RESUMO
STUDY OBJECTIVE: To show a new laparoscopic technique of hysteropexy for uterine retrodisplacement (retroversion and/or retroflexion). DESIGN: Narrated step-by-step explanation of the Bologna hysteropexy technique using descriptive text and an educational video. SETTING: Tertiary referred center of minimally invasive gynecology, Sant'Orsola Hospital, Bologna University. INTERVENTIONS: The Bologna hysteropexy is proposed as an additional procedure after surgical laparoscopic interventions for benign gynecologic disease. The technique consists of 2 semicontinuous absorbable sutures (Biosyn monofilament no. 1 [Covidien, Mansfield, MA] with 2/3 inch diameter needle, 36 mm) suspending the uterus to the anterior abdominal wall, through the plication and shortening of round ligaments. A knot is tied intracorporeally between the 2 free ends of the semicontinuous sutures, drawing a V shape figure and resulting in uterine ventrosuspension. CONCLUSION: The Bologna technique hysteropexy is simple and quick to perform. It is effective in suspending the uterus in anteverted and anteflexed positions at 6-month ultrasound follow-up. No perioperative complications were recorded. It can be done with a standard surgical suture-passer and does not add additional cost to surgery. Furthermore, an absorbable suture is desirable for fertile women.
Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Complicações Pós-Operatórias/prevenção & controle , Ligamento Redondo do Útero , Técnicas de Sutura , Retroversão Uterina , Útero , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Humanos , Itália , Laparoscopia/métodos , Pessoa de Meia-Idade , Ligamento Redondo do Útero/patologia , Ligamento Redondo do Útero/cirurgia , Resultado do Tratamento , Retroversão Uterina/diagnóstico , Retroversão Uterina/cirurgia , Útero/patologia , Útero/cirurgiaRESUMO
The term "isthmocele" refers to a niche on the anterior wall of the uterine isthmus or of the cervical canal at the site of a previous cesarean delivery scar. Such anatomic defect can cause many gynecologic sequelae that only recently have being identified and described. Hysteroscopy is commonly considered the gold standard for the diagnosis and also for the treatment, at least in the case of defects of small size. The authors described the case of a 37-year-old woman who underwent a cesarean section (CS) seven years before, with a long lasting history of menstrual irregularities, and pelvic pain increasing during menstruation at the hypogastric level. Magnetic resonance imaging (MRI) showed an exceptionally large isthmocele on the anterior wall of a retroflexed uterus which was otherwise misinterpreted as the uterine cavity filled with menstrual blood during a previous hysteroscopy (HSC). Although exceptional, this case highlights the possibility that a large sized isthmocele in a retroflexed uterus could be misinterpreted as the uterine cavity filled by menstrual blood at HSC. In this case MRI definitely clarified the diagnosis.
Assuntos
Cesárea , Cicatriz/patologia , Retroversão Uterina/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Histeroscopia , Imageamento por Ressonância Magnética , Dor Pélvica/etiologia , Retroversão Uterina/complicações , Retroversão Uterina/patologiaRESUMO
BACKGROUND: An incarcerated uterus refers to the retroversion of a pregnant uterus within the pelvis due to the absence of a forward tilt at the end of the first trimester. An incarcerated uterus that is overlooked or only discovered perpartum can cause severe obstetrical complications. Several authors have shared their experience with uterine incarceration management at 12, 14, and 16 weeks of amenorrhea. CASE: Our report concerns a case of uterine incarceration management at 21 weeks of amenorrhea, achieved by way of a specific anesthesia protocol and the positioning of the patient, which allowed the disimpaction of the uterus with the help of external maneuvers. No recurrence was observed. CONCLUSION: Uterine incarceration management is possible beyond 16 weeks of amenorrhea.
Background: An incarcerated uterus refers to the retroversion of a pregnant uterus within the pelvis due to the absence of a forward tilt at the end of the first trimester. An incarcerated uterus that is overlooked or only discovered perpartum can cause severe obstetrical complications. Several authors have shared their experience with uterine incarceration management at 12, 14, and 16 weeks of amenorrhea. Case: Our report concerns a case of uterine incarceration management at 21 weeks of amenorrhea, achieved by way of a specific anesthesia protocol and the positioning of the patient, which allowed the disimpaction of the uterus with the help of external maneuvers. No recurrence was observed. Conclusion: Uterine incarceration management is possible beyond 16 weeks of amenorrhea.
Assuntos
Manipulações Musculoesqueléticas/métodos , Posicionamento do Paciente/métodos , Complicações na Gravidez , Propofol/administração & dosagem , Succinilcolina/administração & dosagem , Retroversão Uterina , Adulto , Anestésicos Intravenosos/administração & dosagem , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Fármacos Neuromusculares Despolarizantes/administração & dosagem , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Segundo Trimestre da Gravidez , Resultado do Tratamento , Retroversão Uterina/diagnóstico , Retroversão Uterina/terapiaRESUMO
OBJECTIVE: The objective of this article is to review the MRI and ultrasound appearances of incarcerated uterus. CONCLUSION: Incarcerated uterus is a rare but serious complication of pregnancy in which the gravid uterus becomes trapped in the posterior pelvis. Characteristic MRI and ultrasound imaging features enable definitive diagnosis of incarcerated uterus, which reduces risks of complications that can lead to maternal and fetal morbidity and mortality.
Assuntos
Imageamento por Ressonância Magnética/métodos , Complicações na Gravidez/diagnóstico , Ultrassonografia Pré-Natal/métodos , Retroversão Uterina/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Fatores de Risco , Retroversão Uterina/diagnóstico por imagemRESUMO
OBJECTIVE: Incarcerated gravid uterus is a condition in which uterine myoma and intraperitoneal adhesion lead to persistent uterine retroversion. Accurate diagnosis before cesarean section is crucial so that the procedure can be planned with regard to the spatial relationship between the uterine incision and other organs. This study investigated the effects of well-planned management on the outcome of cesarean sections. MATERIALS AND METHODS: Four patients with incarcerated gravid uterus who received well-planned management and preoperative magnetic resonance imaging were compared with three unexpected patients who were operated without preoperative diagnosis. RESULTS: In the preoperatively diagnosed group, compared with the non-preoperatively diagnosed group, the frequency of cervical canal damage tended to be lower (0% vs. 100%), blood loss tended to be less (1171 ± 290 mL vs. 2000 ± 300 mL), and surgery duration tended to be shorter (82 ± 17 min vs. 147 ± 84 min). None of the preoperatively diagnosed cases required allogeneic blood transfusion, and no organ damage was observed. CONCLUSION: The early detection of a suspected incarcerated uterus, and a thorough understanding of diagnostic methods and the use of preoperative magnetic resonance imaging and ultrasonography facilitate the safe performance of a cesarean section.
Assuntos
Cesárea/métodos , Planejamento de Assistência ao Paciente , Complicações Neoplásicas na Gravidez/diagnóstico , Diagnóstico Pré-Natal/métodos , Retroversão Uterina/diagnóstico , Adulto , Feminino , Humanos , Leiomioma/complicações , Leiomioma/diagnóstico , Imageamento por Ressonância Magnética , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/cirurgia , Gravidez , Complicações Neoplásicas na Gravidez/cirurgia , Ultrassonografia Pré-Natal , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico , Retroversão Uterina/etiologia , Retroversão Uterina/cirurgiaRESUMO
OBJECTIVE: The aim of this review was to describe the risk factors, clinical and radiographic criteria, and management of this rare complication of pregnancy. METHODS: A PubMed, Web of Science, and CINAHL search was undertaken with no limitations on the number of years searched. RESULTS: There were 60 articles identified, with 53 articles being the basis of this review. Multiple risk factors have been suggested in the literature including retroverted uterus in the first trimester, deep sacral concavity with an overlying sacral promontory, endometriosis, previous abdominal or pelvic surgery, pelvic or uterine adhesions, ovarian cysts, leiomyomas, multifetal gestation, uterine anomalies, uterine prolapse, and uterine incarceration in a prior pregnancy. The diagnosis is difficult to make owing to the nonspecific presenting symptoms. The diagnosis is clinical and confirmed by imaging. Magnetic resonance imaging is superior to ultrasound to accurately diagnose and elucidate the distorted maternal anatomy. Treatment is dictated by gestational age at diagnosis based on risks and benefits. The recommended route of delivery is cesarean delivery when uterine polarity cannot be corrected. CONCLUSIONS: Incarceration of the gravid uterus is a rare but serious complication of pregnancy. The diagnosis is clinical and confirmed with imaging, with magnetic resonance imaging being superior to delineate the distorted maternal anatomy. Reduction of the incarcerated uterus should be attempted to restore polarity and avoid unnecessary cesarean delivery.
Assuntos
Cesárea/métodos , Retroversão Uterina , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Administração dos Cuidados ao Paciente/métodos , Gravidez , Resultado da Gravidez , Medição de Risco , Avaliação de Sintomas , Retroversão Uterina/diagnóstico , Retroversão Uterina/etiologia , Retroversão Uterina/cirurgiaRESUMO
Incarceration of the gravid uterus is a rare obstetric disorder that is often not recognized despite the ready availability of ultrasound. However, detailed imaging of the disturbed uterine and pelvic anatomy - from an obstetric point of view- is the key in reducing the potentially severe complications of this condition and planning its treatment. In this paper, we will describe the specific magnetic resonance imaging (MRI) features of an incarceration of the gravid uterus and we will discuss the role of magnetic resonance imaging in defining anatomy and in the medical decision whether to operate or not.
Assuntos
Complicações na Gravidez/diagnóstico , Retroversão Uterina/diagnóstico , Feminino , Humanos , Apresentação no Trabalho de Parto , Imageamento por Ressonância Magnética , Gravidez , Complicações na Gravidez/patologia , Complicações na Gravidez/cirurgia , Período Pré-Operatório , Retroversão Uterina/patologia , Retroversão Uterina/cirurgiaRESUMO
Incarceration of the retroverted gravid uterus in the third trimester is a rare but distinctive diagnosis. Initial symptoms are more frequently urinary and digestive symptoms which became more acute at the third trimester. Severe abdominal pain associated with bleeding in early labor leads to make the diagnosis during an emergency cesarean section. However, the typical features of the clinical transvaginal exam and the abdominal ultrasound exam can confirm easily this diagnosis. We report two additional cases where Joël-Cohen incision for cesarean section was possible after manual reposition of the uterus. We discuss the diagnostic approach and the management regarding a literature review.
Assuntos
Complicações do Trabalho de Parto/diagnóstico , Retroversão Uterina/diagnóstico , Dor Abdominal , Adulto , Cesárea , Feminino , Humanos , Trabalho de Parto , Complicações do Trabalho de Parto/cirurgia , Gravidez , Terceiro Trimestre da Gravidez , Hemorragia Uterina , Retroversão Uterina/cirurgiaAssuntos
Leiomioma/complicações , Placenta Prévia , Complicações Neoplásicas na Gravidez/diagnóstico , Neoplasias do Colo do Útero/complicações , Retroversão Uterina/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Gravidez , Ultrassonografia Pré-NatalRESUMO
Acute urinary retention at first trimester of pregnancy are uncommon, but have to alert the physician on the possibility of an incarcerated retroverted uterus. Through the management of iterative acute urinary retention before 18weeks of gestation with an incarcerated uterus and a review of the literature, we are going to see the various aetiologies, particularly gravid incarcerated uterus. Acute urinary retention during pregnancy is an emergency. Vaginal operations to open up the uterus should be tried at premature terms, successfully in most of cases.
Assuntos
Complicações na Gravidez/diagnóstico , Retenção Urinária/diagnóstico , Retenção Urinária/etiologia , Retroversão Uterina/complicações , Retroversão Uterina/diagnóstico , Adulto , Feminino , Idade Gestacional , Humanos , Gravidez , Complicações na Gravidez/terapia , Resultado da Gravidez , Retenção Urinária/terapia , Retroversão Uterina/terapiaRESUMO
A 36-year-old woman presented with a urinary retention at gestational age 15 weeks + 5 days. After two days with intermittent catheterisation a magnetic resonance imaging confirmed the diagnosis. Under spinal anaesthesia with ultrasonographic guidance, manual reposition of the incarcerated uterus was first tried, but unsuccessfully. The patient was rolled to her left side, and a diagnostic colonoscopy was performed. A post-procedure ultrasonography and a vaginal examination revealed that the uterus was repositioned. The patient was released with no following symptoms. Follow-up at the gestational age 19 weeks + 5 days showed normal conditions.