scholarly journals Sonohysterography: A Formidable Diagnostic Tool in the Evaluation of the Caesarean Scar Defect in Comparison to MRI

EMJ Radiology ◽  
2021 ◽  
pp. 83-89
Author(s):  
Saika Amreen ◽  
Cimona L. Saldanha ◽  
Naseer A. Choh ◽  
Yawar Yaseen ◽  
Tariq A. Gojwari
Keyword(s):  
Abnormal Uterine Bleeding ◽  
Obstetric Care ◽  
Uterine Bleeding ◽  
Defect Depth ◽  
Caesarean Scar ◽  
The Past ◽  
Wide Range ◽  
The Mean ◽  
Caesarean Scar Defect ◽  
Myometrial Thickness

Introduction: The use of the caesarean section (C-section) in obstetric care has exponentially increased in the past few decades. The caesarean scar defect (CSD) is a potential complication of C-section and is associated with a wide range of problems. The purpose of this study was to compare the evaluation of the CSD in non-pregnant women by sonohysterography (SHG) and MRI. Methods: This study was performed in patients having undergone a single C-section more than 6 months prior, presenting with abnormal uterine bleeding, dysmenorrhoea, or pelvic pain. Since ultrasonography and pelvic examination were inconclusive, these patients underwent MRI followed by saline infusion SHG. Measurements and characteristics of the ‘niche’ were acquired from both MRI and SHG and compared for analysis. Results: Patients with a single C-section presenting with prolonged bleeding, spotting, and dysmenorrhoea were included in this prospective study. SHG and MRI were used to measure scar thickness, width, depth, and adjacent myometrial thickness, in which the findings concurred. The mean defect depth was greater in patients with postmenstrual bleeding. Conclusion: SHG is noninferior to MRI, and SHG has the potential to assess the dynamic status of the CSD, with morphological clarity.

scholarly journals Double Approach (Laparoscopy and Hysteroscopy) Repair of Istmochele (Niche)

2020 ◽  
pp. 254-257
Author(s):  
Herbert Situmorang ◽  
Ribkhi A. Putri ◽  
Cepi T. Pramayadi ◽  
Riyan H. Kurniawan ◽  
Muhammad D. Priangga ◽  
...  
Keyword(s):  
Transvaginal Ultrasound ◽  
Abnormal Uterine Bleeding ◽  
Oral Contraception ◽  
Patient Admission ◽  
Uterine Bleeding ◽  
Day Hospital ◽  
Caesarean Scar ◽  
Double Approach ◽  
Optimal Approach ◽  
Caesarean Scar Defect

Objectives: Reported a case demonstrate the double approach repair of niche treatment through the hysteroscopy and laparoscopy technique.Methods: Case report. We reported a case starting from the patient admission untill 3 months postoperative condition.Case: A 33 years old woman came with abnormal uterine bleeding, already got medication and combine oral contraception pill, but the bleeding never stopped. We found a cavity (niche) filled by menstrual blood with thin lower uterine segment (just serous layer) from transvaginal ultrasound. We did hysteroscopy and laparoscopy approach. We illuminated the niche by hysteroscopy, then resected it by laparoscopy. Patient had a day hospital admission and no symptoms anymore after the procedure.Conclusion: Many treatment methods have been described for repair of niche with varies effectivities. Double approach (hysteroscopy and laparoscopy) technique was a minimal access, but optimal approach of niche resection with up to 100% effectivity.Keywords: abnormal uterine bleeding, caesarean scar defect, hysteroscopy, istmochele laparoscopy, niche   Abstrak Tujuan: Melaporkan sebuah kasus yang menggambarkan pendekatan ganda dalam memperbaiki niche dengan histeroskopi dan laparoskopi.Metode: Laporan kasus. Kami melaporkan sebuah kasus dimulai dari pasien masuk sampai dengan 3 bulan pascaoperasi.Kasus: Perempuan 33 tahun datang dengan perdarahan uterus abnormal, telah diberikan terapi obat dan pil kombinasi, namun perdarahan tidak berhenti. Dari ultrasonografi ditemukan rongga berisi darah menstrusasi dengan segmen bawah uterus yang tipis (hanya lapisan serosa). Kami melakukan pendekatan histeroskopi dan laparoskopi. Dilakukan iluminasi dengan histeroskopi, kemudian reseksi dengan laparoskopi. Perawatan pasien di rumah sakit selama satu hari, dan tidak terdapat keluhan pada pasien setelah tindakan.Kesimpulan: Terdapat banyak metode dalam tata laksana niche dengan efektivitas yang beragam. Pendekatan ganda dengan histeroskopi dan laparoskopi merupakan tehnik dengan akses minimal namun hasil optimal, dengan efektivitas hingga 100%.Kata Kunci: perdarahan uterus abnormal, defek skar sesar, histeroskopi, istmpchele, laparoskopi, niche  

A Review and Reconsideration of Nonneoplastic Myometrial Pathology

2017 ◽  
Vol 26 (2) ◽  
pp. 104-119 ◽  
Author(s):  
Stewart F. Cramer ◽  
Debra S. Heller
Keyword(s):  
Abnormal Uterine Bleeding ◽  
Venous Drainage ◽  
Outer Wall ◽  
Uterine Bleeding ◽  
Dysfunctional Uterine Bleeding ◽  
The Past ◽  
Naturally Occurring ◽  
Tangible Evidence ◽  
Major Review ◽  
Myometrial Thickness

From 1861 to 1962, clinicopathologic research tried to explain the association of abnormal uterine bleeding with uterine enlargement. The etiology was theorized as metropathy, suggesting that myometrial dysfunction may predispose to abnormal uterine bleeding. Research reached a nadir in 1962, when a major review dismissed myometrial hypertrophy as a plausible explanation after prior rejections of the theories of chronic myometritis, fibrosis uteri, and subinvolution as causes of bleeding. Subsequent to this arose a crusade against unnecessary hysterectomies in the 1970s. Although myometrial hyperplasia was proposed in 1868, it is only in the past 25 years that tangible evidence has supported that idea. It now appears that clinically enlarged uteri are due to globoid outward bulging of the uterus, caused by increased intramural pressure—often unrelated to either uterine weight or myometrial thickness. Abnormal (dysfunctional) uterine bleeding may often be due to spontaneous rupture of thrombosed dilated endometrial vessels, due to the combined effects of obstructed venous drainage by increased intramural pressure, and Virchow’s triad. Despite a century-old known association of parity with naturally occurring outer wall myometrial scars (fibrosis uteri with elastosis), it was not previously suggested that these may reflect healing reactions to muscle tears during labor and delivery. We now suggest that smaller, similar inner wall elastotic scars in the nerve-rich inner myometrium may explain many cases of pelvic pain. This review suggests that diverse pressure-related lesions may be present in clinically abnormal uteri that have been called “normal” since the crusade against unnecessary hysterectomy.

scholarly journals AUDIT OF EVOLVING ROLES OF LAPAROSCOPY IN THE CURRENT SURGICAL PRACTICE AT CHRIS HANI BARAGWANATH ACADEMIC HOSPITAL: A 5 YEAR REVIEW

2021 ◽  
Vol 8 (5) ◽  
pp. 16-24
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Standard Of Care ◽  
Descriptive Statistics ◽  
Academic Hospital ◽  
Surgical Practice ◽  
The Past ◽  
Wide Range ◽  
Accepted Standard ◽  
The Mean

Background: Laparoscopic surgery (LS) is gaining momentum and has revolutionised the practice of surgery. Over the past thirty years, LS has been used to manage a wide range of surgical pathologies and has become a recognised and generally accepted standard of care. Aim: The aim of this study is to describe the evolution of LS in selected procedures.. Methods: Data were collected from theatre registries. Statistical analysis was performed using the software IMB SPSS. The data were analysed using descriptive statistics of mean and standard deviation for age, and percentage and frequencies for categories of variables . Results: Of the 3745 patients involved in the study, 59.1% were males and 40.9% were females. The mean age of the patients was 35.17±17.30 years. Laparoscopic surgery was represented in 43.2% of the procedures, with laparoscopic appendicectomy (46.73%) and laparoscopic cholecystectomy (32.69%) being the most commonly performed procedures.. Twenty-five adrenalectomies were performed over the study period, and of those 12 (52%) were performed laparoscopically. All the thymectomies (12) were performed thoracoscopically, with one conversion. Conclusion: The findings of this study suggest that there has been an increase in the overall incidence of laparoscopic surgery in selected procedures at CHBAH.

scholarly journals Correlation of body mass index and abnormal uterine bleeding in premenopausal women

2020 ◽  
Vol 9 (11) ◽  
pp. 4640
Author(s):  
Kumarasamy Akalyaa ◽  
Pattacheravanda Nanaiah Shakuntala ◽  
Ramaiah Renuka
Keyword(s):  
Body Mass Index ◽  
Endometrial Cancer ◽  
Body Mass ◽  
Endometrial Hyperplasia ◽  
Premenopausal Women ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Significant Difference ◽  
Menstrual Patterns ◽  
The Mean

Background: As the rate of obesity is increasing in women in the recent years, the incidence of endometrial cancer increases as the body mass index (BMI) increases. Despite the clear evidence linking endometrial cancer and obesity, there is limited public awareness of this relationship. This study was undertaken to evaluate the association of BMI and endometrial pathology in premenopausal women with abnormal uterine bleeding (AUB).Methods: An analytical case control study was conducted in 100 women between the age group of 40 to 55, with AUB in the Department of Obstetrics and Gynecology, ESIC-PGIMSR Bangalore between January 2018 and June 2019. The menstrual patterns and endometrial pattern by histopathology were analysed in women with BMI of 18.5 to 24.99 and ≥25.Results: The mean age of women participated in the study group of between 40- 55 years was 44.83. The mean duration of symptoms was 10.18 months in the cases group and 8.52 months in the control group. The menstrual patterns were comparable and there was no significant difference in both the groups. The mean endometrial thickness, mean BMI, hyperplasia with or without atypia were all higher in the cases group. The frequency of occurrence of atypical endometrial hyperplasia was higher in women with increasing BMI.Conclusions: We found increased BMI to be an important independent risk factor for the development of endometrial hyperplasia with atypia which is a precursor to endometrial carcinoma in premenopausal women with AUB. 

scholarly journals Assessment of thyroid and prolactin levels among the women with abnormal uterine bleeding

2017 ◽  
Vol 6 (6) ◽  
pp. 2547
Author(s):  
Jovita Deepthy John ◽  
Vimala Damodaran ◽  
Shankar Radhakrishnan
Keyword(s):  
Abnormal Uterine Bleeding ◽  
Cross Sectional Study ◽  
High Serum ◽  
Uterine Bleeding ◽  
Serum Prolactin ◽  
Age Group ◽  
Free T4 ◽  
Cross Sectional ◽  
The Mean ◽  
Tsh Levels

Background: Thyroid disorders are 10 times more common in women than men.1 Menstrual disturbances usually accompany clinical alterations in thyroid function and every clinician would have encountered altered menstrual pattern among women suffering from either hypo or hyper thyroidism. A high serum prolactin level can distrurb the follicular maturation and corpus luteum function, and leads to inhibition of normal pulsatile secretion of gonadotrophin-releasing hormone in hypothalamus resulting in anovulation. The aim of the study was to assess the thyroid and the prolactin levels among the women with abnormal uterine bleeding and to evaluate the association between them by comparing with normal females.Methods: A cross sectional study was conducted for a period of one year between Jan 2016 and December 2016 in our institution at the gynaecology OPD. Patients in the age group of 15 to 45 with the complaints of abnormal uterine bleeding and with the ultrasound findings showing normal uterus and ovary were included in the study. Hundred age and sex matched controls without any complaints of abnormal uterine bleeding in the age group of 15 – 45 years were also included in the study. Free T3, Free T4, TSH and prolactin estimation was done by chemiluminescent immunoassay for both the patients and the controls.Results: The mean TSH levels among the cases were much higher than that of the controls and the difference in the levels found to be statistically significant. Similarly, hyperprolactinemia was found in 18 cases when compared to 2 cases in controls and the mean prolactin levels were higher in cases. The serum prolactin levels and the serum TSH levels showed a perfect positive correlation which indicates that as the TSH level increases prolactin levels also increases with the R value >0.5.Conclusions: Early detection of hypothyroidism in such subjects saves the patient from recurrent curettage and at times hysterectomy. The financial implications of screening for prolactin/thyroid hormone abnormalities will have to be evaluated before a general recommendation can be made.

A Comparison between the Effectiveness of Norethisterone and Dydrogesterone for treatment of Irregular Menstrual Cycle

2021 ◽  
Vol 15 (11) ◽  
pp. 2876-2878
Author(s):  
Asma Yasin ◽  
Madiha Afzal ◽  
Uzma Aziz
Keyword(s):  
Patient Satisfaction ◽  
Menstrual Cycle ◽  
Prospective Study ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Coagulation Disorder ◽  
Menstrual Cycles ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Abnormal uterine bleeding is defined as irregularities in the menstrual cycle involving frequency, regularity, duration, and volume of flow outside of pregnancy. Up to 1/3rd of women experience abnormal uterine bleeding in their life, with irregularities most commonly occurs at menarche and perimenopause due to disruption of the hypothalamic-pituitary-ovarian axis. Aim: To compare the effectiveness of Norethisterone and Dydrogesterone for the treatment of irregular menstrual cycles due to abnormal uterine bleeding of ovulatory or endometrial dysfunction and to check for patient satisfaction after the use of prescribed hormones by taking their feedback. Methods: This observational, comparative, cohort-prospective study was conducted on 100 nonpregnant women between the ages of 15-45 years who presented with complaints of irregular menstruation in gynae outdoor of AMTH for 6 months from April 2021 to September 2021. After excluding pelvic pathology, known thyroid disease, coagulation disorder, or use of the contraceptive method, the participants were divided into Group A and Group B, each having 50 participants. Results: The mean age±SD of the participants in Group A was 29±3.4 while Group B had mean age±SD was 29.5±3.6. In Group A, 38(76%) patients reported a regular menstrual cycle after 3 months of use while 12(24%) patients complained of persistent irregular menstrual cycle despite 3 months use of Norethisterone with compliance in Group B using Dydrogesterone, 22(44%) patients had regular menstrual cycles while 28(56%) patients had persistent irregular menstrual cycles after three months of use. Conclusion: So we concluded from our study that Norethisterone had a better cycle control than Dydrogesterone. Keywords: Abnormal uterine bleeding of ovulatory and/or endometrial dysfunction, Norethisterone, Dydrogesterone,

scholarly journals DIAGNOSTIC HYSTEROSCOPY IN ABNORMAL UTERINE BLEEDING & IT'S HISTOPATHOLOGIC CORRELATION: OUR EXPERIENCE

2013 ◽  
Vol 03 (02) ◽  
pp. 013-017
Author(s):  
Neetha Nandan ◽  
Lakshmi Manjeera ◽  
Supriya Rai ◽  
Mangala Gowri
Keyword(s):  
Endometrial Hyperplasia ◽  
Histopathological Examination ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Histopathological Diagnosis ◽  
Normal Endometrium ◽  
The Past ◽  
Dilatation And Curettage ◽  
Medical Academy ◽  
Diagnostic Hysteroscopy

Abstract Aims & objectives: 1) To study the accuracy of hysteroscopy in evaluation of abnormal uterine bleeding in perimenopausal and postmenopausal women. 2) To correlate hysteroscopic findings with histopathologic results. Materials and methods: It is a retrospective study done in the department of OBG at K. S.Hegde Medical Academy, Mangalore. All patients who underwent diagnostic hysteroscopy for abnormal uterine bleeding in the past 6 years were included in this study. Patients underwent clinical and sonographical evaluation. Following hysteroscopic evaluation, patients had undergone dilatation and curettage and endometrial curetting were sent for histopathological examination (HPE). The correlation between findings on hysteroscopy & HPE were tabulated. Results: On hysteroscopy, endometrium was classified as suggestive of normal, hyperplasia, atrophic, polyp, fibroid, cancer. Histopathological diagnosis was taken as gold standard to determine the efficacy of hysteroscopy in diagnosing endometrial pathologies. Out of 175 patients, 108 patients were diagnosed to have endometrial hyperplasia on hysteroscopy, however only 53 confirmed to have on histopathologically. Similarly 25 patients were said to have normal findings on hysteroscopy but by histopathology 85 were having normal endometrium. Hysteroscopy was highly specific for diagnosis of polyp (95.9%), cancer (100.0%), and atrophy (96. 9%), normal endometrium (92.2%) but low specificity for diagnosing hyperplasia (48.4%). The sensitivity of hysteroscopy in diagnosing polyp and endometrial hyperplasia were 100% and 84.9% respectively but it was low in case of cancer (16.7%) and normal endometrium (21.2%). Conclusion: Hysteroscopy is a highly accurate diagnostic tool in diagnosing intrauterine lesions like endometrial polyp and submucous fibroid. In fact, it was also found to be highly specific in conditions like endometrial cancer, polyp, atrophic and normal endometrium.

scholarly journals The role of the ultrasound examination in atypical placental site trophoblastic tumour differential diagnosis and management. A case report

2021 ◽  
Author(s):  
Monica Mihaela Cirstoiu ◽  
Maria Sajin ◽  
Alexandru Baros ◽  
Sorin Vasilescu ◽  
Natalia Turcan
Keyword(s):  
Differential Diagnosis ◽  
Ultrasound Examination ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Unique Form ◽  
Caesarean Scar ◽  
Placental Site ◽  
Slow Growing ◽  
Trophoblastic Tumours

Placental site trophoblastic tumour (PSTT) is a very rare and unique form of gestational trophoblastic tumour, representing about 1-2% of all gestational trophoblastic tumours. Usually, the pattern is a slow growing nodule implicating the endometrium and myometrium, accompanied by abnormal uterine bleeding. Three ultrasound types of PSTT are described, but thereis no specific characteristic for diagnosis. We present the case of a patient with an atypical placental site trophoblastic tumour diagnosed two months after a caesarean scar pregnancy. In the presented case there are several particularities, such as the rapid growth and progression of the tumour, the limitation to the myometrium and the difficulty of the differential diagnosis and approach.

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