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1.
Yonsei Med J ; 61(10): 868-874, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32975061

RESUMO

PURPOSE: To investigate the efficacy and safety of a newly developed thermo-responsive sol-gel, ABT13107, for reducing the formation of intrauterine adhesions (IUAs) after hysteroscopic surgery. MATERIALS AND METHODS: In this multicenter, prospective, randomized trial (Canadian Task Force classification I), 192 women scheduled to undergo a hysteroscopic surgery at one of the eight university hospitals in South Korea were randomized into the ABT13107 group or the comparator (Hyalobarrier®) group in a 1:1 ratio. During hysteroscopic surgery, ABT13107 or Hyalobarrier® was injected to sufficiently cover the entire intrauterine cavity. RESULTS: The patients returned to their respective sites for safety assessments at postoperative weeks 1 and 4 and for efficacy assessments at postoperative week 4. The post-surgery incidence of IUAs was 23.4% in the ABT13107 group and 25.8% in the comparator group; this difference met the criteria for ABT13107 to be considered as not inferior to the comparator. No differences were found in the extent of adhesions, types of adhesions, or the cumulative American Fertility Society score between the two treatment groups. Most adverse events were mild in severity, and no serious adverse events occurred. CONCLUSION: ABT13107, a new anti-adhesive barrier containing hyaluronic acid, was not inferior to the highly viscous hyaluronic acid anti-adhesive barrier, Hyalurobarrier® in IUA formation after hysteroscopic surgery (Clinical trial registration No. NCT04007211).


Assuntos
Géis/administração & dosagem , Ácido Hialurônico/administração & dosagem , Histeroscopia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Aderências Teciduais/prevenção & controle , Doenças Uterinas/cirurgia , Adulto , Feminino , Géis/uso terapêutico , Humanos , Ácido Hialurônico/uso terapêutico , Incidência , Gravidez , Estudos Prospectivos , República da Coreia , Índice de Gravidade de Doença , Aderências Teciduais/etiologia , Resultado do Tratamento , Doenças Uterinas/etiologia
2.
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
3.
Eur J Obstet Gynecol Reprod Biol ; 245: 107-113, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31891893

RESUMO

OBJECTIVE: Myomectomy is the standard surgical treatment for symptomatic uterine leiomyomas, especially for patients wishing to preserve their fertility. However, this procedure is associated with adhesion formation. Several strategies have been proposed to reduce them. Cellulose absorbable barrier is widely used. We aimed to assess its effectiveness in the prevention of de-novo adhesion formation after laparoscopic myomectomy. STUDY DESIGN: A systematic review and meta-analysis was performed by searching electronic databases (i.e. MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, Sciencedirect, the Cochrane Library at the CENTRAL Register of Controlled Trials, Scielo) from their inception until May 2019. We included all randomized clinical trials (RCT) comparing use of cellulose absorbable barrier (i.e. intervention group) with either placebo or no treatment (i.e. control group) in the prevention of de-novo adhesion formation at the time of laparoscopic myomectomy. Primary and secondary outcomes were defined before data extraction. The primary outcome was the incidence of adhesions at second-look laparoscopy. The secondary outcome was the operative time. RESULTS: Three RCT, including 366 participants, were included. All trials evaluated women undergoing laparoscopic myomectomy who were randomized to intervention (either oxidized regenerated cellulose or carboxymethylcellulose powder adhesion barrier) or no treatment (control group). Women who received treatment had significantly lower incidence of adhesions at the second look laparoscopy (RR 0.63, 95 % CI 0.40-0.99). Interventions with use of cellulose absorbable barrier were 4 min longer (MD 4 min, 95 % CI 2.82-5.18). CONCLUSION: Use of cellulose absorbable barrier at the time of laparoscopic myomectomy reduces the risk of postoperative adhesions.


Assuntos
Implantes Absorvíveis , Celulose Oxidada/administração & dosagem , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Doenças Uterinas/prevenção & controle , Miomectomia Uterina/efeitos adversos , Adulto , Feminino , Humanos , Laparoscopia/métodos , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Aderências Teciduais/etiologia , Aderências Teciduais/prevenção & controle , Resultado do Tratamento , Doenças Uterinas/etiologia , Miomectomia Uterina/métodos
4.
Hum Reprod Update ; 26(2): 161-173, 2020 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-31863097

RESUMO

BACKGROUND: As cancer survival rates improve, understanding and preventing the adverse off-target and long-term impacts of cancer treatments, including impacts on fertility, have become increasingly important. Cancer therapy-mediated damage to the ovary and depletion of the primordial follicle reserve are well characterised. However, our knowledge of the full extent of damage to the rest of the female reproductive tract, in particular the uterus, is limited. OBJECTIVE AND RATIONALE: Improving our understanding of the off-target effects of cancer therapies on the entire female reproductive tract is a critical step towards developing truly effective strategies to protect the fertility of cancer survivors. The objective of this narrative review was to critically evaluate the available literature regarding the capacity for the uterus to sustain a healthy pregnancy following exposure to radiotherapy or chemotherapy. SEARCH METHODS: The authors performed PubMed (Medline) searches using the following key words: uterus, cancer survivors, radiotherapy, chemotherapy, pregnancy outcome, fertility preservation, infertility. There were no limits placed on time of publication. OUTCOMES: Overall, there were major limitations to the current available literature, meaning that interpretations should be taken with caution. Despite these drawbacks, data suggest that the uterus may sustain off-target damage, with the extent of damage dependent on the type of cancer treatment and patient age. Specifically, uterine growth is stunted and resistant to hormone replacement therapy in prepubertal girls receiving abdominal, pelvic or whole-body radiotherapy. In contrast, females treated with radiotherapy post-puberty can benefit from hormone replacement therapy, as demonstrated by increased uterine volume and function. No live births have been reported in women previously exposed to radiotherapy after transplantation of cryopreserved ovarian tissue, even when menstruation returns. However, this technique has proven to be a successful fertility preservation method for women previously treated with chemotherapy. Obstetricians commonly report that women who maintain sufficient ovarian function can achieve pregnancy naturally following radiotherapy, but they have thin and/or fibrotic myometrium at delivery, compromising safe delivery and subsequent pregnancy. Furthermore, women exposed to either radiotherapy or chemotherapy have a higher prevalence of preterm birth and low birth weight infants, even in those with normal ovarian function or when oocyte donation is utilised. The mechanisms of potential uterine damage are poorly understood. While the myometrium, vasculature and endometrial progenitor cells are possibly targets, further studies are clearly required and well-controlled animal models could provide the best avenue for these types of future investigations. WIDER IMPLICATIONS: Female cancer survivors experience greater rates of early pregnancy loss and complications, suggesting that cancer therapy-induced damage to the uterus contributes to infertility. Despite clinical reports dating back to 1989, we highlight a surprising lack of detail in the literature regarding the precise nature and extent of off-target damage inflicted to the uterus in response to cancer therapies. Young women requiring cancer treatment, and the clinicians treating them, must be equipped with accurate information to aid informed decision-making regarding cancer treatment regimens as well as the development and use of effective fertility preservation measures. As the current literature on the impacts of cancer treatments is limited, we hope that our narrative review on this subject will stimulate more research in this important field.


Assuntos
Protocolos Antineoplásicos , Fertilidade/fisiologia , Neoplasias/terapia , Resultado da Gravidez , Doenças Uterinas , Útero/patologia , Animais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/fisiopatologia , Feminino , Fertilidade/efeitos dos fármacos , Fertilidade/efeitos da radiação , Preservação da Fertilidade/métodos , Humanos , Recém-Nascido , Neoplasias/patologia , Neoplasias/fisiopatologia , Ovário/efeitos dos fármacos , Ovário/fisiologia , Ovário/efeitos da radiação , Gravidez , Resultado da Gravidez/epidemiologia , Lesões por Radiação/epidemiologia , Lesões por Radiação/patologia , Lesões por Radiação/fisiopatologia , Radioterapia/efeitos adversos , Doenças Uterinas/epidemiologia , Doenças Uterinas/etiologia , Doenças Uterinas/fisiopatologia , Útero/efeitos dos fármacos , Útero/efeitos da radiação
5.
Artigo em Inglês | MEDLINE | ID: mdl-31520876

RESUMO

OBJECTIVES: To determine the risk factors for development of caesarean scar defect (CSD), compare the efficacy of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) for CSD assessment, and investigate the association between CSD size and clinical symptoms. STUDY DESIGN: One hundred and eighty-nine women with CSD and 378 women without CSD with a history of caesarean section (CS) at the Obsterics and Gynaecology Hospital of Fudan University between January 2008 and February 2016 were enrolled. The potential risk factors for CSD were investigated using multivariate logistic regression analysis. TVS and MRI were performed for CSD measurements, including residual myometrial thickness, and depth, length and width of CSD. Associations between CSD size by TVS/MRI and symptoms were evaluated. RESULTS: CS time ≥85 min, peripartum fever or infection, and retroflexed uterus were risk factors for CSD, and age at last CS < 30 years, intraoperative blood loss <150 ml and double-layer closure were protective factors for CSD. Prolonged menstruation, dysmenorrhoea, chronic pelvic pain and infertility were the main clinical manifestations. Women with a larger CSD presented with more prolonged menstruation. Compared with TVS, measurements by MRI showed better prediction of the clinical symptoms of CSD. CONCLUSIONS: Various factors contribute to the development of CSD. Prevention of peripartum infection, reduction of CS time, reduction of blood loss and more careful uterine closure are needed to decrease the risk of developing CSD. MRI is a reliable method for the diagnosis and measurement of CSD, and can be utilized in clinical practice.


Assuntos
Cesárea/efeitos adversos , Cicatriz/diagnóstico por imagem , Doenças Uterinas/diagnóstico por imagem , Útero/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Cicatriz/etiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Ultrassonografia , Doenças Uterinas/etiologia
6.
Zygote ; 27(6): 367-374, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31452481

RESUMO

Endometrial injury is an important cause of intrauterine adhesion (IUA), amenorrhea and infertility in women, with limited effective therapies. Recently, stem cells have been used in animal experiments to repair and improve injured endometrium. To date, our understanding of adipose-derived stem cells (ADSCs) in endometrial injury repair and their further therapeutic mechanisms is incomplete. Here, we examined the benefit of ADSCs in restoration of injured endometrium by applying a rat endometrial injury model. The results revealed by immunofluorescence showed that green fluorescent protein (GFP)-labelled ADSCs can differentiate into endometrial epithelial cells in vivo. At 30 days after ADSCs transplantation, injured endometrium was significantly improved, with increased microvessel density, endometrial thickness and glands when compared with the model group. Furthermore, the fertility of rats with injured endometrium in ADSCs group was improved and had a higher conception rate (60% vs 20%, P = 0.014) compared with the control phosphate-buffered saline (PBS) group. However, there was no difference in the control group compared with the sham group. In addition, expression levels of the oestrogen receptor Eα/ß (ERα, ERß) and progesterone receptor (PR) detected by western blot and enzyme-linked immunosorbent assay (ELISA) were higher in the ADSCs group than in the PBS group. Taken together, these results suggested that ADSC transplantation could improve endometrial injury as a novel therapy for IUA.


Assuntos
Tecido Adiposo/citologia , Endométrio/lesões , Transplante de Células-Tronco/métodos , Células-Tronco/citologia , Aderências Teciduais/terapia , Doenças Uterinas/terapia , Ferimentos e Lesões/terapia , Animais , Células Cultivadas , Endométrio/metabolismo , Feminino , Humanos , Infertilidade/etiologia , Infertilidade/terapia , Ratos Sprague-Dawley , Receptores Estrogênicos/metabolismo , Receptores de Progesterona/metabolismo , Aderências Teciduais/etiologia , Doenças Uterinas/etiologia , Ferimentos e Lesões/complicações
7.
Medicine (Baltimore) ; 98(28): e16282, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305411

RESUMO

RATIONALE: Pain management is an essential part of good obstetrical care. The rapid onset of pain relief after combined spinal-epidural (CSE) analgesia may cause a transient imbalance in maternal catecholamine level, leading to uterine hyperactivity and fetal heart rate (FHR) abnormalities. How to manage the uterine basal tone and FHR abnormalities after labor analgesia still remains controversial. PATIENT CONCERNS: A 33-year-old nulliparous woman at 40 weeks' gestation underwent induction of labor after premature rupture of membranes. CSE analgesia was provided when the patient described her pain as the top on a scale of 10 during induction of labor with oxytocin infusion. DIAGNOSES: Uterine hypertonus and fetal bradycardia were diagnosed within 10 minutes after CSE analgesia. INTERVENTIONS: Oxytocin infusion and CSE analgesia were immediately suspended, and measures of staying in left lateral decubitus position and giving supplemental oxygen were attempted to resuscitating the baby. Because of suspicious fetal distress, the baby was rapidly delivered by emergency cesarean section. OUTCOMES: The Apgar score of the baby was 8 and 10 at 1 and 5 minutes after birth. Subsequent follow-up confirmed that both mother and baby were in good condition. LESSONS: The loss of the tocolytic effect of epinephrine after CSE analgesia and continuous oxytocin infusion may work together to form a totally synergistic function, finally leading to inevitable uterine hypertonus and fetal bradycardia. Both the obstetrical provider and anesthesiologist should carefully monitor all patients in the first 15 minutes after CES analgesia induction. Oxytocin administration in this critical period deserves attention. Additionally, intraprofessional collaboration is also necessary to ensure high quality and safe delivery for all childbearing women.


Assuntos
Analgesia Obstétrica , Bradicardia/etiologia , Doenças Fetais/etiologia , Trabalho de Parto Induzido , Hipertonia Muscular/etiologia , Doenças Uterinas/etiologia , Adulto , Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Feminino , Humanos , Recém-Nascido , Ocitócicos , Ocitocina
8.
Einstein (Sao Paulo) ; 17(3): eRC4570, 2019 Jul 01.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269093

RESUMO

Vesicouterine fistula is a rare condition. Its incidence, however, has been increasing due to the higher incidence of cesarean sections. The presence of a live fetus inside the bladder who passed through a vesicouterine fistula is an extremely rare situation. We report a case of woman who underwent two previous cesarean sections, was referred to a hospital due to mild pelvic pain and genital bleeding. At the moment, physical examination was normal. Ultrasound scan revealed a gestational sac inserted into the anterior wall of the uterus, with a living fetus of approximately 13 weeks, with active body movement and normal heart rate inside it. The fetal abdomen, around the waist, was stuck at the opening of a vesicouterine fistula, so that the fetal head and trunk were entirely into the bladder cavity, while lower limbs remained at the uterine cavity. Laparotomy was performed, the fistulous tract was excised, the fetus (without heart beating) was removed on opening the bladder, and the uterine cavity was emptied. The defects in the bladder and uterus were repaired. The postoperative period was uneventful. A live fetus inside the urinary bladder is a rare condition the continuation of pregnancy is unlikely and the vesicouterine correction can be made by the time of surgical intervention.


Assuntos
Complicações na Gravidez/cirurgia , Fístula da Bexiga Urinária/cirurgia , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , Laparotomia , Imagem por Ressonância Magnética , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Complicações na Gravidez/etiologia , Ultrassonografia , Fístula da Bexiga Urinária/diagnóstico por imagem , Fístula da Bexiga Urinária/etiologia , Doenças Uterinas/diagnóstico por imagem , Doenças Uterinas/etiologia , Doenças Uterinas/cirurgia
9.
Rev Assoc Med Bras (1992) ; 65(5): 714-721, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31166450

RESUMO

An isthmocele, a cesarean scar defect or uterine niche, is any indentation representing myometrial discontinuity or a triangular anechoic defect in the anterior uterine wall, with the base communicating to the uterine cavity, at the site of a previous cesarean section scar. It can be classified as a small or large defect, depending on the wall thickness of the myometrial deficiency. Although usually asymptomatic, its primary symptom is abnormal or postmenstrual bleeding, and chronic pelvic pain may also occur. Infertility, placenta accrete or praevia, scar dehiscence, uterine rupture, and cesarean scar ectopic pregnancy may also appear as complications of this condition. The risk factors of isthmocele proven to date include retroflexed uterus and multiple cesarean sections. Nevertheless, factors such as a lower position of cesarean section, incomplete closure of the hysterotomy, early adhesions of the uterine wall and a genetic predisposition may also contribute to the development of a niche. As there are no definitive criteria for diagnosing an isthmocele, several imaging methods can be used to assess the integrity of the uterine wall and thus diagnose an isthmocele. However, transvaginal ultrasound and saline infusion sonohysterography emerge as specific, sensitive and cost-effective methods to diagnose isthmocele. The treatment includes clinical or surgical management, depending on the size of the defect, the presence of symptoms, the presence of secondary infertility and plans of childbearing. Surgical management includes minimally invasive approaches with sparing techniques such as hysteroscopic, laparoscopic or transvaginal procedures according to the defect size.


Assuntos
Cesárea/efeitos adversos , Cicatriz/diagnóstico , Cicatriz/terapia , Doenças Uterinas/diagnóstico , Doenças Uterinas/terapia , Cicatriz/etiologia , Feminino , Humanos , Histeroscopia/métodos , Metrorragia/diagnóstico , Metrorragia/etiologia , Metrorragia/terapia , Fatores de Risco , Doenças Uterinas/etiologia
10.
Rev. Assoc. Med. Bras. (1992) ; 65(5): 714-721, May 2019.
Artigo em Inglês | LILACS | ID: biblio-1012966

RESUMO

SUMMARY An isthmocele, a cesarean scar defect or uterine niche, is any indentation representing myometrial discontinuity or a triangular anechoic defect in the anterior uterine wall, with the base communicating to the uterine cavity, at the site of a previous cesarean section scar. It can be classified as a small or large defect, depending on the wall thickness of the myometrial deficiency. Although usually asymptomatic, its primary symptom is abnormal or postmenstrual bleeding, and chronic pelvic pain may also occur. Infertility, placenta accrete or praevia, scar dehiscence, uterine rupture, and cesarean scar ectopic pregnancy may also appear as complications of this condition. The risk factors of isthmocele proven to date include retroflexed uterus and multiple cesarean sections. Nevertheless, factors such as a lower position of cesarean section, incomplete closure of the hysterotomy, early adhesions of the uterine wall and a genetic predisposition may also contribute to the development of a niche. As there are no definitive criteria for diagnosing an isthmocele, several imaging methods can be used to assess the integrity of the uterine wall and thus diagnose an isthmocele. However, transvaginal ultrasound and saline infusion sonohysterography emerge as specific, sensitive and cost-effective methods to diagnose isthmocele. The treatment includes clinical or surgical management, depending on the size of the defect, the presence of symptoms, the presence of secondary infertility and plans of childbearing. Surgical management includes minimally invasive approaches with sparing techniques such as hysteroscopic, laparoscopic or transvaginal procedures according to the defect size.


RESUMO A istmocele ou nicho uterino é representada por uma descontinuidade miometrial ou um defeito anecoico triangular na parede uterina anterior, com a base se comunicando com a cavidade uterina no local de uma cicatriz anterior de cesárea. O defeito pode ser classificado como pequeno ou grande, dependendo da espessura da parede miometrial deficiente. Embora geralmente assintomático, seu principal sintoma é o sangramento uterino anormal ou pós-menstrual; a dor pélvica crônica também pode ocorrer. Infertilidade, placenta acreta ou prévia, deiscência de cicatriz, ruptura uterina e gravidez ectópica em cicatriz de cesárea prévia também podem aparecer como complicações dessa condição. Os fatores de risco para desenvolvimento da istmocele comprovados até o momento incluem útero retroverso e múltiplas cesarianas. No entanto, fatores como localização mais inferior de uma cesárea prévia, fechamento incompleto da histerotomia, aderências precoces na parede uterina e predisposição genética também podem contribuir para o desenvolvimento de um nicho. Como não existem critérios definitivos para o diagnóstico de uma istmocele, vários métodos de imagem podem ser usados para avaliar a integridade da parede uterina e, assim, diagnosticar uma istmocele. Entretanto, ultrassonografia transvaginal e sono-histerografia com infusão salina surgem como métodos específicos, sensíveis e custo-efetivos para o diagnóstico de istmocele. O tratamento inclui manejo clínico ou cirúrgico, dependendo do tamanho do defeito, da presença de sintomas, da presença de infertilidade secundária e de planos de gravidez. O manejo cirúrgico inclui abordagens minimamente invasivas como histeroscopia, laparoscopia ou transvaginal, de acordo com o tamanho do defeito.


Assuntos
Humanos , Feminino , Doenças Uterinas/diagnóstico , Doenças Uterinas/terapia , Cesárea/efeitos adversos , Cicatriz/diagnóstico , Cicatriz/terapia , Doenças Uterinas/etiologia , Histeroscopia/métodos , Fatores de Risco , Cicatriz/etiologia , Metrorragia/diagnóstico , Metrorragia/etiologia , Metrorragia/terapia
11.
Mol Med Rep ; 19(5): 4167-4174, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30942434

RESUMO

Intrauterine adhesion (IUA) is one of the most common diseases of the reproductive system. Due to the high postoperative recurrence rate of IUA, it is crucial to identify the possible causes of pathogenesis and recurrence of this disease. In the present study, a high­throughput sequencing approach was applied to compare the vaginal microbiota between healthy women [healthy vaginal secretion (HVS) group] and patients with IUA [intrauterine adhesion patients' vaginal secretion (IAVS) group]. The results indicated that IUA had little effect on the number of vaginal bacterial species. However, at the phylum level, patients with IUA had a significantly lower percentage of Firmicutes and a higher percentage of Actinobacteria than the HVS group (P<0.05). At the genus level, ~50% of patients with IUA were found to have a marked reduction in probiotic Lactobacillus accompanied by an overgrowth of pathogenic Gardnerella and Prevotella (P<0.05), and the Principal Coordinates Analysis confirmed that 10/20 samples in the IAVS group were scattered far away from the HVS group. Therefore, it was concluded that the interaction between IUA and vaginal microbiota greatly influenced the vaginal diversity of patients with IUA. In order to increase the recovery rate and lower the recurrence rate of IUA, increasing the vaginal Lactobacillus population should be considered.


Assuntos
Suscetibilidade a Doenças , Microbiota , Aderências Teciduais/etiologia , Doenças Uterinas/etiologia , Vagina/microbiologia , Adolescente , Adulto , Biodiversidade , Biologia Computacional/métodos , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Metagenoma , Metagenômica/métodos , Vigilância em Saúde Pública , Aderências Teciduais/diagnóstico , Aderências Teciduais/epidemiologia , Doenças Uterinas/diagnóstico , Doenças Uterinas/epidemiologia , Adulto Jovem
12.
Zhonghua Bing Li Xue Za Zhi ; 48(2): 112-115, 2019 Feb 08.
Artigo em Chinês | MEDLINE | ID: mdl-30695862

RESUMO

Objective: To elucidate the clinicopathologic characteristics of atypical epithelioid trophoblastic lesions with cyst and fistula formation after cesarean section. Methods: The clinical and pathological data of 4 cases of post-cesarean atypical epithelioid trophoblastic lesions with cyst and fistula formation diagnosed at Women's Hospital, School of Medicine, Zhejiang University during April 2007 to June 2018 were evaluated by hematoxylin and eosin stain and EnVision two-step immunohistochemical staining technique. Results: The age of the 4 patients ranged from 32 to 41 years, with a mean age of 36.5 years. Three patients recieved cystectomy and one underwent subtotal hysterectomy. Histologically, the lesions were well circumscribed and consisted of uniform cells of medium size, irregularly enlarged with hyperchromatic nuclei and 1 to 2 inconspicuous nucleoli embedded in abundant hyalinized matrix with fibrinoid material in the center. The cells exhibited immunohistochemical feature of chorionic-type intermediate trophoblastic cells (CK18+, p63+ and CD146-). All patients were alive without recurrence during follow-up of 1 to 40 months (mean=22 months). Conclusion: Atypical epithelioid trophoblastic lesion with cyst and fistula formation after cesarean section has unique histological features, and its biological behavior and prognosis are still unclear, which need further exploration.


Assuntos
Cesárea/efeitos adversos , Cistos/patologia , Células Epitelioides/patologia , Fístula/patologia , Complicações Pós-Operatórias/patologia , Neoplasias Trofoblásticas/patologia , Neoplasias Uterinas/patologia , Adulto , Cistos/etiologia , Cistos/cirurgia , Feminino , Fístula/etiologia , Fístula/cirurgia , Humanos , Imuno-Histoquímica , Recidiva Local de Neoplasia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Gravidez , Neoplasias Trofoblásticas/etiologia , Neoplasias Trofoblásticas/cirurgia , Doenças Uterinas/etiologia , Doenças Uterinas/patologia , Neoplasias Uterinas/etiologia , Neoplasias Uterinas/cirurgia
13.
Rev Bras Ginecol Obstet ; 41(1): 44-52, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30646424

RESUMO

OBJECTIVE: The aim of the present study was to perform a comprehensive review of the literature to provide a complete and clear picture of isthmocele-a hypoechoic area within the myometrium at the site of the uterine scar of a previous cesarean section-by exploring in depth every aspect of this condition. METHODS: A comprehensive review of the literature was performed to identify the most relevant studies about this topic. RESULTS: Every aspect of isthmocele has been studied and described: pathophysiology, clinical symptoms, classification, and diagnosis. Its treatment, both medical and surgical, has also been reported according to the actual literature data. CONCLUSION: Cesarean section is the most common surgical procedure performed worldwide, and one of the consequences of this technique is isthmocele. A single and systematic classification of isthmocele is needed to improve its diagnosis and management. Further studies should be performed to better understand its pathogenesis.


Assuntos
Cicatriz , Miométrio , Doenças Uterinas , Cesárea/efeitos adversos , Cicatriz/diagnóstico , Cicatriz/epidemiologia , Cicatriz/etiologia , Cicatriz/terapia , Feminino , Humanos , Fatores de Risco , Doenças Uterinas/diagnóstico , Doenças Uterinas/epidemiologia , Doenças Uterinas/etiologia , Doenças Uterinas/terapia
15.
J Minim Invasive Gynecol ; 26(6): 1056-1062, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30340052

RESUMO

STUDY OBJECTIVE: To analyze short-term effectiveness and symptom resolution after surgical removal of Essure (Bayer AG, Leverkusen, Germany) sterilization devices. DESIGN: A single-center retrospective cohort study (Canadian Task Force classification III). SETTING: A large secondary care teaching hospital in the Netherlands. PATIENTS: All patients who underwent surgical removal of Essure devices between January 2009 and December 2015. INTERVENTIONS: Surgical removal of Essure devices was predominantly performed by laparoscopic surgery. In the majority of patients, Essure devices were removed by performing bilateral salpingectomy (66.6%). MEASUREMENTS AND MAIN RESULTS: Data regarding patient characteristics, symptoms, the insertion procedure, the removal procedure, results of the pathological assessment, and follow-up were extracted from patient files. A total of 93 patients had Essure devices removed in the selected period. The onset of symptoms after Essure sterilization was variable. The most frequently reported symptom was abdominal pain (69.9%) followed by lower back pain and fatigue. Most patients reported multiple symptoms; 39.8% of women reported complete relief of symptoms after removal surgery, whereas 15.1% did not notice any relief in symptoms. CONCLUSION: Six weeks after removal surgery, 39.8% of patients reported complete resolution of symptoms. Further research to reported symptoms after Essure sterilization and symptom resolution after removal surgery is necessary to inform both patients and gynecologists in order to make a well-considered decision about taking the risks of (major) surgery and the expected benefits of removal.


Assuntos
Remoção de Dispositivo/métodos , Histeroscopia/métodos , Dispositivos Intrauterinos , Salpingectomia/métodos , Esterilização Tubária/instrumentação , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Adulto , Feminino , Humanos , Migração de Dispositivo Intrauterino/efeitos adversos , Dispositivos Intrauterinos/efeitos adversos , Laparoscopia/métodos , Pessoa de Meia-Idade , Países Baixos , Gravidez , Estudos Retrospectivos , Esterilização Tubária/efeitos adversos , Esterilização Tubária/métodos , Fatores de Tempo , Resultado do Tratamento , Doenças Uterinas/etiologia , Doenças Uterinas/cirurgia
18.
J Obstet Gynaecol Res ; 45(2): 482-486, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30338891

RESUMO

Although lymphangioleiomyomatosis is often observed with tuberous sclerosis, uterine lymphangioleiomyomatosis is rare. Our patient was 36 years old (gravida 0, para 0). She had a history of tuberous sclerosis, and many myometrial cystic lesions were identified during assisted reproductive therapy. Although we administered a gonadotropin-releasing hormone analog, myometrial cystic lesions increased in size. Therefore, simple hysterectomy, bilateral salpingo-oophorectomy and pelvic lymph node biopsy were performed. Postoperative histology showed lymphangioleiomyomatosis and myometrial abscess. For uterine lesions in young women with tuberous sclerosis, the possibility of uterine lymphangioleiomyomatosis should also be considered.


Assuntos
Linfangioleiomiomatose , Miométrio , Peritonite , Esclerose Tuberosa/complicações , Doenças Uterinas , Adulto , Feminino , Humanos , Histerectomia , Linfangioleiomiomatose/diagnóstico , Linfangioleiomiomatose/etiologia , Linfangioleiomiomatose/cirurgia , Miométrio/patologia , Miométrio/cirurgia , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/cirurgia , Salpingo-Ooforectomia , Doenças Uterinas/diagnóstico , Doenças Uterinas/etiologia , Doenças Uterinas/cirurgia
19.
JSLS ; 22(4)2018.
Artigo em Inglês | MEDLINE | ID: mdl-30524185

RESUMO

Background and Objectives: The authors sought to assess the effect of the use of a new crosslinked hyaluronan (NCH) gel on the prevention of intrauterine adhesions (IUAs) in women underwent curettage in the second trimester. Methods: Between June 2016 and September 2017, 60 patients who underwent curettage for retained placental tissue after medically induced or spontaneous pregnancy loss in the second trimester were enrolled in the study. The patients were randomly assigned to 1 of 2 groups: Group 1 patients received curettage plus NCH gel (intervention group), and group 2 patients received curettage alone (control group). The main outcomes were the rate and severity of IUA formation, which were assessed by follow-up hysteroscopy performed in the ensuing 2-6 months. Results: The hysteroscopic findings were available for 20 patients in group 1 and 28 patients in group 2. IUAs were observed in 6 patients in group 2, while no IUAs was observed in group 1 (P = .007). IUAs were staged as mild in 4 patients (14.28%) and moderate in 2 patients (7.14%) in group 2 according to the American Fertility Society classification of IUAs. Conclusions: Our study demonstrates that NCH gel appears to be able to reduce the formation of IUAs in women who undergo curettage in the second trimester, although larger controlled, randomized, multicenter studies are needed to confirm these results.


Assuntos
Aborto Induzido/efeitos adversos , Aborto Espontâneo/cirurgia , Anti-Inflamatórios/administração & dosagem , Dilatação e Curetagem/efeitos adversos , Ácido Hialurônico/administração & dosagem , Aderências Teciduais/prevenção & controle , Doenças Uterinas/prevenção & controle , Aborto Induzido/métodos , Adulto , Feminino , Géis/administração & dosagem , Humanos , Histeroscopia , Gravidez , Segundo Trimestre da Gravidez , Aderências Teciduais/diagnóstico , Aderências Teciduais/etiologia , Doenças Uterinas/etiologia , Adulto Jovem
20.
Med Sci (Paris) ; 34 Focus issue F1: 47-51, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30403175

RESUMO

OBJECTIVE: The postmenstrual bleeding with cesarean-induced diverticulum is a bothersome symptom and can be confused with other abnormal-uterine bleeding disease. The aim of the present study was to evaluate the efficacy and safety of laparoscopic combined with hysteroscopic repair vs operative hysteroscopy in treatment of symptomatic cesarean-induced diverticulum. METHODS: Eighty-two women with cesarean-induced diverticulum who underwent either laparoscopic combined with hysteroscopic repair or operative hysteroscopy between January 2012 and September 2015 were retrospectively included in the study. We evaluated the menstrual duration before and after the surgery, the width, length and depth of the niche, operating time, blood loss, complications, and postoperative pregnancy status. RESULTS: 62.2% (51/82) patients started to have postmenstrual bleeding immediately when they gained regular menstruation after their cesarean section. The laparoscopic group has longer operative time and greater blood loss (p<0.001). Both groups have a significant improvement in their menstruation duration ( p< 0.001). The patients in the laparoscopic repair group had a greater improvement in bringing the uterine bleeding into normal menstruation duration (P=0.046) and the same in pregnancy rate (P=0.505). The interval between operation and pregnancy in laparoscopic combined with hysteroscopic group was much longer than the hysteroscopic group (27 vs 10 months, p<0.001). CONCLUSION: the laparoscopic repair exhibited a better efficiency in bringing the uterine bleeding into normal menstruation duration and in improving the pregnancy rate However, there was not a clear absolute advantage for one of the two type of surgeries. Thus, patients with post-cesarean section diverticulum (PCSD) should choose with caution the type of surgery, considering the residual myometrial thickness (RMT), the age, the desire for further fertility and ovarian reserve capacity.


Assuntos
Cesárea/efeitos adversos , Divertículo/etiologia , Divertículo/cirurgia , Histeroscopia/métodos , Laparoscopia/métodos , Doenças Uterinas/etiologia , Doenças Uterinas/cirurgia , Adulto , Cicatriz/cirurgia , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Gravidez , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
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