUCCESSFULLY BY LAPARATOMY
CASE 2
A case of P1L1 , Last child birth 8 years back by LSCS. IUCD inserted in immediate
post-operative period. Patient complains of lower abdominal pain for 1 month. Referred as a
case of misplaced IUCD to our department. X ray with uterine sound shows radio opaque
IUCD noted in pelvis in upside down orientation and far away from uterine sound(Fig.6).
USG was done subsequently. Uterine cavity is free, IUCD is seen outside the uterine cavity,
vertical limb is seen in superior aspect of fundus, horizontal limb is seen piercing the adjacent
bladder wall(Fig.7 & 8). Planned for cystoscopy and IUCD removal done successfully(Fig.9
& 10).
4. 4
FIG.7 & 8: IUCD IS SEEN OUTSIDE THE UTERINE CAVITY,VERTICALLIMB IS SEEN IN SUPERIORASPECT
OF FUNDUS, HORIZONTALLIMB IS SEEN PIERCINGTHE ADJACENTBLADDER WALL
Fig.9 & 10: CYSTOSCOPICVISUALISATION OFCu-TINSIDETHE URINARY BLADDER.
FIG.6: IUCD NOTED IN PELVIS IN
UPSIDE DOWN ORIENTATION
AND FAR AWAY FROM UTERINE
SOUND
5. 5
CASE 3
21 year female,P1L1, last child birth 3 years back by LSCS. IUCD inserted in immediate
postpartum period. Now came for IUCD removal and had minimal lower abdominal pain.
Referred as misplaced IUCD to our department. Xray with uterine sound shows radio opaque
IUCD noted in pelvis which was in close approximation to upper end uterine sound(Fig.11). Usg
abdomen & pelvis shows IUCD which is not within endometrial cavity and it is seen piercing the
myometrium(Fig.12 & 13). Subsequently CT performed and confirmed the findings(Fig.14-16).
Then patient planned for Hysteroscopic examination and removal of IUCD done at same sitting
without major adverse effects.
Fig.12 & 13: AXIALANDSAGITAL SECTIONSOFUTERUS SHOWS IUCD BURIED IN MYOMETRIUM WITH
EMPTY ENDOMETRIAL CAVITY.
FIG.11: IUCD NOTED IN PELVIS
WHICH WAS IN CLOSE
APPROXIMATION TO UPPER END
UTERINE SOUND
6. 6
Fig.14 & 15: CT IMAGING - AXIALANDSAGITALSECTIONSOF UTERUS SHOWS IUCD BURIED IN
MYOMETRIUM WITH EMPTY ENDOMETRIAL CAVITY.
CASE 4
29 year female,P2L2, LSCS done 5 months back, IUCD inserted in postpartum period.
Patient complains of pain during menstruation and menorrhagia . Xray shows IUCD within
pelvis close to uterine sound with abnormal angulation(Fig.17). Subsequently USG
performed, endometrial cavity appears empty, vertical limb of IUCD embedded within the
FIG.16: 3D –VOLUME RENDERINGTECHNIQUE SHOWS
RELATIVEPOSITION OFCu-T IN PELVIS
7. 7
myometrium(Fig.18 & 19). Then hysteroscopic removal of IUCD done in a single sitting
without major adverse effects.
FIG.18 & 19: SHOWS USG APPEARANCE OF EMBEDDED Cu-T IN MYOMETRIUM.
DISCUSSION
IUCDs are the most acceptable, safe, efficacious, reversible and widely used
contraceptive method but it may be associated with menorrhagia, irregular bleeding, pelvic
inflammatory diseases, ectopic pregnancy and silent uterine perforation. The reported
incidence of the transmigration of the IUCD from the uterus to the neighbouring organs is 1-
3/1000 IUCD insertions.
The incidence of transmigration is affected by the several factors which includes
parity, timing of IUCD insertion, uterine position, past history of abortions, type of IUCD and
the operator experience. Out of these risk factors, chance of uterine perforation is maximum
at the time of IUCD insertion. Moreover the incorrect positioning of the IUCD is the result of
faulty technique and insertion by insufficiently trained staff. Review of the literature
FIG.17: SHOWS IUCD WITHIN PELVIS
CLOSE TO UTERINE SOUND WITH
ABNORMAL ANGULATION
8. 8
suggested various mechanisms for the migration of IUCDs which includes the faulty insertion
technique or the chronic inflammatory process due to the copper content of the IUCDs which
leads to the erosion of the uterine wall. Copper-containing devices are known to cause
massive tissue response and thus leading to complications once lying in the peritoneal cavity.
The complete extrusion of the IUCD through myometrium is facilitated by the uterine
contractions and the pressure difference between the uterine (high) and the peritoneal cavity
(low).The movement and the migration in the peritoneal cavity is facilitated by the
contractions of the abdominal organs i.e. urinary bladder, intestine as well as movement of
the peritoneal fluid.
Patient with the misplaced IUCD remain asymptomatic in 85% of cases and there is
no effect on the adjacent organs. But in 15% of the cases it may present with unwanted
pregnancy, irregular vaginal bleeding and abdominal pain. Dangerous complications
associated with the misplaced IUCD include bowel perforation, rectovaginal fistula, rectal
strictures, bladder perforation, bowel obstruction, appendiceal perforation and mesenteric
perforation.
Removal of misplaced IUCD is desirable even if the patient is asymptomatic so that
the future complications like perforation of the adjacent organs or any fistula development
can be avoided. WHO also advocates the removal of the misplaced or malpositioned IUCD
because of the risk of injury to the adjoining organs and medicolegal issues
Various imaging modalities are used in the evaluation of IUCDs. US is
appropriate for initial evaluation; it is widely available and inexpensive and does not
involve radiation. Furthermore, US can often provide answers to clinical questions
related to the IUCD. It easily helps determine whether an IUCD is correctly
positioned and can often help identify IUCD-related complications. IUCD
displacement and myometrial perforation can be fully evaluated by performing US
alone. Three-dimensional (3D) US is often helpful for further characterizing these
findings, and its use is becoming standard practice in the routine evaluation of
IUCDs.
Abdominal radiography can be helpful in demonstrating an extrauterine IUCD
and is required for the diagnosis of IUCD expulsion. Conventional radiography
exposes the patient to only minimal radiation, and the radiopaque IUCD is easily
identified if it has not been expelled. Occasionally, computed tomography (CT) is
used for the assessment of IUCD positioning; more often, however, IUCDs are
incidentally visualized at CT studies that were ordered for different indications . CT
is the best modality for the evaluation of complications associated with intra
abdominal IUCDs, such as visceral perforation, abscess formation, and bowel
obstruction. However, CT does expose the patient to significantly more radiation.
Magnetic resonance (MR) imaging is not typically used specifically for the
evaluation of intrauterine contraception, but modern IUCDs are safely imaged with
both 1.5-T and 3.0-T magnets and appear as signal voids.
Endoscopic procedures have emerged as a preferred modality for the removal of all
types of misplaced or malpositioned IUCDs. Devices in the uterine cavity or partially
embedded in the myometrium can be easily dealt with the hysteroscopy. Misplaced IUCDs
anywhere in the abdomen can be managed with the laparoscopy and in very few cases of
misplaced IUCD's laparotomy is required.
9. 9
FLOW CHART ILLUSTRATES AN OVERVIEW OF IMAGING-BASED MANAGEMENT OF
TRANSLOCATED IUDS.
CONCLUSIONS
IUCDs are a widely used method of contraception with inherent risks that the
radiologist should understand both radiologically and clinically. Multiple imaging
modalities can be used to evaluate an IUCD, but US is appropriate for initial
evalua- tion. Conventional radiography of the abdomen is used to assess the
location of an IUCD when it is not clearly visualized at US. CT is the most use- ful
modality for identifying complications of an intra abdominal IUCD.
The radiologist should make sure to communicate any findings of IUCD
malpositioning to the clinician. Detection of expulsion or displacement should be
immediately communicated to the patient and her healthcare provider, since they can
lead to decreased contraceptive efficacy and may require further management.
Embedment of an IUCD in the myometrium may necessitate intervention in the
outpatient clinical setting and warrants communication of this finding to the referring
clinician, as well as clear documentation in the radiology report. Timely and direct
communication with the clinician is most urgent for those patients with complete
uterine perforation and partial or complete protrusion of the IUCD into the
peritoneal cavity. Patients with an uncomplicated perforation will likely undergo
10. 10
laparoscopic removal of the IUCD. Early surgical intervention appears to decrease
the likelihood of adhesion formation, thereby making laparoscopic removal easier.
Emergent surgical intervention should be guided by the patient’s clinical
presentation, supplemented by findings at crosssectional imaging performed to
detect serious intra abdominal complications.
It is also important to understand the complications associated with pregnancy
in females with an IUCD. Such pregnancies are associated with multiple adverse
outcomes for the mother and fetus. Understanding these complications will allow a
more thorough assessment of the study and may provide impetus for expedited
clinical communication of pertinent findings.
References
1. Speroff L, Darney PD. A clinical guide for contra- ception. 3rd ed.
Philadelphia, Pa: Lippincott Wil- liams & Wilkins, 2001.
2. Moschos E, Twickler DM. Does the type of intra- uterine device affect
conspicuity on 2D and 3D ultrasound? AJR Am J Roentgenol 2011;196(6):
1439–1443.
3. Rivera R,Yacobson I, Grimes D. The mechanism of action of hormonal
contraceptives and intrauter- ine contraceptive devices. Am J Obstet Gynecol
1999;181(5 pt 1):1263–1269.
4. Ortiz ME, Croxatto HB. Copper-T intrauterine device and levonorgestrel
intrauterine system: bio- logical bases of their mechanism of action. Contra-
ception 2007;75(6 suppl):S16–S30.
5. Sivin I, Schmidt F. Effectiveness of IUDs: a review. Contraception
1987;36(1):55–84.
6. Sivin I, Stern J. Health during prolonged use of levonorgestrel 20
micrograms/d and the copper TCu 380Ag intrauterine contraceptive
devices: a multicenter study. International Committee for Contraception
Research (ICCR). Fertil Steril 1994;61(1):70–77.
7. Gunbey HP, Sayit AT, Idilman IS, Aksoy O. Migration of intrauterine devices with
radiological findings: report on two cases. BMJ case reports.
2014;2014:bcr2013202522/.
8. Sankareswari R, Indira, Geetha K, Vani S. Misplaced and Migrated IUCD: A case
report. J Evol Med Dent Sci. 2014;3(25):7031-5.
9. Nigam A, Ahmad A, Gupta N, Kumari A. Malpositioned IUCD: the menace of
postpartum
10. IUCD insertion. BMJ Case Rep. 2015;2015:bcr2015211424.
11. Sinha M, Gupta R, Tiwari A. Minimally invasive surgical approach to retrieve
migrated intrauterine contraceptive device. Int J Reprod Contracept Obstet Gynecol.
2013;2:147-51.
12. Krupa BM, Manjula, Swarup A. Case report: misplaced copper-T device. Int J Sci
Res. 2015;4(6):2229-30.
13. Hillary E. Boortz, MD • Daniel J. A. Margolis, MD • Nagesh Ragavendra, MD •
Maitraya K. Patel, MD • Barbara M. Kadell, MD-RadioGraphics 2012; 32:335–
352 • Published online 10.1148/rg.322115068 •