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1.
J Obstet Gynaecol Can ; 46(6): 102435, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38458270

RESUMO

OBJECTIVES: To compare surgeon responses regarding their surgical plan before and after receiving a patient-specific three-dimensional (3D)-printed model of a patient's multifibroid uterus created from their magnetic resonance imaging. METHODS: 3D-printed models were derived from standard-of-care pelvic magnetic resonance images of patients scheduled for surgical intervention for multifibroid uterus. Relevant anatomical structures were printed using a combination of transparent and opaque resin types. 3D models were used for 7 surgical cases (5 myomectomies, 2 hysterectomies). A staff surgeon and 1 or 2 surgical fellow(s) were present for each case. Surgeons completed a questionnaire before and after receiving the model documenting surgical approach, perceived difficulty, and confidence in surgical plan. A postoperative questionnaire was used to assess surgeon experience using 3D models. RESULTS: Two staff surgeons and 3 clinical fellows participated in this study. A total of 15 surgeon responses were collected across the 7 cases. After viewing the models, an increase in perceived surgical difficulty and confidence in surgical plan was reported in 12/15 and 7/15 responses, respectively. Anticipated surgical time had a mean ± SD absolute change of 44.0 ± 47.9 minutes and anticipated blood loss had an absolute change of 100 ± 103.5 cc. 2 of 15 responses report a change in pre-surgical approach. Intra-operative model reference was reported to change the dissection route in 8/15 surgeon responses. On average, surgeons rated their experience using 3D models 8.6/10 for pre-surgical planning and 8.1/10 for intra-operative reference. CONCLUSIONS: Patient-specific 3D anatomical models may be a useful tool to increase a surgeon's understanding of complex gynaecologic anatomy and to improve their surgical plan. Future work is needed to evaluate the impact of 3D models on surgical outcomes in gynaecology.


Assuntos
Imageamento por Ressonância Magnética , Modelos Anatômicos , Impressão Tridimensional , Útero , Humanos , Feminino , Útero/cirurgia , Útero/diagnóstico por imagem , Útero/anatomia & histologia , Neoplasias Uterinas/cirurgia , Neoplasias Uterinas/diagnóstico por imagem , Miomectomia Uterina/métodos , Histerectomia/métodos , Leiomioma/cirurgia , Leiomioma/diagnóstico por imagem , Leiomioma/patologia , Adulto , Cirurgiões
2.
J Minim Invasive Gynecol ; 27(2): 270-279, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31669551

RESUMO

Endometriosis-associated pain (EAP) has a significant impact on the quality of life of those affected and their families. Recognizing that endometriosis is a chronic condition associated with an impairment in function and negative social impact, there is a shift toward reducing diagnostic delays and initiating timely management. This article provides a comprehensive and practical approach to the clinical diagnosis of EAP, which can subsequently facilitate prompt and directed treatment. The key components of the history, physical examination, and high-quality imaging to evaluate suspected EAP and related pain conditions are presented. Currently, biomarkers have limited utility in the diagnosis of endometriosis, but research in this area continues; development of a reliable noninvasive test for endometriosis may further improve early identification of this condition.


Assuntos
Técnicas de Diagnóstico Obstétrico e Ginecológico/normas , Endometriose/complicações , Endometriose/diagnóstico , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Guias de Prática Clínica como Assunto , Doença Crônica , Diagnóstico Diferencial , Feminino , Humanos , Doenças Peritoneais/complicações , Doenças Peritoneais/diagnóstico , Exame Físico/métodos , Exame Físico/normas , Qualidade de Vida
3.
J Obstet Gynaecol Can ; 42(6): 726-733.e1, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31882290

RESUMO

OBJECTIVE: This study sought to evaluate ethnic variations in the clinical presentation of women with uterine fibroids. METHODS: A total of 996 premenopausal women with symptomatic uterine fibroids were enrolled in a prospective, non-interventional, observational registry at 19 clinical sites across Canada (CAPTURE Registry). Patient-reported outcomes were assessed using Uterine Fibroid Symptom and Health-Related Quality of Life Symptom Severity questionnaires and the Aberdeen Menorrhagia Severity Scale (Ruta score). Linear and logistic regression models, adjusted for patient and fibroid characteristics, were used to examine differences among ethnicities for continuous and binary outcomes of interest. RESULTS: Black women were 4.9 years younger (P < 0.001), were more likely to be nulligravid (P = 0.046), had a 41% longer duration of symptoms before enrolment (P = 0.01), had a 49% larger fibroid volume (P = 0.01), and were more likely to be anemic (P < 0.001) compared with White women. Black women reported lower health-related quality of life scores (-5.19 points; 95% CI -9.90 to -0.48, P = 0.03) compared with White women. East Asian women were 2.0 years younger (P = 0.01), were more likely to be nulligravid (P < 0.001), had a 53% longer duration of symptoms (P = 0.01), had 67% larger fibroid volume (P = 0.01), and were more likely to be anemic (P = 0.003) compared with White women. East Asian women had lower symptom severity scores (-5.95 points; 95% CI -11.16 to -0.75, P = 0.02). Non-White women preferred uterine-preserving treatment options (P < 0.001). CONCLUSION: Black and East Asian women have an increased burden of disease compared with White women and prefer uterine preservation. There is a discrepancy between disease burden and patient-reported outcomes that may reflect ethnocultural differences in disease experience.


Assuntos
Etnicidade/estatística & dados numéricos , Leiomioma/psicologia , Qualidade de Vida/psicologia , Neoplasias Uterinas/psicologia , Adulto , Povo Asiático , População Negra , Canadá , Etnicidade/psicologia , Feminino , Humanos , Leiomioma/etnologia , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Pré-Menopausa , Estudos Prospectivos , Sistema de Registros , Neoplasias Uterinas/etnologia , População Branca
4.
J Obstet Gynaecol Can ; 41(10): 1521-1524, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31548041

RESUMO

OBJECTIVES: The aim of this guideline is to provide clinicians with an update to the 2015 Clinical Practice Guideline on the Management of Uterine Fibroids. As new information and evidence has become available since 2015, the Gynaecology Clinical Practice Committee of the Society for Obstetricians and Gynaecologists of Canada has determined that an addendum to that document was necessary to inform members about treatment modalities for uterine fibroids. OUTCOMES: Implementation of this guideline update should optimize the decision-making process of women and their health care providers in proceeding with further investigation or therapy for uterine leiomyomas, having considered the disease process and available treatment options and reviewed the risks and anticipated benefits. EVIDENCE: Published literature was retrieved through searches of PubMed, CINAHL, and Cochrane Systematic Reviews in February 2015 to April 2018, using appropriate controlled vocabulary (uterine fibroids, myoma, leiomyoma, myomectomy, myolysis, heavy menstrual bleeding, and menorrhagia) and key words (myoma, leiomyoma, fibroid, myomectomy, uterine artery embolization, hysterectomy, heavy menstrual bleeding, menorrhagia). The reference lists of articles identified were also searched for other relevant publications. Results were restricted to systematic reviews, randomized controlled trials or controlled clinical trials, and observational studies. There were no date limits, but results were limited to English or French language materials. Searches were updated on a regular basis and incorporated in the guideline to April 2018. Most of the unpublished data have not been evaluated scientifically. The product monograph was also reviewed up to December 31st, 2018. BENEFITS, HARMS, AND COSTS: The majority of fibroids are asymptomatic and require no intervention or further investigations. For symptomatic fibroids such as those causing menstrual abnormalities (e.g., heavy, irregular, and prolonged uterine bleeding), iron deficiency anemia, or bulk symptoms (e.g., pelvic pressure/pain, obstructive symptoms), hysterectomy is a definitive solution. However, it is not the preferred solution for women who wish to preserve fertility and/or their uterus. The selected treatment should be directed towards an improvement in symptomatology and quality of life. The cost of the therapy to the health care system and to women with fibroids must be interpreted in the context of the cost of untreated disease conditions and the cost of ongoing or repeat investigative or treatment modalities. VALUES: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Contraceptivos Hormonais/uso terapêutico , Leiomioma/tratamento farmacológico , Leuprolida/uso terapêutico , Menorragia/tratamento farmacológico , Norpregnadienos/uso terapêutico , Neoplasias Uterinas/tratamento farmacológico , Anemia/tratamento farmacológico , Anemia/etiologia , Feminino , Hormônio Liberador de Gonadotropina/agonistas , Hematínicos/uso terapêutico , Humanos , Compostos de Ferro/uso terapêutico , Leiomioma/complicações , Leiomioma/fisiopatologia , Testes de Função Hepática , Menorragia/etiologia , Menorragia/fisiopatologia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/fisiopatologia
8.
J Obstet Gynaecol Can ; 38(11): 1024-1027, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27969555

RESUMO

BACKGROUND: Prior to Caesarean section (CS) for morbidly adherent placenta (MAP), endovascular balloons are often placed prophylactically to minimize hemorrhage. However, there have been few reports describing complications of this intervention. CASE: A 41-year-old woman with a diagnosis of placenta percreta had endovascular balloon catheters placed before CS. Intraoperatively the right internal iliac artery ruptured, requiring vascular repair, multiple transfusions of blood and plasma, and admission to the intensive care unit. CONCLUSION: Prophylactic placement of endovascular balloons to reduce maternal hemorrhage at CS for MAP may result in complications. Until more evidence becomes available supporting their use, safety guidelines must be instated in centres using them.


Assuntos
Oclusão com Balão/efeitos adversos , Artéria Ilíaca/lesões , Placenta Acreta/terapia , Ruptura/etiologia , Adulto , Feminino , Humanos , Gravidez
9.
Abdom Imaging ; 40(3): 587-94, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25236953

RESUMO

OBJECTIVE: The objective of this study is to evaluate the sensitivity of routine trans vaginal ultrasound (TVUS) compared to expert-guided transvaginal ultrasound (ETVUS) for the diagnosis of endometriosis. METHODS: A retrospective chart review performed at a Canadian tertiary center specializing in the diagnosis and management of endometriosis. All cases with surgically confirmed endometriosis and an ETVUS completed at a single center were included for review and compared to routine TVUS performed for the same indication. RESULTS: Forty cases met the inclusion criteria. Mean patient age of the study population at first surgical diagnosis was 31.2 ± 6.9 years. Dysmenorrhea (76.9 %) and chronic pelvic pain (74.3 %) were the most common presenting symptoms. Sensitivity of routine TVUS was 25 % (10/40), compared to 78 % (31/40) with ETVUS, (P < 0.01). Comparisons were made based on site of disease. Routine TVUS and ETVUS detected bladder involvement in (0/40) vs. 5 % (2/40); ureter (0/40) vs. 7.5 % (3/40); ovary 25 % (10/40) vs. 72.5 % (29/40); retrocervical area (0/40) vs. 60 % (24/40), rectosigmoid 5 % (2/40) vs. 77.5 % (31/40), respectively. Specific endometriotic lesions recognized by TVUS versus ETVUS, were: ovarian endometriomas in 25 % (10/40) vs. 45 % (18/40), adhesions leading to abnormal anatomy in 2.5 % (1/40) vs. 77.5 % (31/40); endometriotic implants or plaques in 2.5 % (1/40) vs. 70 % (28/40); and endometriotic nodules in 2.5 % (1/40) vs. 35 % (14/40), respectively. Routine TVUS diagnosis relied on the presence or absence of endometrioma (10/10), whereas ETVUS showed additional sites of disease in 97 % (30/31) patients. CONCLUSIONS: ETVUS is more sensitive than routine TVUS to diagnose endometriosis, identifying lesions other than endometrioma and is of assistance in surgical planning and patient counseling.


Assuntos
Endometriose/diagnóstico por imagem , Adulto , Competência Clínica , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia/métodos , Vagina , Adulto Jovem
11.
J Obstet Gynaecol Res ; 41(2): 309-13, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25303112

RESUMO

A 38-year-old woman was found to have a deep 3.3-cm endometriotic nodule of the bladder, confirmed by cystoscopic resection and imaging. Ultrasound also confirmed a 2.6-cm vaginal fornix implant with similar appearance to the bladder mass. The patient's primary symptoms were mild dysmenorrhea, catamenial dysuria and hematuria. The patient conceived shortly after referral and 3 months post-delivery was offered surgical management but declined in favor of medical management. Dienogest 2 mg once a day was started and after 16 months of treatment, more than 50% reduction in the size of the bladder nodule was seen (pretreatment: 3.3 × 3.0 × 2.7 cm, volume: 13.9 cm(3) ; post-treatment: 2.8 × 2.3 × 1.0 cm, volume: 6.4 cm(3) ). The vaginal mass also decreased in size from a pretreatment value of 2.0 × 2.6 × 1.4 cm (3.8 cm(3) ) to 1.1 × 1.4 × 0.5 mm (0.40 cm(3) ) after the treatment. The patient remained asymptomatic with no significant adverse drug reaction during management. Dienogest may be one of the options for medical management of deep endometriosis in young women especially when surgical intervention is declined.


Assuntos
Endometriose/tratamento farmacológico , Antagonistas de Hormônios/uso terapêutico , Nandrolona/análogos & derivados , Doenças da Bexiga Urinária/tratamento farmacológico , Doenças Vaginais/tratamento farmacológico , Adulto , Feminino , Humanos , Nandrolona/uso terapêutico
12.
Reprod Sci ; 31(8): 2508-2522, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38664357

RESUMO

OBJECTIVE: To perform a scoping review of the literature in which ultrasound elastography (UE) has been used in benign gynecology and identify avenues for its use in future research and clinical implementations. METHODS: A structured search of EMBASE, Medline and Cochrane databases was conducted (last search date April 15th, 2022). Eligible studies included adult participants with female pelvic anatomy. English language papers focusing on the utility of ultrasound elastography applied to benign gynecology were included. Narrative reviews, conference abstracts, and letters to the editor were excluded. Two independent reviewers screened titles and abstracts for inclusion, a third reviewer was consulted in cases of disagreement. Study quality was assessed by a checklist for study implementation and elastography technique. Extracted data included elastography technology, gynecologic application, opportunities for clinical implementation, and strengths and limitations. RESULTS: The search returned 2026 studies. A total of 40 studies, published between 2013 and 2022, were retained for data extraction. Studies most frequently used shear wave elastography as the method of UE (n = 23), followed by strain elastography (n = 13) and acoustic radiation force impulse (n = 4). Most common clinical applications for UE were the diagnosis of adenomyosis and uterine fibroids (27.5%), assessment of pelvic floor muscle function (22.5%), and describing the elastic properties of polycystic ovaries (17.5%) and the uterine cervix (15.0%). Limitations of the technology were identified as the lack of published reference values for gynecologic organs and difficulties in assessing tissues deep to the transducer. CONCLUSION: Future research is needed to validate the use of ultrasound elastography in gynecology under both normal and pathologic conditions.


Assuntos
Técnicas de Imagem por Elasticidade , Técnicas de Imagem por Elasticidade/métodos , Humanos , Feminino , Doenças dos Genitais Femininos/diagnóstico por imagem , Ginecologia/métodos
16.
Obstet Gynecol Clin North Am ; 49(2): 241-256, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35636806

RESUMO

Endometriosis surgery requires thoughtful consideration and planning for those with infertility or those who wish to conceive in the future. Clinical history, examination, imaging, and fertility assessment can help plan, prepare and provide goal-directed surgical interventions when required. Further understanding of the benefits and limitations of surgery on future fertility outcomes is essential for those who provide care for patients with endometriosis. Endometriosis is a prevalent gynecologic condition, especially among patients with infertility. Studies demonstrate that, from a fertility perspective, surgery for endometriosis likely has a beneficial impact on the chance of spontaneous conception; however, selecting the appropriate surgical candidate can be challenging. To make a fully informed decision with regard to surgery, it is important to determine the patient's fertility goals and to conduct a thorough workup. Among patients with endometriosis-related infertility, first-line-assisted reproductive technology (ART) is generally preferred over surgery. Specific consideration in cases of minimal or mild endometriosis, ovarian endometrioma(s), and deep endometriosis (DE) are required for targeted counseling. Patients with symptoms significantly impacting their quality of life (QOL), or indications to proceed with surgery (ie, risk of malignancy, organ obstruction, or dysfunction) are best managed with surgical care by an experienced team. Surgery should be considered cautiously given the risks of damage to ovarian reserve, adhesions, and surgical complications. Risk of damage to ovarian reserve is a particularly important consideration among patients with endometrioma(s), with or without low ovarian reserve, and surgical complications are especially prevalent among patients undergoing surgery for bowel endometriosis. Goal-directed surgical treatment, as opposed to the traditional perspective of complete disease eradication, may be of particular importance among selected patients whereby fertility is a priority.


Assuntos
Endometriose , Infertilidade Feminina , Reserva Ovariana , Endometriose/complicações , Endometriose/cirurgia , Feminino , Fertilidade , Humanos , Infertilidade Feminina/etiologia , Infertilidade Feminina/cirurgia , Qualidade de Vida
19.
J Obstet Gynaecol Can ; 32(12): 1172-1175, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21176330

RESUMO

BACKGROUND: Spontaneous hemoperitoneum in pregnancy or the postpartum period is an uncommon but potentially life-threatening complication. CASE: A 29-year-old woman presented with severe abdominal pain, decreased consciousness, and a reduced hemoglobin level three days after an uneventful spontaneous vaginal delivery. Initial ultrasound and CT imaging showed significant hemoperitoneum with no identifiable cause. Laparoscopic surgery was performed, during which bleeding from the left uterine artery was identified and resolved with laparoscopic internal iliac artery ligation. Concomitant cul-de-sac obliteration and adhesions secondary to decidualized endometriosis were found. CONCLUSION: Decidualized endometriosis is a possible etiologic factor in spontaneous hemoperitoneum. Prompt diagnosis and treatment are critical for improving outcomes. When surgical intervention is indicated, a laparoscopic approach should be considered because of its minimally invasive nature and shorter recovery time.


Assuntos
Hemoperitônio/diagnóstico , Hemoperitônio/cirurgia , Artéria Ilíaca/cirurgia , Laparoscopia , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/cirurgia , Adulto , Escavação Retouterina/patologia , Endometriose/complicações , Endometriose/patologia , Feminino , Hemoperitônio/etiologia , Humanos , Ligadura , Doenças Peritoneais/complicações , Doenças Peritoneais/diagnóstico , Doenças Peritoneais/patologia , Doenças Peritoneais/cirurgia , Período Pós-Parto , Gravidez , Complicações Cardiovasculares na Gravidez/etiologia , Complicações Cardiovasculares na Gravidez/patologia , Resultado do Tratamento
20.
Obstet Gynecol ; 136(1): 33-36, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32384386

RESUMO

With the current global coronavirus disease 2019 (COVID-19) pandemic, new challenges arise as social distancing and isolation have become the standard for safety. Evidence supports the protective benefits of social connections and support during pregnancy and labor; there are increased maternal, fetal, and pregnancy risks when pregnant and laboring women lack support. As health care professionals take appropriate precautions to protect patients and themselves from infection, there must be a balance to ensure that we do not neglect the importance of social and emotional support during important milestones such as pregnancy and childbirth. Resources are available to help pregnant women, and technology represents an opportunity for innovation in providing care.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Cuidado Pré-Natal/psicologia , Quarentena/psicologia , COVID-19 , Infecções por Coronavirus/virologia , Parto Obstétrico/psicologia , Feminino , Humanos , Pneumonia Viral/virologia , Gravidez , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez/epidemiologia , SARS-CoV-2 , Apoio Social
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