scholarly journals Laparoscopic Isthmocele Repair: Efficacy and Benefits before and after Subsequent Cesarean Section

2021 ◽  
Vol 10 (24) ◽  
pp. 5785
Author(s):  
Stavros Karampelas ◽  
Georges Salem Wehbe ◽  
Laurent de Landsheere ◽  
Dominique A. Badr ◽  
Linda Tebache ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Outcome Measures ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Secondary Infertility ◽  
Significant Difference ◽  
Before And After ◽  
Myometrial Thickness

Objective: To evaluate the effect of laparoscopic isthmocele repair on isthmocele-related symptoms and/or fertility-related problems. The residual myometrial thickness before and after subsequent cesarean section was also evaluated. Design: Retrospective, case series. Setting: Public university hospital. Population: Women with isthmocele (residual myometrium < 5 mm) complaining of abnormal uterine bleeding, chronic pelvic pain or secondary infertility not otherwise specified. Methods: Women’s complaints and the residual myometrium were assessed pre-operatively and at three to six months post-operatively. In patients who conceived after surgery, the latter was measured at least six months after delivery by cesarean section. Main Outcome Measures: Resolution of the main symptom three to six months after surgery and persistence of laparoscopic repair benefits after subsequent cesarean section were considered as primary outcome measures. Results: Overall, 31 women underwent laparoscopic isthmocele repair. The success rates of the surgery as improvement of abnormal uterine bleeding, chronic pelvic pain and secondary infertility were 71.4% (10 of 14), 83.3% (10 of 12) and 83.3% (10 of 12), respectively. Mean residual myometrial thickness increased significantly from 1.77 mm pre-operatively to 6.67 mm, three to six months post-operatively. Mean myometrial thickness in patients who underwent subsequent cesarean section (N = 7) was 4.49 mm. In this sub-group, there was no significant difference between the mean myometrial thickness measured after the laparoscopic isthmocele repair and that measured after the subsequent cesarean section. None of these patients reported recurrence of their symptoms after delivery. Conclusion: Our findings suggest that the laparoscopic isthmocele excision and repair is an appropriate approach for the treatment of isthmocele-related symptoms when done by skilled laparoscopic surgeons. The benefit of this new surgical approach seems to persist even after a subsequent cesarean section. Further investigations and prospective studies are required to confirm this finding.

scholarly journals Treatment of C-section diverticula with hysteroscopic resection in women without childbearing intention: a retrospective cohort study

2019 ◽  
Author(s):  
Hui Shi ◽  
Jingyan He ◽  
Yunhe Gao ◽  
Shuang Qin ◽  
Jiaying Fan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cesarean Section ◽  
Pelvic Pain ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Chronic Pelvic Pain ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Timing Of Surgery ◽  
Hysteroscopic Resection

Abstract Background: Diverticulum, one of the long-term squelae of cesarean section, can cause abnormal uterine bleeding, dysmenorrhea and chronic pelvic pain. Hysteroscopic resection of diverticula is thought to reduce abnormal uterine bleeding and chronic pelvic pain. In this study, we aim to describe the improvement after hysteroscopic resection of cesarean section diverticula hysteroscopic resection of cesarean section diverticula (CSD) in women without childbearing intention, and to explore the variables associated with poor prognosis.Methods: A retrospective cohort study of women aged 25-48 with CSD diagnosis by transvaginal ultrasonography (TVS) and hysteroscopy that were enrolled at Guangzhou Women and Children’s Medical Center between June 2017 and December 2018. A total of 124 women met the inclusion criteria and all patients had undergone hysteroscopic resection and accepted a follow-up interview at the 3rd and 6th months postoperatively to record symptom improvement.Result: The mean of intraoperative blood loss and operative time of hysteroscopic resection were (12.94±12.63) ml and (33.63±6.87) min in 124 patients. Overall observed improvement rates of CSD symptom were 47.2% and 65.6% in the first 3 and 6 months, respectively. Multivariable logistic regression models revealed that timing of surgery <14 days was a good prognostic factor associated with both 3-month improvement (OR, 16.59; 95% CI, 2.62-104.90; P=0.003) and 6-month improvement (OR, 15.51; 95%CI, 1.63-148.00; P=0.02); Patients with numbers of cesarean section(CS) ≥2 had a lower rate of improvement after 6 months of CSD repair surgery compared with patients who underwent one CS(OR, 8.29; 95%CI, 1.05-65.75; P=0.04).Conclusions: A hysteroscopic repair might be an appropriate method for CSD in women who no childbearing intentions. The timing of surgery and the number of CS seems to be factors influencing the postoperative improvement of CSD.

Success of uterus-preserving treatments for abnormal uterine bleeding, chronic pelvic pain, and symptomatic fibroids: age and bridges to menopause

2011 ◽  
Vol 204 (3) ◽  
pp. 272.e1-272.e7 ◽  
Author(s):  
Lee A. Learman ◽  
Sanae Nakagawa ◽  
Steven E. Gregorich ◽  
Rebecca A. Jackson ◽  
Alison Jacoby ◽  
...  
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding

scholarly journals Clinical Evaluation of Li Brush Endometrial Samplers for Diagnosing Endometrial Lesions in Women With Intrauterine Devices

2020 ◽  
Vol 7 ◽  
Author(s):  
Lu Han ◽  
Sijia Ma ◽  
Lanbo Zhao ◽  
Yu Liu ◽  
Yiran Wang ◽  
...  
Keyword(s):  
Transvaginal Ultrasound ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
High Yield ◽  
Control Group ◽  
Intrauterine Devices ◽  
Significant Difference ◽  
Before And After ◽  
The Impact

Background: For women with intrauterine devices (IUDs), it is difficult to sample the endometrium when abnormal uterine bleeding occurs or when regular screening of endometrial cancer is proposed. The purpose of this study is to evaluate the validity of endometrial sampling using Li Brush in IUD users.Methods: This study was a prospective cohort study and conducted in two parts. Part I was to assess the impact of Li Brush on the position of IUDs. Transvaginal ultrasound was used to locate IUDs before and after sampling. Part II was to explore the diagnostic accuracy of Li Brush in detecting endometrial lesions. IUD users with irregular uterine bleeding were recruited in the IUD group and IUD non-users who arranged for dilatation and curettage (D&amp;C) were recruited in the control group. The endometrium was sampled by Li Brush for cells and by D&amp;C for tissues in both groups. The satisfactoriness of sampling and validity of Li Brush were evaluated.Results: Seventeen cases in part I confirmed no significant difference in the position of IUDs before and after sampling (p = 0.20). 112 IUD users and 139 IUD non-users were recruited in part II. Li Brush achieved 94.64 and 92.09% satisfactory sampling rates in the IUD group and control group, respectively, without statistically significant difference between the two groups (p = 0.42). The Sensitivity and specificity of Li Brush for detection of endometrial lesions in IUD group were 95.35 and 87.76% respectively.Conclusions: Li Brush used for endometrial biopsy did not affect the position of IUDs and had high yield of satisfactory samples and good validity for endometrial diagnoses. It was feasible to screen endometrial lesions by Li Brush for women with IUDs.

scholarly journals The Prevalence of Cesarean Scar Niche and Its Relation to Certain Gynecological and Obstetrical Issues

2021 ◽  
pp. 152-158
Author(s):  
Mazen Mohammed AlRassad ◽  
Mohammed Mohsen ElNamoury ◽  
Mona Khaled Omar ◽  
Manal Mostafa Abdallah
Keyword(s):  
Cesarean Section ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Abnormal Uterine Bleeding ◽  
University Hospital ◽  
Major Surgery ◽  
P Value ◽  
Long Term Effects ◽  
Cross Sectional ◽  
Cesarean Scar

Background: A cesarean section (CS) is a life-saving surgical procedure when certain complications arise during pregnancy and labor. However, it is a major surgery and is associated with immediate maternal and perinatal risks and may have implications for future pregnancies as well as long-term effects that are still being investigated. This study aims at determining the prevalence of isthmocele (niche) among those who gave birth through Cesarean section, and figure out how many of the women diagnosed with scar niche are symptomatic. Methods: This observational cross-sectional study involved 300 women who gave birth by CS at the latest 6 months and they were recruited from the outpatient clinics of obstetrics and gynecology department, Tanta university hospital. Results: The prevalence of the niche was 21.7%. And the most common shapes of niche documented were the semicircular defects followed by the triangular defects. The majority of cases were symptomatic while only 7.7% were asymptomatic and discovered accidentally by routine ultrasound examination. The most common symptoms documented were abnormal uterine bleeding (AUB), chronic pelvic pain, dysmenorrhea, and secondary infertility. There was a positive significant relationship between the number of CS, the size of the niche, and the severity or frequency of the presenting symptom (P value < 0.01). Conclusion: Cesarean scar niche has a strong statistically significant association with symptoms such as AUB (especially inter-menstrual bleeding), chronic pelvic pain, and dysmenorrhea. In our study, the prevalence of cesarean niche was 21.7% and the common niche shapes documented were the semicircular and triangular niches.

scholarly journals Treatment of C-section diverticula with hysteroscopic resection in women without childbearing intention: a retrospective cohort study

2019 ◽  
Author(s):  
Hui Shi ◽  
Jingyan He ◽  
Yunhe Gao ◽  
Shuang Qin ◽  
Jiaying Fan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prognostic Factor ◽  
Cesarean Section ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Chronic Pelvic Pain ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Timing Of Surgery ◽  
Hysteroscopic Resection

Abstract Background: Diverticulum, one of the long-term sequelae of cesarean section, can cause abnormal uterine bleeding, dysmenorrhea and chronic pelvic pain. Hysteroscopic resection of diverticula is thought to reduce abnormal uterine bleeding and chronic pelvic pain. In this study, we aim to describe the improvement after hysteroscopic resection of cesarean section diverticula (CSD) in women without childbearing intention, and to explore the variables associated with poor prognosis. Methods: A retrospective cohort study of women aged 25-48 with CSD diagnosis by transvaginal ultrasonography (TVS) and hysteroscopy that were enrolled at Guangzhou Women and Children’s Medical Center between June 2017 and December 2018. A total of 124 women met the inclusion criteria and all patients had undergone hysteroscopic resection and accepted a follow-up interview at the 3rd and 6th months postoperatively to record symptom improvement. Result: The mean of intraoperative blood loss and operative time of hysteroscopic resection were (12.94±12.63) ml and (33.63±6.87) min in 124 patients. Overall observed improvement rates of CSD symptom were 47.2% and 65.6% in the first 3 and 6 months, respectively. Multivariable logistic regression models revealed that timing of surgery <14 days was a good prognostic factor associated with both 3-month improvement (OR, 16.59; 95% CI, 2.62-104.90; P=0.003) and 6-month improvement (OR, 15.51; 95%CI, 1.63-148.00; P=0.02); Patients with numbers of cesarean section(CS) ≥2 had a lower rate of improvement after 6 months of CSD repair surgery compared with patients who underwent one CS(OR, 8.29; 95%CI, 1.05-65.75; P=0.04). Conclusions: A hysteroscopic repair might be an appropriate method for CSD in women who no childbearing intentions. The timing of surgery and the number of CS seems to be factors influencing the postoperative improvement of CSD. Keywords: Cesarean section diverticulum; Cohort study; Hysteroscopic; Prognostic factor

scholarly journals Treatment of C-section diverticula with hysteroscopic resection in women without childbearing intention: a retrospective cohort study

2020 ◽  
Author(s):  
Hui Shi ◽  
Jingyan He ◽  
Yunhe Gao ◽  
Shuang Qin ◽  
Jiaying Fan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prognostic Factor ◽  
Cesarean Section ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Chronic Pelvic Pain ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Timing Of Surgery ◽  
Hysteroscopic Resection

Abstract Background: Diverticulum, one of the long-term sequelae of cesarean section, can cause abnormal uterine bleeding, dysmenorrhea and chronic pelvic pain. Hysteroscopic resection of diverticula is thought to reduce abnormal uterine bleeding and chronic pelvic pain. In this study, we aim to describe the improvement after hysteroscopic resection of cesarean section diverticula (CSD) in women without childbearing intention, and to explore the variables associated with poor prognosis. Methods: A retrospective cohort study of women aged 25-48 with CSD diagnosis by transvaginal ultrasonography (TVS) and hysteroscopy that were enrolled at Guangzhou Women and Children’s Medical Center between June 2017 and December 2018. A total of 124 women met the inclusion criteria and all patients had undergone hysteroscopic resection and accepted a follow-up interview at the 3rd and 6th months postoperatively to record symptom improvement. Result: The mean of intraoperative blood loss and operative time of hysteroscopic resection were (12.94±12.63) ml and (33.63±6.87) min in 124 patients. Overall observed improvement rates of CSD symptom were 47.2% and 65.6% in the first 3 and 6 months, respectively. Multivariable logistic regression models revealed that timing of surgery <14 days was a good prognostic factor associated with both 3-month improvement (OR, 16.59; 95% CI, 2.62-104.90; P=0.003) and 6-month improvement (OR, 15.51; 95%CI, 1.63-148.00; P=0.02); Patients with numbers of cesarean section(CS) ≥2 had a lower rate of improvement after 6 months of CSD repair surgery compared with patients who underwent one CS(OR, 8.29; 95%CI, 1.05-65.75; P=0.04). Conclusions: A hysteroscopic repair might be an appropriate method for CSD in women who no childbearing intentions. The timing of surgery and the number of CS seems to be factors influencing the postoperative improvement of CSD. Keywords: Cesarean section diverticulum; Cohort study; Hysteroscopic; Prognostic Factor

scholarly journals Adenomyosis at Hysterectomy: Prevalence, Patient Characteristics, Clinical Profile and Histopatholgical Findings

2012 ◽  
Vol 10 (1) ◽  
pp. 44-47 ◽  
Author(s):  
A Shrestha ◽  
R Shrestha ◽  
LB Sedhai ◽  
U Pandit
Keyword(s):  
Medical Therapy ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Histopathological Examination ◽  
Menopausal Status ◽  
Lower Abdominal Pain ◽  
Abnormal Uterine Bleeding ◽  
Clinical Findings ◽  
Uterine Bleeding ◽  
Clinical Profile

Background Underlying adenomyosis is often the cause of treatment failure for patients undergoing medical therapy for abnormal uterine bleeding and or chronic pelvic pain. Given the limitation of ultrasonography in diagnosing adenomyosis and MRI being unaffordable to most of the patients belonging to developing countries like us, it often remains undiagnosed before a hysterectomy. Objective To find out the clinical profile associated with adenomyosis and to determine the prevalence of adenomyosis in hysterectomy specimens; frequency distribution, as well as to correlate clinical examination with histopathological examination. Methods A total of 60 women who had undergone hysterectomy with histopathologically proven adenomyosis between April 2009 and March 2010 were included . Data were collected on indication for the intervention, age, symptoms, clinical findings, hemoglobin, menopausal status, gross and histopathological findings. Results A total of 256 women were scheduled for hysterectomy. Adenomyosis was diagnosed in 60 of 256 cases (23.4%). Menorrhagia (91.2%), dysmenorrhoea (84.2%), lower abdominal pain (84.2%) beginning later in reproductive life (mean age- 45yrs) is the classic presentation. Adenomyosis was present in 10 of 61 patients (16.3%) with fibroids; 27 of 60 (45%) with abnormal uterine bleeding; 11 of 55 (20%) with prolapse; four of 35 (11.4%) with ovarian mass; five of 25 (20%) with chronic pelvic pain; three of four (75%) with endometriosis. Conclusion Women undergoing hysterectomy with diagnosis of adenomyosis have a distinct symptomatology. The choice of therapy in adenomyosis is hysterectomy for those women who have completed family and had failed medical therapy . KATHMANDU UNIVERSITY MEDICAL JOURNAL  VOL.10 | NO. 1 | ISSUE 37 | JAN - MAR 2012 | 53-56 DOI: http://dx.doi.org/10.3126/kumj.v10i1.6915

scholarly journals Hysteroscopic evaluation in infertility and abnormal uterine bleeding

2018 ◽  
Vol 7 (2) ◽  
pp. 612
Author(s):  
Navneet Kaur ◽  
Ruby Bhatia ◽  
Paramjit Kaur ◽  
Surinder K. Bhopal
Keyword(s):  
Endometrial Hyperplasia ◽  
Uterine Cavity ◽  
Invasive Procedure ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Therapeutic Modality ◽  
Secondary Infertility ◽  
Endometrial Polyps ◽  
Submucous Fibroid

Background: Hysteroscopy an endoscopic procedure for visualization of uterine cavity may be extensively used in both primary and secondary infertility and abnormal uterine bleeding for evaluating intrauterine pathology. The objectives of this study were to visualize and identity intrauterine pathology in both primary and secondary infertility and abnormal uterine bleeding (AUB) by hysteroscopic evaluation and to perform hysteroscopic guided therapeutic procedures like endometrial currettage, polypectomy, adhesiolysis.Methods: Hysteroscopic evaluation of uterine cavity for any intrauterine pathology in AUB and Infertility. Adhesiolysis, polypectomy, endometrial biopsy misplaced copper T removal were carried out under hysteroscopic vision.Results: Intrauterine synechia in 20.51%, Submucous fibroid in 5.13%, bicornuate uterus, endometrial hyperplasia and endometrial polyp were seen in 2.56% patient each were detected in infertility group while 81.95% cases with AUB had abnormal intrauterine pathology commonest being endometrial hyperplasia in 33.33% followed by endometrial polyps in 23.81% cases, submucous fibroid and misplaced copper T in 9.52% each and intrauterine synechia in 4.76% patient. Endometrial biopsy and polypectomy was done in 23.80% each with AUB, misplaced copper T removal in 9.52% and adhesiolysis in 4.76% patient with AUB.Conclusions: Hysteroscopy remains gold standard for evaluating intrauterine lesions in abnormal uterine bleeding and infertility. A safe, simple minimally invasive procedure not only diagnostic but therapeutic modality for adhesiolysis, endometrial biopsy/curettage, polypectomy, misplaced copper T removal under direct vision with minimal complication within reach of every Gynaecologist thereby reducing burden of major surgical intervention.

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