Database : MEDLINE
Search on : uterine and perforation [Words]
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[PMID]: 29524723
[Au] Autor:Sedrati A; Drizi A; van Herendael B; Djokovic D
[Ad] Address:Independent consultant in Obstetrics & Gynecology, Constantine, Algeria.
[Ti] Title:Hysteroscopic Diagnosis of Omentum Incarceration Subsequent to an Iatrogenic Uterine Perforation.
[So] Source:J Minim Invasive Gynecol;, 2018 Mar 07.
[Is] ISSN:1553-4669
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:STUDY OBJECTIVE: To present and discuss the hysteroscopic aspects of incarcerated omentum through uterine perforation caused by previous dilatation and curettage (D&C) for incomplete first-trimester abortion. DESIGN: Case report. SETTING: Constantine University Hospital, Constantine, Algeria. PATIENT: A 40-year-old, G3P2 patient, with a history of an incomplete first-trimester spontaneous abortion, treated 6 months before by D&C, requiring medical assistance due to moderate, chronic pelvic pain. No other clinical or biological alteration was found. The ultrasound showed intracavitary hyperechogenic formation, infiltrating the myometrium posteriorly. INTERVENTION: Hysteroscopy revealed a fat-like lesion, arousing suspicion of residual trophoblast while differential diagnosis included intramyometrial fat metaplasia as well. A mechanical cold loop resection was initiated. Instrumental manipulation of the mass released yellow drops, probably of lipid nature, subsequently leading to the discovery of an uterine perforation, giving passage to omentum. Histological examination confirmed fat tissue. There was immediate resolution of symptoms. Laparoscopic repair was subsequently performed and consisted of suturing the defect. There were no further complications. MAIN RESULT: Few cases of omentum incarceration in perforated uterus, diagnosed during laparotomy or by magnetic resonance, have previously been reported. To our knowledge, this is the first case revealed through hysteroscopy. CONCLUSION: In women with a history of intracavitary interventions such as D&C, omentum incarceration should be considered when hysteroscopy demonstrates a fat-like formation and yellow droplets released by pressing or mobilizing the formation. Surgeons should be cautious, never using electrosurgery on formations whose origin arouses suspicion.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  2 / 2034 MEDLINE  
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[PMID]: 29362796
[Au] Autor:Bouillon K; Bertrand M; Bader G; Lucot JP; Dray-Spira R; Zureik M
[Ad] Address:Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France.
[Ti] Title:Association of Hysteroscopic vs Laparoscopic Sterilization With Procedural, Gynecological, and Medical Outcomes.
[So] Source:JAMA;319(4):375-387, 2018 01 23.
[Is] ISSN:1538-3598
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Importance: Safety of hysteroscopic sterilization has been recently questioned following reports of general symptoms such as allergy, tiredness, and depression in addition to associated gynecological results such as pelvic pain, perforation of fallopian tubes or uterus, and unwanted pregnancy. Objective: To compare the risk of reported adverse events between hysteroscopic and laparoscopic sterilization. Design, Setting, and Participants: French nationwide cohort study using the national hospital discharge database linked to the health insurance claims database. Women aged 30 to 54 years receiving a first hysteroscopic or laparoscopic sterilization between 2010 and 2014 were included and were followed up through December 2015. Exposures: Hysteroscopic sterilization vs laparoscopic sterilization. Main Outcomes and Measures: Risks of procedural complications (surgical and medical) and of gynecological (sterilization failure that includes salpingectomy, second sterilization procedure, or pregnancy; pregnancy; reoperation) and medical outcomes (all types of allergy; autoimmune diseases; thyroid disorder; use of analgesics, antimigraines, antidepressants, benzodiazepines; outpatient visits; sickness absence; suicide attempts; death) that occurred within 1 and 3 years after sterilization were compared using inverse probability of treatment-weighted Cox models. Results: Of the 105 357 women included (95.5% of eligible participants; mean age, 41.3 years [SD, 3.7 years]), 71 303 (67.7% ) underwent hysteroscopic sterilization, and 34 054 (32.3%) underwent laparoscopic sterilization. During the hospitalization for sterilization, risk of surgical complications for hysteroscopic sterilization was lower: 0.13% for hysteroscopic sterilization vs 0.78% for laparoscopic sterilization (adjusted risk difference [RD], -0.64; 95% CI, -0.67 to -0.60) and was lower for medical complications: 0.06% vs 0.11% (adjusted RD, -0.05; 95% CI, -0.08 to -0.01). During the first year after sterilization, 4.83% of women who underwent hysteroscopic sterilization had a higher risk of sterilization failure than the 0.69% who underwent laparoscopic sterilization (adjusted hazard ratio [HR], 7.11; 95% CI, 5.92 to 8.54; adjusted RD, 4.23 per 100 person-years; 95% CI, 3.40 to 5.22). Additionally, 5.65% of women who underwent hysteroscopic sterilization required gynecological reoperation vs 1.76% of women who underwent laparoscopic sterilization (adjusted HR, 3.26; 95% CI, 2.90 to 3.67; adjusted RD, 4.63 per 100 person-years; 95% CI, 3.38 to 4.75); these differences persisted after 3 years, although attenuated. Hysteroscopic sterilization was associated with a lower risk of pregnancy within the first year of the procedure but was not significantly associated with a difference in risk of pregnancy by the third year (adjusted HR, 1.04; 95% CI, 0.83-1.30; adjusted RD, 0.01 per 100 person-years; 95% CI, -0.04 to 0.07). Risks of medical outcomes were not significantly increased with hysteroscopic sterilization compared with laparoscopic sterilization. Conclusions and Relevance: Among women undergoing first sterilization, the use of hysteroscopic sterilization was significantly associated with higher risk of gynecological complications over 1 year and over 3 years than was laparoscopic sterilization. Risk of medical outcomes was not significantly increased over 1 year or over 3 years. These findings do not support increased medical risks associated with hysteroscopic sterilization.
[Mh] MeSH terms primary: Hysteroscopy/adverse effects
Laparoscopy/adverse effects
Postoperative Complications/etiology
Sterilization, Tubal/methods
[Mh] MeSH terms secundary: Adult
Cohort Studies
Female
France
Humans
Middle Aged
Postoperative Complications/epidemiology
Pregnancy
Pregnancy, Unplanned
Reoperation/statistics & numerical data
Sterilization, Tubal/adverse effects
Treatment Failure
[Pt] Publication type:COMPARATIVE STUDY; JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Entry month:1801
[Cu] Class update date: 180311
[Lr] Last revision date:180311
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:180125
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.21269

  3 / 2034 MEDLINE  
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[PMID]: 29185260
[Au] Autor:Vizza E; Chiofalo B; Cutillo G; Mancini E; Baiocco E; Zampa A; Bufalo A; Corrado G
[Ad] Address:Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
[Ti] Title:Robotic single site radical hysterectomy plus pelvic lymphadenectomy in gynecological cancers.
[So] Source:J Gynecol Oncol;29(1):e2, 2018 Jan.
[Is] ISSN:2005-0399
[Cp] Country of publication:Korea (South)
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To evaluate the feasibility and the safety of robotic single-site radical hysterectomy (RSSRH) plus pelvic lymphadenectomy (PL) in endometrial or cervical cancer. METHODS: Patients with endometrial cancer (EC) International Federation of Gynecology and Obstetrics (FIGO) stage II, early cervical cancer (ECC) FIGO stage IB1 or locally advanced cervical cancer (LACC) FIGO stage IB2-IIB with clinical response ≥50% after neo-adjuvant chemotherapy (NACT) were enrolled in a prospective cohort trial. All cases were performed using the da Vinci Si Surgical Single Site System. RESULTS: Between April 2014 and November 2016, twenty patients were included in our pilot study. Three and 17 patients underwent type B1 or C1 RSSRH plus PL, respectively. The median age of patients was 46 years (range, 36-68 years) and the median body mass index was 23.5 kg/m (range, 19.1-36.3 kg/m). The median total operative time was 190 minutes (range, 90-310 minutes). The median blood loss was 75 mL (range, 20-700 mL) and the median number of pelvic lymph nodes removed was 16 (range, 5-27). No laparoscopic/laparotomic conversions were reported and the median time to discharge was 6 days (range, 4-16 days). No intra-operative complications occurred while 4 (20%) post-operative complications were reported: one pelvic abscess, one lymphorrea, one bowel perforation, and one vaginal dehiscence. CONCLUSION: RSSRH plus PL is technically feasible in patients affected by gynecological cancer.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Process
[do] DOI:10.3802/jgo.2018.29.e2

  4 / 2034 MEDLINE  
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[PMID]: 29371171
[Au] Autor:Jan H; Ghai V; Thakar R
[Ad] Address:Department of Obstetrics and Gynaecology, Epsom and St Helier's University Hospitals NHS Trust, Epsom, United Kingdom.
[Ti] Title:Simplified Laparoscopic Sacrohysteropexy.
[So] Source:J Minim Invasive Gynecol;, 2018 Jan 31.
[Is] ISSN:1553-4669
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:STUDY OBJECTIVE: To demonstrate a simplified technique of performing laparoscopic sacrohysteropexy for uterine prolapse. DESIGN: A technical video demonstrating a simplified method of laparoscopic sacrohysteropexy (Canadian Task force classification level III). SETTING: The benign gynecology department at a university hospital. INTERVENTIONS: A 38-year old woman with grade 3 uterine descent presented requesting surgical management for symptomatic prolapse. CONCLUSION: Laparoscopic sacrohysteropexy is becoming an increasingly popular alternative to hysterectomy to treat uterine prolapse in women. We present a novel approach of performing laparoscopic sacrohysteropexy that differs from previously described methods [1,2]; it is shorter, simpler, and reduces possible complications. Key differences include the mesh type, site of attachment, and dissection of the peritoneum while creating the possibility of future vaginal delivery after pregnancy. Our simplified technique uses a polyvinylidene fluoride mesh woven with a square weave secured to the posterior aspect of the cervix under a layer of visceral peritoneum. Because there is no longitudinal give of the mesh, unlike polypropylene meshes with a diamond weave, a wrap method [2] is not required. No dissection of the broad ligament and bladder is needed, eliminating the risk of bladder perforation and anterior mesh erosion with fewer adhesions and simplifying hysterectomy if required in the future. We also uniquely "tunnel" the peritoneum, reducing the size of defect for suture closure, and reperitonize the mesh. Previous methods restrict cervical dilatation and require women to have cesarean sections. The method described in the video allows women to deliver vaginally and, in the event of late miscarriage, avoid the need for hysterotomy. We have performed 25 cases with 1 mild cystocoele recurrence requiring no surgery, 1 reoperation for posterior compartment repair, and 1 case of cervical elongation requiring Manchester repair. No cases of recurrent uterine prolapse have occurred.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180305
[Lr] Last revision date:180305
[St] Status:Publisher

  5 / 2034 MEDLINE  
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[PMID]: 29477553
[Au] Autor:Braga A; Biscaro A; do Amaral Giordani JM; Viggiano M; Elias KM; Berkowitz RS; Seckl MJ
[Ad] Address:Postgraduate Program in Perinatal Health, Rio de Janeiro Trophoblastic Disease Center, Maternity School, Federal University of Rio de Janeiro and Antonio Pedro University Hospital at Fluminense Federal University, Rio de Janeiro, Brazil; Postgraduate Program in Maternal and Child Health, Fluminense
[Ti] Title:Does a human chorionic gonadotropin level of over 20,000 IU/L four weeks after uterine evacuation for complete hydatidiform mole constitute an indication for chemotherapy for gestational trophoblastic neoplasia?
[So] Source:Eur J Obstet Gynecol Reprod Biol;223:50-55, 2018 Feb 15.
[Is] ISSN:1872-7654
[Cp] Country of publication:Ireland
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To evaluate whether a human chorionic gonadotropin (hCG) level ≥20,000 IU/L four weeks after uterine evacuation for complete hydatidiform mole (CHM) is an appropriate indicator for initiating chemotherapy for the treatment of gestational trophoblastic neoplasia (GTN). STUDY DESIGN: Historical database review of 1228 women with CHM who received treatment and follow-up between January 2000 and June 2013 at four Brazilian trophoblastic disease centers. The primary outcome measure was the progression from CHM to GTN. The secondary outcomes were the occurrence of uterine perforation, staging of GTN, WHO/FIGO risk score, and treatment (use of single- or multiagent chemotherapy). RESULTS: An hCG level ≥20,000 IU/L four weeks after uterine evacuation for CHM, while occurring in only 6.1% of women, was the most important risk factor for the development of postmolar GTN (adjusted RR = 5.83; p < 0.01; CI: 3.47-9.79), with a sensitivity of 36.8%, a specificity of 98.6%, a positive predictive value of 80%, and a negative predictive value of 91.1%. On the other hand, there were no differences in postmolar GTN stage, prognostic score, or need for multiagent chemotherapy relative to hCG level ≥20,000 IU/L versus <20,000 IU/L. CONCLUSIONS: Although hCG level ≥20,000 IU/L four weeks after uterine evacuation for CHM was very predictive of development of post-molar GTN, delay in treatment until hCG plateau or increase did not affect outcomes, with no uterine perforations or treatment failures.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180225
[Lr] Last revision date:180225
[St] Status:Publisher

  6 / 2034 MEDLINE  
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[PMID]: 29472419
[Au] Autor:Davis AA
[Ad] Address:Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
[Ti] Title:A womb like a broken heart.
[So] Source:BMJ Case Rep;2018, 2018 Feb 22.
[Is] ISSN:1757-790X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Uterine perforation during hysteroscopic operative procedures is a potential complication well known to gynaecologists. Uterine septa are a commonly encountered Mllerian anomaly related to pregnancy loss and infertility. Hysteroscopic resection of septa has shown to improve pregnancy outcome. There are limited case reports of uterine rupture in subsequent pregnancies after hysteroscopic septal resection. Our patient had a hysteroscopic septal resection done a year prior which was complicated by a uterine fundal perforation, left to spontaneously heal after immediate sealing with cautery. The patient conceived spontaneously soon after and underwent an emergency caesarean section for severe pre-eclampsia. Intraoperatively, after removal of the placenta, we discovered a 3 cm symmetrical circular defect at the fundus of the uterus with no myometrium or serosa. The potentially disastrous consequences of this silent uterine rupture were mitigated due to another life-threatening condition which prevented the onset of labour.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180223
[Lr] Last revision date:180223
[St] Status:In-Process

  7 / 2034 MEDLINE  
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[PMID]: 29384976
[Au] Autor:Wangping Z; Hanbing W
[Ad] Address:Department of Anesthesiology.
[Ti] Title:Radiofrequency-induced endometrial ablation for the treatment of postpartum hemorrhage after vaginal delivery: Case report.
[So] Source:Medicine (Baltimore);96(52):e9564, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:RATIONALE: Postpartum hemorrhage is a common complication and difficult problem in obstetrics. Radiofrequency-induced endometrial ablation (RFIEA) widely used in abnormal uterine bleeding and achieved good effects. This article will investigate the effect of RFIEA for treatment of postpartum hemorrhage. PATIENTS CONCERNS: A 26-year-old healthy full-term parturient woman presented with postpartum hemorrhage after vaginal delivery for 11 hours, who was ready to emergency surgery (hysterectomy) 7 hours after inserting an intrauterine balloon into uterine cavity. DIAGNOSES: Blood loss after vaginal delivery was more than 500 mL during 11 hours in the full-term parturient woman. INTERVENTION: We applied RFIEA to treatment of postpartum hemorrhage. With the patient in dorsal lithotomy position, we advanced the disposable device according to the instruction and operated the Novasure system in semi-automatic mode. OUTCOMES: There was no obvious endometrial bleeding found with hysteroscopy at the end of surgery. No complications (such as thermal injury to adjacent tissue, uterine perforation, bowel perforation) were observed. LESSONS: It is safe and effective to treat postpartum hemorrhage after vaginal delivery using RFIEA.
[Mh] MeSH terms primary: Endometrial Ablation Techniques/methods
Postpartum Hemorrhage/surgery
[Mh] MeSH terms secundary: Adult
Female
Humans
[Pt] Publication type:JOURNAL ARTICLE; META-ANALYSIS
[Em] Entry month:1802
[Cu] Class update date: 180220
[Lr] Last revision date:180220
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009564

  8 / 2034 MEDLINE  
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[PMID]: 29432904
[Au] Autor:Rajwani A; Papillon-Smith J; Murji A
[Ad] Address:From the Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
[Ti] Title:Bowel Perforation Following Global Endometrial Ablation.
[So] Source:J Minim Invasive Gynecol;, 2018 Feb 09.
[Is] ISSN:1553-4669
[Cp] Country of publication:United States
[La] Language:eng
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180212
[Lr] Last revision date:180212
[St] Status:Publisher

  9 / 2034 MEDLINE  
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[PMID]: 28463907
[Au] Autor:Mittal N; Pineda M; Lim B; Carey E
[Ad] Address:ACT Pathology (N.M., E.C.) Fetal Medicine Unit (M.P., B.L.), The Canberra Hospital Clinical School, Australian National University (B.L.), Canberra, Australian Capital Territory, Australia.
[Ti] Title:Placenta Previa Increta in an Unscarred Uterus With Marked Thinning of Myometrium in the Entire Uterus in a Patient With Systemic Lupus Erythematosus.
[So] Source:Int J Gynecol Pathol;37(2):198-203, 2018 Mar.
[Is] ISSN:1538-7151
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:A 36-yr-old woman, G5P2, who had a background history of systemic lupus erythematosus (SLE) was found to have placenta previa and placenta accreta on second trimester ultrasound scan. She had previous 3 spontaneous miscarriages but there was no history of gynecologic interventions. Apart from SLE, there was no other explanation for her recurrent miscarriage. The patient had ongoing thrombocytopenia in this pregnancy. The patient was taken for elective lower uterine segment cesarean section at 36 wk+5 d gestation. Balloon catheters were placed in the anterior branches of the internal iliac arteries before the operation. Despite this and aggressive medical management, she experienced significant bleeding requiring peripartum hysterectomy. Histologic examination showed placenta increta with marked thinning of the myometrium. The myometrium was <1 mm thick in most of the uterus except for lower uterine segment without any evidence of uterine rupture or perforation. This paper presents this unusual case of diffuse marked thinning of myometrium in the uterus as well as presence of placenta previa increta, without any prior history of gynecologic intervention in a patient with SLE.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1705
[Cu] Class update date: 180206
[Lr] Last revision date:180206
[St] Status:In-Process
[do] DOI:10.1097/PGP.0000000000000397

  10 / 2034 MEDLINE  
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[PMID]: 29322856
[Au] Autor:Barnett C; Moehner S; Do Minh T; Heinemann K
[Ad] Address:a ZEG Berlin - Berlin Center for Epidemiology and Health Research , Berlin , Germany.
[Ti] Title:Perforation risk and intra-uterine devices: results of the EURAS-IUD 5-year extension study.
[So] Source:Eur J Contracept Reprod Health Care;22(6):424-428, 2017 Dec.
[Is] ISSN:1473-0782
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:OBJECTIVES: The objective of this analysis was to identify intra-uterine devices (IUD) perforations detected from 12 to 60 months following IUD insertion, and to combine this information with (our previously published) data about perforations detected in the first 12 months to calculate cumulative perforation rates. METHODS AND MATERIALS: Prospective, non-interventional cohort study with new users of levonorgestrel-releasing intra-uterine systems (LNG-IUS) and copper-IUD. The original cohort included 61,448 women followed for 12 months. Of these, we had sufficient resources to perform an additional follow-up and analysis at 60 months in 39,009 women. Inclusion criteria for this analysis was insertion prior to 31 July 2010. All potential cases were validated via the health care professional or medical records. Crude and adjusted relative risks were calculated using a logistic regression model. RESULTS: We identified 23 additional perforations (19 LNG-IUS and 4 copper-IUD) more than 12 months after insertion. Added to perforations detected at 12 months, the overall perforation rate was 2.1 per 1000 insertions (95% CI: 1.6-2.8) for LNG-IUS users (40 + 19 perforations/27,630 insertions) and 1.6 per 1000 insertions (95% CI: 0.9-2.5) for copper-IUD users (14 + 4 perforations/11,379 insertions). LNG-IUS users had a borderline higher risk of perforation compared with copper-IUD users (ORadj 1.7; 95% CI: 1.0-2.8). Forty-five (58%) of the 77 perforations were associated with suspected risk factors. Breastfeeding (RR 4.9, 95% CI: 3.0-7.8) and time since delivery (RR 3.0, CI: 1.5-5.4) remained significant risk factors in perforations detected after 12 months. No perforations resulted in serious injury to intra-abdominal or pelvic structures. CONCLUSIONS: The incidence of uterine perforations in this study was low, although higher than the commonly reported rate. Approximately one third of perforations are detected 12 months after insertion. Clinical sequalae of perforations are generally mild and associated with a very low risk of injury to intra-abdominal and pelvic structures. Implications Uterine perforation is a rare risk associated with intra-uterine device use. Late diagnosed perforations can occur, although women can be reassured that the morbidity associated with detection and removal is low.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180123
[Lr] Last revision date:180123
[St] Status:In-Process
[do] DOI:10.1080/13625187.2017.1412427


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