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1.
Medicine (Baltimore) ; 99(43): e22845, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120815

RESUMO

The aim of the study was to compare the efficacy of laparoscopy and hysteroscopy for the treatment of cesarean scar pregnancy (CSP) and analyze the clinical factors associated with successful selection for hysteroscopic or laparoscopic treatment of CSP.We retrospectively studied 112 cases of CSP that were treated by laparoscopy and/or hysteroscopy in our hospital from December 2014 to December 2017. In total, 72 of these patients underwent ultrasound-guided curettage and hysteroscopic resection without uterine scar defect repair. Fourty of these patients underwent laparoscopic resection and repair of the uterine scar defect. We analyzed the different clinical variables between the 2 groups and identified the clinical factors which could predict the need for the laparoscopic repair of uterine scar defect. Results showed that laparoscopy and hysteroscopy were safe ways to treat CSP, and no patient underwent hysterectomy. The ß-hCG level in both of the 2 groups decreased to normal 4 to 8 weeks after surgery. There were significant differences between the hysteroscopy group and laparoscopy uterine scar repair group in terms of days of amenorrhea, gestational sac diameter, myometrial thickness, operation time, intraoperative blood loss, and hospitalization duration (P < .05). Logistic regression analysis showed that the days of amenorrhea, gestational sac diameter and myometrial thickness were independent risk factors for CSP treated by minimally invasive surgery, which were also shown by ROC curve analysis to be predictors of the need for the repair of the uterine scar defect, with optimal cutoffs of 52.50 days, 3.25 cm, and 2.05 mm, respectively; and the areas under their corresponding ROC were 0.721, 0.851, and 0.927, respectively.We conclude that laparoscopy and hysteroscopy are safe and efficient minimally invasive procedures for the treatment of CSP. The days of amenorrhea, gestational sac diameter and myometrial thickness may be key factors associated with successful selection for hysteroscopic or laparoscopic treatment of CSP.


Assuntos
Cesárea/efeitos adversos , Cicatriz/complicações , Histeroscopia/métodos , Laparoscopia/métodos , Gravidez Ectópica/cirurgia , Adulto , Cicatriz/cirurgia , Feminino , Humanos , Gravidez , Gravidez Ectópica/etiologia , Estudos Retrospectivos , Ultrassonografia de Intervenção
2.
Am J Cardiol ; 136: 87-93, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-32946863

RESUMO

Although radiofrequency catheter ablation (RFCA) is indicated in electrical storm (ES) refractory to antiarrhythmic drugs, its most appropriate timing has not been determined. Our objective is to analyse the impact of the timing of RFCA on 30-day mortality in patients with ES and previous scar-related systolic dysfunction. In this multi-centre study, we analysed 104 patients (age: 72 ± 10, left ventricular ejection fraction: 30 ± 6%) attended consecutively due to an ES caused by monomorphic ventricular tachycardia. Sixty-four subjects were treated with RFCA (mean time from admission = 83 ± 67 hours) and 40 were not. Upon admission 25 (24%) individuals had severe heart failure. Mortality rate at 30 days was 24 (23%) patients. RFCA was associated with a reduction of 30-day mortality (hazard ratio = 0.2; p = 0.008). After showing a positive correlation between the time of the RFCA (hours) and survival at 30 days (C-statistic = 0.77; p <0.001), we found that only subjects ablated >48 hours after admission had lower mortality at 30 days than those treated conservatively: 38% (no RFCA) versus 30% (RFCA ≤48 hours) versus 7% (RFCA >48 hours) (adjusted hazard ratio for RFCA >48 hours vs others = 0.2; p = 0.007). Among the patients ablated, those who were non-inducible had lower 30-day mortality: 8% versus 29% (p = 0.03). Extracorporeal membrane oxygenation was associated with a higher rate of non-inducibility in RFCA >48 hours (100% vs 76%; p = 0.03), but not in RFCA ≤48 hours (60% vs 60%; p = 1). In conclusion, among high-risk patients with ES, RFCA performed >48 hours after admission is associated with a reduction in 30-day mortality. In such subjects, the probability of successful RFCA increases when performed under extracorporeal membrane oxygenation support.


Assuntos
Ablação por Cateter , Taquicardia Ventricular/cirurgia , Idoso , Idoso de 80 Anos ou mais , Ablação por Cateter/métodos , Cicatriz/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Taquicardia Ventricular/complicações , Taquicardia Ventricular/mortalidade , Fatores de Tempo , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/etiologia
3.
Pan Afr Med J ; 36: 44, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32774620

RESUMO

Despite all the health policies implemented in our developing countries, uterine rupture (RU) remains common. They are severe and involve maternal and fetal prognosis. Among the multiple risk factors, the most common cited in the literature is C-section scar. Most occurs during labor or at the end of pregnancy. Uterine rupture during the first or second trimester is exceptional and its clinical manifestation is variable. We here report a case of spontaneous uterine rupture at 15 weeks' gestation in a pauciparous woman with scarred uterus. Exacerbation of clinical symptoms was manifested by peritoneal irritation. Surgical exploration revealed complete vertical rupture from the bottom to the lower segment of the uterus with open book opening of the uterus. This study highlights that uterine rupture should be considered in patients with scarred uterus presenting with abdominal pain associated with signs of hemoperitoneum, regardless of whether their pregnancies are at term or in the first two trimesters, and regardless of age (young patients) and parity.


Assuntos
Cicatriz/complicações , Ruptura Uterina/etiologia , Útero/patologia , Dor Abdominal/etiologia , Adulto , Cesárea/efeitos adversos , Feminino , Hemoperitônio/etiologia , Humanos , Gravidez , Segundo Trimestre da Gravidez
4.
Rev. habanera cienc. méd ; 19(4): e3006, tab, ilus
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1139179

RESUMO

RESUMEN Introducción: el embarazo ectópico se produce cuando el embrión se implanta fuera de la cavidad uterina, y se ubica mayormente en las trompas de Falopio. Objetivo: presentar un caso clínico en el que la paciente desarrolló un embarazo ectópico en la cicatriz de una histerorrafia previa, fue diagnosticada cuando cursaba la sexta semana de gestación y se resistió ante la idea de perderlo irremediablemente, aunque su cuadro clínico es muy doloroso y se complica rápidamente. Presentación del caso: paciente de 27 años de edad, de color de piel negra, con antecedente de cesárea previa 9 meses atrás. Según reporte ecográfico se diagnostica embarazo de 8,6 semanas de gestación localizado en la zona de cicatriz de cesárea previa. Recibe tratamiento inicial con metotrexate y cloruro de potasio, para luego ser intervenida quirúrgicamente a través de legrado instrumental, se corrobora diagnóstico ecográfico y se logra extraer el embrión exitosamente. Conclusión: el manejo atendió a las características clínicas e individuales de la gestante y se respetó el principio de autonomía de la embarazada. La paciente pudo ser dada de alta con un estado de salud satisfactorio, conservó su capacidad de fecundidad(AU)


ABSTRACT Introduction: Ectopic pregnancy occurs when the embryo is implanted outside the uterine cavity, mostly located in the fallopian tubes. Objective: To present a clinical case in which the patient developed an ectopic pregnancy over a previous cesarean section scar; the diagnosis was made when she was in the sixth week of her pregnancy and she could not withstand the idea of losing the baby, but the clinical picture worsened, she was very painful and became complicated quickly. Case report: Twenty-seven-year-old black patient with previous history of a cesarean section 9 months ago. According to ultrasound criteria, 8.6 weeks of pregnancy located in the area of a previous cesarean section scar is diagnosed. The patient receives initial treatment with methotrexate and potassium chloride to undergo a surgical procedure through instrumental intervention (curettage), confirming the diagnosis of the ultrasound and removing the embryo successfully. Conclusions: The management was based on the clinical and individual characteristics of the pregnant woman respecting the principle of autonomy. The patient was in good health at the moment of discharge, preserving her fertility capacity(AU)


Assuntos
Humanos , Gravidez , Adulto , Gravidez Ectópica/cirurgia , Gravidez Ectópica/diagnóstico , Cicatriz/complicações , Curetagem a Vácuo
6.
Cochrane Database Syst Rev ; 7: CD011174, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32609376

RESUMO

BACKGROUND: Non-tubal ectopic pregnancy is the implantation of an embryo at a site lying outside the uterine cavity or fallopian tubes. Sites include a caesarean scar, the cornua uteri, the ovary, the cervix, and the abdomen. There has been an increasing trend in the occurrence of these rare conditions, especially caesarean scar pregnancy (CSP). OBJECTIVES: To evaluate the clinical effectiveness and safety of surgery, medical treatment, and expectant management of non-tubal ectopic pregnancy in terms of fertility outcomes and complications. SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility (CGF) Group Specialised Register of Controlled Trials, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, the World Health Organization (WHO) search portal and nine other databases to 12 December 2019. We handsearched reference lists of articles retrieved and contacted experts in the field to obtain additional data. SELECTION CRITERIA: We included randomized controlled trials (RCTs) published in all languages that examined the effects and safety of surgery, medical treatment, and expectant management of non-tubal ectopic pregnancy. DATA COLLECTION AND ANALYSIS: We used Cochrane standard methodological procedures. Primary outcomes were treatment success and complications. MAIN RESULTS: We included five RCTs with 303 women, all reporting Caesarean scar pregnancy. Two compared uterine arterial embolization (UAE) or uterine arterial chemoembolization (UACE) plus methotrexate (MTX) versus systemic MTX and subsequent dilation and suction curettage; one compared UACE plus MTX versus ultrasonography-guided local MTX injection; and two compared suction curettage under hysteroscopy versus suction curettage under ultrasonography after UAE/UACE. The quality of evidence ranged from moderate to very low. The main limitations were imprecision (small sample sizes and very wide confidence intervals (CI) for most analyses), multiple comparisons with a small number of trials, and insufficient data available to assess heterogeneity. UAE/UACE versus systemic MTX prior to suction curettage Two studies reported this comparison. One compared UAE with systemic MTX and one compared UACE plus MTX versus systemic MTX, in both cases followed by a suction curettage. We are uncertain whether UAE/UACE improved success rates after initial treatment (UAE: risk ratio (RR) 1.00, 95% CI 0.90 to 1.12; 1 RCT, 72 women; low-quality evidence; UACE: RR 0.87, 95% CI 0.54 to 1.38; 1 RCT, 28 women; low-quality evidence). We are uncertain whether UAE/UACE reduced rates of complications (UAE: RR 0.47, 95% CI 0.13 to 1.75; 1 RCT, 72 women; low-quality evidence; UACE: RR 0.62, 95% CI 0.26 to 1.48; 1 RCT, 28 women; low-quality evidence). We are uncertain whether UAE/UACE reduced adverse effects (UAE: RR 1.58, 95% CI 0.41 to 6.11; 1 RCT, 72 women; low-quality evidence; UACE: RR 1.16, 95% CI 0.32 to 4.24; 1 RCT, 28 women; low-quality evidence), and it was not obvious that the types of events had similar values to participants (e.g. fever versus vomiting). Blood loss was lower in UAE/UACE groups than systemic MTX groups (UAE: mean difference (MD) -378.70 mL, 95% CI -401.43 to -355.97; 1 RCT, 72 women; moderate-quality evidence; UACE: MD -879.00 mL, 95% CI -1135.23 to -622.77; 1 RCT, 28 women; moderate-quality evidence). Data were not available on time to normalize ß-human chorionic gonadotropin (ß-hCG). UACE plus MTX versus ultrasonography-guided local MTX injection We are uncertain whether UACE improved success rates after initial treatment (RR 0.95, 95% CI 0.56 to 1.60; 1 RCT, 45 women; very low-quality evidence). Adverse effects: the study reported the same number of failed treatments in each arm (RR 0.88, 95% CI 0.40 to 1.92; 1 RCT, 45 women). We are uncertain whether UACE shortened the time to normalize ß-hCG (MD 1.50 days, 95% CI -3.16 to 6.16; 1 RCT, 45 women; very low-quality evidence). Data were not available for complications. Suction curettage under hysteroscopy versus under ultrasonography after UAE/UACE. Two studies reported this comparison. One compared suction curettage under hysteroscopy versus under ultrasonography after UAE, and one compared these interventions after UACE. We are uncertain whether suction curettage under hysteroscopy improved success rates after initial treatment (UAE: RR 0.91, 95% CI 0.81 to 1.03; 1 RCT, 66 women; very low-quality evidence; UACE: RR 1.02, 95% CI 0.96 to 1.09; 1 RCT, 92 women; low-quality evidence). We are uncertain whether suction curettage under hysteroscopy reduced rates of complications (UAE: RR 4.00, 95% CI 0.47 to 33.91; 1 RCT, 66 women; very low-quality evidence; UACE: RR 0.18, 95% CI 0.01 to 3.72; 1 RCT, 92 women; low-quality evidence). We are uncertain whether suction curettage under hysteroscopy reduced adverse effects (UAE: RR 3.09, 95% CI 0.12 to 78.70; 1 RCT, 66 women; very low-quality evidence; UACE: not estimable; 1 RCT, 92 women; very low-quality evidence). We are uncertain whether suction curettage under hysteroscopy shortened the time to normalize ß-hCG (UAE: MD 4.03 days, 95% CI -1.79 to 9.85; 1 RCT, 66 women; very low-quality evidence; UACE: MD 0.84 days, 95% CI -1.90 to 3.58; 1 RCT, 92 women; low-quality evidence). Non-tubal ectopic pregnancy other than CSP No studies reported on non-tubal ectopic pregnancies in locations other than on a caesarean scar. AUTHORS' CONCLUSIONS: For Caesarean scar pregnancies (CSP) it is uncertain whether there is a difference in success rates, complications, or adverse events between UAE/UACE and administration of systemic MTX before suction curettage (low-quality evidence). Blood loss was lower if suction curettage is conducted after UAE/UACE than after administration of systemic MTX (moderate-quality evidence). It is uncertain whether there is a difference in treatment success rates, complications, adverse effects or time to normalize ß-hCG between suction curettage under hysteroscopy and under ultrasonography (very low-quality evidence). There are no studies of non-tubal ectopic pregnancy other than CSP and RCTs for these types of pregnancy are unlikely.


Assuntos
Gravidez Ectópica/terapia , Abortivos não Esteroides/administração & dosagem , Abortivos não Esteroides/efeitos adversos , Viés , Cesárea , Quimioembolização Terapêutica/efeitos adversos , Cicatriz/complicações , Intervalos de Confiança , Dilatação e Curetagem/efeitos adversos , Dilatação e Curetagem/métodos , Feminino , Humanos , Histeroscopia , Metotrexato/administração & dosagem , Metotrexato/efeitos adversos , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Tamanho da Amostra , Ultrassonografia de Intervenção , Artéria Uterina , Embolização da Artéria Uterina/efeitos adversos , Curetagem a Vácuo
7.
Ceska Gynekol ; 85(2): 104-110, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32527103

RESUMO

OBJECTIVE: To describe a case history of a patient after two caesarean sections, planning another pregnancy. Due to the dehiscent lower uterine segment, surgical correction of the defect was performed. Performance followed by an unplanned pregnancy five weeks after the operation. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, Hospital in Frýdek-Místek. CASE REPORT: We present a case of a 31-year-old third-graders, anamnestically after two caesarean sections, which were performed laparoscopical correction of isthmocoele in our department. Our patient was diagnosed with six weeks old intrauterine pregnancy only eleven weeks after surgery. The gravidity was successfully completed in the 38th week of pregnancy by the planned caesarean section with finding of a solid lower uterine segment. Whole duration of the pregnancy was uncomplicated. CONCLUSION: Women, after previous surgery of the uterus, are exposed to complications such as nidation disorders, placental disorders, risk of uterine rupture etc. during future pregnancy and childbirth. We want to show possible advantage of laparoscopic isthmocoele resection in combination with ventrosuspension of uterus.


Assuntos
Cesárea/efeitos adversos , Cicatriz/cirurgia , Laparoscopia/métodos , Aderências Teciduais/cirurgia , Doenças Uterinas/cirurgia , Útero/cirurgia , Adulto , Cicatriz/complicações , Cicatriz/patologia , Feminino , Humanos , Gravidez , Resultado da Gravidez , Aderências Teciduais/etiologia , Resultado do Tratamento , Doenças Uterinas/etiologia , Ruptura Uterina , Útero/patologia
8.
Acta Obstet Gynecol Scand ; 99(10): 1278-1289, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32419158

RESUMO

INTRODUCTION: To evaluate subsequent reproductive among women with a prior cesarean scar pregnancy (CSP). MATERIAL AND METHODS: MEDLINE, Embase and ClinicalTrials.gov databases were searched. Inclusion criteria were women with a prior CSP, defined as the gestational sac or trophoblast within the dehiscence/niche of the previous cesarean section scar or implanted on top of it. The primary outcome was the recurrence of CSP; secondary outcomes were the chance of achieving a pregnancy after CSP, miscarriage, preterm birth, uterine rupture and the occurrence of placenta accreta spectrum disorders. Subgroup analysis according to the management of CSP (surgical vs non-surgical) was also performed. Random effect meta-analyses of proportions were used to analyze the data. RESULTS: Forty-four studies (3598 women with CSP) were included. CSP recurred in 17.6% of women. Miscarriage, preterm birth and placenta accreta spectrum disorders complicated 19.1% (65/341), 10.3% (25/243) and 4.0% of pregnancies, and 67.0% were uncomplicated. When stratifying the analysis according to the type of management, CSP recurred in 21% of women undergoing surgical and in 15.2% of those undergoing non-surgical management. Placenta accreta spectrum disorders complicated 4.0% and 12.0% of cases, respectively. CONCLUSIONS: Women with a prior CSP are at high risk of recurrence, miscarriage, preterm birth and placenta accreta spectrum. There is still insufficient evidence to elucidate whether the type of management adopted (surgical vs non-surgical) can impact reproductive outcome after CSP. Further large, prospective studies sharing an objective protocol of prenatal management and long-term follow up are needed to establish the optimal management of CSP and to elucidate whether it may affect its risk of recurrence and pregnancy outcome in subsequent gestations.


Assuntos
Cesárea/efeitos adversos , Cicatriz/complicações , Gravidez Ectópica , Aborto Espontâneo , Feminino , Humanos , Placenta Acreta , Gravidez , Nascimento Prematuro , Recidiva
9.
Medicine (Baltimore) ; 99(17): e19743, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332613

RESUMO

INTRODUCTION: The implantation of a gestational sac within the scar of a previous caesarean delivery is defined as caesarean scar pregnancy (CSP), which is classified into two types: CSP I and CSP II. CSP II is life threatening, and no clear consensus for CSP II management exists. PATIENT CONCERNS: A 31-year-old woman, gravida 1, para 1, with a previous caesarean delivery due to macrosomia, presented with an estimated 45 days of amenorrhea. The patient presented to the emergency department with vaginal bleeding for 1 day and no abdominal pain. DIAGNOSES: An ultrasound examination was performed demonstrating a viable fetus that was embedded in the caesarean scar area and was bulging through the wall of the uterus into the bladder without contact with the uterine cavity or cervical canal. A diagnosis of type II caesarean scar pregnancy was made. INTERVENTIONS: Local lauromacrogol was used to reduce the gestational sac blood supply. Suction curettage was performed under the guidance of abdominal ultrasound 24 h later, and the amount of bleeding was 20 mL. The response to the treatment was monitored by serial beta-human chorionic gonadotropin (ß-hCG). OUTCOMES: Patient was followed up with ß-hCG weekly levels which became <10 mIU/mL after 4 weeks of treatment. CONCLUSION: Ultrasound-guided local lauromacrogol injection combined with suction curettage may be a safer and novel therapeutic method.


Assuntos
Cesárea/efeitos adversos , Cicatriz/complicações , Curetagem a Vácuo/métodos , Adulto , Cesárea/métodos , Feminino , Humanos , Polidocanol/uso terapêutico , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/cirurgia , Ultrassonografia/métodos
11.
Obstet Gynecol ; 135(5): 1104-1111, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32282597

RESUMO

For decades, placenta accreta spectrum disorder has been classified, staged, and described as a disorder of placental invasion. In this commentary, we argue that placenta accreta spectrum exists as a disorder of defective decidua and uterine scar dehiscence, not as a disorder of destructive trophoblast invasion. Adopting this understanding of placenta accreta spectrum will help direct research efforts and clinical resources toward the prevention, accurate diagnosis, and safe treatment of this devastating-and increasingly common-disorder.


Assuntos
Cicatriz/complicações , Placenta Acreta/etiologia , Deiscência da Ferida Operatória/complicações , Feminino , Humanos , Placenta/patologia , Placenta Acreta/classificação , Gravidez , Útero/patologia , Útero/cirurgia
15.
BMC Ophthalmol ; 20(1): 58, 2020 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-32075609

RESUMO

BACKGROUND: To determine characteristics and management of consecutive or recurrent strabismus secondary to stretched scar. METHODS: This is a retrospective review of all patients diagnosed with late secondary consecutive or recurrent strabismus due to stretched scar from 2012 to 2017. The diagnosis of stretched scar was made in any case of late (≥ 1 month) consecutive or recurrent strabismus associated with underaction of the previously operated muscle. The diagnosis was confirmed intraoperatively by negative forced duction test and the characteristic appearance of the scar tissue. Surgical correction involved excision of the scar tissue with muscle re-attachment to the sclera using non-absorbable sutures. Study parameters include improvement in secondary deviations, degree of muscle underaction and diplopia. RESULTS: 21 consecutive and 6 recurrent cases of stretched scar -induced strabismus were identified and all cases were associated with variable degrees of limited ocular duction. After surgical correction of the stretched scar, consecutive deviations in the form of consecutive esotropia and exotropia were corrected by means of 26.1PD and 65.6PD while recurrent deviations in the form recurrent exotropia and recurrent hypertropia were corrected by means of 34.3PD and 11PD respectively with significant improvement of limited ocular ductions. 21 patients had diplopia at presentation and all were improved after surgery. CONCLUSION: management of stretched scar -induced secondary strabismus by excision of the stretched scar and muscle fixation to the sclera using non-absorbable sutures significantly corrects secondary deviations and improves limitation of ocular duction.


Assuntos
Cicatriz/complicações , Esotropia/cirurgia , Exotropia/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Adolescente , Adulto , Criança , Pré-Escolar , Esotropia/diagnóstico , Esotropia/etiologia , Exotropia/diagnóstico , Exotropia/etiologia , Feminino , Humanos , Masculino , Recidiva , Estudos Retrospectivos , Visão Binocular/fisiologia
17.
Br J Anaesth ; 124(3): e117-e130, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31955857

RESUMO

A systematic literature search was performed to identify studies that reported risk factors for persistent pain after childbirth. Many studies have sought to identify risk factors for post-delivery pain in different populations, using different methodologies and different outcome variables. Studies of several different but interrelated post-partum pain syndromes have been conducted. Factors strongly and specifically associated with persistent incisional scar pain after Caesarean delivery include a coexisting persistent pain problem in another part of the body and severe acute postoperative pain. For persistent vaginal and perineal pain, operative vaginal delivery and the magnitude of perineal trauma have been consistently linked. History of pregnancy-related and pre-pregnancy back pain and heavier body weight are robust risk factors for persistent back pain after pregnancy. Unfortunately, limitations, particularly small samples and lack of a priori sample size calculation designed to detect specific effect sizes for risk of persistent pain outcomes, preclude definitive conclusions about many other predictors and the strength of outcome associations. In future studies, assessments of specific phenotypes using a rigorous analysis with appropriate predetermined sample sizes and validated instruments are needed to allow elucidation of stronger and reliable associations. Interventional studies targeting the most robustly associated, modifiable risk factors, such as acute post-partum pain, may lead to solutions for the prevention and treatment of these common problems that impact a large population.


Assuntos
Cesárea/efeitos adversos , Dor Crônica/etiologia , Parto Obstétrico/efeitos adversos , Analgésicos Opioides/uso terapêutico , Catecol O-Metiltransferase/genética , Dor Crônica/prevenção & controle , Cicatriz/complicações , Feminino , Humanos , Períneo , Gravidez , Receptores Opioides mu/genética , Fatores de Risco
18.
J Obstet Gynaecol Res ; 46(2): 272-278, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31943529

RESUMO

AIM: Cesarean scar pregnancy (CSP) is a rare but life-threatening type of ectopic pregnancy. This study's aim is to investigate the clinical characteristics and possible risk factors for cesarean scar pregnancy. METHODS: A clinically randomized, unpaired and retrospective case-control study was implemented. A study group of 291 CSP patients and a control group of 317 full-term pregnant women with a history of cesarean section (CS) were recruited in our hospital from May 2013 to October 2018. Their demographic characteristics and medical and obstetric history were collected. RESULTS: Only symptoms suggestive of an impending abortion, such as vaginal bleeding with or without abdominal pain, were identified as the clinical characteristics of CSP. Maternal age older than 35 years, gravidity higher than 3 (especially gravidity higher than 5), more than two induced abortions (especially more than five abortions), an interval of less than 5 years (especially less than 2 years) between the current pregnancy and the last CS, history of CS performed in a rural hospital, history of induced abortions after CS and retroposition of the uterus were possible independent risk factors for CSP. CONCLUSION: CSP is a result of a combination of multiple factors associated with CS. There are no unique early clinical features of CSP. As a unique type of ectopic pregnancy, early diagnosis, early termination and early clearance should be the treatment principles. Further research is needed to evaluate the relationship between the cesarean scar defect and CSP in the future.


Assuntos
Cesárea/efeitos adversos , Cicatriz/complicações , Gravidez Ectópica/etiologia , Adulto , China/epidemiologia , Feminino , Humanos , Modelos Logísticos , Gravidez , Gravidez Ectópica/epidemiologia , Estudos Retrospectivos , Fatores de Risco
19.
BMC Womens Health ; 20(1): 11, 2020 01 20.
Artigo em Inglês | MEDLINE | ID: mdl-31959158

RESUMO

BACKGROUND: Malignant endometriosis in an episiotomy scar is rare; only seven cases have been reported previously. Here, we compare two cases of benign endometriosis and clear cell carcinoma. CASE PRESENTATION: The first case was a 54-year-old woman who presented with a large perineal lesion in her episiotomy scar with high 18F-fluorodeoxyglucose uptake. This location had a history of endometriosis many years ago. She underwent radical excision of the mass and bilateral inguinal lymph node dissection. Histological and immunohistochemical analysis confirmed the presence of clear cell carcinoma arising from endometriosis. Assisted radiotherapy was performed after surgery due to a positive lymph node. No recurrence was detected over a 1-year follow-up period. The second case deals with a 3 × 2 cm mass in the episiotomy scar of a 33-year-old woman. Part of the anal sphincter was resected because of the close proximity of the lesion. Because the disease lay very close to the anus, she received anal sphincter reconstruction combined with mass excision. Pathology result showed typical endometrial glands and interstitial tissues. CONCLUSIONS: Deleterious change only happens in patients experiencing perineal endometriosis. Complete excision is crucial for this form of disease; sometimes impairment of the anal sphincter is also necessary. Patients with malignancy required a combination of treatments in order to improve their prognosis.


Assuntos
Adenocarcinoma de Células Claras/patologia , Cicatriz/patologia , Endometriose/patologia , Neoplasias Pélvicas/patologia , Complicações Pós-Operatórias , Adenocarcinoma de Células Claras/etiologia , Adulto , Canal Anal/patologia , Cicatriz/complicações , Endometriose/complicações , Episiotomia/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Pélvicas/etiologia , Períneo/patologia , Períneo/cirurgia , Prognóstico
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