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1.
Niger J Clin Pract ; 23(5): 747-749, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32367887

RESUMO

Coronavirus 2, or SARS-CoV-2 disease (COVID-19) is a global public health concern. Although there is a paucity of evidence to advise on the best practice, we recommend postponement of elective gynecological endoscopic surgeries until the pandemic is contained. Emergency surgeries should preferably be done through open surgeries than laparoscopy or hysteroscopy approach. However, if or when laparoscopy or hysteroscopy is considered, health personnel in theatre must wear appropriate personal protective equipment (PPE) and all standard precautions should be observed to prevent COVID-19 infection. When COVID-19 is highly suspected or confirmed, the patient should be referred to centers equipped in taking care of such cases.


Assuntos
Infecções por Coronavirus/prevenção & controle , Coronavirus , Histeroscopia/métodos , Laparoscopia/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Aerossóis , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Controle de Infecções , Nigéria/epidemiologia , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Saúde Pública , Sociedades Médicas , Cirurgiões
2.
West Afr J Med ; 37(2): 178-182, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150637

RESUMO

Hysteroscopy involves the visualization of the endometrial cavity with the aid of a hysteroscope (Telescope) inserted through the cervix. Hysteroscopy can be performed in an office setting and minor pathologies managed. A distension medium is necessary for proper visualization. These media include gaseous media such as carbon dioxide, used for diagnostic hysteroscopy, and liquid based media such as normal saline and 1.5% glycine, used for both diagnostic and operative hysteroscopy. Complications following hysteroscopy are few. A hysteroscope should become part of the armamentarium of every gynaecologist.


Assuntos
Doenças dos Genitais Femininos/diagnóstico , Histeroscopia/métodos , Útero/diagnóstico por imagem , Assistência Ambulatorial , Dióxido de Carbono , Colo do Útero , Dilatação , Feminino , Glicinérgicos , Humanos , Gravidez , Cloreto de Sódio
3.
Int J Gynaecol Obstet ; 149(2): 192-196, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32012261

RESUMO

OBJECTIVE: To investigate the effect of early second-look office hysteroscopy combined with intrauterine balloon dilatation on prognosis and pregnancy rate for women with intrauterine adhesions. METHODS: A retrospective analysis of 156 women diagnosed with intrauterine adhesions by hysteroscopy at Shenyang Women's and Children's Hospital, China, from April 2017 to January 2019. The study women underwent intrauterine balloon dilatation 10 days after transcervical resection of adhesion (TCRA) and hysteroscopy 20 days after TCRA (n=81). The control women underwent hysteroscopy 3 months after TCRA (n=75). Estrogen and aspirin were routinely administered postoperatively to all women. Data, including American Fertility Society (AFS) scores assessed by hysteroscopy, endometrial thickness measured by ultrasound, and menstruation and pregnancy outcomes assessed by interview, were compared between the two groups. RESULTS: The degree of intrauterine adhesions, menstrual status, and endometrial thickness were improved in both groups after TCRA. Greater improvement in AFS score, menstruation, and endometrial thickness was observed in the study group than in the control group. After follow-up, more women in the study group achieved pregnancy (48.1% vs 30.7%, P<0.05). CONCLUSION: Early second-look of hysteroscopy combined with intrauterine balloon dilatation after hysteroscopic TRCA might improve the prognosis and postoperative pregnancy rate for women with intrauterine adhesions.


Assuntos
Histeroscopia/métodos , Aderências Teciduais/cirurgia , Tamponamento com Balão Uterino/métodos , Doenças Uterinas/cirurgia , Adulto , Estudos de Casos e Controles , China , Feminino , Humanos , Menstruação/fisiologia , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Cirurgia de Second-Look/instrumentação
4.
Int J Gynaecol Obstet ; 148(1): 113-117, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31593299

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of flushing the cervical canal and the uterine cavity with local anesthetic in order to reduce the pain felt by patients during office hysteroscopy. METHODS: A double-blind randomized controlled trial was conducted between May 1, 2018, and February 28, 2019, involving 260 women undergoing office hysteroscopy at Kasr Al Ainy Hospital, Cairo, Egypt. Women were randomized using a computerized random number generator to intrauterine and intracervical instillation 5 minutes before the procedure of either 5 mL lidocaine 2% diluted in 15 mL normal saline, or 20 mL normal saline alone. The primary outcome measure was the visual analog scale (VAS) pain score reported by women during the procedure. Secondary outcomes included VAS score at 10 and 30 minutes after the procedure, the need for analgesia, and occurrence of vasovagal attacks. RESULTS: Women in the lidocaine flushing group reported a significantly lower VAS score during the procedure (1.8 ± 1.1 vs 5.2 ± 1.8) and 10 and 30 minutes after it (1.3 ± 1.15 and 0.8 ± 0.9 vs 4.3 ± 2.1 and 2.98 ± 1.96) when compared with control women (P<0.001). More women without lidocaine flushing experienced vasovagal attacks (25/130 vs 9/130, P<0.001) and needed analgesia (84/130 vs 13/130, P<0.001) when compared with women with lidocaine flushing. CONCLUSION: Flushing of the cervical canal and uterine cavity with local anesthetic significantly decreased pain sensation in women undergoing office hysteroscopy. CLINICALTRIALS.GOV: NCT03530488.


Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Histeroscopia/métodos , Lidocaína/administração & dosagem , Adulto , Método Duplo-Cego , Egito , Feminino , Humanos , Pessoa de Meia-Idade , Manejo da Dor/métodos , Gravidez , Cuidados Pré-Operatórios/métodos
5.
BMC Pregnancy Childbirth ; 19(1): 502, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842804

RESUMO

BACKGROUND: The aim of this study was to assess the feasibility, safety and outcome of the embolization of non-gonadal collateral supplying gestational sac (GS) in addition to uterine artery embolization (UAE), followed by hysteroscopic curettage for the management of cesarean scar pregnancy (CSP). METHODS: A retrospective study was undertaken from January 2012 to September 2018 in 24 CSP patients in whom non-gonadal collaterals supplying GS were identified by arterial angiography performed immediately after UAE. These patients underwent attempt collateral embolization in addition to UAE, followed by hysteroscopic curettage for the management of CSP. The 24 patients were divided into two groups based on whether they underwent technically successful collateral embolization (UAE-SCE group) or failed collateral embolization (UAE-FCE group) in addition to UAE. The baseline characteristics and clinical outcomes including time for serum ß-human chorionic gonadotropin (ß-hCG) levels normalization, blood loss, secondary anemia, and pelvic pain were compared between the two groups. The paired t test and Man Whitney test were used for comparisons of discrete and numerical variables, respectively. RESULTS: Collateral embolization was techinically successful in 16 (66.7%, 16/24) patients and failed in the other 8 (33.3%, 8/24) patients. There were no significant differences between the two groups in baseline characteristics. The mean blood loss and secondary anemia in the UAE-SCE group were significantly less than UAE-FCE group. No significant difference was found between the two groups in the mean time for ß-hCG levels normalization and pelvic pain. CONCLUSIONS: During the management of UAE combined with hysteroscopic curettage for CSP, additional embolization of non-gonadal collateral supplying GS during UAE is feasible and safe in patients with non-gonadal collateral supplying GS, and the additional embolization of the collateral may reduce blood bloss related to hysteroscopic curettage.


Assuntos
Curetagem/métodos , Saco Gestacional/irrigação sanguínea , Histeroscopia/métodos , Gravidez Ectópica/cirurgia , Embolização da Artéria Uterina/métodos , Adulto , Cesárea/efeitos adversos , Cicatriz/complicações , Circulação Colateral , Terapia Combinada , Estudos de Viabilidade , Feminino , Humanos , Gravidez , Gravidez Ectópica/etiologia , Estudos Retrospectivos , Resultado do Tratamento
6.
Pan Afr Med J ; 33: 211, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31693718

RESUMO

Introduction: Different diagnostic tools are available to evaluate endometrial focal lesion such as hysteroscopy, sonohystrography and transvaginal ultrasound. The present study aimed to determine the diagnostic value of saline infusion sonohystrography (SIS) in diagnosis of intrauterine lesions in women with Abnormal Uterine Bleeding (AUB). Methods: This cross-sectional study recruited 100 married women with chief complain of AUB referred to gynecologic clinics at the Amir Al-Momenin hospital, Semnan, Iran from March 2014 to February 2016. All participants were in the reproductive age and post-menopausal period that showed abnormal endometrial thickness or endometrial focal lesions through transvaginal ultrasound. Participants underwent SIS, hysteroscopy plus focal lesion resection and endometrial biopsy in order. The gold standard was the histopathology of endometrial specimen reported by pathologist. Results: Mean±SD age of women was 41.2±11.3 years. To diagnose the overall focal lesions, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the SIS were 79.6, 89.1, 89.6, and 78.8% respectively. These figures were 75.0, 87.5, 82.5 and 81.7%, respectively to diagnose polyps. The SIS sensitivity, specificity, PPV and NPV values to diagnose the myomas were 60.0, 97.8, 75.0, and 95.7% respectively. Conclusion: Findings show that, SIS probably is a proper method for detecting endometrial focal lesion including polyps and myomas. Future studies may help to define further advantages of this procedure.


Assuntos
Histeroscopia/métodos , Solução Salina/administração & dosagem , Doenças Uterinas/diagnóstico , Hemorragia Uterina/etiologia , Adulto , Estudos Transversais , Feminino , Humanos , Irã (Geográfico) , Leiomioma/diagnóstico , Leiomioma/patologia , Leiomioma/cirurgia , Pessoa de Meia-Idade , Pólipos/diagnóstico , Pólipos/patologia , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Ultrassonografia/métodos , Doenças Uterinas/patologia , Doenças Uterinas/cirurgia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia
7.
Medicine (Baltimore) ; 98(44): e17742, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689824

RESUMO

Placenta previa and accreta with prior cesarean section is an extremely serious condition that is associated with maternal morbidity and mortality from obstetric hemorrhage. The aim of our study was to evaluate the efficacy and advantages of a novel surgical technique, parallel transverse uterine incisions (PTUI), during conservative cesarean delivery in patients with placenta previa and accreta.This was a retrospective cohort study including 124 pregnant women, who had at least 1 prior cesarean section and were diagnosed with anterior placenta previa and accreta between January 2014 and October 2017. Using the hospital's information system, patients were retrospectively classified into undergoing either the PTUI surgery (Group A) or the ordinary cesarean section (Group B). Surgical outcomes and maternal complications during hospitalization were collected. The results from 2 groups were compared and analyzed statistically. Multivariable regression analyses were further used to assess the effect of PTUI on severe maternal outcomes.Patients who underwent PTUI were not statistically different from patients who underwent the ordinary cesarean section in terms of maternal and infants' characteristics. However, PTUI was associated with remarkably reduced intraoperative blood loss (P = .005), related vaginal blood loss after surgery (P = .026), and transfusion requirement of packed red cells (P = .000), compared to the ordinary cesarean section. Moreover, cesarean hysterectomy (3.3% vs 21.9%; P = .002) and intensive care unit admission (1.7% vs 29.7%; P = .000) were significantly fewer among patients who underwent PTUI. Multivariable regression analyses further showed that the risk of intraoperative hemorrhage (ß = -2343.299, P = .000) and cesarean hysterectomy (odds ratio = 0.027, P = .018) were both significantly decreased by PTUI.PTUI is a novel approach that may significantly reduce maternal complications, while preserving the uterus for patients with anterior placenta previa and accreta.


Assuntos
Cesárea/métodos , Histerectomia/métodos , Histeroscopia/métodos , Tratamentos com Preservação do Órgão/métodos , Placenta Acreta/cirurgia , Placenta Prévia/cirurgia , Hemorragia Pós-Parto/cirurgia , Adulto , Perda Sanguínea Cirúrgica , Transfusão de Sangue/estatística & dados numéricos , Cesárea/efeitos adversos , Feminino , Humanos , Histerectomia/efeitos adversos , Hemorragia Pós-Parto/etiologia , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Útero/cirurgia
8.
Medicine (Baltimore) ; 98(40): e17183, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577708

RESUMO

This study aimed to compare the quality of histological endometrial samples collected through Pipelle aspiration and hysteroscopic biopsies to assess the agreement between these 2 biopsies in the histological diagnosis of malignancy and to compare the costs of both biopsies.This was a cross-sectional study. Forty-five women were biopsied, first using Pipelle and immediately after using hysteroscopy. The material collected was sent for analysis, and hysteroscopy was considered the gold standard. The results were divided into the following 3 categories: normal (atrophic, proliferative, and secretory endometrium); polyps; and malignancies. We report the agreement between Pipelle and hysteroscopy in the diagnosis of malignancy and compare their costs.The study showed that while analyzing endometrial malignancies, Pipelle sampling had 100% sensitivity and specificity. In the detection of polyps, Pipelle sampling showed 26.1% sensitivity, 88.9% specificity, 75% positive predictive value, 48.5% negative predictive value, and 53.7% accuracy. Agreement with hysteroscopy in the diagnosis of malignancy was 100%. The Pipelle device costs 27 times less than hysteroscopic biopsy for health insurance companies. This cost is 13.7 times lower in the Brazilian Unified Health System.Endometrial biopsies using the Pipelle have a high accuracy for endometrial cancer and a low accuracy for polyps. We detected 100% agreement between the reports of Pipelle and hysteroscopy with regard to malignancy. Pipelle is the most cost-effective method of endometrial biopsy.


Assuntos
Biópsia por Agulha/métodos , Neoplasias do Endométrio/patologia , Endométrio/patologia , Histeroscopia/métodos , Adulto , Idoso , Biópsia por Agulha/economia , Biópsia por Agulha/normas , Brasil , Estudos Transversais , Feminino , Humanos , Histeroscopia/economia , Histeroscopia/normas , Menopausa/fisiologia , Pessoa de Meia-Idade , Pólipos , Sensibilidade e Especificidade
9.
Medicine (Baltimore) ; 98(37): e17161, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517865

RESUMO

To report on our experience of surgery of cesarean scar pregnancy with temporary occlusion of the bilateral internal iliac arteries.Single center, retrospective review of patients who were diagnosed as cesarean scar pregnancy between December 2017 and December 2018. All patients were managed by laparoscopic cornuostomy and simultaneously repair the defect with temporary occlusion of the bilateral internal iliac arteries, followed by hysteroscopy to confirm no remnants of the pregnancy and deal with intrauterine lesions synchronously.Five patients were enrolled, the vital signs of all the patients were stable. All 5 patients were managed by laparoscopic cornuostomy and simultaneously repair the defect with temporary occlusion of the bilateral internal iliac arteries, followed by hysteroscopy to confirm no remnants of the pregnancy and 3 patients' free intrauterine adhesions synchronously. No one was converted to laparotomy. Intra-operative bleeding was minimal and the postoperative recoveries were uneventful. Human chorionic gonadotropin was normalized after 3 to 4 weeks.Laparoscopy with temporary internal iliac artery occlusion technique offers effective surgical management of cesarean scar pregnancy, and hysteroscopy is necessary to deal with intrauterine lesions.


Assuntos
Cesárea , Cicatriz/cirurgia , Histeroscopia/métodos , Laparoscopia/métodos , Complicações Pós-Operatórias/cirurgia , Complicações na Gravidez/cirurgia , Adulto , Feminino , Humanos , Artéria Ilíaca , Gravidez , Estudos Retrospectivos
10.
JSLS ; 23(3)2019.
Artigo em Inglês | MEDLINE | ID: mdl-31488942

RESUMO

Background and Objectives: In the past, diagnostic hys- teroscopy was used to diagnose an intrauterine mass or abnormality and surgical hysteroscopy was used to treat a uterine polyp, uterine synechia, uterine septum, and submucosal myoma. The old hysteroscope had large diameters. Thus, general anesthesia was needed for inpatient management. However, due to the development of smalldiameter hysteroscopes, hysteroscopic diagnosis and surgery are now possible on an outpatient basis. Despite the development of small-diameter hysteroscopes, resection of submucosal myoma is possible only through resecto- scopic operation under general anesthesia, including type 0 uterine myoma. The objective of the present study was to determine the usefulness of secondary office operating hysteroscopy after cutting the pedicle of submucosal myoma via primary office operating hysteroscopy. Methods: We primarily cut the pedicle of type 0 submucosal myoma with the first rigid 5-mm operating mini- hysteroscopy in the outpatient clinic. We then expected the myoma to shrink. Two months later, we confirmed the size with use of 3-mm flexible diagnostic hysteroscopy. If the myoma was shrunk to less than one-third the original size, it was removed with the second rigid 5-mm operating mini-hysteroscopy. Results: In 14 of 24 patients, the myoma had shrunk to less than one-third the size. The rest was successfully removed with the second operating mini-hysteroscopy. In 5 of 24 patients, the myoma mass was not present in the uterine cavity. However, in another 5 of 24 patients, the myoma size had not changed significantly. The myomas were removed via resectoscopic operation under general anesthesia. Conclusions: The trial with this 2-step operation was very useful for the removal of type 0 submucosal myoma in an outpatient clinic.


Assuntos
Histeroscopia/métodos , Leiomioma/cirurgia , Neoplasias Uterinas/cirurgia , Adulto , Endossonografia , Feminino , Humanos , Neoplasias Uterinas/diagnóstico , Vagina
11.
Fertil Steril ; 112(2): 203-210, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31352959

RESUMO

For humans, the uterus is their first home. Accurate evaluation and effective therapy are central to optimizing the conditions for implantation and sustained pregnancy. For macroscopic intracavitary disease, hysteroscopy remains the gold standard for diagnosis and treatment. We review the role of hysteroscopy before fertility therapies. We also address intracavitary pathologies and their relevance to procreative outcomes. Controversies in the literature are noted and clarified, and trends in the field of hysteroscopy are identified regarding how they will influence the future of reproductive care and women's health.


Assuntos
Histeroscopia , Infertilidade Feminina/etiologia , Infertilidade Feminina/cirurgia , Doenças Uterinas/complicações , Doenças Uterinas/cirurgia , Útero/cirurgia , Feminino , Humanos , Histeroscopia/métodos , Histeroscopia/tendências , Infertilidade Feminina/patologia , Gravidez , Fatores de Risco , Doenças Uterinas/patologia , Útero/diagnóstico por imagem , Útero/patologia
12.
J Obstet Gynaecol Res ; 45(9): 1913-1917, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31304654

RESUMO

AIM: This article retrospectively analyzed the efficacy and safety of vaginoscopy in the treatment of adolescent abnormal uterine bleeding (AUB) in 204 cases of AUB. METHOD: From January 1, 2007 to December 31, 2017, 204 patients with intact hymen who were admitted to our hospital due to AUB received vaginoscopy, and vaginoscopy did not damage the hymen. In this study, 4.5 mm and 6.5 mm hysteroscopy were used with a pumping fluid pressure of 100-120 mm Hg and a flow rate of 400 mL/min. All 204 vaginoscopy was successfully completed in intravenous anesthesia. RESULTS: Postoperative pathological examination confirmed that of the 204 patients, 53 patients had simple hyperplasia. There were 53 cases of polyps, 50 cases of endometrial gland hyperplasia and disordered arrangement, 35 cases of proliferative phase endometrium, five cases of bleeding phase endometrium, partial glandular secretion, three cases of complex hyperplasia and one case of decidua like change. Follow-up data from 64 patients showed that 34 patients were effective after treatment. Stepwise logistic regression analysis suggested that endometrial thickness was associated with treatment outcome (HR, 0.875, 95% CI, 0.786-0.974, P = 0.014). There was no significant difference in drug use between patients with effective and ineffective treatment. CONCLUSION: 'No-touch' vaginoscopy is feasible for the diagnosis and treatment of adolescent AUB without destroying the intact hymen.


Assuntos
Histeroscopia/métodos , Hemorragia Uterina/cirurgia , Vagina/cirurgia , Adolescente , Estudos de Viabilidade , Feminino , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Hemorragia Uterina/etiologia
13.
Eur J Obstet Gynecol Reprod Biol ; 240: 220-225, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31326637

RESUMO

OBJECTIVE: To test the Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) and determine the frequency of specific/prognostic molecular alterations within a cohort of endometrial cancer (EC) women conservatively treated by combined hysteroscopic resection and progestin therapy. STUDY DESIGN: We used blocks of formalin-fixed paraffin-embedded tissue from the primary tumors of patients enrolled into the ECCo trial (EudraCT 2010-018581-23) between 2007 and 2016. In order to assign EC resectoscopic specimens to one of four ProMisE subgroups, testing involved sequential assessment of i) immunohistochemistry (IHC) for mismatch repair (MMR) proteins MLH1, MSH2, MSH6 and PMS2; ii) sequencing for POLE/POLD1 exonuclease domain mutations (EDMs); iii) p53 IHC. RESULTS: Molecular analysis methods were used in 25 patients (stage IA, G1-2 endometrioid EC), of whom 15 (60%) represented fully evaluable cases. Seven cases (46.7%) had abnormal MMR IHC, POLE/POLD1 EDMs were found in 3 cases (20%), and abnormal p53 IHC in 1 case (6.6%). Three patients (20%) had more than one molecular feature. Among 10 (40%) 'unclassifiable' patients, six failures in achieving complete molecular categorization were due to the low tumor volume. Molecular classification of the 15 fully evaluable cases yielded the following ProMisE subtypes: 7 (46.7%) MMR IHC abnormal, 1 (6.6%) POLE EDM, 0 (0%) p53 IHC abnormal, 7 (46.7%) p53 IHC wild-type. CONCLUSIONS: Although larger series are needed to further assess the feasibility of a molecular categorization in a fertility-sparing setting, data presented are promising. In women with early stage low-volume disease, operative hysteroscopy could be advantageous to provide samples allowing complete genetic risk assessment.


Assuntos
Carcinoma Endometrioide/terapia , Neoplasias do Endométrio/terapia , Histeroscopia/métodos , Progestinas/uso terapêutico , Adulto , Carcinoma Endometrioide/tratamento farmacológico , Carcinoma Endometrioide/patologia , Carcinoma Endometrioide/cirurgia , Tratamento Conservador , Neoplasias do Endométrio/tratamento farmacológico , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Feminino , Preservação da Fertilidade , Humanos , Prognóstico , Medição de Risco , Resultado do Tratamento
14.
Taiwan J Obstet Gynecol ; 58(4): 497-500, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307740

RESUMO

OBJECTIVES: The feasibility of vaginoscopic hysteroscopy combined with office endometrial biopsy after ultrasonography for management of post-menopausal vaginal bleeding (PMB). MATERIALS AND METHODS: A prospective observational study of with PMB whom attending the Outpatient Clinic of Kang Ning Hospital during a four months period (1st Feb to 31st May 2018) was included. Vaginoscopic hysteroscopy was performed with endometrial biopsy after the initial clinical pelvic examination and transvaginal ultrasound examination. RESULTS: A total of 45 consecutive women with PMB was included. The hysteroscopy and endometrial biopsy were successful in 44 out of 45 (98%), a complete view in 82%, adequate tissue was in 91%, only one case was failed both procedures due to pain. The correlation between hysteroscopy and endometrial biopsy by was 100%. The mean operation time was 229 ± 68 s. The most common histological findings was atrophic endometrium 18 (42%). Five endometrial polyps and 2 submucosal leiomyomas were found. One rare case of endometrial carcinosarcoma (2%) was detected. Patients reported less pain for hysteroscopy than endometrial biopsy with rated VAS pain score was 3.5 ± 2.2, with 5 more score in 18%, and for endometrial biopsy 4.2 ± 2 and 33% respectively (p < 0.001). Six cases (13%) experienced vasovagal attacks immediately after the procedure. There is no other complication. CONCLUSION: The Vaginoscopic hysteroscopy combined endometrial biopsy is safe and feasible for assessment of endometrial pathology with postmenopausal bleeding.


Assuntos
Neoplasias do Endométrio/cirurgia , Endossonografia/métodos , Histeroscopia/métodos , Pós-Menopausa , Hemorragia Uterina/diagnóstico por imagem , Hemorragia Uterina/cirurgia , Idoso , Biópsia por Agulha , Estudos de Coortes , Neoplasias do Endométrio/diagnóstico por imagem , Endométrio/patologia , Feminino , Exame Ginecológico/métodos , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença , Taiwan , Resultado do Tratamento , Ultrassonografia Doppler/métodos
15.
Taiwan J Obstet Gynecol ; 58(4): 541-544, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307748

RESUMO

OBJECTIVE: The aim of the present study was to describe various hysteroscopic findings of previous cesarean delivery scar defects (PCDS), and evaluate the relationship between these findings and abnormal uterine bleeding. MATERIALS AND METHODS: This was a retrospective study including patients with abnormal uterine bleeding after a cesarean section. Transvaginal ultrasound and hysteroscopy were used to detect the origin of the symptoms, and the gynecological symptoms and hysteroscopic findings were recorded. Relationships between the hysteroscopic findings and abnormal uterine bleeding were evaluated. RESULTS: Ninety-six (82.8%) patients presented with intermenstrual bleeding. The most common findings of scar defects on hysteroscopy were increased local vascularization (74.1%) and oozing spots (47.4%). Increased local vascularization on the defect was significantly related to intermenstrual bleeding (p = 0.048). CONCLUSION: This study categorized different findings of PCDS under hysteroscopy. Increased local vascularization on the scar defect was significantly related to intermenstrual bleeding.


Assuntos
Cesárea/efeitos adversos , Cicatriz/diagnóstico , Cicatriz/etiologia , Histeroscopia/métodos , Hemorragia Uterina/epidemiologia , Adulto , Cesárea/métodos , Cicatriz/epidemiologia , Estudos de Coortes , Comorbidade , Feminino , Humanos , Incidência , Gravidez , Prognóstico , Estudos Retrospectivos , Medição de Risco , Taiwan , Hemorragia Uterina/etiologia , Hemorragia Uterina/cirurgia
16.
Medicine (Baltimore) ; 98(30): e16623, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348312

RESUMO

Different sizes of uterine septum between infertile women and patients with abortions may have a clinical relevance in reproductive performance after surgery. This study aimed to assess if the fecundity of women after surgical correction of the uterine septum is associated with septum size.A retrospective, single-center, cohort study was conducted in Peking Union Medical College Hospital using patients aged between 21 and 37 years. Hysteroscopic metroplasty was performed on 121 patients with a uterine septum. The septum size was assessed by ultrasonography and hysteroscopy. The subjects were divided into 3 groups: Group A consisted of 35 women with complete uterine septum (mean ± standard deviation (SD) age 28.29 ±â€Š3.53; group B consisted of 48 women with uterine septum >2.5 cm (mean ±â€ŠSD age 28.85 ±â€Š3.63); and group C consisted of 48 women with uterine septum ≤2.5 cm (mean ±â€ŠSD age 28.79 ±â€Š3.74). Age and body mass index (BMI) were not significantly different among the 3 groups.No serious hysteroscopic complications occurred. However, uterine septa were observed in 4 cases after surgery and 6 cases of intrauterine adhesions were observed after long-term follow-up. The abortion rate decreased, and term delivery rate increased significantly in the 3 groups after hysteroscopic metroplasty. The infertility rate was significantly lower in group C after surgery. However, no significant difference was observed in the infertility rate between groups A and B. The recurrent abortion rate was significantly lower in group A than in groups B and C before surgery. After surgery, the infertility rate was significantly higher in group A than in group B (28.57% and 10.53%, respectively; P = .048). After at least 12-months of follow-up, the pregnancy rate in group A was significantly lower than that in group C (71.43% and 89.47%, respectively; P = .048).Uterine septum resection improves obstetrical outcomes. After surgery, the infertility rate was significantly higher in patients with complete uterine septum than in those with a large partial uterine septum, and the pregnancy rate in patients with complete uterine septum was lower than that in the patients with a small partial uterine septum.


Assuntos
Fertilidade , Histeroscopia/métodos , Infertilidade Feminina/cirurgia , Doenças Uterinas/cirurgia , Adulto , Feminino , Humanos , Estudos Retrospectivos , Adulto Jovem
17.
Rev Assoc Med Bras (1992) ; 65(5): 714-721, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31166450

RESUMO

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


Assuntos
Cesárea/efeitos adversos , Cicatriz/diagnóstico , Cicatriz/terapia , Doenças Uterinas/diagnóstico , Doenças Uterinas/terapia , Cicatriz/etiologia , Feminino , Humanos , Histeroscopia/métodos , Metrorragia/diagnóstico , Metrorragia/etiologia , Metrorragia/terapia , Fatores de Risco , Doenças Uterinas/etiologia
18.
Int J Gynaecol Obstet ; 146(3): 277-288, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31197826

RESUMO

BACKGROUND: Endometrial cancer and atypical hyperplasia are rare in young women but create a dilemma between desire for pregnancy and oncologic outcomes. OBJECTIVE: To identify remission rates and associated prognostic factors in patients undergoing fertility-sparing management for endometrial cancer and atypical hyperplasia. SEARCH STRATEGY: MEDLINE was searched for studies published between January 1, 1950 and July 31, 2017 using various search terms. SELECTION CRITERIA: Studies evaluating fertility-sparing management in patients aged between 19 and 44 years with atypical hyperplasia or stage I endometrial cancer. DATA COLLECTION AND ANALYSIS: Use of PRISMA guidelines to conduct a meta-analysis of the proportion of patients in remission and meta-regression analysis to test the effect of possible prognostic factors for remission. MAIN RESULTS: A total of 3673 studies were screened; 65 studies including 1604 patients met the inclusion criteria. The remission rate was 0.75 (95% CI, 0.73-0.77). Operative hysteroscopy for endometrial sampling was associated with higher remission rates (OR 2.31; 95% CI, 1.10-4.84; P=0.03). Studies with higher ratios of infertile women were associated with higher remission rates (OR 4.21; 95% CI, 1.44-12.33; P<0.01). CONCLUSION: Operative hysteroscopy is the preferred endometrial sampling method for patients with atypical hyperplasia or endometrial cancer undergoing fertility-sparing management.


Assuntos
Adenocarcinoma/cirurgia , Hiperplasia Endometrial/cirurgia , Neoplasias do Endométrio/cirurgia , Preservação da Fertilidade/métodos , Histeroscopia/métodos , Adenocarcinoma/patologia , Adulto , Feminino , Humanos , Infertilidade Feminina/prevenção & controle , Lesões Pré-Cancerosas/cirurgia , Gravidez , Prognóstico , Estudos Prospectivos , Indução de Remissão/métodos , Estudos Retrospectivos
20.
Photodiagnosis Photodyn Ther ; 27: 295-297, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31252140

RESUMO

Surgical resection for atypical polypoid adenomyoma (APA) is an option for fertility preservation. Due to the high recurrence rate of APA, studies have been conducted to improve total resection of tumors. Photodynamic diagnosis (PDD) using 5-aminolevulinic acid (5-ALA) improves tumor resection, but this has not been applied for APA. The patient was 35-year-old. After initial treatment, the APA lesion did not disappear. We performed hysteroscopic tumor resection using 5-ALA-PDD. Only one PDD-positive lesion was found and histopathologically diagnosed as APA. Other areas were PDD-negative and showed no histopathologic APA or malignant findings. This is the first report of hysteroscopic 5-ALA-PDD for APA. This method makes it easy to identify morbid lesions, and may lead to improved total resection and decreased recurrence.


Assuntos
Adenomioma/tratamento farmacológico , Neoplasias do Endométrio/tratamento farmacológico , Histeroscopia/métodos , Ácidos Levulínicos/uso terapêutico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Adenomioma/diagnóstico , Adenomioma/cirurgia , Adulto , Neoplasias do Endométrio/diagnóstico , Neoplasias do Endométrio/cirurgia , Feminino , Preservação da Fertilidade , Humanos
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