scholarly journals A Preliminary Study to Propose an Algorithm for Management of Cesarean Scar Pregnancy

2020 ◽  
Vol 9 (4) ◽  
pp. 258-262
Author(s):  
Azam Tarafdari ◽  
Sedigheh Borna ◽  
Sheida Janatrostami ◽  
Sedighe Hantoushzadeh ◽  
Fatemeh Keikha
Keyword(s):  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Cesarean Scar Pregnancy ◽  
Fetal Reduction ◽  
Cesarean Scar ◽  
Beta Human Chorionic Gonadotropin ◽  
Median Period ◽  
Β Hcg ◽  
Age Range

Objectives: There is no consensus on the management of cesarean scar pregnancy (CSP). In this regard, this study proposed an algorithm for CSP management with consecutive outcomes. Materials and Methods: In this randomized clinical trial study, the data of 44 patients with CSP were collected, and the diagnosis was confirmed by transvaginal ultrasonography (TVS). Unstable patients underwent uterine artery embolization (UAE), and the fetal reduction was done for patients with the fetal heart rate (FHR). In addition, patients received systemic methotrexate (MTX) injections according to their beta-human chorionic gonadotropin (β-hCG) levels and then were followed on a predetermined schedule by β-hCG levels and TVS. Finally, prophylactic UAE was considered for patients with ongoing bleeding, placental hypervascularity, and the prospect of limited access to care. Results: Patients were within the age range of 33.9±4.9 years and the gestational age of 7.37±1.57 weeks. Twenty-two patients (50%) had vaginal bleeding, 3 of whom were unstable and underwent UAE. Five patients underwent a total abdominal hysterectomy, and fourteen patients with FHR underwent a fetal reduction. Based on β-hCG levels and changes, and placental vascularity, 4 patients received no treatment. In general, 11, 2, and 9 patients received single, double, and multiple MTX injections. A total of 10 patients underwent both multi-doses of MTX and prophylactic UAE. The median period to reach undetectable β-hCG levels was 7.3 weeks and the median interval to start menstruation was 2.8 weeks. In addition, the pregnancy remnant was resolved 3.6 months after the treatment. On the follow-up, no curettage or hysterectomy was needed and seven patients became pregnant (15.9%), 2 of whom presented recurrent CSP (28.6%). Conclusions: The proposed stepwise algorithm could be employed for CSP management with accountable outcomes, low hysterectomy rates, and fertility preservation.

Medical Treatment in Cesarean Scar Pregnancy with Fetal Heart Activity and High Level of Serum β-hCG: A Case Report

2020 ◽  
Vol 16 ◽  
Author(s):  
Nafiseh Saghafi ◽  
Leila Pourali ◽  
Atiyeh Vatanchi ◽  
Zahra Rastin
Keyword(s):  
Medical Treatment ◽  
Fetal Heart ◽  
High Serum ◽  
Heart Activity ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Beta Human Chorionic Gonadotropin ◽  
Positive Pregnancy Test ◽  
Β Hcg ◽  
High Level

Background : Cesarean scar pregnancy (CSP) is the implantation of the gestational sac in the hysterotomy scar. The optimal treatment for a cesarean scar pregnancy is unclear and therapy should be selected according to the patients' clinical presentation. The aim of this study was reporting a successful medical treatment of a cesarean scar pregnancy with fetal heart activity and a very high level of beta human chorionic gonadotropin (β-hCG). Case Presentation: A 38-year-old woman referred for routine prenatal visit after 2 months of menstrual retard and positive pregnancy test. She had the history of 3 cesarean sections and a uterine curettage. Untrasonography revealed cesarean scar ectopic pregnancy. The serum level of β-hCG was 109063 mIU/ml. Two doses of systemic methotrexate therapy and intragestational sac injection of methotrexate and potassium chloride were administered. 8 weeks after the initial treatment, β-hCG level became undetectable. Conclusion: Combined medical treatment with local and systemic MTX administration may be a successful treatment with low complication even in the presence of high serum β-hCG level.

scholarly journals A Rare Case of Life-Threatening Invasive Mole

2018 ◽  
Vol 1 (2) ◽  
pp. 53-55
Author(s):  
Rajiv Shah ◽  
A.M. Samal
Keyword(s):  
Acute Abdominal Pain ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Emergency Laparotomy ◽  
Partial Mole ◽  
Life Threatening ◽  
Β Hcg ◽  
Invasive Mole ◽  
Uterine Fundus

A 23-year-old female with a known case of partial mole and under hCG follow up presented with acute abdominal pain and signs of hemoperitoneum. Emergency laparotomy revealed a molar pregnancy perforating through the uterine fundus, resulting in massive haemoperitoneum of 4 litres. Total abdominal hysterectomy was done. The serum β-hCG level regressed following hysterectomy.

scholarly journals P16.06: Cesarean scar pregnancy: diagnosis, treatment and sonohysterography follow up. A case report

2013 ◽  
Vol 42 (s1) ◽  
pp. 173-173
Author(s):  
P. Piekarski ◽  
T. Maciejewski ◽  
A. Olszewski ◽  
K. Opuchlik ◽  
B. Mikulska ◽  
...  
Keyword(s):  
Case Report ◽  
Cesarean Scar Pregnancy ◽  
Pregnancy Diagnosis ◽  
Cesarean Scar

scholarly journals A Rare Case of Epithelioid Trophoblastic Tumor Presenting as Hematoma of a Caesarean Scar in the Lower Uterine Segment

Medicina ◽  
2021 ◽  
Vol 58 (1) ◽  
pp. 34
Author(s):  
Radomir Aničić ◽  
Aleksandar Rakić ◽  
Rastko Maglić ◽  
Dragutin Sretenović ◽  
Aleksandar Ristić ◽  
...  
Keyword(s):  
Normal Values ◽  
Color Doppler ◽  
Color Doppler Imaging ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Doppler Imaging ◽  
Peripheral Blood Flow ◽  
Trophoblastic Tumor ◽  
Trophoblastic Cells ◽  
Beta Human Chorionic Gonadotropin

Epitheliod trophoblastic tumor (ETT) account for only 1–2% of all the cases of gestational trophoblastic neoplasia (GTN), with a reported mortality rate of 10–24%. ETT is derived from chorionic type intermediate trophoblastic cells, which appears to be the reason for the only slightly elevated βhCG levels in these patients. We present a case of a 42-year-old patient who was admitted to the clinic eight months after Caesarean delivery, for irregular vaginal bleed with normal values of beta-human chorionic gonadotropin (βhCG). A 6 × 5 cm hematoma was evacuated from the isthmic uterine segment during the operation, and the histopathological exam of the tissue surrounding the hematoma revealed ETT. There were no metastatic lesions on the thoracal, abdominal, and pelvic CT. The second ultrasonographic exam revealed tumefaction of 5 cm at the site from the previous surgical procedure. Color Doppler imaging revealed no central nor peripheral blood flow. The patient underwent a total abdominal hysterectomy with bilateral adnexectomy without adjuvant chemotherapy. This appears to be one of the shortest intervals from the anteceded gestational event until the diagnosis of this tumor, along with the absence of the significant ultrasonographic feature of the ETT-peripheral Doppler signal pattern. We underline that, even with normal values of βhCG, irregular vaginal bleeding following the antecedent gestational event should always arouse suspicion of GTN.

scholarly journals Vesico-Vaginal Fistula Repair Through Abdominal Approach

KYAMC Journal ◽  
2020 ◽  
Vol 11 (3) ◽  
pp. 129-132
Author(s):  
Hafiz Al Asad ◽  
Asif Yazdani ◽  
Zulfia Zinat Chowdhury ◽  
Muhammad Faruk Hussain ◽  
AKM Shahadat Hossaion ◽  
...  
Keyword(s):  
Wound Infection ◽  
Operative Time ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Pelvic Surgery ◽  
Vaginal Fistula ◽  
Abdominal Approach ◽  
History Of ◽  
Vesico Vaginal Fistula

Background: Vesico-Vaginal Fistula (VVF) is a major cause for concern in many developing countries with significant morbidity. Among the different techniques abdominal approach of VVF repair is important one. Objective: To find out the outcome of VVF repair by abdominal approach. Materials and Methods: It is a prospective study. Twenty-three patients with VVF were operated with abdominal approach from the period of January 2016 to January 2019. Age of patients, co-morbidities, cause, size and location of VVF were evaluated. Then abdominal approach of VVF repair was done. Operative time and need of blood transfusion were encountered. Post operative (POD) urine leakage, wound infection or other complications were enlisted. Patients were discharged with keeping urethral catheter for 14 days. Follow up was done after 1 and 3 month and in each follow up history and physical examination was done. All collected data were evaluated. Results: Mean age of the patient was 40 years. Among the 23 patients 12 (52%) patients had history of total abdominal hysterectomy, 9 had history of caesarian section and 2 cases had history of pelvic surgery. VVF repair was done at least 12 weeks after its occurrence. Operative time ranged from 90 minutes to 150 minutes. In the immediate POD no obvious complications were noted except one patient developed wound infection on 7th POD. Follow-up done as per schedule and no recurrence of VVF noted. Conclusion: VVF repair through abdominal approach is a feasible, safe and effective technique if performed meticulously. KYAMC Journal Vol. 11, No.-3, October 2020, Page 129-132

scholarly journals A Novel Case of Fibroids after Menopause

2018 ◽  
Vol 2018 ◽  
pp. 1-2
Author(s):  
Jade Edwards ◽  
Hamza Katali
Keyword(s):  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Younger Women ◽  
Benign Pathology ◽  
Leiomyomatosis Peritonealis Disseminata ◽  
Long Term Follow Up ◽  
Risk Of Malignancy ◽  
Risk Of Malignancy Index

Fibroids are a condition commonly seen as part of routine gynaecological practice and generally present with menorrhagia, infertility, or pressure symptoms depending on their exact location. We report the case of a postmenopausal 57-year-old lady presenting with left-sided pain and frequency with a complex 15 cm mass mid pelvis and an adjacent additional 7 cm cyst but a risk of malignancy index suggesting benign pathology. She underwent total abdominal hysterectomy (TAH) and right-sided salpingo-oophrectomy (RSO) on recommendation of the multidisciplinary team (MDT) and histology confirmed leiomyomatosis peritonealis disseminata. This rare but important condition is often confused with peritoneal carcinomatosis on imaging. The mainstay of treatment involves lesion and omental excision followed by removal of hormonal stimuli although this approach must be personalised as many younger women may wish to retain their uteri. Long-term follow-up is essential due to the potential for malignant transformation.

Impact of treatment strategies on local control and survival in uterine carcinosarcomas.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16526-e16526
Author(s):  
Selim Yalcin ◽  
Omer Dizdar ◽  
Nadire Kucukoztas ◽  
Samed Rahatli ◽  
Ozlem Ozen ◽  
...  
Keyword(s):  
Uterine Cancer ◽  
Treatment Strategies ◽  
Stage Iv ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Uterine Carcinosarcoma ◽  
Treatment Regimens ◽  
Stage Iv Disease ◽  
Standardized Treatment

e16526 Background: Carcinosarcoma is a biphasic neoplasm composed of a mixture of malignant epithelial and mesenchymal components. Uterine carcinosarcomas comprise only 3% of all uterine malignancies, however they account for a disproportionally higher rate of mortality from uterine cancer because of their agressive nature. No standardized treatment has yet been established. The purpose of this study was to determine the clinical characteristics, patterns of recurrence and survival outcomes in patients with uterine carcinosarcoma treated in our institution. Methods: Records of the patients with uterine carcinosarcoma were retrospectively evaluated and 29 pts with carcinosarcoma diagnosed between 2007 and 2012 were identified. All patients were initially treated surgically by the same surgeon with comprehensive staging, i.e. total abdominal hysterectomy, bilateral salphingooopherectomy , bilateral pelvic and paraaortic lymph node dissection and omentectomy. Demographic features, tumor characteristics, treatment regimens and patient outcomes in terms of relapse-free survival (RFS) and overall survival (OS) were analyzed. Results: Median age was 63 (range 43-78). 13 patients (45%) had stage I disease, 5 patients (17%) had stage III and 11 patients (38%) had stage IV disease at diagnosis. Median tumor size was 6 cm (range 1.7-20 cm) and lymphovascular invasion was present in 17 patients 59%). Twenty patients (69%) received chemotherapy (90% with paclitaxel and carboplatin) for 6 cycles. One patient received radiotherapy. Median follow up was 13 mos. Seventeen patients (59%) relapsed and 20 patients (69%) died on follow up. Two patients had vaginal cuff recurrence, 4 had pelvic, 4 had abdominal and 7 had distant recurrences. All recurrences were fatal. 3 year RFS was 31%. 3 year OS was 15%. Conclusions: Our data show that uterine carcinosarcomas tend to be more at more advanced stage at diagnosis and despite the use of chemotherapy and radiotherapy, overall prognosis is poor. Surgery remains the mainstay of treatment. More effective adjuvant strategies are needed to reduce relapse and death rates because recurrences are generally fatal.

scholarly journals Supraclavicular Lymphadenopathy: Initial Manifestation of Metastasis in Carcinoma of Cervix

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Mutahir A. Tunio ◽  
Mushabbab Al Asiri ◽  
Reham Mohamed ◽  
Sadeq Al-Dandan
Keyword(s):  
Lymph Nodes ◽  
Case Reports ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Initial Manifestation ◽  
Cervical Lymph Nodes ◽  
Supraclavicular Lymph Nodes ◽  
Carcinoma Of Cervix ◽  
Rare Site

Introduction. Carcinoma of cervix rarely metastasizes to cervical lymph nodes and is associated with poor prognosis. To date, only few case reports have been reported in the medical literature. Here, we report a case of this unusual manifestation of carcinoma of cervix.Case Presentation. A 39-year-old Saudi woman who was treated three years ago for bulky IB stage carcinoma of cervix with total abdominal hysterectomy and bilateral salpingo-oophorectomy and adjuvant chemoradiation presented to us during her routine follow-up visit with left supraclavicular lymphadenopathy. Staging workup revealed additional para-aortic nodal and osseous metastases. The biopsy of left supraclavicular mass confirmed the diagnosis of carcinoma of the cervix. Patient was started on chemotherapy and bisphosphonates.Conclusion. Supraclavicular lymph nodes are a rare site of metastasis in carcinoma of cervix, and this can be explained by outlining the drainage of the lymphatic system from the cervix. Supraclavicular lymphadenopathy is associated with variable prognosis.

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