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1.
Comput Intell Neurosci ; 2022: 6951692, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35669673

RESUMO

In order to explore the diagnostic value of the improved clustering algorithm of vaginal ultrasound combined with hysteroscopy in abnormal uterine bleeding (AUB), 128 patients diagnosed with AUB in the hospital were selected as the research objects. A K-means improved clustering color image segmentation algorithm was designed and applied to AUB vaginal ultrasound image processing. The running time, mean square error (MSE), and peak to signal noise ratio (PSNR) were calculated to evaluate the algorithm, and the sensitivity, specificity, negative likelihood ratio, and positive likelihood ratio were used to evaluate the diagnostic accuracy of the detection method. In addition, combined with hysteroscopy, a comprehensive evaluation of the diagnostic value of abnormal uterine bleeding diseases was implemented. The results showed that compared with the traditional K-means clustering algorithm, the running time of the improved K-means clustering color image segmentation algorithm in the training set was significantly shortened, the MSE was significantly decreased, and the PSNR was significantly increased (P < 0.05). The sensitivity, specificity, negative likelihood ratio, and positive likelihood ratio (90.5%, 93.2%, 84.3, and 96.3%) of AUB diagnosis were significantly improved in the algorithm of vaginal ultrasound combined with hysteroscopy (P < 0.05). In summary, the combination of vaginal ultrasound and hysteroscopy based on K-means improved clustering color image segmentation algorithm can significantly improve the clinical diagnostic accuracy of AUB patients.


Assuntos
Histeroscopia , Hemorragia Uterina , Algoritmos , Análise por Conglomerados , Endométrio , Feminino , Humanos , Gravidez , Sensibilidade e Especificidade , Hemorragia Uterina/diagnóstico por imagem , Hemorragia Uterina/etiologia
2.
Curr Opin Obstet Gynecol ; 34(3): 107-113, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35645008

RESUMO

PURPOSE OF REVIEW: To succinctly review the basic mechanisms of implantation and luteal phase endometrial differentiation, the etiologies of impaired endometrial function and receptivity, and the current methods that exist to evaluate and treat impaired endometrial receptivity. RECENT FINDINGS: Human embryo implantation requires bidirectional communication between blastocyst and a receptive endometrium. Etiologies of impaired endometrial receptivity are varied. Some of these include delayed endometrial maturation, structural abnormalities, inflammation, and progesterone resistance. Current methods to evaluate endometrial receptivity include ultrasonography, hysteroscopy, and endometrial biopsy. Treatments are limited, but include operative hysteroscopy, treatment of endometriosis, and personalized timing of embryo transfer. SUMMARY: Although some mechanisms of impaired endometrial receptivity are well understood, treatment options remain limited. Future efforts should be directed towards developing interventions targeted towards the known mediators of impaired endometrial receptivity.


Assuntos
Implantação do Embrião , Endométrio , Blastocisto , Transferência Embrionária , Feminino , Humanos , Histeroscopia , Gravidez
3.
Comput Math Methods Med ; 2022: 4082266, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35726229

RESUMO

Objective: A case-control study was performed to explore the efficacy and adverse reactions of Mirena combined with hysteroscopy when treating AUB. Methods: 108 patients with perimenopausal AUB treated in our hospital from June 2019 to December 2021 were enrolled, and their clinical data were collected and analyzed retrospectively. According to the mode of treatment, the patients were assigned into control group (54 cases) and study group (54 cases). The therapeutic effects were compared. Visual analog score (VAS) was adopted to evaluate the degree of incision pain, Barthel index score was adopted to evaluate the ability of daily living, quality of life scale was adopted to investigate the quality of life before and after treatment, and the changes of sex hormone levels, endometrial thickness, and menstruation were detected before and after treatment. The incidence of adverse reactions was calculated. Results: In terms of the therapeutic effects, 46 cases were cured, 6 cases were effective, and 2 cases were ineffective in the study group, and the effective rate was 96.30%; in the control group, 32 cases were cured, 10 cases were effective, and 12 cases were ineffective, and the effective rate was 77.78%; the effective rate of the study group was higher than that of the control group (P < 0.05). In terms of VAS score, the VAS score decreased after treatment, and the VAS score in the study group was significantly lower than that in the control group at 1 week, 2 weeks, 1 month, and 3 months after treatment. With regard to the Barthel index scores after treatment, the Barthel index scores increased, and the Barthel index scores of the study group at 1 week, 2 weeks, 1 month, and 3 months after treatment were higher compared to the control group (P < 0.05). In terms of the Barthel index scores after treatment, the Barthel index scores increased, and the Barthel index scores of the study group at 1 week, 2 weeks, 1 month, and 3 months after treatment were higher compared to the control group (P < 0.05). Compared with those before treatment, the levels of FSH, LH, and E2 in both groups decreased remarkably (all P < 0.05). In terms of the changes of endometrium and menstruation, the endometrial thickness, menstrual time, and menstrual volume were significantly improved after treatment (P < 0.05). After treatment, the endometrial thickness, menstrual time, and menstrual volume in the study group were better than those in the control group (P < 0.05). With regard to the scores of qualities of life, the scores of qualities of life decreased after treatment. Compared between the two groups, the scores of physiological function, psychological function, social function, and health self-cognition in the study group were lower compared to the control group. Regarding the incidence of adverse reactions, in the study group, there were 1 case of breast pain, 2 cases of vaginal bleeding, and no dizziness and nausea, and the incidence of adverse reaction was 5.56%; In the control group, there were 1 case of dizziness, 2 cases of breast pain, 4 cases of nausea, and 3 cases of vaginal bleeding, and the incidence of adverse reactions in the study group was 18.52%. The incidence of adverse reactions in the study group was lower compared to the control group (P < 0.05). Conclusion: Hysteroscopy combined with Mirena when treating perimenopausal AUB can remarkably enhance the related symptoms, regulate the level of sex hormones, and remarkably reduce the amount of menstrual bleeding. The curative effect is better than hysteroscopy combined with dydrogesterone tablets, which is worth popularizing in clinic.


Assuntos
Levanogestrel , Mastodinia , Estudos de Casos e Controles , Feminino , Humanos , Histeroscopia/efeitos adversos , Levanogestrel/efeitos adversos , Mastodinia/induzido quimicamente , Mastodinia/complicações , Mastodinia/tratamento farmacológico , Náusea/induzido quimicamente , Náusea/complicações , Náusea/tratamento farmacológico , Gravidez , Qualidade de Vida , Estudos Retrospectivos , Hemorragia Uterina/induzido quimicamente , Hemorragia Uterina/cirurgia
4.
Fertil Steril ; 118(1): 205-206, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35610094

RESUMO

OBJECTIVE: To demonstrate safe and efficient techniques for hysteroscopic partial and complete uterine septum incisions with radiofrequency electrosurgery. Review of these techniques may be particularly helpful for a surgical trainee or a less experienced hysteroscopic surgeon. DESIGN: Video instruction of the hysteroscopic uterine septum incision techniques. SETTING: Academic hospital setting. PATIENT(S): One patient with a partial uterine septum and 1 patient with a complete uterine septum and a duplicated cervix (2 distinct external cervices) (1). INTERVENTION(S): Hysteroscopic partial and complete uterine septum incisions with a 7-mm unipolar knife electrode. Importantly, the demonstrated techniques can be performed using any hysteroscopic cutting instrument with which the surgeon is comfortable. MAIN OUTCOME MEASURE(S): Surgical techniques that can be used to safely and efficiently incise a uterine septum and determine when the incision is complete. RESULT(S): For a partial uterine septum, surgical techniques include uterine septum shortening, uterine septum thinning, and measurement of the residual septum length with the operating instrument to determine when the incision is complete. Visualization of the tubal ostia should be used throughout the procedure to maintain a horizontal incision plane. For a complete uterine septum with a duplicated cervix, we additionally demonstrate how to make a window through the septum at the level of the internal os to incise the uterine body portion while preserving the tissue wall inferiorly that separates the duplicated cervices. CONCLUSION(S): Uterine septum incision is typically a short procedure that can be successfully performed with operative hysteroscopy. However, if a systematic approach is not followed, the surgeon can quickly and unknowingly become disoriented, resulting in inadvertent uterine perforation, incomplete septum incision, or excessive septum incision causing myometrial thinning, which has been shown to increase the risk of uterine rupture during pregnancy. In practice, the choice of technique used for septum incision should be made intraoperatively and will depend on the septum size and shape. Often, septum shortening, thinning, and residual measurement are best used in combination to achieve a successful result. Surgeons will find the use of these techniques helpful to maintain intraoperative orientation and provide a framework to guide adequate removal of either a partial or complete uterine septum.


Assuntos
Histeroscopia , Útero , Colo do Útero/diagnóstico por imagem , Colo do Útero/cirurgia , Feminino , Humanos , Histeroscopia/efeitos adversos , Histeroscopia/métodos , Miométrio , Gravidez , Útero/diagnóstico por imagem , Útero/cirurgia
5.
Nan Fang Yi Ke Da Xue Xue Bao ; 42(4): 591-597, 2022 Apr 20.
Artigo em Chinês | MEDLINE | ID: mdl-35527496

RESUMO

OBJECTIVE: To evaluate the impact of a history of vaginal delivery on anesthesia management of patients undergoing hysteroscopic surgery under intravenous general anesthesia without tracheal intubation. METHODS: Ninety-nine patients undergoing hysteroscopic surgery under intravenous general anesthesia were enrolled in this study, including 43 patients with (VD group) and 56 patients without a history of vaginal delivery (NVD group). For all the patients, blood pressure, heart rate (HR), blood oxygen saturation (SpO2) and bispectral index (BIS) were recorded before anesthesia (T1), after anesthesia (T2), after cervical dilation (T3), and at 3 min after cervical dilation (T4). Propofol and etomidate doses during anesthesia induction, the total dose of propofol administered, additional intraoperative bolus dose and times of propofol, intraoperative body movement, total operation time and surgeons' satisfaction feedback scores were compared between the two groups. The postoperative awake time, recovery time, VAS score at 30 min after operation, and postoperative nausea and vomiting (PONV) were also compared. RESULTS: There was no significant differences in SBP, DBP, HR, SpO2, or BIS between the two groups at T1 and T2, but at T3 and T4, SBP and DBP were significantly higher in NVD group than in VD group (P < 0.01); HR was significantly higher in NVD group only at T3 (P < 0.01). The application of vasoactive drugs did not differ significantly between the two groups. The total dose of propofol, additional intraoperative dose and times of propofol were all greater in NVD group than in VD group (P < 0.01). More body movements of the patients were observed in NVD group (P < 0.01), which also had lower surgeons' satisfaction score for anesthesia (P < 0.01), higher postoperative VAS score (P < 0.05), and shorter postoperative awake time (P < 0.05) and recovery time (P < 0.01). CONCLUSION: A history of vaginal delivery has a significant impact on anesthesia management of patients undergoing hysteroscopic surgery under intravenous general anesthesia without tracheal intubation in terms of hemodynamic changes, anesthetic medication, and postoperative recovery quality, suggesting the necessity of individualized anesthesia management for these patients.


Assuntos
Propofol , Anestesia Geral , Anestesia Intravenosa , Anestésicos Intravenosos , Estudos de Coortes , Parto Obstétrico , Feminino , Humanos , Histeroscopia , Gravidez
6.
Biomed Res Int ; 2022: 1232495, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35528176

RESUMO

Objective: To investigate the effect of hysteroscopy surgery combined with Mirena on postoperative adverse reactions and recurrence rate of endometrial polyps (EP). Methods: A total of 312 patients who underwent hysteroscopic polypectomy of EP in our hospital from June 2017 to November 2020 were enrolled retrospectively. Among them, 42 patients did not take any treatment after the operation (control group), 156 patients were treated with levonorgestrel intrauterine birth control system (Mirena group), and 114 patients were treated with oral spironolone ethinylestradiol tablets (oral group). The clinical data of 312 patients were recorded and followed up regularly. All patients were followed up through an outpatient clinic or telephone to 12 months after the operation. The patients' age, disease course, number of pregnancies, clinical manifestations, endometrial thickness before the operation, duration of operation, amount of bleeding during the operation, and number and size of polyps were analyzed. The recurrence and postoperative side effects of EP in the three groups were followed up within 12 months after the operation. Results: There was no significant difference in endometrial thickness among the three groups before treatment (P > 0.05). After 3 months, 6 months, and 12 months of treatment, the endometrial thickness of the three groups decreased, while the decrease in the Mirena group and the oral group was better compared to the control (P < 0.05). The decrease in the Mirena group was better than that in the oral group (P < 0.05). There was no significant difference in hemoglobin levels among the three groups before treatment (P > 0.05). After 3, 6, and 12 months of treatment, the hemoglobin levels of the three groups increased to varying degrees, while the levels of the Mirena group and oral group were better compared to the control (P < 0.05). Three months after the operation, the improvement of clinical symptoms was similar in the three groups, and there was no significant difference among the three groups (P > 0.05). At 6 and 12 months after the operation, the improvement of clinical symptoms in the oral group and Mirena group was better compared to the control group (P < 0.05), but there was no significant difference between the oral group and Mirena group (P > 0.05). After the operation, some patients had complications such as lower abdominal pain, breast distension pain, irregular vaginal bleeding, and abnormal liver function. There was no significant difference in the number of complications among the three groups (P > 0.05). During the follow-up to 12 months after the operation, the recurrence rate in the oral group and Mirena group was lower compared to the control (P < 0.05), and the recurrence rate in the Mirena group was lower than that in the oral group (P < 0.05). Conclusion: Placing Mirena immediately after hysteroscopic polypectomy of EP can reduce the recurrence rate of endometrial polyps, increase the level of hemoglobin, and reduce the thickness of the endometrium, which can be employed and popularized according to the condition of patients in clinical work.


Assuntos
Pólipos , Neoplasias Uterinas , Endométrio/patologia , Endométrio/cirurgia , Feminino , Humanos , Histeroscopia/efeitos adversos , Levanogestrel/uso terapêutico , Pólipos/patologia , Pólipos/cirurgia , Gravidez , Estudos Retrospectivos , Neoplasias Uterinas/patologia
7.
BMC Womens Health ; 22(1): 190, 2022 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-35614405

RESUMO

OBJECTIVE: We aimed to evaluate the hysteroscopic management of first-trimester pregnancy loss compared to surgical evacuation either blind or under ultrasonographic guidance . METHODS: This clinical trial included 315 women with first-trimester pregnancy loss, divided equally into three groups. Group 1 underwent traditional blind surgical evacuation, group 2 underwent ultrasound-guided evacuation, and group 3 underwent hysteroscopic management. All women were assessed for retained products, surgical complications, the need for further management, and pregnancy occurrence after evacuation within 2 years of follow up. RESULTS: The rate of presence of conception remnants and the need for further treatment was significantly higher in group 1 compared to groups 2 and 3 (4.8% vs. 0% vs. 0%, P = 0.012). The conception rate within 2 years was significantly lower in group 1 compared to groups 2 and 3 (57.4% vs. 73.2% vs. 82.7%, P = 0.002), and the duration needed to conceive was significantly prolonged in group 1 compared to groups 2 and 3 (9.8 vs. 8.3 vs. 6.9 months, P < 0.001). Interestingly, women who underwent hysteroscopic management needed a significantly shorter time to conceive than those who underwent ultrasound-guided evacuation (6.9 vs. 8.3 months, P = 0.006). CONCLUSIONS: Hysteroscopic management of first-trimester pregnancy loss was superior to ultrasound-guided surgical evacuation regarding the time interval to conceive. Both techniques were superior to the blind evacuation technique regarding removal of the whole conception remnants, need for further treatment and fertility outcomes. Clinical trial registration: It was first registered at ClinicalTrials.gov on 16/03/2017 with registration number NCT03081104.


Assuntos
Fertilização , Histeroscopia , Feminino , Fertilidade , Humanos , Histeroscopia/métodos , Gravidez , Primeiro Trimestre da Gravidez , Ultrassonografia de Intervenção
10.
Obstet Gynecol Clin North Am ; 49(2): 315-327, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35636811

RESUMO

Office hysteroscopy is a highly effective procedure for the evaluation and treatment of intrauterine pathology. The "see and treat" approach allows for patient treatment with the fewest amount of patient visits. The development of smaller cameras and instruments, as well as the employment of a vaginoscopy technique, has led to greater tolerability of office hysteroscopy and significant success of the "see and treat" approach. Most office hysteroscopic procedures can be accomplished with minimal premedication. There are many choices for equipment types and sterilization methods for the office hysteroscopy practice. Reimbursement for office hysteroscopy has improved, but economic challenges remain.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Histeroscopia , Feminino , Humanos , Histeroscopia/métodos , Gravidez
11.
Obstet Gynecol Clin North Am ; 49(2): 329-353, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35636812

RESUMO

Hysteroscopic myomectomy is the treatment of choice for symptomatic submucosal myomas, with excellent success rate and low complication rate.


Assuntos
Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Feminino , Humanos , Histeroscopia , Leiomioma/cirurgia , Gravidez , Neoplasias Uterinas/cirurgia
12.
Fertil Steril ; 117(6): 1322-1331, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35428480

RESUMO

OBJECTIVE: To compare real-world effectiveness of hysteroscopic to laparoscopic sterilization. DESIGN: Retrospective cohort of Medicaid claims for hysteroscopic or laparoscopic sterilization procedures performed in California, 2008-2014. After excluding postpartum procedures, we applied log-linear (Poisson) event-history regression models for clustered person-period data, weighted for propensity to receive either sterilization procedures, and adjusted for sociodemographic and clinical variables to examine the poststerilization pregnancy rates. SETTING: Clinics, hospitals. PATIENT(S): Women aged 18-50 years with Medicaid claims between January 1, 2008, and August 31, 2014. INTERVENTION(S): Hysteroscopic or laparoscopic sterilization procedure. MAIN OUTCOME MEASURE(S): Poststerilization pregnancy measured by pregnancy-related claims. RESULT(S): Among women with hysteroscopic (n = 5,906) or laparoscopic (n = 23,965) sterilization, poststerilization pregnancy claims were identified for 4.74% of women after hysteroscopic sterilization and 5.57% after laparoscopic sterilization. The pregnancy rates decreased over time after either procedure. Twelve months after the procedure, the crude incidence of pregnancy claims was higher for hysteroscopic sterilization than for laparoscopic sterilization (3.26 vs. 2.61 per 100 woman-years), but the propensity-weighted adjusted incidence rate ratio was 1.06 (95% confidence interval [CI], 0.85-1.26). Between 13 and 24 months after the procedure, there were fewer pregnancies for women after hysteroscopic sterilizations than for those after laparoscopic sterilizations (adjusted incidence rate ratio, 0.63 [95% CI, 0.45-0.88]), with no statistically significant differences in later years. The cumulative pregnancy rates 5 years after sterilization were lower with hysteroscopic sterilization than with laparoscopic sterilization (6.26 vs. 7.22 per 100 woman-years; propensity-weighted, adjusted risk ratio, 0.76 [95% CI, 0.62-0.90]). The poststerilization pregnancy rates varied by age and race/ethnicity. CONCLUSION(S): The pregnancy rates after female sterilization are higher than expected, whether performed hysteroscopically or laparoscopically. These findings are reassuring that the effectiveness of hysteroscopic sterilization was not inferior to laparoscopic sterilization. CLINICAL TRIAL REGISTRATION NUMBER: NCT03438682.


Assuntos
Laparoscopia , Esterilização Tubária , Estudos de Coortes , Feminino , Humanos , Histeroscopia/métodos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Gravidez , Estudos Retrospectivos , Esterilização , Esterilização Reprodutiva/métodos , Esterilização Tubária/métodos
13.
Fertil Steril ; 117(6): 1334-1336, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35437146

RESUMO

OBJECTIVE: To present a case of endometriosis within an isthmocele membrane and concomitant diffuse peritoneal endometriosis after cesarean sections. In addition, we describe a unique, color-contrasted surgical repair technique and propose a possible correlation between isthmocele formation and endometriosis. DESIGN: Narrated video article featuring the diagnosis, unique surgical management, and pathological findings of a case of isthmocele endometriosis. Informed consent was obtained from the patient, and all identifiers were removed. SETTING: University-affiliated hospital. PATIENT(S): A 44-year-old patient with three prior cesarean sections and a laparoscopic appendectomy, in none of which endometriosis was visualized. She presented with progressive pelvic pain, dysmenorrhea, dyspareunia, and secondary infertility with recurrent embryo transfer failures. The progressively debilitating symptoms started 14 years ago, shortly after her last cesarean section. Magnetic resonance imaging and ultrasound demonstrated a retroverted uterus and a prominent, thin, fluid-filled cesarean scar defect with a residual myometrial thickness of 1.1 mm. INTERVENTION(S): A combined hysteroscopic and laparoscopic approach was performed to allow for complete resection of the defect and reconstruction of the myometrium. The bladder was backfilled with indocyanine green dye to help identify its borders. Methylene blue was added to the hysteroscopy irrigation solution to create contrast and assist with the isthmocele identification. Wide excision of the isthmocele was performed, followed by a three-layer closure and excision of all apparent peritoneal lesions using the Aqua Blue Contrast Technique. MAIN OUTCOME MEASURE(S): Restoration of normal anatomy, resection of isthmocele, and resolution of the symptoms. RESULT(S): In the pathological assessment, multiple foci of endometriosis were identified within the isthmocele membrane, clearly differentiated from intrauterine endometrial tissue. Additionally, all seven excised peritoneal specimens contained peritoneal endometriosis. Two weeks after the procedure, a transvaginal sonographic scan confirmed a thick anterior uterine wall with a myometrial thickness of 9.2 mm, and the patient reported almost complete resolution of her symptoms. CONCLUSION(S): This case demonstrates endometriosis within the isthmocele membrane, with concomitant symptomatic peritoneal endometriosis. We propose a laparoscopic isthmocele excision technique and a three-layer reconstruction, followed by peritoneal endometriosis excision using methylene blue contrast. We suggest a possible link between isthmocele and endometriosis and emphasize the need for wide excision of the isthmocele margins and maintaining clean borders, given the possibility of endometriosis within the isthmocele, which may be a cause or a contributor to the tissue weakness and isthmocele formation.


Assuntos
Endometriose , Laparoscopia , Adulto , Cesárea/efeitos adversos , Cicatriz/cirurgia , Endometriose/complicações , Endometriose/diagnóstico , Feminino , Humanos , Histeroscopia/métodos , Laparoscopia/métodos , Azul de Metileno , Gravidez
14.
Reprod Biomed Online ; 44(5): 881-887, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35361544

RESUMO

RESEARCH QUESTION: What are the prevalence and risk factors of intrauterine adhesions (IUA) in patients with a septate uterus? DESIGN: In this retrospective cohort study, patients with a septate uterus who underwent septum resection between 2015 and 2020 were analysed. Two-dimensional transvaginal ultrasonography plus hysteroscopy was used to diagnose uterine septum or IUA. The prevalence and risk factors for IUA in patients with a septate uterus were examined. RESULTS: Among 522 eligible patients with a septate uterus, 165 patients were diagnosed with IUA (prevalence 31.6% [95% CI 27.7 to 35.5%]). In the multivariable logistic regression analysis of risk factors for IUA, patients who had experienced one or more miscarriages were more likely to have IUA than patients who had not (OR 3.38, 95% CI 1.96 to 5.83, P < 0.001, and OR 2.55, 95% CI 1.24 to 5.23, P = 0.011, respectively). Patients who underwent one or more dilatation and curettage (D&C) procedures had a significantly increased risk of IUA compared with patients who did not (OR 3.42, 95% CI 1.87 to 6.26, P < 0.001, and OR 3.99, 95% CI 1.93 to 8.26, P < 0.001, respectively). For patients with a history of miscarriage or D&C, the prevalence rates of IUA were 46.5% (95% CI 40.6 to 52.4%) and 44.0% (95% CI 38.5 to 49.5%), respectively. CONCLUSION: Nearly one-third of patients with a septate uterus have concomitant IUA. A previous miscarriage or D&C is an important risk factor for IUA in patients with a septate uterus.


Assuntos
Aborto Espontâneo , Doenças Uterinas , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/etiologia , Feminino , Humanos , Histeroscopia/métodos , Gravidez , Prevalência , Estudos Retrospectivos , Fatores de Risco , Aderências Teciduais/epidemiologia , Aderências Teciduais/etiologia , Doenças Uterinas/cirurgia , Útero/diagnóstico por imagem , Útero/cirurgia
15.
Indian J Tuberc ; 69(2): 151-156, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35379394

RESUMO

BACKGROUND: Genital tuberculosis (TB) continues to remain an important cause of infertility in women, especially in developing countries. It is mostly consequent to a primary infection elsewhere in the body. The diagnosis is challenging, considering its paucibacillary nature. Although there are many studies on association of genital tuberculosis with infertility, there is paucity of literature on impact of extragenital tuberculosis on fertility of women through involvement of female reproductive organs. The various diagnostic modalities available have limitations and quest is ongoing for the best diagnostic test. METHOD: This was a prospective observational study conducted at the infertility clinic of a tertiary care health facility where 60 infertile women with either tubal factor or unexplained infertility with or without past history of extragenital tuberculosis were enrolled as study subjects or controls respectively. Mantoux test was performed in all women and diagnostic laparo-hysteroscopy was performed in all women to look for any evidence of uterine and/or tubal damage. The peritoneal fluid was sent for GeneXpert and Liquid culture for mycobacterium tuberculosis. Results of Mantoux test, GeneXpert and liquid culture were compared with the laparohysteroscopic findings. RESULT: Of the thirty infertile women in the study group, 27/30 (90%) had a history of pulmonary tuberculosis and 3/30 (10%) had history of tubercular cervical lymphadenopathy. It was observed that Mantoux test was positive (induration >10 mm) in 27/30 (90%) of women in the study group as compared to only 4/30 (13.3%) controls. Abnormal hysteroscopic findings were documented in 26.6% (8/30) study group women as compared to 6.6% (2/30) women in the control group. Similarly, 60% (18/30) of women in the study group had abnormal laparoscopic findings compared to 33% (10/30) in the control group. Seven out of thirty (23.3%) women were positive for GeneXpert in the study group compared to only 1/30 (3.3%) in the control group. Similarly, liquid culture was positive in 6/30 (20%) of women in the study group as compared to 1/30 (3.3%) in the control group. All the above differences were statistically significant. We observed that the sensitivity of Mantoux test (75.8%) stand alone was higher than the other tests combined (50%). However, specificity and positive predictive value (PPV) increases markedly (up to 100%) to when all the three tests are combined. CONCLUSION: The authors conclude that all women presenting with infertility should be screened for a past history of tuberculosis and actively worked up for genital tuberculosis in case the history is positive. The various available tests (Mantoux test, GeneXpert and liquid culture) have their limitations for the diagnosis of genital tuberculosis. Thus an approach of early resort to laparohysteroscopy in suspected patients is desirable so that definitive management may be instituted timely and promptly.


Assuntos
Infertilidade Feminina , Mycobacterium tuberculosis , Tuberculose dos Genitais Femininos , Feminino , Genitália , Humanos , Histeroscopia/efeitos adversos , Histeroscopia/métodos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/etiologia , Gravidez , Tuberculose dos Genitais Femininos/complicações , Tuberculose dos Genitais Femininos/diagnóstico , Tuberculose dos Genitais Femininos/microbiologia
16.
Comput Math Methods Med ; 2022: 1906769, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35401781

RESUMO

Endometrial carcinoma (EC) is one of the most common gynecological malignancies. Its incidence rate has been increasing year by year. The prognostic factors and treatment strategies of EC have aroused wide concern. The effects of peritoneal cytology on the prognosis and treatment of EC remain controversial. Some factors, such as differentiation degree, muscle invasion, and tumor size, are related to positive peritoneal cytology. Hysteroscopy is commonly used in the diagnosis and treatment of endometrial cancer, but hysteroscopic surgery may cause the tumor to spread into the abdominal cavity, resulting in positive peritoneal cytology. In this review, we discuss the factors related to positive peritoneal cytology and the influence of positive peritoneal cytology on the prognosis of endometrial cancer. Suspicious positive peritoneal cytology may be an independent risk factor for endometrial cancer. The positive rate of peritoneal tumor cells in type II endometrial cancer is higher than other cells and is an independent risk factor for type II endometrial cancer. We also discuss the effects of peritoneal cytology on treatment decisions. Aggressive treatments seem to be more beneficial for patients with positive ascites cytology, but there is a lack of large-scale prospective clinical studies on their effectiveness and safety. The application of peritoneal cytology for endometrial cancer has been decreased in recent years. We believe that peritoneal cytology is necessary for this type of cancer. However, more studies on peritoneal cytology in endometrial cancer should be carried out.


Assuntos
Neoplasias do Endométrio , Citodiagnóstico , Neoplasias do Endométrio/patologia , Feminino , Humanos , Histeroscopia/métodos , Estadiamento de Neoplasias , Gravidez , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos
17.
Am J Case Rep ; 23: e936182, 2022 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-35387961

RESUMO

BACKGROUND Interstitial ectopic pregnancy, a pregnancy occurring in the part of the fallopian tube that is within the body of the uterus, poses a significant risk to patients, with a mortality rate of up to 2.5%, which is 7 times higher than for tubal ectopic pregnancies. Hysteroscopic sterilization reversal carries a potential risk of interstitial ectopic pregnancy; therefore, it is important to counsel patients appropriate and review the alternative option for in vitro fertilization. In vitro fertilization has been shown to have a superior pregnancy and live birth rate in comparison to sterilization reversal. Women who have undergone sterilization via hysteroscopic placement of the Essure device may complete in vitro fertilization with sterilization devices left in situ without significantly reducing the pregnancy rate. CASE REPORT A 34-year-old woman, G6P3023, presented to the Emergency Department after incidental detection of left interstitial ectopic pregnancy measuring 9 weeks of gestation. She had previously undergone a right salpingectomy for ectopic pregnancy soon after reversal of Essure sterilization via bilateral tubouterine reimplantation; this is a procedure that is infrequently performed due to limited evidence to suggest that this is a safe and efficacious method to achieve future pregnancies. This patient underwent an uncomplicated left cornuostomy and salpingectomy, rendering the need for in vitro fertilization to conceive in the future. CONCLUSIONS Patients seeking fertility treatment after hysteroscopic sterilization should be counseled that tubouterine reimplantation poses significant morbidity risk based on the nature of the surgery. Instead, patients who have undergone hysteroscopic sterilization who desire future pregnancy should be advised that in vitro fertilization, with or without salpingectomy, may be a safer and more efficacious option to achieve live birth.


Assuntos
Laparoscopia , Gravidez Ectópica , Esterilização Tubária , Adulto , Feminino , Humanos , Histeroscopia/métodos , Laparoscopia/métodos , Gravidez , Gravidez Ectópica/etiologia , Esterilização , Esterilização Tubária/efeitos adversos
18.
BMC Womens Health ; 22(1): 106, 2022 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-35392892

RESUMO

BACKGROUND: The overall clinical significance of the finding of endometrial abnormalities in predicting premalignant/malignant endometrial lesions is still incompletely determined. For this reason the management, surgical or expectant, of women in which an endometrial abnormality has been detected is debated. METHODS: This retrospective study was carried out on 1020 consecutive women, 403 premenopausal and 617 postmenopausal, who underwent operative hysteroscopy in a University Hospital for suspected endometrial abnormalities, which were detected by transvaginal ultrasound (TVS) and/or office hysteroscopy. In these women, the clinical characteristics and findings at TVS and hysteroscopy were evaluated in relation to the presence/absence of premalignant/malignant endometrial lesions at pathology report. RESULTS: The clinical characteristics considered were significantly different when the study women were compared according to their menopausal status. Premalignant/malignant lesions were found in 34/1020 (3.33%) women. Complex hyperplasia with atypia and endometrial cancer were detected in 22 (2.15%) and 12 (1.17%) cases, respectively. The postmenopausal women had a significantly higher risk of premalignant/malignant lesions than premenopausal women (O.R. = 5.098 [95% C.I.: 1.782-14.582], P < 0.005). This risk was even higher when abnormal uterine bleeding (AUB) was present (O.R. = 5.20 [95% C.I.: 2.38-11.35], P < 0.0001). The most significant associations with premalignant/malignant endometrial lesions were BMI, AUB in postmenopause, overall polyp size, atypical aspect of endometrial polyps at hysteroscopy, postmenopausal status, diabetes mellitus and patient age. CONCLUSIONS: The results of the present study suggest that the proper, aggressive or expectant, management of endometrial abnormalities should take into account both ultrasonographic and hysteroscopic findings together with the specific clinical characteristics of the patients.


Assuntos
Neoplasias do Endométrio , Pólipos , Lesões Pré-Cancerosas , Doenças Uterinas , Neoplasias Uterinas , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Endométrio/diagnóstico por imagem , Endométrio/patologia , Feminino , Humanos , Histeroscopia/métodos , Pólipos/diagnóstico por imagem , Pólipos/cirurgia , Gravidez , Estudos Retrospectivos , Ultrassonografia , Doenças Uterinas/diagnóstico por imagem , Doenças Uterinas/cirurgia , Hemorragia Uterina/etiologia , Neoplasias Uterinas/patologia
19.
Hong Kong Med J ; 28(2): 133-139, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35410963

RESUMO

INTRODUCTION: Available examinations for women with postmenopausal bleeding include transvaginal sonography to measure endometrial thickness (TVS-ET), and invasive endometrial assessment using hysteroscopy/endometrial biopsy. However, selection of the examination method seldom involves consideration of patient preferences. The aim of this study was to examine patient preferences for the method used to investigate postmenopausal bleeding. METHODS: Women were asked to complete an interviewer-administered structured survey before they underwent clinical investigations at a university gynaecology unit from June 2016 to June 2017. Using the standard gamble approach, women were asked to choose between invasive assessment by hysteroscopy/endometrial biopsy (gold standard) or TVS-ET with a risk of missing endometrial cancer. The risk of missing endometrial cancer during TVS-ET was varied until each woman was indifferent to either option. RESULTS: The median detection rate for endometrial cancer required using TVS-ET was 95% (interquartile range=80%-99.9%). In total, 200 women completed the survey, and 77 (38.5%) women required TVS-ET to have a 99.9% detection rate for endometrial cancer. Prior hysteroscopy experience was the only factor that influenced the women's decisions: a significantly higher detection rate was required by this patient group than by patients without previous hysteroscopy experience (P=0.047). CONCLUSION: A substantial proportion of women would accept TVS-ET alone for the investigation of postmenopausal bleeding. In the era of patientcentred care, clinicians should incorporate patient preferences and enable women to make informed choices concerning the management of postmenopausal bleeding.


Assuntos
Neoplasias do Endométrio , Histeroscopia , Biópsia , Neoplasias do Endométrio/diagnóstico por imagem , Feminino , Humanos , Masculino , Pós-Menopausa , Gravidez , Sensibilidade e Especificidade , Ultrassonografia , Hemorragia Uterina/diagnóstico por imagem , Hemorragia Uterina/etiologia
20.
J Healthc Eng ; 2022: 2929800, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35449839

RESUMO

Uterine adhesions are mainly manifested as menstrual changes in women of childbearing age and affect fertility. Resection of uterine adhesions can well restore the shape of the patient's uterine cavity and improve the patient's menstruation. However, how to promote the growth of the endometrium and prevent the recurrence of adhesions after the operation is still a major problem. This article aims to study the use of traditional treatment methods as a control and use low-frequency nerve therapy device to assist in the treatment of posterior intrauterine adhesions recurrence rate, menstrual recovery effective rate, adverse reaction rate, liver function, etc. to study the low-frequency nerve therapy device auxiliary treatment method to prevent the postoperative effect of intrauterine adhesions. This article proposes an image processing algorithm based on intelligent medical related algorithms such as deep learning, Apriori algorithm, and an improved algorithm that introduces the degree of interest and details of 140 patients diagnosed with moderate to severe intrauterine adhesions who underwent hysteroscopic TCRA surgery in a certain affiliated hospital. The medical records were followed up by hysteroscopy and electric resection, and they were randomly divided into a control group and an observation group, with 70 cases in each group. Both groups of patients were closely monitored postoperatively, followed by postoperative review, and recorded menstrual recovery and pregnancy. At the same time, we performed hysteroscopy for recurrence of endometrial adhesions. The experimental results of this article show that the actual treatment rate of the control group is 65.7%, which is much lower than the 95.7% of the experimental group. The probability of returning to normal after 3 months of menstruation in the control group was 34.0%, much lower than the 69% in the experimental group. Three months after operation, the endometrial thickness of the experimental group was much higher than that of the control group, and the RI was lower than that of the control group. The difference was statistically significant (P < 0.05). The clinical treatment results are satisfactory and worthy of clinical screening.


Assuntos
Histeroscopia , Doenças Uterinas , Endométrio/cirurgia , Feminino , Humanos , Gravidez , Aderências Teciduais/etiologia , Aderências Teciduais/prevenção & controle , Aderências Teciduais/cirurgia , Doenças Uterinas/etiologia , Doenças Uterinas/cirurgia , Útero/cirurgia
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