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1.
Georgian Med News ; (319): 36-41, 2021 Oct.
Artigo em Russo | MEDLINE | ID: mdl-34749320

RESUMO

The objective of this work was to identify prognostic factors of the environment and heredity in the families of girls with abnormal uterine bleeding during puberty. Clinical and genealogical analysis has been carried out according to P. Harper in the families of 70 girls with abnormal uterine bleeding (AUB) during puberty. The control group consisted of families of 30 healthy girls 12-18 years old with a regular menstrual cycle without severe somatic pathology, which have been selected during preventive examinations in educational institutions by specialists of the institute. Statistical analysis of the data has been carried out with the Student's t-test and χ2 for unequal samples using Excel and SPSS Statіstіcs 17.0. Prognostic signs have been selected using Valda's criterion. On the basis of the analysis, the family accumulation of multifactorial pathology has been revealed. The risk factors of AUB have been identified: hereditary burden for reproductive disorders, harmful working conditions and bad habits of parents before conceiving a child, maternal stress before pregnancy, early maternal age during pregnancy (up to 20 years), unfavorable course of pregnancy and childbirth, mixed feeding of infants, stress of girls at home and in an educational institution. The effectiveness of the selected features was 75.0%.


Assuntos
Puberdade , Hemorragia Uterina , Adolescente , Criança , Feminino , Humanos , Ciclo Menstrual , Exame Físico , Gravidez , Fatores de Risco
2.
J Int Med Res ; 49(11): 3000605211054706, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34738473

RESUMO

OBJECTIVE: The aim of this study was to examine the risk factors for antepartum hemorrhage (APH) in women with placenta previa. METHODS: In this retrospective cohort study, we analyzed the medical records of 233 women with singleton pregnancies presenting with placenta previa whose deliveries were performed at our hospital between January 2009 and July 2018. RESULTS: Of the 233 women included in this study, 130 (55.8%) had APH. In the APH group, the gestational age and neonatal birth weight were significantly lower compared with the no hemorrhage group. Maternal age <30 years and multiparity were identified as significant risk factors for APH in both the univariate and multivariate analyses. Focusing on the previous route of delivery in multiparous women, the risk of APH was significantly higher in multiparous women who had experienced at least one vaginal delivery compared with nulliparous women (adjusted odds ratio (OR): 3.42 [95% confidence interval: 1.83-6.38]). CONCLUSION: We showed that women with placenta previa who were under 30 years old and who had a history of vaginal delivery may be at significant risk of experiencing APH.


Assuntos
Placenta Prévia , Adulto , Feminino , Humanos , Recém-Nascido , Paridade , Placenta Prévia/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Hemorragia Uterina
3.
Prim Care ; 48(4): 555-567, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34752269

RESUMO

Abnormal uterine bleeding is a frequent medical concern for premenopausal and postmenopausal patients. Endometrial biopsy is a safe, cost-effective option offered in the office setting. Although endometrial biopsy may result in insufficient tissue or false-negative results, data suggest that endometrial biopsy is 90% sensitive for endometrial cancer and 82% sensitive for atypical hyperplasia, with specificity of 100% for postmenopausal patients and similar results in premenopausal patients. Topical cervical analgesia and oral nonsteroidal anti-inflammatory drugs decrease a patient's discomfort during endometrial biopsy. Aftercare instructions and how patients want to receive results should be reviewed in advance of performing the endometrial biopsy.


Assuntos
Neoplasias do Endométrio , Hemorragia Uterina , Biópsia , Neoplasias do Endométrio/diagnóstico , Endométrio , Feminino , Humanos , Histeroscopia , Gravidez , Hemorragia Uterina/diagnóstico
4.
Am J Case Rep ; 22: e934120, 2021 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-34818313

RESUMO

BACKGROUND Endometriosis is defined as the growth of ectopic endometrial tissue beyond the uterine cavity, and endometriosis on the uterine cervix is a rare variant. Although asymptomatic patients with cervical endometriosis or those with minor symptoms are treated conservatively, there are reports of life-threatening hemorrhage due to cervical endometriosis. Here, we report 2 cases of massive genital bleeding caused by cervical endometriotic cysts and we performed a literature review. CASE REPORT Case 1: A 32-year-old woman presented to our hospital due to massive genital bleeding on her 11th day of menstruation. An arterial hemorrhage in a cervical endometriotic cyst was suspected. As pressure hemostasis proved difficult, urgent uterine artery embolization (UAE) by interventional radiology was performed. Angiography during the UAE showed extravascular leakage from the branch of the left uterine artery. After embolization, hemostasis was achieved. No further genital bleeding was observed, and transvaginal ultrasound showed the cyst has continued to shrink for 9 months after the UAE with sequential dienogest, a progesterone receptor agonist, treatment. Case 2: A 43-year-old woman presented to our hospital with increasing massive genital bleeding after completing a 12-day course of 0.5 mg of norgestrel and 0.05 mg of ethinyl estradiol as a treatment for irregular intermenstrual bleeding. We suspected cervical endometriotic cyst rupture on imaging and performed an urgent laparoscopic total hysterectomy. In the excised uterine specimen, a cystic lesion that contained old, blood-like fluid was macroscopically observed in the cervix and was diagnosed pathologically as endometriosis. CONCLUSIONS Cervical endometriotic cyst rupture is rare; however, it should be kept in mind as a differential diagnosis when treating massive genital bleeding because urgent intervention is sometimes required to control the bleeding.


Assuntos
Cistos , Endometriose , Embolização da Artéria Uterina , Adulto , Colo do Útero , Cistos/complicações , Endometriose/complicações , Feminino , Hemorragia/terapia , Humanos , Hemorragia Uterina/etiologia
5.
Medicina (Kaunas) ; 57(10)2021 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-34684040

RESUMO

Background and Objectives: Endometrial hyperplasia (EH) is a precursor lesion to endometrial cancer (EC), and when cellular atypia is present, in 40% of cases, they are diagnosed with EC on hysterectomy. Usually, EH is clinically manifested by uterine bleeding. In patients with oral anticoagulant therapy (OAT), the uterus is the second most common source of bleeding. The aim of the study was to show that uterine bleeding in postmenopausal patients undergoing OAT may reveal precancerous endometrial lesions with atypia, or neoplastic lesions in patients with an initial diagnosis of endometrial hyperplasia without atypia (non-atypical endometrial hyperplasia, NAEH) on dilation and curettage (D&C). We will be able to estimate the risk of a postmenopausal female patient with uterine bleeding during an OAT to have a precancerous endometrial lesion. Materials and Methods: The subjects of the study were 173 female patients with uterine bleeding, who have had total hysterectomy with bilateral salpingoovarectomy, of whom 99 underwent an OAT. There were 101 female patients initially diagnosed with NAEH, of which 60 did not have anticoagulant treatment (mean age 57.36 ± 6.51) and 41 had anticoagulant treatment (mean age 60.39 ± 7.35) (p = 0.006). From the pathology diagnosis moment, the surgery was performed at 42.09 ± 14.54 days in patients without OAT and after 35.39 ± 11.29 days in those who received such treatment (p = 0.724). Results: Initial diagnosis of NAEH established at D&C was changed at the final diagnosis after hysterectomy in EH with cellular atypia (atypical endometrial hyperplasia AEH) or EC in 18.18% of patients without OAT, and in 40.54% of patients who received this treatment. Conclusions: Based on a logistic regression model, it is estimated that female patients with an initial histopathological diagnosis of NAEH and who underwent OAT have, on average, 4.85 times greater odds (OR = 4.85, 95% CI 1.79-14.06) than the others of being identified postoperatively with more advanced lesions.


Assuntos
Hiperplasia Endometrial , Neoplasias do Endométrio , Idoso , Anticoagulantes/efeitos adversos , Hiperplasia Endometrial/diagnóstico , Hiperplasia Endometrial/cirurgia , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Pós-Menopausa , Estudos Retrospectivos , Hemorragia Uterina/etiologia , Hemorragia Uterina/cirurgia
6.
JNMA J Nepal Med Assoc ; 59(234): 200-203, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-34506473

RESUMO

Uterine adenosarcoma is a rare variant of mixed Mullerian tumors comprised of neoplastic glands with the benign appearance and sarcomatous stroma. The epithelium most often consists of endometrium- like cells, while the sarcomatous component usually shows low-grade homologous uterine sarcoma. These tumors present as a pelvic mass or an enlarged uterus with abnormal vaginal bleeding. Here, we present a case of 61 years old postmenopausal female patient with chief complaints of excessive vaginal bleeding and urine retention.


Assuntos
Adenossarcoma , Tumor Mulleriano Misto , Neoplasias Uterinas , Adenossarcoma/diagnóstico , Adenossarcoma/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Hemorragia Uterina/etiologia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/cirurgia
7.
JNMA J Nepal Med Assoc ; 59(239): 635-639, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508505

RESUMO

INTRODUCTION: Thyroid hormone is known to affect reproductive biology. Abnormal uterine bleeding is one of the common presentations in gynaecology outpatient departments and thyroid dysfunction is known to affect its progression. This study aims to find the prevalence of thyroid dysfunction in diagnosed cases of abnormal uterine bleeding in patients in a tertiary hospital of eastern Nepal. METHODS: A descriptive cross-sectional study was conducted in patients diagnosed with abnormal uterine bleeding in a tertiary care hospital of eastern Nepal from April 2019-March 2020 after taking ethical clearance from the Institutional Review Committee. On basis of inclusion and exclusion criteria, 95 cases of abnormal uterine bleeding were included in the study. A blood sample was taken and a thyroid function test was done by chemiluminescence assay on an automated analyzer. Convenient sampling method was used for sample collection. Statistical analysis was done using Statistical Package for the Social Sciences version 16. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of the total cases of abnormal uterine bleeding, 15 (15.79%) (8.46-23.12 at 95% Confidence Interval) had thyroid dysfunction. Among total cases, 80 (84.21%) were euthyroid. The mean age of the patients was 33±8 years. Among thyroid dysfunction, 9 (60.0%) were hypothyroid, 4 (26.66 %) were subclinical hypothyroid, and 2 (13.33 %) were hyperthyroid. CONCLUSIONS: Thyroid dysfunction was common among patients with abnormal uterine bleeding, with hypothyroidism being the most common type.


Assuntos
Glândula Tireoide , Hemorragia Uterina , Adulto , Estudos Transversais , Feminino , Humanos , Nepal/epidemiologia , Centros de Atenção Terciária , Hemorragia Uterina/epidemiologia , Hemorragia Uterina/etiologia
8.
BMJ Case Rep ; 14(9)2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34497058

RESUMO

A 35-year-old woman (gravida 1, para 0) underwent termination of pregnancy (ToP) at 12 weeks of gestation. One month after ToP, she experienced significant vaginal bleeding and the mass with blood flow was identified on imaging. The presence of a placental polyp with arteriovenous malformation (AVM) was suspected on transvaginal sonography and MRI. Since the bleeding had ceased when she visited our hospital, we decided to treat the placental polyp with AVM with gonadotropin-releasing hormone (GnRH) antagonist therapy instead of surgery. Two months after GnRH antagonist treatment, the mass and blood flow in the uterus disappeared. Menstruation resumed 1 month after the completion of treatment. In our case, we were able to successfully treat placental polyps with AVM using GnRH antagonist therapy.


Assuntos
Malformações Arteriovenosas , Placenta , Adulto , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/tratamento farmacológico , Feminino , Hormônio Liberador de Gonadotropina , Número de Gestações , Antagonistas de Hormônios , Humanos , Placenta/diagnóstico por imagem , Gravidez , Hemorragia Uterina/etiologia
9.
Zhongguo Zhong Yao Za Zhi ; 46(15): 3990-3997, 2021 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-34472276

RESUMO

To systematically evaluate the efficacy and safety of Gongxuening Capsules in the treatment of abnormal vaginal bleeding after medical abortion. CNKI, Wanfang, SinoMed, VIP, PubMed, Cochrane Library and EMbase databases were retrieved to comprehensively collect the clinical randomized controlled trials(RCTs) of Gongxuening Capsules for treatment of abnormal vaginal bleeding after medical abortion from the establishment of the databases to October 10, 2020. Literature screening, data extraction and quality evaluation were conducted independently by two system reviewers according to the inclusion and exclusion criteria. Cochrane Handbook bias risk assessment tool was used for the literature methodology quality evaluation, RevMan 5.3 software was used for Meta-analysis, and the evidence quality of outcomes was evaluated by the evidence quality grading system(GRADE). A total of 16 RCTs were inclu-ded. The results of Meta-analysis showed that as compared with the western medicine treatment alone, the addition of Gongxuening Capsules to the western medicine treatment can reduce the amount of vaginal bleeding(RR=1.23, 95%CI[1.19, 1.27], P<0.000 01), shorten vaginal bleeding time(RR_(≤15 d number of people)=1.39, 95%CI[1.31, 1.48], P<0.000 01; MD_(number ofdays)=-1.20, 95%CI[-1.66,-0.74],P<0.000 01). However, there was no obvious advantage in abortion effect(RR=1.02, 95%CI[0.99, 1.06], P=0.14) and menstrual recovery(MD=-0.35, 95%CI[-0.96, 0.25], P=0.25). The results of GRADE showed that the grading level was low for vaginal bleeding volume and vaginal bleeding time, and extremely low for abortion effect and mens-trual recovery. In terms of safety, 16 studies reported adverse events. Only one study showed no adverse events and the rest showed transient nausea, vomiting, stomach burning, upper abdominal discomfort and other gastrointestinal symptoms. The results show that the addition of Gongxuening Capsules to the application of western medicine in treatment of drug abortion can reduce the amount of vaginal bleeding and shorten vaginal bleeding time, but the abortion effect and menstrual recovery have no obvious advantages. The use of Gongxuening Capsules helps to achieve less adverse reactions and higher safety. Due to the small sample size of the included studies and many methodological quality problems, no conclusions with clinical guidance value can be obtained. Large sample-zise, high-qua-lity randomized controlled trials are still needed for further verification.


Assuntos
Aborto Induzido , Medicamentos de Ervas Chinesas , Aborto Induzido/efeitos adversos , Cápsulas , Medicamentos de Ervas Chinesas/efeitos adversos , Feminino , Humanos , Masculino , Gravidez , Hemorragia Uterina
10.
Life Sci ; 285: 119960, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34536495

RESUMO

AIMS: Sertraline (SE) is one of the most prescribed medications for treating gestational depression, anxiety and stress. However, little is known about its effects on nervous-system development in offspring. Therefore, this study investigated the somatic, reflex and neurobehavioral development of rats exposed to SE during pregnancy, associated or not with stress. MAIN METHODS: Pregnant Wistar rats were assigned to the following groups (n = 10-8 rats/group): CO - control animals administered filtered water by gavage; SE - animals administered 20 mg/kg SE by gavage; ST - animals subjected to restraining stress and administered filtered water; ST/SE - animals subjected to restraining stress and administered 20 mg/kg SE. The treatment was administered between gestational days (GD) 13 to 20. Somatic and reflex developments were investigated in the male offspring from postnatal day (PND) 1 to 21. The elevated plus maze was performed on PND 25 and 80. The open field and light/dark box test were performed on PND 90 and 100, respectively. KEY FINDINGS: Body weight reduction and vaginal bleeding were observed in pregnant rats exposed to SE. The male offspring of the SE group showed delay in incisor eruption, fur development and negative geotaxis. In addition, the SE group was less exploratory (anxious personality) compared to the CO and ST groups. SIGNIFICANCE: The results obtained in the present study demonstrate that sertraline not only impairs maternal health, but also, associated or not with stress, can compromise the somatic, reflex and neurobehavioral development of male rats.


Assuntos
Pelo Animal/efeitos dos fármacos , Antidepressivos/efeitos adversos , Exposição Materna/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Sertralina/efeitos adversos , Estresse Psicológico/tratamento farmacológico , Erupção Dentária/efeitos dos fármacos , Hemorragia Uterina/induzido quimicamente , Animais , Animais Recém-Nascidos , Antidepressivos/administração & dosagem , Feminino , Incisivo/crescimento & desenvolvimento , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Gravidez , Ratos , Ratos Wistar , Reflexo/efeitos dos fármacos , Sertralina/administração & dosagem , Resposta Táctica/efeitos dos fármacos , Perda de Peso
11.
Medicine (Baltimore) ; 100(31): e26844, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397857

RESUMO

RATIONALE: Primary signet ring cell carcinoma of the uterine cervix is extremely rare and the clinical characteristics and prognosis are not well known and there are no specific guidelines for treatment. PATIENT CONCERNS: A 43-year-old woman was referred to our hospital for abnormal uterine bleeding lasting 1 month. DIAGNOSES: Histological examination revealed a signet ring cell carcinoma of the uterine cervix. After evaluation of extragenital origin, the patient was diagnosed International Federation of Gynecology and Obstetrics stage IIIC1 primary signet ring cell carcinoma or the uterine cervix. INTERVENTION: The patient was prescribed concomitant chemo-radiation followed by intracavitary brachytherapy. OUTCOMES: She showed no evidence of disease after treatment but, it recurred after 7 months of last treatment. LESSONS: Different approaches to diagnosis and treatment of this rare disease are needed and molecular pathological studies related to the onset of the disease are required.


Assuntos
Carcinoma de Células em Anel de Sinete , Colo do Útero , Quimiorradioterapia/métodos , Cisplatino/administração & dosagem , Neoplasias do Colo do Útero , Esfregaço Vaginal/métodos , Adulto , Antineoplásicos/administração & dosagem , Biópsia/métodos , Braquiterapia/métodos , Carcinoma de Células em Anel de Sinete/patologia , Carcinoma de Células em Anel de Sinete/fisiopatologia , Carcinoma de Células em Anel de Sinete/terapia , Colo do Útero/diagnóstico por imagem , Colo do Útero/patologia , Evolução Fatal , Feminino , Humanos , Recidiva Local de Neoplasia/patologia , Papillomaviridae/isolamento & purificação , Retratamento/métodos , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/fisiopatologia , Neoplasias do Colo do Útero/terapia , Hemorragia Uterina/diagnóstico , Hemorragia Uterina/etiologia
12.
Obstet Gynecol ; 138(3): 482-486, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34352832

RESUMO

BACKGROUND: Cervical varices complicating pregnancy are rare but can cause significant maternal and perinatal morbidity. There is limited evidence regarding the optimal management of bleeding caused by cervical varices during pregnancy. CASE: A 38-year-old woman was admitted to the hospital at 16 weeks of gestation due to vaginal hemorrhage in the setting of cervical varices accompanied by placenta previa. A cervical pessary was placed at 21 weeks of gestation without further bleeding. Magnetic resonance imaging demonstrated variceal reduction after pessary placement, and a cesarean delivery was performed at 36 weeks of gestation without complications. CONCLUSION: Cervical pessary should be considered as conservative option to control the bleeding associated with cervical varices during pregnancy.


Assuntos
Colo do Útero/irrigação sanguínea , Complicações Hematológicas na Gravidez/diagnóstico , Diagnóstico Pré-Natal , Hemorragia Uterina/diagnóstico , Varizes/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Pessários , Gravidez , Complicações Hematológicas na Gravidez/terapia , Segundo Trimestre da Gravidez , Hemorragia Uterina/terapia , Varizes/terapia
13.
BMC Womens Health ; 21(1): 298, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34399742

RESUMO

BACKGROUND: The formation of a uterine artery pseudoaneurysm is rare and isolated cases have been reported in the existing literature following caesarean sections, curettages and cone biopsies. There has been no report of pseudoaneurysm formation following a loop electrosurgical excision procedure. Vaginal bleeding could potentially be life threatening if this diagnosis is not considered following cervical instrumentation or surgery. Management options range from haemostatic sutures, image-guided embolisation to surgical repair. We report the diagnosis and management of a case of uterine artery pseudoaneurysm after a loop electrosurgical excision procedure. CASE PRESENTATION: A 37-year-old woman was diagnosed with cervical intraepithelial neoplasia grade 3 (CIN3) and underwent a therapeutic loop electrosurgical excision procedure. One month after the procedure, the patient presented to the emergency department with repeated episodes of sudden-onset heavy vaginal bleeding associated with hypotension and syncope. A computed tomography angiogram was performed, which demonstrated a pseudoaneurysm of the right uterine artery. Following the diagnosis, image-guided embolisation was performed successfully. Post-embolisation angiograms showed successful embolisation of the pseudoaneurysm and the patient had no further episodes of bleeding. CONCLUSIONS: Loop electrosurgical excision procedures are generally safe but rarely, can be complicated by the formation of uterine artery pseudoaneurysms. The depth of the loop electrosurgical excision procedure and vascular anatomy should be considered to prevent such complications. A computed tomography angiogram appears to be ideal for diagnosis. Image-guided embolisation is safe and effective as a therapeutic measure, with minimal morbidity.


Assuntos
Falso Aneurisma , Neoplasias do Colo do Útero , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Eletrocirurgia/efeitos adversos , Feminino , Humanos , Gravidez , Artéria Uterina/diagnóstico por imagem , Artéria Uterina/cirurgia , Neoplasias do Colo do Útero/cirurgia , Hemorragia Uterina/etiologia
14.
J Pediatr Adolesc Gynecol ; 34(6): 865-868, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34390861

RESUMO

BACKGROUND: The DICER1 mutation is a pathogenic, germline mutation that predisposes patients to uncommon malignancies at a young age. CASE: A 6-month-old female infant presented with vaginal bleeding and a protruding vaginal mass of unclear pathogenesis. Chemotherapy was initially targeted toward a germ cell tumor; after pathologic testing and auto-amputation of the tumor, the patient was diagnosed with a rare DICER1-associated embryonal rhabdomyosarcoma. Subsequently, her treatment course was restructured and family genetic surveillance instituted. SUMMARY AND CONCLUSION: Consideration for DICER1 mutation in tumors with complex pathology and unique presentation is critical to aid in diagnosis and management, and direct future comprehensive surveillance.


Assuntos
Neoplasias Embrionárias de Células Germinativas , Rabdomiossarcoma Embrionário , Rabdomiossarcoma , RNA Helicases DEAD-box/genética , Feminino , Mutação em Linhagem Germinativa , Humanos , Lactente , Mutação , Rabdomiossarcoma Embrionário/genética , Ribonuclease III/genética , Hemorragia Uterina
15.
JAMA ; 326(5): 390-400, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34342619

RESUMO

Importance: Women with an early nonviable pregnancy of unknown location are at high risk of ectopic pregnancy and its inherent morbidity and mortality. Successful and timely resolution of the gestation, while minimizing unscheduled interventions, are important priorities. Objective: To determine if active management is more effective in achieving pregnancy resolution than expectant management and whether the use of empirical methotrexate is noninferior to uterine evacuation followed by methotrexate if needed. Design, Setting, and Participants: This multicenter randomized clinical trial recruited 255 hemodynamically stable women with a diagnosed persisting pregnancy of unknown location between July 25, 2014, and June 4, 2019, in 12 medical centers in the United States (final follow up, August 19, 2019). Interventions: Eligible patients were randomized in a 1:1:1 ratio to expectant management (n = 86), active management with uterine evacuation followed by methotrexate if needed (n = 87), or active management with empirical methotrexate using a 2-dose protocol (n = 82). Main Outcomes and Measures: The primary outcome was successful resolution of the pregnancy without change from initial strategy. The primary hypothesis tested for superiority of the active groups combined vs expectant management, and a secondary hypothesis tested for noninferiority of empirical methotrexate compared with uterine evacuation with methotrexate as needed using a noninferiority margin of -12%. Results: Among 255 patients who were randomized (median age, 31 years; interquartile range, 27-36 years), 253 (99.2%) completed the trial. Ninety-nine patients (39%) declined their randomized allocation (26.7% declined expectant management, 48.3% declined uterine evacuation, and 41.5% declined empirical methotrexate) and crossed over to a different group. Compared with patients randomized to receive expectant management (n = 86), women randomized to receive active management (n = 169) were significantly more likely to experience successful pregnancy resolution without change in their initial management strategy (51.5% vs 36.0%; difference, 15.4% [95% CI, 2.8% to 28.1%]; rate ratio, 1.43 [95% CI, 1.04 to 1.96]). Among active management strategies, empirical methotrexate was noninferior to uterine evacuation followed by methotrexate if needed with regard to successful pregnancy resolution without change in management strategy (54.9% vs 48.3%; difference, 6.6% [1-sided 97.5% CI, -8.4% to ∞]). The most common adverse event was vaginal bleeding for all of the 3 management groups (44.2%-52.9%). Conclusions and Relevance: Among patients with a persisting pregnancy of unknown location, patients randomized to receive active management, compared with those randomized to receive expectant management, more frequently achieved successful pregnancy resolution without change from the initial management strategy. The substantial crossover between groups should be considered when interpreting the results. Trial Registration: ClinicalTrials.gov Identifier: NCT02152696.


Assuntos
Abortivos não Esteroides/administração & dosagem , Metotrexato/administração & dosagem , Gravidez Ectópica/tratamento farmacológico , Gravidez Ectópica/cirurgia , Conduta Expectante , Aborto Espontâneo , Adulto , Gonadotropina Coriônica/sangue , Terapia Combinada , Dilatação e Curetagem , Feminino , Humanos , Satisfação do Paciente , Gravidez , Ultrassonografia Pré-Natal , Hemorragia Uterina
16.
J Dermatol ; 48(11): 1754-1762, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34462945

RESUMO

Women with abnormal uterine bleeding (AUB) have been reported to develop chronic spontaneous urticaria (CSU). Nevertheless, whether or not AUB women have an increased risk of CSU has not been examined in large-scale epidemiologic studies. This study aimed to investigate the risk of CSU among reproductive-aged women with AUB. A total of 79 595 patients and 79 107 propensity-score matched controls were recruited from Taiwan's National Health Insurance Research Database to conduct a nationwide cohort study. The Cox proportional-hazard regression model was applied to examine the adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for CSU in relation to AUB. We found that women with AUB had a higher risk for CSU (aHR = 1.83; 95% CI, 1.76-1.90) than women without AUB. Subgroup analyses revealed that AUB with an abnormal bleeding frequency (aHR = 1.70; 95% CI, 1.60-1.79), irregular bleeding (aHR = 1.80; 95% CI, 1.71-1.89), and intermenstrual bleeding (aHR = 1.65; 95% CI, 1.49-1.83) were associated with an increased risk of CSU compared with those without abnormalities. The Kaplan-Meier analysis revealed that the cumulative incidence of developing CSU was consistently higher in the AUB cohort than in the non-AUB cohort during the entire follow-up period (log-rank test, p < 0.001). In conclusion, reproductive-aged women with AUB were found to have a higher risk of developing CSU. This study emphasizes the importance of enquiring CSU patients about menstrual problems in clinical practice. Further consultation with obstetrician-gynecologists may be beneficial.


Assuntos
Urticária Crônica , Urticária , Adulto , Estudos de Coortes , Feminino , Humanos , Incidência , Distúrbios Menstruais , Urticária/epidemiologia , Hemorragia Uterina/epidemiologia , Hemorragia Uterina/etiologia
18.
J Obstet Gynaecol Can ; 43(7): 864-868, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34253305

RESUMO

A 39-year-old woman presented with bleeding 4 months after a surgical termination of pregnancy. Persistent beta-human chorionic gonadotropin levels were suggestive of retained products of conception (RPOC). However, multimodal imaging revealed a concurrent uterine arteriovenous malformation (AVM). Although most stable AVMs can be managed conservatively, the need for surgical management of chronic RPOC and consequential hemorrhage risk complicates this approach. Patient-determined management prioritized blood conservation while minimizing risks to fertility. This case is discussed with respect to the rare concurrent existence of RPOC and AVM. Little is known regarding the optimal tandem therapeutic approach. As depicted, successful treatment requires careful diagnostic workup and a multidisciplinary approach.


Assuntos
Malformações Arteriovenosas , Anormalidades Urogenitais , Adulto , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Feminino , Humanos , Gravidez , Hemorragia Uterina/etiologia
19.
Eur J Obstet Gynecol Reprod Biol ; 264: 97-102, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34298451

RESUMO

OBJECTIVE: To study the accuracy of frozen section biopsy for endometrial pathology in high-risk women with abnormal uterine bleeding (AUB). STUDY DESIGN: A case-control study was conducted between November 2017 to April 2019, a total of 150 women with postmenopausal bleeding, perimenopausal AUB, and high-risk women of age < 40 years with AUB were recruited. All women underwent transvaginal sonography and Doppler, based on age-appropriate endometrial thickness cut-offs 80 women then underwent hysteroscopy. Based on hysteroscopy, women suspicious of malignancy were taken as cases (n = 40) and those with benign findings as controls (n = 40). All cases and controls underwent dilatation and curettage (D & C) with frozen section (FS) and routine histopathology. RESULTS: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR), negative LR, and overall test accuracy of FS were 90.9%, 93.19%, 83.33%, 96.19%, 13.8, 0.1 and 86.25% respectively for diagnosing endometrial hyperplasia and cancer taking histopathology as the gold standard. Correlation between frozen section biopsy and histopathology was highly significant (p < 0.001) on D & C specimens and the level of agreement was good (K = 0.778). CONCLUSION: In women suspicious of malignancy on hysteroscopy, frozen section has high accuracy on D&C specimen and can be used to diagnose endometrial hyperplasia and cancer in an effort to fast-track investigations and work-up for definitive treatment while awaiting final histopathology.


Assuntos
Hiperplasia Endometrial , Secções Congeladas , Adulto , Biópsia , Estudos de Casos e Controles , Hiperplasia Endometrial/diagnóstico por imagem , Endométrio/diagnóstico por imagem , Feminino , Humanos , Histeroscopia , Gravidez , Sensibilidade e Especificidade , Ultrassonografia , Hemorragia Uterina/etiologia
20.
Emerg Med Pract ; 23(8): 1-20, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34310092

RESUMO

Uterine bleeding that is abnormal in timing, duration, or quantity affects nearly one-third of women and carries a substantial financial and quality-of-life burden. An estimated 5% of ED visits are for vaginal bleeding, and 1% of those patients will have a life-threatening cause that must be identified. Emergency clinicians need to have a comprehensive understanding of the pathophysiology and etiologies of abnormal uterine bleeding to manage and treat these patients. This issue reviews the most recent updates on common causes and the approach to abnormal uterine bleeding in the nonpregnant patient, including vaginal bleeding in prepubescent females.


Assuntos
Serviço Hospitalar de Emergência , Hemorragia Uterina/diagnóstico , Hemorragia Uterina/etiologia , Hemorragia Uterina/terapia , Diagnóstico Diferencial , Diagnóstico por Imagem , Feminino , Humanos , Exame Físico , Qualidade de Vida , Triagem
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