A morphological study of symptomatic uterine niche using three-dimensional models from thin-slice magnetic resonance imaging.

RESEARCH QUESTION: Is there a correlation between various morphological parameters of the uterine niche and post-menstrual spotting using three-dimensional models from thin-slice (1 mm) magnetic resonance imaging (MRI)? DESIGN: This study retrospectively identified women diagnosed with a symptomatic niche by thin-slice MRI between December 2019 and December 2021. Univariable and multivariable linear regression models assessed the correlations between morphological parameters and the duration post-menstrual spotting. Morphological differences of the niche formed by one versus two Caesarean sections were analysed by univariable and multivariable logistic analysis. RESULTS: A total of 205 women diagnosed with symptomatic niche were included in the study. The niche among most women with post-menstrual spotting was ellipsoidal, with width greater than length greater than depth, from which niche volume was estimated based on manual measurements (volume = 0.520 × length × width × depth). Manually calculated niche length (ß = 0.257, 95% confidence interval [CI] 0.040-0.473, P = 0.020) and radiomically assessed minor axis length (ß = 0.329, 95% CI 0.009-0.795, P = 0.045) both positively correlated with the duration of post-menstrual spotting, whereas the distance between the niche and external os (ß = -0.120, 95% CI -0.202 to -0.038, P = 0.004) was inversely correlated. Women with two Cesarean sections reported more days of post-menstrual spotting (8.76 ± 3.54 versus 6.68 ± 3.90 days, P < 0.001) and had increased niche length diameter (adjusted odds ratio [aOR] 1.304, 95% CI 1.190-1.429) and a smaller surface-area-to-volume ratio (aOR 0.296, 95% CI 0.129-0.680). CONCLUSIONS: Niche-associated post-menstrual spotting correlates with the length diameter of the niche and the distance between the niche and external os. Niches in women after two Caesarean sections tend to be longer in length diameter and more spherical.

Assessment of the clinical outcomes and complications of hysteroscopic and laparoscopic approaches in the treatment of symptomatic isthmocele: An observational study.

OBJECTIVES: To investigate the outcomes of patients undergoing laparoscopic or hysteroscopic approaches for isthmoplasty. METHODS: A total of 99 isthmocele patients with an average age of 38.45 ± 4.72 years were included in the 2 years of this retrospective cohort study. Forty-five underwent laparoscopic and 54 underwent hysteroscopic isthmocele excision and myometrial repair. RESULTS: Pain scores were significantly higher in the hysteroscopy group before the procedure, but there were no significant pain score differences after the surgery. In 1 year of follow up, dysmenorrhea and dyspareunia were higher among hysteroscopy patients. Furthermore, hysteroscopy significantly improved postmenstrual spotting after surgery better than laparoscopy, but in the follow up, there was no significant difference between the two groups in this regard (mean rank for hysteroscopy vs. laparoscopy: 32.30 vs. 37.48, U = 418, P = 0.29). CONCLUSION: In patients with a history of infertility, ectopic pregnancy, lower gravidity, lower parity, and a lower number of cesarean sections, laparoscopic isthmoplasty is preferred over the hysteroscopic approach. Both methods have similar effects on midcycle vaginal bleeding, duration of postmenstrual spotting, and pain. However, a higher rate of dyspareunia and dysmenorrhea could be associated with hysteroscopy.

Safety of FEIBA and emicizumab (SAFE): Dose escalation study evaluating the safety of in vivo administration of activated prothrombin complex concentrate in haemophilia A patients on emicizumab.

INTRODUCTION: Emicizumab is a humanized bispecific monoclonal antibody licensed for patients with severe haemophilia A. Breakthrough bleeding still occurs in patients on emicizumab and can be managed with recombinant factor VIIa (rFVIIa) or activated prothrombin complex concentrate (aPCC). Thrombotic events were reported when patients on emicizumab received concomitant aPCC at relatively high doses. We studied the effect of infusing various doses of aPCC to patients on emicizumab. MATERIAL AND METHODS: Nine patients with severe haemophilia A with inhibitors who are on emicizumab were recruited to participate. Patients were infused with varying doses of aPCC in vivo. Samples were tested with thrombin generation (TG) assay. RESULTS: In the current in vivo arm of the study four out of nine patients reached the highest dose, 75 U/kg of aPCC and six out of nine patients were actually eligible for the highest dose. In the previous in vitro arm of the study seven out of eight patients reached the normal plasma with spiking aPCC at a very low concentration equivalent to 5 U/kg. CONCLUSION: The in vitro portion of the study demonstrated that clinically relevant concentrations of aPCC resulted in excessive TG, however, in vivo administration of aPCC to the same patients demonstrated that most of the patients had normal TG at the approved doses of aPCC. In the management of breakthrough bleeding clinicians should heed the boxed warning for concomitant use of emicizumab and aPCC, however, should also be aware that low doses of aPCC may not result in sufficient TG.

Definition of large niche after Cesarean section based on prediction of postmenstrual spotting: Chinese cohort study in non-pregnant women.

OBJECTIVE: A large niche after Cesarean section (CS) is associated with long-term complications, of which postmenstrual spotting is associated positively with the size of the niche. However, the diagnosis of a large niche in the literature is inconsistent and the definition is largely subjective. The aim of this study was to generate a definition for a large niche in non-pregnant women based on the presence of postmenstrual spotting. METHODS: Women who had undergone CS in our hospital between January 2012 and June 2017 were selected randomly from our database, contacted by telephone and subsequently examined between January 2016 and June 2020. Eligible for inclusion were non-pregnant women who had their last CS more than 1 year earlier and agreed to undergo transvaginal sonography (TVS). All participants underwent examination of their CS scar by TVS (two-dimensional color Doppler) during the midfollicular phase. Niche depth, length, width, residual myometrial thickness (RMT), adjacent myometrial thickness (AMT) and ratio of niche depth/AMT were recorded. Women diagnosed with a niche, defined as an indentation at the site of the CS with a depth of at least 2 mm, were classified into two groups (symptomatic or asymptomatic) according to whether they experienced postmenstrual spotting. Logistic regression analysis was used to establish the best cut-off values for the niche parameters to predict postmenstrual spotting. A new definition was generated based on the niche parameters with the highest area under the receiver-operating-characteristics (ROC) curve (AUC) for the prediction of postmenstrual spotting. RESULTS: A total of 727 women who had a CS > 1 year earlier underwent TVS examination, of whom 263 were diagnosed with a niche (prevalence of 36.2%). Of these, 160 women experienced postmenstrual spotting and 103 were asymptomatic. The three variables with the highest AUC for prediction of postmenstrual spotting were niche depth/AMT ratio (AUC, 0.798; 95% CI, 0.745-0.852), niche depth (AUC, 0.731; 95% CI, 0.668-0.795) and RMT (AUC, 0.683; 95% CI, 0.618-0.748). Based on the best cut-offs according to ROC-curve analysis, a large niche was defined as: niche depth ≥ 0.50 cm, RMT ≤ 0.21 cm or niche depth/AMT ratio ≥ 0.56. The prevalence of a large niche according to this definition was 22.4% (163/727). The new definition had a specificity of 61.17% (95% CI, 52.34-70.41%) and sensitivity of 76.87% (95% CI, 70.28-84.16%) for a large niche. CONCLUSION: This study has provided a new definition for a large niche after CS. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Oxigenación por membrana extracorpórea veno-arterial en un paciente con embolia pulmonar de alto riesgo / Oxygenation by extracorporeal veno-arterial membrane in a patient with high-risk pulmonary embolism

No disponible

Immunohistochemical results and case report of an incidental finding of uterine polypoid adenomyoma after long-time therapy for metrorrhagia.

We present a 25-year-old female woman with a 9-year history of metrorrhagia, in whom a uterine polypoid adenomyoma (UPA) was incidentally detected. Intense nuclear staining in the uterine adenomyoma tissue showed an immunoreaction with BAF250a/ARID1A, Arginase-2 as well as 1LRH-2E1/NR5A2, suggesting a role of these proteins and transcriptional activity of their genes in uterine polypoid adenomyoma development. Neither Nidogen-2 nor SF-1/NR5A1 were expressed in UPA.

Hysteroscopic endometrial resection vs. hysterectomy for abnormal uterine bleeding: impact on quality of life and sexuality. Evidence from a systematic review of randomized controlled trials.

PURPOSE OF REVIEW: The aim of this systematic review is to summarize the current evidence regarding the effectiveness of hysterectomy and hysteroscopic endometrial resection in improving quality of life (QoL), sexual function and psychological wellbeing of women abnormal uterine bleeding. RECENT FINDINGS: We performed a systematic literature search in PubMed/MEDLINE and Embase for original studies written in English (registered in PROSPERO 2019 CRD42019133632), using the terms 'endometrial ablation', 'endometrial destruction', 'endometrial resection', 'hysterectomy', 'menorrhagia', 'dysfunctional uterine bleeding', 'quality of life', 'sexuality' published up to April 2019. Our literature search produced 159 records. After exclusions, nine studies were included showing the following results: both types of treatment significantly improve QoL and psychological wellbeing; hysterectomy is associated with higher rates of satisfaction; hysterectomy is not associated with a significant deterioration in sexual function. SUMMARY: Hysterectomy is currently more advantageous in terms of improving abnormal uterine bleeding and satisfaction rates than hysteroscopic endometrial destruction techniques. Furthermore, there is some evidence of a greater improvement in general health for women undergoing hysterectomy. However, high-quality prospective randomized controlled trials should be implemented to investigate the effectiveness of hysterectomy and endometrial ablation in the improvement of QoL outcomes in larger patient cohorts.

Sex matters: Practice 5P's when treating young women with venous thromboembolism.

Sex matters when it comes to venous thromboembolism (VTE). We defined 5P's - period, pill, prognosis, pregnancy, and postthrombotic syndrome - that should be discussed with young women with VTE. Menstrual blood loss (Period) can be aggravated by anticoagulant therapy. This seems particularly true for direct oral anticoagulants. Abnormal uterine bleeding can be managed by hormonal therapy, tranexamic acid, or modification of treatment. The use of combined oral contraceptives (Pill) is a risk factor for VTE. The magnitude of the risk depends on progestagen types and estrogen doses used. In women using therapeutic anticoagulation, concomitant hormonal therapy does not increase the risk of recurrent VTE. Levonorgestrel-releasing intrauterine devices and low-dose progestin-only pills do not increase the risk of VTE. In young women VTE is often provoked by transient hormonal risk factors that affects prognosis. Sex is incorporated as predictor in recurrent VTE risk assessment models. However, current guidelines do not propose using these to guide treatment duration. Pregnancy increases the risk of VTE by 4-fold to 5-fold. Thrombophilia and obstetric risk factors further increase the risk of pregnancy-related VTE. In women with a history of VTE, the risk of recurrence during pregnancy or post partum appears to be influenced by risk factors present during the first VTE. In most women with a history of VTE, antepartum and postpartum thromboprophylaxis with low-molecular-weight heparin is indicated. Women generally are affected by VTE at a younger age then men, and they have to deal with long-term complications (Post-thrombotic syndrome) of deep vein thrombosis early in life.

Individualized Homeopathic Therapy in a Case of Obesity, Dysfunctional Uterine Bleeding, and Autonomic Dystonia.

BACKGROUND Obesity is one of the leading causes of morbidity and mortality globally and challenging to treat because of the multifactorial etiology and presentation. Individualized homeopathy takes into account factors that led to a patient's health condition and hence may have a role in the treatment of obesity and related co-morbidities; co-morbidities that may arising from the same etiology may respond as a whole to homeopathy treatment. CASE REPORT A 39-year-old Russian female who developed multiple problems after severe emotional stress was treated with individualized classical homeopathic therapy. Obesity, dysfunctional uterine bleeding, and dysautonomia were pathologies that showed improvement. CONCLUSIONS The response in this patient's case, supports the need for further investigation on the relevance of individualized homeopathy in these related conditions.

Extrofia vesical en el recién nacido. Diagnóstico antenatal y postnatal / Bladder exstrophy in the newborn. Antenatal and postnatal diagnosis

Entre las semanas 6ª y 7ª de amenorrea, el disco embrionario se pliega en cuatro direcciones: cefálico, caudal y laterales, izquierdo y derecho. Cada uno de los pliegues converge a nivel del ombligo con lo que se oblitera el celoma extraembrionario. Las cinco anomalías asociadas a defectos de pared abdominal son el onfalocele, la gastrosquisis, la ectopia cordis, la anomalía body stalk y la extrofia de cloaca en la que se incluye, la extrofia vesical. Presentamos el caso de una gestante con feto afecto de genitales ambiguos diminutos cuyo diagnóstico postnatal fue la extrofia vesical (AU)

Between the 6th and 7th weeks of amenorrhea, the embryonic disc folds on both longitudinal and transverse plains. The embryonic plate converges at the level of the umbilicus, thereby closing the extracelomic area. The following five anomalies are associated with abdominal wall defects: onphalocele, gastroschisis, ectopia cordis, Body stalk anomaly and cloacal exstrophy which includes bladder extrophy. We describe the case of a pregnant woman with fetus diagnosed with ambiguous genitalia during pregnancy, and postnatal diagnosis of bladder exstrophy (AU)

Abnormal Uterine Bleeding Is Associated With Increased BMP7 Expression in Human Endometrium.

Abnormal uterine bleeding (AUB), a common health concern of women, is a heterogeneous clinical entity that is traditionally categorized into organic and nonorganic causes. Despite varied pharmacologic treatments, few offer sustained efficacy, as most are empiric, unfocused, and do not directly address underlying dysregulated molecular mechanisms. Characterization of such molecular derangements affords the opportunity to develop and use novel, more successful treatments for AUB. Given its implication in other organ systems, we hypothesized that bone morphogenetic protein (BMP) expression is altered in patients with AUB and hence comprehensively investigated dysregulation of BMP signaling pathways by systematically screening 489 samples from 365 patients for differences in the expression of BMP2, 4, 6, and 7 ligands, BMPR1A and B receptors, and downstream SMAD4, 6, and 7 proteins. Expression analysis was correlated clinically with data abstracted from medical records, including bleeding history, age at procedure, ethnicity, body mass index, hormone treatment, and histological diagnosis of fibroids, polyps, adenomyosis, hyperplasia, and cancer. Expression of BMP7 ligand was significantly increased in patients with AUB (H-score: 18.0 vs 26.7; P < .0001). Patients reporting heavy menstrual bleeding (menorrhagia) as their specific AUB pattern demonstrated significantly higher BMP7 expression. Significantly, no differences in the expression of any other BMP ligands, receptors, or SMAD proteins were observed in this large patient cohort. However, expression of BMPR1A, BMPR1B, and SMAD4 was significantly decreased in cancer compared to benign samples. Our study demonstrates that BMP7 is a promising target for future investigation and pharmacologic treatment of AUB.

Nueva propuesta quirúrgica para úteros miomatosos grandes: histerectomía asistida inversa / New surgical approach for large fibroid uterus. Reverse assisted hysterectomy

Objetivo: describir una nueva técnica que combina la vía vaginal y la laparoscopia en caso de úteros grandes y con poca movilidad permitiendo evitar la vía laparotómica. Material y métodos: se realiza un estudio descriptivo y retrospectivo entre marzo de 2011 y abril de 2013. Se recogen 15 casos realizados con esta técnica en el Hospital de Mataró. Se analizan la edad, la paridad, número de cesáreas u otras cirugías anteriores ya fuesen abdominales o vaginales, estado hormonal de la paciente, tamaño uterino clínico y por ecografía, prolapso uterino, incontinencia de orina, hemoglobina pre y post quirúrgicas, sangrado durante la cirugía, peso por anatomía patológica, diagnóstico anatomopatológico y días de hospitalización. Resultados: la media de edad de las pacientes fue de 46,7 años. El motivo de consulta en el 53,3% de los casos fue por metrorragia y en el 46,7% por tumoración abdominal. El peso medio de las piezas quirúrgicas fue de 705 g y no hubo complicaciones importantes asociadas a la cirugía. La media de tiempo operatorio fue de 122 minutos. Conclusiones: si bien los avances en la vía laparoscópica han permitido realizar histerectomías de úteros miomatosos con éxito, dejando en un segundo plano la vía abdominal, todavía existen casos de úteros grandes con poca movilidad lateral que nos obligan a realizar un abordaje abdominal. Para estas situaciones, nuestro grupo, realiza una traquelectomía simple vía vaginal con posterior histerectomía subtotal vía laparoscópica. Se trata de una alternativa viable, segura, con una baja tasa de complicaciones y con una estancia hospitalaria reducida, por lo que parece una opción razonable en casos seleccionados (AU)

Objective: To describe a new technique that combines vaginally and laparoscopy approach for large and no-mobil uteri allowing to avoid laparotomy. Material and methods: A descriptive and retrospective study was performed between March 2011 and April 2013. 15 cases performed with this procedure in Mataró Hospital are collected. We analize age, parity , number of caesarean section or other previous surgeries (abdominal or vaginal), hormonal status of the patient, uterine size clinical and by ultrasound , uterine prolapse, urinary incontinence, pre and post surgical hemoglobin, bleeding during surgery, weight pathology, pathological diagnosis and hospital stay. Results: The average age of the patients was 46.66 years. The main reason for consultation in 53.33% of cases was for menorrhagia and in 46.66% of abdominal tumor. The average weight of the surgical specimens was 705 g and there were no major complications related to surgery. The mean operative time was 122 minutes. Conclusions: Despite of advances in laparoscopic approach for hysterectomies that have allowed us to perform successfully fibroid uterus, leaving in the background the abdominal route, there are still cases of large uteri with minimum lateral mobility that would make us think of a better abdominal approach. For these situations we propose the vaginal trachelectomy with subsequent laparoscopic subtotal hysterectomy is a feasible and safe alternative, with a low complication rate and a reduced hospital stay, it seems a reasonable option in selected cases (AU)

Histerectomía laparoscópica total con acceso a un solo puerto: reporte de 10 casos / Total laparoscopic hysterectomy with single-port access: report of 10 cases

Objectivo: el objetivo de este estudio es demostrar la viabilidad de un solo puerto quirúrgico laparoscópico transumbilical para la histerectomía y explicar nuestra grata experiencia con el fin de introducir este tipo de técnica quirúrgica para la cirugía ginecológica. Método: desde enero de 2010 hasta junio de 2010 en el Hospital de Igualada, Barcelona, España, se realizó histerectomía total mediante cirugía laparoscópica con un sólo puerto a una serie de 10 mujeres pre, peri y postmenopáusicas, diagnosticadas de varias patologías benignas. Resultados: resultados demográficos y quirúrgicos: edad (y): X = 56,5 (41-72), índice de masa corporal (kg/m2): X = 26,7 (19,9-33,9), tiempo quirúrgico (min): X = 92 (60-110), pérdida sanguínea estimada (Hb pre-Hbpost): X = 1,4 (0,9-2,0), peso uterino (gr): X = 139 (64-298). Días estancia hospitalaria (d): X = 3 (2-7). No hubo complicaciones quirúrgicas. Sólo un caso de íleo paralítico aumentó la media de estancia hospitalaria en 7 días. Conclusión: la laparoscopia en un solo puerto es una alternativa a la laparoscopia convencional multipuerto y se puede realizar a cualquier edad y cualquier índice de masa corporal. Las ventajas de un sólo acceso de laparoscopia con un puerto transumbilical consisten en no presentar infecciones y formación de hernias postoperatorias, buenos resultados cosméticos, poco dolor postoperatorio, poca pérdida de sangre y poco tiempo de estancia hospitalaria postoperatoria. Las desventajas y limitaciones son, entre otras, dificultad de aprendizaje de la técnica y la necesidad de instrumentos especializados (AU)

Objective: The objective of the present study is to demonstrate the feasibility of single-port transumbilical laparoscopic surgery for hysterectomy and elaborate on our experience in order to introduce the single-port approach for gynecologic surgery. Method: From January 2010 to June 2010 at Igualada’s Hospital, Barcelona, Spain, laparoendoscopic single-site surgery total hysterectomy was performed in 10 pre, peri and post-menopausical patients diagnosed with a variety of benign pathology. Results: Demographics and surgical outcomes: age (y): X = 56.5 (41-72), BMI (kg/m2): X = 26,7(19,9-33,9), operative time (min): X = 92(60-110), estimated blood loss (Hbpre-Hbpost): X = 1,4 (0,9-2,0), weight of uterus (gr): X = 139 (64-298). Postoperative hospital stay (d): X = 3 (2-7). There were no operative complications. One case of paralytic ileo increased time spent in a hospital by 7 days. Conclusion: laparo endoscopic Single-SIH surgery is an alternative to conventional multiport laparoscopy and can be performed to any age and BMI. The advantages of Single-access laparoscopy using a transumbilical port may include no infection and hernia formation and good cosmetic outcomes. There is less of postoperation pain, little lost of blood postoperation and short postoperative hospital stay. The disadvantages and limitations include difficulty in learning the technique, and need for specialized instruments (AU)

Defectos de crecimiento fetal tardío: manejo prenatal y resultados perinatales en el ámbito de un hospital de nivel II / Late fetal growth defects: prenatal management and perinatal outcomes in a level II hospital setting

Objetivo: comparar el manejo prenatal y los resultados perinatales entre fetos pequeños para la edad gestacional y con crecimiento intrauterino restringido. Sujetos y métodos: estudio retrospectivo observacional de gestantes con fetos con peso estimado inferior al percentil 10 entre 2010 y 2013. Revisamos 5.162 partos; 139 cumplieron criterios de inclusión (48 pequeños para la edad gestacional y 91 crecimiento intrauterino restringido). Resultados: el análisis estadístico comparando ambos grupos mostró diferencias significativas (p <0,05) en: semanas en el momento del parto (39,6 en pequeños para la edad gestacional vs. 38,4 en crecimiento intrauterino restringido), prematuridad (0% vs. 14,3%), peso neonatal (2.595 g vs. 2.368 g), inducciones (41,7% vs. 81,3%), registros cardiotocográficos intraparto patológicos (14,5% vs. 36,2%) y tasa de cesáreas por pérdida del bienestar fetal (12,5% vs. 36,2%). Conclusiones: los hallazgos confirman la existencia de diferencias entre ambos grupos. A pesar de que los fetos con crecimiento intrauterino restringido presentan más riesgo de resultados perinatales adversos, la estrecha monitorización antenatal y durante el parto permite obtener resultados comparables a los fetos pequeños para la edad gestacional (AU)

Objective: To compare perinatal outcomes between fetuses small-for-gestational-age and those with intrauterine growth restriction. Subjects and methods: This is a retrospective observational study of pregnancies between 2010 and 2013 with an estimated fetal weight below 10th centile diagnosed by ultrasonography. We reviewed 5,162 deliveries and 139 were included in the study (48 were small-for-gestational-age and 91 were intrauterine growth restriction). Results: Statistical analysis comparing both groups showed significant differences (p <0,05) in: gestational age at delivery (39.6 in small-for-gestational-age vs. 38.4 in intrauterine growth restriction), prematurity (0% vs. 14.3%), newborn weight (2,595 g vs. 2,368 g), induction of labour (41.7% vs. 81.3%), non-reassuring features on cardiotocograph (14.5% vs. 36.2%) and caesarean section rate for non-reassuring fetal status (12.5% vs. 36.2%). Conclusion: Our findings confirm the suspicion of differences between both groups. Although fetuses with intrauterine growth restriction are at higher risk of poor outcome when compared to small-for-gestational-age, close monitoring antenatally and during labour allows to obtain outcomes similar to those fetuses small-for-ges-tational-age (AU)

Varices cervicales como motivo de sangrado durante la gestación / Cervical varicose veins as a source of bleeding during pregnancy

Introducción: el sangrado vaginal es una complicación que puede aparecer durante toda la gestación, siendo las causas más frecuentes la placenta previa y el desprendimiento de placenta. Las varices cervicales como causa de metrorragia en gestantes representan una situación infrecuente, pero suponen un importante factor de riesgo para posibles resultados obstétricos desfavorables. Caso clínico: se presenta el caso de una gestante de 29 semanas de gestación con hemorragia masiva, siendo el diagnóstico varices cervicales. Conclusiones: a pesar de la baja incidencia de las varices cervicales y en un intento de reducir al máximo las complicaciones asociadas, es necesario incluirla en el diagnóstico diferencial de todo sangrado vaginal severo durante la gestación (AU)

Introduction: Vaginal bleeding is a complication that can occur throughout pregnancy, being placenta previa and placental abruption the most frequent causes. Cervical varicosities as a cause of vaginal bleeding during pregnancy are a rare situation, but are an important risk factor for potential adverse pregnancy outcomes. Case report: We reported the case of 29 weeks pregnant with massive bleeding caused by cervical varicosities. Conclusions: Despite the low incidence of cervical varicose veins and in an attempt to minimize associated complications, you must include it in the differential diagnosis of all severe vaginal bleeding during pregnancy (AU)

Dehiscencia uterina diagnosticada un mes postparto: presentación de un caso y revisión bibliográfica / Uterine dehiscence discovered one month after delivery: case report and literature review

La rotura uterina es una complicación obstétrica cuyas consecuencias pueden ser graves. Se diagnostica principalmente antes o durante el trabajo de parto en mujeres con antecedente de cesárea y una extracción rápida del feto es necesaria. Sin embargo, pocos casos de dehiscencia uterina son diagnosticados a distancia del parto. Presentamos el caso de una paciente con útero cicatrizado, que consulta por metrorragia 27 días después de parto por vía vaginal, en la que se diagnosticó una dehiscencia uterina con consecuente histerectomía abdominal a través de una incisión de Pfannenstiel. Por medio de este caso se evaluarán los signos y síntomas para el diagnóstico temprano de una dehiscencia, permitiendo así proporcionar el tratamiento más conservador posible (AU)

Uterine rupture is an uncommon but potentially devastating maternal and obstetric complication that is usually diagnosed in women with a prior caesarean delivery before or during labour, leading to an emergency foetal extraction. However, there are very few reports of uterine rupture diagnosed in the postpartum period. We report the case of a patient with a scarred uterus who presenting with metrorrhagia 27 days after a vaginal delivery. A diagnosis of uterine dehiscence was made, requiring an abdominal hysterectomy through Pfannenstiel incision. Through this case we highlight the symptoms and signs to establish an early diagnosis, which allow provision of the most conservative treatment possible (AU)

La embolización arterial selectiva como alternativa terapéutica en el manejo del hematoma puerperal disecante / Selective arterial embolization as a therapeutic alternative in the management of puerperal dissecting haematoma

La mayoría de los hematomas puerperales son secundarios a laceraciones o desgarros producidos como consecuencia del traumatismo del parto, y rara vez tienen consecuencias maternas importantes. En ocasiones, estos hematomas pueden expandirse y disecar el tejido circundante suponiendo una complicación obstétrica potencialmente grave. Aunque es necesario un diagnóstico y tratamiento precoz, su manejo no está estandarizado y es causa de controversia ya que la literatura no es concluyente en cuanto a los beneficios del tratamiento conservador respecto al quirúrgico. El propósito de presentar este caso es demostrar la importancia de las técnicas de imagen para la identificación del lugar de la hemorragia y la posibilidad de realizar una embolización arterial selectiva como alternativa eficaz para el control de la misma (AU)

Most puerperal haematomas are produced by lacerations or tears as a result of birth trauma and rarely have significant maternal consequences. These hematomas can sometimes expand and dissect surrounding tissues, becoming a potentially serious obstetric complication. Although early diagnosis and treatment is necessary, the management of these entities remains controversial and there is no conclusive evidence on the benefits of surgery compared with non-surgical treatment. The present case report illustrates the importance of imaging techniques in identifying the site of bleeding and the possibility of selective arterial embolization as an effective alternative for bleeding control (AU)

Torsión aislada de trompa de Falopio en paciente sometida a bloqueo tubárico bilateral / Isolated Fallopian tube torsion in a patient with bilateral tube blockage

La torsión aislada de la trompa de Falopio es un motivo infrecuente de consulta en Ginecología. La clínica que produce es sumamente inespecífica, dificultando mucho la realización de un diagnóstico de sospecha y de un tratamiento precoz (AU)

Isolated torsion of the fallopian tube is a rare reason for seeking consultation in gynaecology. Symptoms are non-specific, which hampers its presumptive diagnosis and early treatment (AU)

Correlation between transvaginal ultrasound measured endometrial thickness and histopathological findings in Turkish women with abnormal uterine bleeding.

AIM: The present study aims to determine how transvaginal ultrasonography and histopathological examination findings are correlated in a cohort of premenopausal and postmenopausal Turkish women with abnormal uterine bleeding. METHODS: This is a retrospective review of 350 Turkish women who underwent transvaginal ultrasonography and suction curettage as a result of abnormal uterine bleeding. RESULTS: Sonographic appearance of the endometrium was normal in 244 patients (69.7%), while homogeneous thickening was detected in 47 patients (13.4%) and cystic thickening in 21 patients (6.0%). A sonographic diagnosis of endometrial polyp was made in 38 patients (10.9%). Histopathological analysis of endometrial samplings revealed proliferative endometrium (36%), secretory endometrium (24.6%), decidualization (10.9%), endometrial polyp (8.3%), endometritis (6.8%), endometrial hyperplasia (4.6%), irregular shedding (3.7%), atrophic endometrium (3.1%), endometrial cancer (1.1%) and placental retention (0.9%). The sonographic and histopathological findings correlated significantly (χ(2) = 122 768, P = 0.001; r = 0.215, P = 0.001). Approximately 51% of the women with homogeneous endometrial thickening had proliferative endometrium. Only 44.7% of the women with ultrasonographically visualized endometrial polyps had histopathologically diagnosed endometrial polyps. Nearly 57% of the women with cystic endometrial thickening had proliferative endometrium. CONCLUSION: If there is no facility for hysteroscopy or hysteroscopy-guided endometrial biopsy for women with abnormal uterine bleeding, transvaginal ultrasonography findings can be efficiently used to make a preliminary diagnosis and, thus, notify the pathologists.

Gestación heterotópica accidentada / Ruptured heterotopic pregnancy

La gestación heterotópica es una circunstancia rara y de difícil diagnóstico, puesto que en ciclos de concepción natural su incidencia es muy baja. Por ello es importante descartar su diagnóstico en aquellas pacientes con una gestación intrauterina y dolor abdominal y hemoperitoneo. Presentamos el caso clínico de una primigesta de 35 años, sin antecedentes, con gestación actual espontánea, que consultó por metrorragia. Tras la sospecha de gestación heterotópica, se realizaron una salpingectomía laparoscópica y un legrado evacuador del aborto en curso. La anatomía patológica confirmó el diagnóstico (AU)

Heterotopic pregnancy is a rare event. Because the incidence is very low in natural conception cycles, this entity is difficult to diagnose. Therefore, it is important to rule out this diagnosis in patients with an intrauterine pregnancy, abdominal pain and hemoperitoneum. We report the case of a 35-year-old woman with no relevant medical history and a spontaneous pregnancy, who presented with metrorrhagia. Due to suspicion of a heterotopic pregnancy, laparoscopic salpingectomy and curettage of the abortion in progress were performed. The diagnosis was confirmed by pathological analysis (AU)