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1.
Ann Afr Med ; 18(2): 108-110, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31070154

RESUMO

Acquired gynatresia is a common gynecological condition in developing countries where puerperal complications and unskilled interventions prevail. A 23-year-old primipara who had spontaneous vaginal delivery complicated by gynatresia had vaginoplasty that failed due to erectile dysfunction in the spouse. She subsequently developed secondary amenorrhea and was relieved with dilatation and evacuation. She was planned for definitive surgery, however,she incidentally conceived with q pin-hole vagina. She was delivered of a live fetus at term via an elective cesarean section. This case is peculiar as spontaneous conception occurred with a pinhole opening. There is a need to adequately evaluate cases before definitive management to maximize success.


Assuntos
Ginatresia/diagnóstico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Vagina/anormalidades , Cesárea , Feminino , Ginatresia/cirurgia , Humanos , Gravidez , Resultado da Gravidez , Vagina/cirurgia , Adulto Jovem
2.
J Med Case Rep ; 12(1): 344, 2018 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-30454053

RESUMO

BACKGROUND: We present a case involving conservative treatment of placenta accreta, with a subsequent diagnosis of Asherman's syndrome. CASE PRESENTATION: A 41-year-old Japanese woman (G2P0A2) delivered a healthy male infant via cesarean section due to preeclampsia. The placenta did not spontaneously separate and was manually removed. Adhesion was tight and placenta accreta was diagnosed. During the procedure, no uterine inversion or perforation, and no uterine cavity adhesion, were observed. Four months postoperatively, hysteroscopy was performed. Adhesion was detected at the fundus of her uterus where the placenta had adhered to the uterus. Asherman's syndrome was diagnosed. CONCLUSIONS: Asherman's syndrome might occur after conservative management of placenta accreta, which may be a direct cause of placenta accreta recurrence. When Asherman's syndrome is diagnosed, the site of the placenta and adhesion should be monitored during subsequent pregnancies.


Assuntos
Cesárea/efeitos adversos , Tratamento Conservador , Ginatresia/diagnóstico , Placenta Acreta/terapia , Aderências Teciduais/patologia , Útero/patologia , Adulto , Feminino , Ginatresia/patologia , Ginatresia/terapia , Humanos , Histeroscopia , Placenta Acreta/diagnóstico por imagem , Placenta Acreta/patologia , Gravidez , Prognóstico , Aderências Teciduais/complicações , Aderências Teciduais/diagnóstico por imagem , Resultado do Tratamento
3.
J Perinat Med ; 47(1): 41-44, 2018 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-29858908

RESUMO

Background Pregnancy loss is probably the most common problem faced by women worldwide. There are differences in the rates of early and late pregnancy loss based on geography among the developing compared with the developed nations of the world. Most physicians worldwide have different criteria for treating pregnancy loss. Although pregnancy loss is not a disease, it might be best approached with a medical evaluation in order to define the cause and offer specific treatment. Methods This report describes the results obtained by a multi-disciplinary pregnancy loss prevention center in the initial 104 patients. Results The most common diagnoses were Asherman syndrome (intrauterine adhesions), cervical insufficiency and uterine fibroids, accounting for 47% of the patients. When the diagnosis was not obtained, which occurred in 19% of the patients, in vitro fertilization (IVF) was the treatment provided. Specifically diagnosed and treated patients achieved a 91% success rate. The 19 patients without a specific diagnosis who were treated with IVF had a 60% success rate. Thus patients for whom it was possible to specifically diagnose and treat had better results (P<0.01 t-test). There was an overall success rate of 87% including patients lost to follow-up with this multidisciplinary medical approach. Conclusion A pregnancy loss prevention center using the described multidisciplinary model can accomplish success rates of 85-90%. Preventing recurrent pregnancy loss we suggest can best be achieved by a dedicated center with a multidisciplinary medical approach.


Assuntos
Aborto Espontâneo , Ginatresia , Leiomioma , Equipe de Assistência ao Paciente/organização & administração , Incompetência do Colo do Útero , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/etiologia , Aborto Espontâneo/prevenção & controle , Adulto , Instituições de Assistência Ambulatorial , Feminino , Fertilização In Vitro/métodos , Fertilização In Vitro/estatística & dados numéricos , Ginatresia/complicações , Ginatresia/diagnóstico , Ginatresia/epidemiologia , Humanos , Leiomioma/complicações , Leiomioma/diagnóstico , Leiomioma/epidemiologia , Modelos Organizacionais , Gravidez , Estados Unidos/epidemiologia , Incompetência do Colo do Útero/diagnóstico , Incompetência do Colo do Útero/epidemiologia
4.
Ceska Gynekol ; 83(6): 440-444, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30848149

RESUMO

OBJECTIVE: To point out the importance of proper indication and careful performance of intrauterine surgical procedures. To highlight the key role of early diagnostic and treatment of intrauterine adhesions. SETTING: Department of Obstetrics and Gynecology, Hospitals of Pardubice Region, Chrudim Hospital. Clinic of Obstetrics and Gynecology, General University Hospital in Prague and 1st Faculty of Medicine Charles university. DESIGN: Case report. METHODS: The description of 2 different cases of the patients with the Asherman´s syndrome. CONCLUSION: Ashermans syndrome is a serious condition with complicated treatment and uncertain prognosis regarding fertility. Primary prevention as well as timely diagnosis and treatment seems to be crucial in the management of this patology. Keywords Ashermans syndrome, intrauterine adhesions, surgical revision of uterine cavity, hysteroscopy.


Assuntos
Ginatresia/cirurgia , Histeroscopia/métodos , Aderências Teciduais/cirurgia , Doenças Uterinas/cirurgia , Feminino , Ginatresia/diagnóstico , Humanos , Avaliação de Resultados em Cuidados de Saúde , Gravidez
5.
Bull Exp Biol Med ; 162(4): 539-544, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28239797

RESUMO

We isolated and characterized cell cultures from eutopic endometrium and endometriotic lesions of women with malformations of the internal reproductive organs. The cells had fibroblast-like shape and intensively expressed CD90, CD73, CD105, CD44, CD146, and CD117 and were capable of induced adipogenic and osteogenic differentiation in vitro. The obtained cultures exhibited properties of multipotent mesenchymal stromal cells; at the same time, they demonstrated in vitro immunophenotypic differences from cell cultures of eutopic and ectopic endometrium of women without developmental abnormalities, which suggests their functional difference. The cells from eutopic endometrium and from ectopic endometriotic lesions can be used as the model for studying of the etiology and pathogenesis of endometriosis and for testing new drugs for this specific group of patients. Markers CD90 and CD117 were identified as promising molecules for the development of minimally invasive diagnostics of endometriosis based on cell cultures from eutopic endometrium.


Assuntos
Adipócitos/citologia , Endometriose/patologia , Endométrio/anormalidades , Ginatresia/patologia , Células-Tronco Mesenquimais/citologia , Osteoblastos/citologia , Adipócitos/metabolismo , Adolescente , Adulto , Biomarcadores/metabolismo , Diferenciação Celular , Forma Celular , Endometriose/diagnóstico , Endometriose/metabolismo , Endométrio/metabolismo , Feminino , Expressão Gênica , Ginatresia/diagnóstico , Ginatresia/metabolismo , Humanos , Imunofenotipagem , Células-Tronco Mesenquimais/metabolismo , Osteoblastos/metabolismo , Proteínas Proto-Oncogênicas c-kit/genética , Proteínas Proto-Oncogênicas c-kit/metabolismo , Antígenos Thy-1/genética , Antígenos Thy-1/metabolismo
7.
J Minim Invasive Gynecol ; 24(2): 299-304, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27856386

RESUMO

STUDY OBJECTIVE: To analyze the reproductive outcome of hysteroscopic adhesiolysis and assess the diagnostic accuracy of transvaginal ultrasonography (TVS) in infertile women resulting from intrauterine adhesions (IUAs). DESIGN: Retrospective, cross-sectional study (Canadian Task Force classification II-2). SETTING: University tertiary referral center. PATIENTS: Three hundred and fifty-seven patients with mild, moderate, and severe IUAs who underwent hysteroscopic adhesiolysis between January 2012 and December 2015. INTERVENTIONS: Hysteroscopic adhesiolysis in the outpatient analgesic setting for infertility and IUAs. MEASUREMENTS AND MAIN RESULTS: Among the 357 patients (135 with mild IUAs, 116 with moderate IUAs, and 106 with severe IUAs) who underwent hysteroscopic adhesiolysis, 334 (93.6%) experienced a completely restored uterine cavity. The reproductive outcomes of 332 women (93%) were followed for an average duration of 27 ± 9 months, and the overall conception rate after hysteroscopic adhesiolysis was 48.2%, which decreased with increased IUA severity (mild, 60.7%; moderate, 53.4%; severe, 25%). The mean time to conception following hysteroscopic adhesiolysis was 9.7 ± 3.7 months. The miscarriage rate was 9.4%, and the live birth rate was no lower than 85.6%. Eleven patients (7.9%) had postpartum hemorrhage, including 6 (4.3%) due to adherent placenta and 3 (2.1%) due to placenta accreta. CONCLUSION: Hysteroscopic adhesiolysis is a feasible and effective way to improve fertility in patients with Asherman's syndrome.


Assuntos
Ginatresia , Histeroscopia , Infertilidade Feminina , Saúde Reprodutiva/estatística & dados numéricos , Adulto , China/epidemiologia , Estudos Transversais , Dissecação/efeitos adversos , Dissecação/métodos , Feminino , Fertilização/fisiologia , Ginatresia/diagnóstico , Ginatresia/epidemiologia , Ginatresia/etiologia , Ginatresia/cirurgia , Humanos , Histeroscopia/efeitos adversos , Histeroscopia/métodos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/etiologia , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Retrospectivos , Índice de Gravidade de Doença
8.
Rev. centroam. obstet. ginecol ; 21(2): 41-42, abr.-jun. 2016. ilus
Artigo em Espanhol | LILACS | ID: biblio-982829

RESUMO

Menos del 1% de los embarazos ectópicos se implantan en el canal cervical por abajo del orificio cervical interno, la etiología de esta implantación es desconocida aunque se asocia a curetaje previo, síndrome de Asherman, leiomiomas, presencia de DIU entre otras. Timor-Tritsch define el diagnóstico ecográfico como el saco coriónico implantado debajo de OCI, canal cervical dilatado, embrión con latido cardiaco o presencia de infiltración cervical confirmada por Doppler. No existe un consenso en relación al tratamiento de esta condición, se ha tratado con Metrotexate sistémico o intracervical, embolización arterial selectiva, aspiración guiada por ecografía, aunque la histerectomía fue el tratamiento en los casos de sangrado incontrolable...


Assuntos
Feminino , Cerclagem Cervical/métodos , Ginatresia/diagnóstico , Gravidez Ectópica/etiologia , Ultrassonografia
9.
Fertil Steril ; 104(6): 1561-8.e1, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26428306

RESUMO

OBJECTIVE: To study the success rate of hysteroscopic adhesiolysis and the spontaneous recurrence rate of intrauterine adhesions (IUAs) in patients with Asherman syndrome. DESIGN: Cohort study. SETTING: University-affiliated hospitals. PATIENT(S): A total of 638 women with Asherman syndrome were included, all diagnosed using hysteroscopy, and operated on between 2003 and 2013. INTERVENTION(S): Hysteroscopic adhesiolysis. MAIN OUTCOME MEASURE(S): Hysteroscopic adhesiolysis was classified as successful if a normalization of menstrual blood flow occurred, along with a restored, healthy, cavity anatomy, free of adhesions, with hysteroscopic visualization of ≥ 1 tubal ostium. Recurrences of adhesions were diagnosed using hysteroscopy after an initial successful procedure. RESULT(S): A first-trimester procedure preceded Asherman syndrome in 371 women (58.2%) and caused adhesions of grades 1-2A. In 243 (38.1%) women, a postpartum procedure caused IUAs of grades 3-5. The procedure was successful in 606 women (95%), and restoration of menstrual blood flow occurred in 97.8%; IUAs spontaneously recurred in 174 (27.3%) of these cases. High grades of adhesions were predictive of a higher chance of spontaneous recurrence of adhesions. CONCLUSION(S): In 95% of women with Asherman syndrome, a healthy uterine cavity was restored with hysteroscopic adhesiolysis, in 1-3 attempts, with a 28.7% recurrence rate of spontaneous IUAs.


Assuntos
Serviços Centralizados no Hospital/organização & administração , Assistência à Saúde/organização & administração , Ginatresia/cirurgia , Hospitais Universitários/organização & administração , Histeroscopia , Doenças Uterinas/cirurgia , Útero/cirurgia , Adulto , Feminino , Ginatresia/diagnóstico , Ginatresia/epidemiologia , Ginatresia/fisiopatologia , Humanos , Histeroscopia/efeitos adversos , Menstruação , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Recidiva , Encaminhamento e Consulta , Reoperação , Fatores de Tempo , Aderências Teciduais , Resultado do Tratamento , Doenças Uterinas/diagnóstico , Doenças Uterinas/epidemiologia , Doenças Uterinas/fisiopatologia , Útero/patologia , Útero/fisiopatologia , Adulto Jovem
10.
Ginecol Obstet Mex ; 83(6): 340-9, 2015 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-26285485

RESUMO

BACKGROUND: Uterine synechiae are defined as abnormal adhesions and fibrosis within the uterine cavity due to direct trauma or injury to the basal membrane of the endometrium. OBJECTIVE: To identify, by routine hysteroscopy, how many patients who were treated because of intrauterine pathology developed uterine synechiae within the first six months after treatment with monopolar resectoscope. MATERIAL AND METHOD: A descriptive, open, observational, retrospective and cross-sectional study was performed at Hysteroscopy Unit, Gynecology Service of General Hospital Manuel Gea Gonzalez, Mexico City. From January 1, 2008 to December 31, 2011, we took, from the record books of the operating rooms, the file number of those patients who were treated with monopolar resectoscopy, and subsequently underwent routine hysteroscopy within the first six months. RESULTS: 69 records were included in the study. The main diagnoses were: endometrial polyp in 48% (n=33), submucosal myoma in 45% (n=3 1); 48% (n=33) polypectomy and 45% (n=31) myomectomy. Within the first six months after the main procedure, patients underwent a routine hysteroscopy, which revealed the development of intrauterine synechiae in 5.8% (n=4) of the patients. Of the patients who underwent myomectomy, 5.8% (n=4) developed uterine synechiae; while those patients who underwent polypectomy, synechiaes were not found. Minimal synechiaes were found in 4.3% (n=3) of patients, moderate synechiaes were found in 1.4% (n=1) of patients, and severe synechiaes were found in none patient. CONCLUSION: Uterine synechiaes were found in 5.8% of patients with intrauterine pathology and treated with monopolar resectoscopy. Minimal to moderate synechia occur more commonly after myomectomy.


Assuntos
Endoscópios/efeitos adversos , Endoscopia/efeitos adversos , Ginatresia/etiologia , Adulto , Idoso , Estudos Transversais , Feminino , Ginatresia/diagnóstico , Ginatresia/epidemiologia , Humanos , Histeroscopia , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Miomectomia Uterina/efeitos adversos , Adulto Jovem
11.
Fertil Steril ; 104(1): 235-40, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25936237

RESUMO

OBJECTIVE: To compare the efficacy of heart-shaped intrauterine balloon and intrauterine contraceptive device (IUD) in the prevention of adhesion reformation after hysteroscopic adhesiolysis. DESIGN: Prospective, randomized, controlled trial. SETTING: University hospital. PATIENT(S): A total of 201 women with Asherman syndrome. INTERVENTION(S): Women were randomized to having either a heart-shaped intrauterine balloon or an IUD fitted after hysteroscopic adhesiolysis. The devices were removed after 7 days. A second-look hysteroscopy was carried out 1 to 2 months after the surgery. MAIN OUTCOME MEASURE(S): Incidence of adhesion reformation and reduction of adhesion score before and after surgery. RESULT(S): Initially 201 cases were recruited; 39 cases dropped out, resulting in 82 cases in the balloon group and 80 cases in IUD group. The age, menstrual characteristics, pregnancy history, and American Fertility Society score before surgery were comparable between the two groups. The median adhesion score reduction (balloon group, 7; IUD group, 7) and the adhesion reformation rate (balloon group, 30%; IUD group, 35%) were not significantly different between the two groups. CONCLUSION(S): The heart-shaped intrauterine balloon and IUD are of similar efficacy in the prevention of adhesion reformation after hysteroscopic adhesiolysis for Asherman syndrome. CLINICAL TRIAL REGISTRATION NUMBER: ISRCTN 69690272.


Assuntos
Ginatresia/cirurgia , Histeroscopia/tendências , Dispositivos Intrauterinos , Complicações Pós-Operatórias/prevenção & controle , Adulto , Feminino , Ginatresia/diagnóstico , Humanos , Histeroscopia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Estudos Prospectivos , Desenho de Prótese/normas , Aderências Teciduais/diagnóstico , Aderências Teciduais/etiologia , Aderências Teciduais/prevenção & controle , Resultado do Tratamento , Doenças Uterinas/diagnóstico , Doenças Uterinas/cirurgia
12.
J Minim Invasive Gynecol ; 22(3): 446-50, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25497164

RESUMO

OBJECTIVE: To evaluate the feasibility and success rate of treating Asherman syndrome in an outpatient hysteroscopy unit. DESIGN: Retrospective case series (Canadian Task Force classification III). SETTING: The outpatient hysteroscopy clinic at Ottawa Hospital from November 26, 2008, to January 31, 2014. PATIENTS: Patients undergoing treatment for Asherman syndrome. INTERVENTIONS: All cases of hysteroscopic adhesiolysis were reviewed. MEASUREMENTS AND MAIN RESULTS: Demographic data were collected by a retrospective chart review including patients' age, obstetric history, referring complaint, etiology of Asherman syndrome, antecedent treatment, and outcome measures when available. The severity of Asherman syndrome was determined based on the March classification by the operating surgeon. Analgesia used during the procedure was recorded. Twenty patients were treated for Asherman syndrome in the outpatient hysteroscopy suite. There were a total of 38 procedures (adhesiolysis or diagnostic hysteroscopies) performed for this indication in the patient set. The most common etiologies for intrauterine adhesions were previous curettage (60%) and previous missed abortion (45%). Outcomes were available for 19 patients. All of the patients had normal menses after treatment. Eighty-four percent of patients had either no adhesions or mild adhesions at their final hysteroscopy. Six patients had a spontaneous pregnancy after treatment, and 5 went on to have a term delivery to date. In terms of analgesia used for the procedure, 89% of patients had preoperative nonsteroidal anti-inflammatory drugs, 2.8% required intravenous fentanyl and midazolam, and 5.6% required oral lorazepam. CONCLUSION: This series showed that Asherman syndrome may be successfully treated in an outpatient hysteroscopy setting outside the operating room and without general or regional anesthesia.


Assuntos
Ginatresia , Histeroscopia/métodos , Cuidados Pré-Operatórios , Adulto , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Canadá , Dissecação/métodos , Feminino , Ginatresia/diagnóstico , Ginatresia/fisiopatologia , Ginatresia/cirurgia , Humanos , Avaliação de Resultados em Cuidados de Saúde , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/estatística & dados numéricos , História Reprodutiva , Estudos Retrospectivos , Índice de Gravidade de Doença
13.
J Gynecol Obstet Biol Reprod (Paris) ; 44(4): 366-79, 2015 Apr.
Artigo em Francês | MEDLINE | ID: mdl-25479692

RESUMO

Intra-uterine adhesions are a major cause of secondary infertility. The prevalence of adhesions is probably underestimated due to the heterogeneity of the symptoms. An exhaustive literature search using search engines MEDLINE, Pubmed, Cochrane library and Web of Science was performed to make a focus on the origins, consequences and methods of prevention of intra-uterine adhesions. Intra-uterine adhesions are likely to occur after any endo-uterine surgery via dysregulated activation of coagulation chain linked to the inflammatory process. Early and late obstetric complications are also recognized as caused by adhesions. The diagnosis is currently performed by hysteroscopy but it remains an invasive procedure even if it can be done with an ambulatory management. Several research approaches inspired by intra-abdominal surgery for the prevention of pelvic adhesions have been developed. However, no current method of prevention has proven its effectiveness in terms of improving spontaneous fertility. The improvement in surgical practices, the design of new intra-uterine medical devices and new research especially in the field of endometrial stem cells can maybe reduce the rate of adhesions end their complications after intra-uterine surgery.


Assuntos
Ginatresia/terapia , Feminino , Ginatresia/complicações , Ginatresia/diagnóstico , Ginatresia/etiologia , Humanos
14.
Fertil Steril ; 102(5): 1398-403, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25241369

RESUMO

OBJECTIVE: To study which variables are able to influence women's experience of pain during diagnostic hysteroscopy. DESIGN: Multivariate analysis (phase II) after a randomized, controlled trial (phase I). SETTING: Endoscopic gynecologic center. PATIENT(S): In phase I, 392 patients were analyzed. Group A: 197 women with carbon dioxide (CO2); group B: 195 women with normal saline. In phase II, 392 patients were assigned to two different groups according to their pain experience as measured by a visual analogue scale (VAS): group VAS>3 (170 patients); group VAS≤3 (222 patients). INTERVENTION(S): Free-anesthesia diagnostic hysteroscopy performed using CO2 or normal saline as distension media. MAIN OUTCOME MEASURE(S): Procedure time, VAS score, image quality, and side effects during and after diagnostic hysteroscopy. RESULT(S): In phase I the median pain score in group A was 2, whereas in group B it was 3. In phase II the duration of the procedure, nulliparity, and the use of normal saline were significantly correlated with VAS>3. A higher presence of cervical synechiae was observed in the group VAS>3. The multivariate analysis revealed an inverse correlation between parity and a VAS>3, whereas the use of normal saline, the presence of synechiae in the cervical canal, and the duration of the hysteroscopy were all directly correlated to a VAS score>3. CONCLUSION(S): Pain in hysteroscopy is significantly related to the presence of cervical synechiae, to the duration of the procedure, and to the use of normal saline; conversely, parity seems to have a protective role. CLINICAL TRIAL REGISTRATION NUMBER: NCT01873391.


Assuntos
Ginatresia/complicações , Histeroscopia/efeitos adversos , Insuflação/efeitos adversos , Dor/etiologia , Cloreto de Sódio/efeitos adversos , Adulto , Meios de Contraste/efeitos adversos , Feminino , Ginatresia/diagnóstico , Humanos , Itália , Análise Multivariada , Dor/diagnóstico , Fatores de Risco
15.
Minerva Ginecol ; 66(1): 69-76, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24569405

RESUMO

AIM: The aim of the study was to evaluate the clinical usefulness of the selective removal of residual intrauterine trophoblastic tissue by using a hysteroscopic procedure, especially in the prevention of the Intra-Uterine Adhesion's Syndrome. METHODS: Seventy-six patients had an Asherman's Syndrome: 5 cases after laparotomic myomectomy, 1 after caesarean section, 2 after hysteroscopic myomectomy, 10 after VIP, 1 with a severe vaginal endometriosis, 1 after conisation, 4 after a post-partum hemorrhage due to coagulopathy or uterine atony, 20 cases after D&C because of PPH due to placental retention, 26 after repetitive D&Cs because of AUB due to post abortion chorial residues' retention, 6 cases after D&C for post menopausal AUB. Thirty-six patients presented AUB due to chorioplacental residues retention: 14 cases after a vaginal delivery or a caesarean section, 4 after VIP, 18 cases after repetitive D&Cs for incomplete or internal spontaneous abortion. Complete physical examination, transvaginal ultrasonography and operative hysteroscopy was offered as first treatment to all patients. Surgical treatment of IUA depends on the type (I-IV) and is based on the section of synechiae, liberation of the uterine cavity and tubal recesses, recovery of the residual endometrium to restore the physiology of the reproductive tract. Our technique to remove the chorioplacental residues is based on: correct use of loops and electric currents, enucleation by cold loops of the base of the placental implant, and to single out the level of miometrial infiltration. RESULTS: After treatment we have noticed: two hysterectomies (for persistent AUB after myomectomy and for severe bleeding after dehiscence of a C. section), restoration of regular menstruations in 94.6% of patients (6 women in menopause), disappearance of pelvic pain and dysmenorrhea in all cases (100%), 8 pregnancies of the 9 women who were wanting child after hysteroscopic synechiolysis (88.9%). CONCLUSION: According to the present study, the best way to prevent IUA is to make D&C for abortion, avoiding waiting longer than 24 hours, perform a D&C and then a diagnostic hysteroscopy after PPH in symptomatic women, reserve D&Cs only for a PPH, or an incomplete abortion, limit to only one D&C, always make a diagnostic hysteroscopy after D&C and uterine plugging for PPH.


Assuntos
Amenorreia/prevenção & controle , Ginatresia/cirurgia , Histeroscopia/métodos , Doenças Uterinas/cirurgia , Adulto , Idoso , Amenorreia/diagnóstico , Amenorreia/etiologia , Diagnóstico Diferencial , Dilatação e Curetagem/métodos , Feminino , Seguimentos , Ginatresia/diagnóstico , Ginatresia/etiologia , Humanos , Pessoa de Meia-Idade , Síndrome , Fatores de Tempo , Aderências Teciduais/prevenção & controle , Aderências Teciduais/cirurgia , Trofoblastos/patologia , Doenças Uterinas/patologia , Miomectomia Uterina/métodos
16.
Acta Obstet Gynecol Scand ; 93(4): 425-7, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24484072

RESUMO

Intrauterine adhesions (Asherman syndrome) are rare and mainly seen after delivery or abortion in the presence of retained placental tissue. This descriptive study aimed to identify common risk factors for intrauterine adhesions. In a 10-year period 61 women were identified with intrauterine adhesions. The pathology was suspected from symptoms, ultrasonography or on hysterosalpingography, but a final diagnosis could only be given after hysteroscopy. There was no definite evidence regarding methods for prevention and treatment of the disorder. It seems, however, that a conservative approach to curettage, hysteroscopic removal of retained tissue, and the use of distending media are important, together with gentle tissue handling when such procedures are required.


Assuntos
Ginatresia/diagnóstico , Ginatresia/epidemiologia , Taxa de Gravidez , Aderências Teciduais/complicações , Útero/patologia , Adulto , Curetagem/efeitos adversos , Dinamarca/epidemiologia , Feminino , Ginatresia/etiologia , Ginatresia/terapia , Humanos , Incidência , Gravidez , Prevalência , Estudos Retrospectivos , Aderências Teciduais/epidemiologia , Aderências Teciduais/etiologia , Aderências Teciduais/cirurgia , Resultado do Tratamento , Útero/cirurgia
17.
Minim Invasive Ther Allied Technol ; 23(2): 115-9, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24024657

RESUMO

The aim of this report was to define the best diagnostic and therapeutic approach when secondary amenorrhea is related to undiagnosed Asherman syndrome. We present a single case of secondary amenorrhea with a previous diagnosis of alterated hypothalamic-hypophysary regulation, with a component of ovarian function in probable reduction, which was evaluated in our department and resulted affected by Asherman's syndrome IV stage. We describe step by step the diagnosis and treatment of a previously misdiagnosed case of severe Asherman's syndrome. An appropriate diagnosis and adequate treatment are mandatory to allow menses and fertility to be restored when severe Asherman's syndrome occurs.


Assuntos
Amenorreia/etiologia , Fertilidade , Ginatresia/complicações , Ginatresia/diagnóstico , Histeroscopia/métodos , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Sistema Hipotálamo-Hipofisário/metabolismo
19.
Zhonghua Yi Xue Za Zhi ; 93(45): 3617-9, 2013 Dec 03.
Artigo em Chinês | MEDLINE | ID: mdl-24534315

RESUMO

OBJECTIVE: To compare the efficacy of different time interval in the prevention of adhesion reformation after hysteroscopic adhesiolysis for moderate-severe Asherman's syndrome. METHODS: A total of 125 women with moderate-severe Asherman's syndrome undergoing hysteroscopic division of intrauterine adhesion were enrolled into this retrospective cohort study. All patients underwent second-look hysteroscopy after a certain period of the first hysteroscopic adhesiolysis, and the operation would be performed again if any adhesion existed. According to the different time interval of hysteroscopy examination, they were divided into 3 groups: A: < 1 month (n = 50), B:1-2 months (n = 39), C >2 months (n = 36). The effect of hysteroscopic adhesiolysis was evaluated by American Fertility Society (AFS) score. RESULTS: The AFS score decreased significantly after hysteroscopic adhesiolysis in each group and the normal uterine rate was up to 64.8%. The median of decreased AFS score and normal uterine rate were as follows:group A:7 point and 78%, group B:7 point and 66.7%, group C:5 point and 44.4%. And groups A and B achieved significantly (P < 0.01) greater reductions in the adhesion score than that of group C. The median time of recovery to normal uterine cavity were 1.64, 2.75 and 5.26 months in each group and great differences existed among them (P < 0.01). CONCLUSION: The time interval of second-look hysteroscopy less than 1 month offers a better prognosis in the prevention of adhesion reformation for moderate-severe Asherman's syndrome.


Assuntos
Ginatresia/diagnóstico , Ginatresia/reabilitação , Doenças Uterinas/diagnóstico , Doenças Uterinas/reabilitação , Adulto , Feminino , Ginatresia/cirurgia , Humanos , Histeroscopia , Estudos Retrospectivos , Fatores de Tempo , Aderências Teciduais/prevenção & controle , Resultado do Tratamento , Doenças Uterinas/cirurgia
20.
Aust N Z J Obstet Gynaecol ; 53(1): 37-45, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23163583

RESUMO

BACKGROUND: Uterine compression suturing is considered a successful, safe, inexpensive and simple method for the conservative treatment of atonic postpartum haemorrhage (PPH). However, insufficient data are available about the potential risk of subsequent intrauterine synechiae (IUS). AIM: To determine the risk of postpartum uterine synechiae in women who received isolated uterine compression suturing for the management of major uncontrolled PPH. MATERIALS & METHODS: All women with major PPH from May 2005 to June 2011 were reviewed retrospectively. Diagnostic hysteroscopy was performed to assess the uterine cavity in the 27 women who successfully underwent isolated uterine compression suturing for major atonic PPH and fulfilled the study inclusion and exclusion criteria. RESULTS: Among the 27 women who underwent isolated uterine compression suturing, 5 (18.5%) were found to have IUS on hysteroscopic examination. The mode of delivery for all women who developed IUS was caesarean section. Among these five women, three had mild IUS, one had moderate IUS and one had severe IUS. All adhesions were later successfully resected by hysteroscopy, except for one case with dense IUS. CONCLUSIONS: Uterine compression suturing was found to be associated with a risk of postpartum uterine synechiae formation, which may subsequently affect future fertility.


Assuntos
Ginatresia/etiologia , Técnicas Hemostáticas , Complicações Pós-Operatórias , Hemorragia Pós-Parto/cirurgia , Técnicas de Sutura , Adulto , Cesárea , Feminino , Ginatresia/diagnóstico , Ginatresia/cirurgia , Humanos , Histeroscopia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Gravidez , Estudos Retrospectivos , Risco , Índice de Gravidade de Doença
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