Successful organ-sparing surgical treatment in a patient with the placenta previa growing into the uterine scar region

Our statistical analysis, based on ultrasound examination of 7069 pregnant women, showed that both in the absence and in the presence of a scar on the uterus in the region of its lower segment, the placenta in the 3rd trimester of pregnancy was located extremely rarely, only in 0.1%. It was either primarily located in other parts of the uterus, or migrated from the lower segment of the uterus towards the bottom. In the case of the location of the placenta in this area, its ingrowth was not observed only in 2.3% of women. The main ultrasound signs of ingrowth of the placenta into the scar was the absence of its migration, as well as the presence of a combination of placenta previa with its localization in the scar zone. From the data obtained, it follows that the sensitivity of ultrasound diagnosis of placental accreta was 97.7%, and the specificity was 99.9%. According to our data, ingrown placenta in most cases can be delivered as early as 14–19 weeks, and the time spent on detecting this pathology usually does not exceed one minute.

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Organ-sparing surgical treatment for early cervical cancer

Akusherstvo i ginekologiia ◽

10.18565/aig.2019.1.154-160 ◽

2019 ◽

Vol 1_2019 ◽

pp. 154-160

Author(s):

Bakhtiyarov K.R. Bakhtiyarov ◽

Yudina A.I. Yudina ◽

Raikova A.A. Raikova ◽

Keyword(s):

Cervical Cancer ◽

Surgical Treatment ◽

Organ Sparing ◽

Early Cervical Cancer

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Various Types of Niche Imaging by Sonohysterography: A Pictorial Review

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1369 ◽

2014 ◽

Vol 8 (3) ◽

pp. 311-315 ◽

Cited By ~ 3

Author(s):

Firoozeh Ahmadi ◽

Farnaz Akhbari ◽

Fatemeh Niknejad

Keyword(s):

Cesarean Section ◽

Transvaginal Ultrasound ◽

Subsequent Pregnancy ◽

Previous Cesarean Section ◽

Cesarean Section Delivery ◽

Cesarean Scar ◽

Pictorial Review ◽

Scar Region ◽

Uterine Scar ◽

Previous Cesarean

ABSTRACT Cesarean scar defects (CSD) or niche are the myometrial discontinuity at the previous cesarean section scar region. Recently cesarean section delivery has been raised around the world markedly; therefore women with cesarean scar defects are increased and present in up to 19% of women post cesarean section. The increase of repeat cesarean section has been associated with an increase in complications in subsequent pregnancies such as scar pregnancy with life threatening bleeding, uterus rupture, placenta accreta and its subtypes and prolonged postmenstrual Spotting. The deeper the niche (or the thinner the overlying myometrium), the higher the risk for complications in a subsequent pregnancy. Although the ability of transvaginal ultrasound (TVUS) to detect cesarean scars remains unknown, its higher frequency and proximity to the pelvic organs have been used as a powerful tool for detecting the uterine scar of a previous cesarean section. Recently with the increasing use of sonohysterography (SHG) (transvaginal ultrasound with saline infusion) detection of scar defect has been enhanced frequently. How to cite this article Ahmadi F, Akhbari F, Niknejad F. Various Types of Niche Imaging by Sonohysterography: A Pictorial Review. Donald School J Ultrasound Obstet Gynecol 2014;8(3):311-315.

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Clinical outcomes of placenta previa with and without coverage of a uterine scar: A retrospective cohort study in a tertiary hospital

10.21203/rs.2.13946/v1 ◽

2019 ◽

Author(s):

Jiaming Rao ◽

Dazhi Fan ◽

Zixing Zhou ◽

Gengdong Chen ◽

Huiting Ma ◽

...

Keyword(s):

Cohort Study ◽

Postpartum Hemorrhage ◽

Retrospective Cohort ◽

Placenta Previa ◽

Fetal Distress ◽

Neonatal Outcomes ◽

Intraoperative Blood Loss ◽

Maternal And Neonatal Outcomes ◽

Uterine Scar ◽

Singleton Pregnancies

Abstract Background To compare the maternal and neonatal outcomes of placenta previa (PP) with and without coverage of a uterine scar in China. Methods A retrospective cohort study comparing all singleton pregnancies with PP was conducted at a tertiary, university-affiliated medical center between January 2012 and April 2017. Maternal and neonatal outcomes of PP with and without coverage of a uterine scar were compared. Results There were 58,062 deliveries during the study period, of which 738 (1.27%) were complicated PP in singleton pregnancies and were further classified into two groups: the PP with coverage of a uterine scar group (PPCS, n=166) and the PP without coverage of a uterine scar group (Non-PPCS, n=572). Overall, the PPCS group had poorer maternal and neonatal outcomes for premature birth (< 37 weeks,68.1% vs 54.8%; P=0.010), cesarean section(100% vs 97.6%; P=0.042), Intraoperative blood loss > 1000 ml (78.3% vs 16.0%; P<0.001) or > 3000ml (29.5% vs 3.0%; P<0.001), postpartum hemorrhage(48.8% vs 15.7%; P<0.001), transfusion (35.2% vs 16.1%; P<0.001), hemorrhage shock(8.4% vs 1.9%; P<0.001), hysterectomy (3.0% vs 0.5%; P=0.006) and fetal distress (36.1% vs 12.0%; P<0.001) than the Non-PPCS group. In pregnancies complicated without abnormal invasive placenta (AIP, n=587), the PPCS group had poorer maternal and neonatal outcomes for Intraoperative blood loss > 1000 ml (69.0% vs 12.5%; P<0.001) or > 3000ml (9.2% vs 1.0%; P<0.001), bleeding within 2-24 hours after delivery (114.7±283.9 vs 47.7±45.1 ml, P<0.001), postpartum hemorrhage (70.1% vs 15.2%, P<0.001), transfusion (28.7% vs 13.6%, P<0.001) and fetal stress (35.6% vs 11.4%, P<0.001) than the Non-PPCS group. Conclusion The PPCS group had poorer maternal and neonatal outcomes than the Non-PPCS group. Women with PPCS were more likely to have intraoperative and postpartum hemorrhage, transfusion and fetal distress, even without AIP.

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Maternal and neonatal outcomes of placenta previa with and without coverage of a uterine scar: A retrospective cohort study in a tertiary hospital

10.21203/rs.3.rs-31117/v1 ◽

2020 ◽

Author(s):

Jiaming Rao ◽

Dazhi Fan ◽

Zixing Zhou ◽

Gengdong Chen ◽

Pengsheng Li ◽

...

Keyword(s):

Cohort Study ◽

Blood Loss ◽

Retrospective Cohort ◽

Placenta Previa ◽

Fetal Distress ◽

Neonatal Outcomes ◽

Intraoperative Blood Loss ◽

Maternal And Neonatal Outcomes ◽

Uterine Scar ◽

Singleton Pregnancies

Abstract Background To compare the maternal and neonatal outcomes of placenta previa (PP) with and without coverage of a uterine scar in Foshan, China. Methods A retrospective cohort study comparing all singleton pregnancies with PP was conducted at a tertiary, university-affiliated medical center from 1 January 2012 to 31 April 2017 in Foshan, China. Demographic, clinical and laboratory data were extracted from electronic medical records. Maternal and neonatal outcomes of PP with and without coverage of a uterine scar were compared by statistical method. Results There were 58,062 deliveries during the study period, of which 738 (1.27%) were complicated PP in singleton pregnancies and were further classified into two groups: the PP with coverage of a uterine scar group (PPCS, n = 166) and the PP without coverage of a uterine scar group (Non-PPCS, n = 572). Overall, premature birth (< 37 weeks,68.1% vs 54.8%; P = 0.010), cesarean section(100% vs 97.6%; P = 0.042), Intraoperative blood loss > 1000 ml (78.3% vs 16.0%; P < 0.001) or > 3000 ml (29.5% vs 3.0%; P < 0.001), postpartum hemorrhage(48.8% vs 15.7%; P < 0.001), transfusion (35.2% vs 16.1%; P < 0.001), hemorrhage shock(8.4% vs 1.9%; P < 0.001), hysterectomy (3.0% vs 0.5%; P = 0.006) and fetal distress (36.1% vs 12.0%; P < 0.001) had a significant difference between PPCS group and Non-PPCS group. After grouping by whether complicated with AIP, we found that PPCS was significant associated with more intraoperative blood loss༞1000 ml, intraoperative blood loss༞3000 ml, bleeding within 2–24 hours after delivery, fetal distress and higher hospitalization expenses than the Non-PPCS group. After grouping by whether complicated with AIP and different placenta positions(Anterior, Posterior and Ante-posterior or laterally positioned), we found that PPCS was significant associated with more intraoperative blood loss༞1000 ml and higher hospitalization expenses than the Non-PPCS in AIP women and more intraoperative blood loss༞1000 ml, postpartum hemorrhage and higher hospitalization expenses in Non-AIP women. Conclusion The PPCS group had poorer maternal and neonatal outcomes than the Non-PPCS group after grouping by whether pregnancies complicated with AIP or with different placental positions.

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Frequency, Complications and Outcomes of Myomectomy in Reproductive Age Women: Retrospective Analysis and Expert Opinion

Journal of Endometriosis and Pelvic Pain Disorders ◽

10.5301/jeppd.5000285 ◽

2017 ◽

Vol 9 (2) ◽

pp. 116-119 ◽

Cited By ~ 1

Author(s):

Alexander A. Popov ◽

Anton A. Fedorov ◽

Ekaterina A. Loginova

Keyword(s):

Surgical Treatment ◽

Retrospective Analysis ◽

Medical Center ◽

Uterine Fibroids ◽

High Technology ◽

Reproductive Age ◽

Newly Diagnosed ◽

Female Population ◽

Reproductive Age Women ◽

Uterine Scar

The incidence of uterine fibroid in the general female population is estimated at 20%-25%. In 2008, a study involving 145 gynecologists from a few large Russian cities demonstrated that the majority of the respondents had to handle from 10 to 30 (mean 20) women with fibroid every month. Only 28.8% of the patients had newly diagnosed uterine fibroids. Surgical treatment was recommended to 29.8% of the women. A few variants of myoma treatment are distinguished. Fortunately, over 40% of these tumors are asymptomatic. We performed a retrospective analysis of 218 patients submitted to myomectomy in our medical center between 2011 and 2013. In 149 cases (68%) myomectomy was conducted as a step of preparation for pregnancy. The pregnancy rate was 51.6%. A single (1.3%) complication in the form of uterine scar rupture was documented in week 34 of pregnancy. In our opinion, myomectomy is a high-technology operation that must be performed strictly based on the principle of “best” surgery for the “best” patient.

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Organ-sparing surgery in a patient with necrotic endometritis and an incompetent uterine scar after cesarean section

Rossiiskii vestnik akushera-ginekologa ◽

10.17116/rosakush201616480-84 ◽

2016 ◽

Vol 16 (4) ◽

pp. 80

Author(s):

N. A. Shchukina ◽

S. N. Buyanova ◽

M. A. Chechneva ◽

T. S. Budykina ◽

E. I. Blagina ◽

...

Keyword(s):

Cesarean Section ◽

Organ Sparing ◽

Uterine Scar

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Clinical Features and Follow-up Results of Sporadic Medullary Thyroid Carcinoma Patients Surgical Treatment

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1031 ◽

2010 ◽

Vol 1 (3) ◽

pp. 161-166

Author(s):

Anatoly F Romanchishen ◽

OV Lisovsky ◽

KV Vabalayte

Keyword(s):

Thyroid Cancer ◽

Surgical Treatment ◽

Survival Rate ◽

Sporadic Medullary Thyroid Carcinoma ◽

Medullary Thyroid ◽

Lymphatic Metastases ◽

Organ Sparing ◽

Group 2 ◽

Group 1

Abstract Objectives Influence of lymphatic metastases presence at immediate and follow-up results of pts surgical treatment is controversial especially for sporadic medullary thyroid carcinoma (SMTC). Methods 3330 thyroid cancer pts were operated on (1973-2009), among them—226 (6.8%) medullary thyroid cancer (MTC) patients. In 11 observations MTC was appeared as a part of MEN syndrome. Sporadic character of disease was confirmed in 215 (95.1%) cases. There were 140 (80.8%) females and 33 (19.2%) males (4.2:1.0) with average age 48.6 ± 2.7. Long-term results (1-40 years) were investigated in 173 (94.2%) cases. All SMTC patients were divided into 3 groups. Group 1 made of 80 (46.2%) T1- 3N0M0, Group 2 made of 47 (27.3%) T1-3N1a-bM0, 3 Group made of 46 (26.6%) T4N1a-bM0 patients. Results: Group 1 Organ-sparing operations were carried out in 59 (73.7%), thyroidectomies—in 21 (26.3%) patients. Multicentric tumor growth (MTG) was observed in 19.1%: in T1 cases—5.7%, T2—20.5%, T3—46.7%. All patients were undergone ipsilateral prophylactic central neck dissection (CND). Average period of postoperative observation (APPO) made 12.0 ± 1.7. 5 years survival rate made 98.4%, 10—91.7%. Local relapse of MTC was found in 1 patients (in contralateral thyroid lobe). Group 2 Organ-sparing operations were carried out in 20 (42.6%), thyroidectomies—27 (57.4%) with curative central or central and lateral lymphadenectomy (LAE). MTG took place in 47.2%. 6 group metastases only (T1a) were found in 38.9% and CND was performed. In other cases (61.1%) CND, lateral and mediastinal (8.3%) LAE were performed. APPO correspondent to 10.8 + 2.1 years. Repeated LAE because lymphatic metastases were carry out in 15 (31.9%) patients through 7.2 ± 2.4 years in average after initial operations. Tumor relapses were not found in thyroid remnant. 5 years survival rate made 89.2%, 10—67.8%. Group 3 MTG was observed in 64.3%. Central compartment group lymphatic metastases were revealed in 93.3%, in 2 to 5 groups — 86.7%, in mediastinum—38.5%, distant metastases—in 22.0%. Combined operations were performed in 58.9%, palliative—in 45 (26.6%) cases. Operations were completed by Tracheostomy in 38.4%. Adjuvant therapy (X-ray, chemotherapy) was applied in 28.9%. Postoperative lethality made 6.5%. APPO corresponded to 3.3 ± 0.8 (1-10 years). During first year, 8 patients have dead. 5 years survival rate made 32.4%. Conclusion Detection of regional metastases of SMTC during the first patients presentation significantly worsen survival rate. Early diagnose of SMTC by calcitonin level detection is the best way to improve results of treatment. Organ-sparing thyroidectomies with mandatory ipsilateral prophylactics CND are justified only at T1N0M0 sporadic MTC.

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