1/92. Pelvic arterial embolization for control of obstetric hemorrhage: a five-year experience.OBJECTIVE: Obstetric hemorrhage is a significant cause of maternal morbidity and death. postpartum hemorrhage that cannot be controlled by local measures has traditionally been managed by bilateral uterine artery or hypogastric artery ligation. These techniques have a high failure rate, often resulting in hysterectomy. In contrast, endovascular embolization techniques have a success rate of >90%. An additional benefit of the latter procedure is that fertility is maintained. We report our experience at Stanford University Medical Center in which this technique was used in 6 cases within the past 5 years. STUDY DESIGN: Six women between the ages of 18 and 41 years underwent placement of arterial catheters for emergency (n = 3) or prophylactic (n = 3) control of postpartum bleeding. Specific diagnoses included cervical pregnancy (n = 1), uterine atony (n = 3), and placenta previa and accreta (n = 2). RESULTS: Control of severe or anticipated postpartum hemorrhage was obtained with transcatheter embolization in 4 patients. A fifth patient had balloon occlusion of the uterine artery performed prophylactically, but embolization was not necessary. In a sixth case, bleeding could not be controlled in time, and hysterectomy was performed. The only complication observed with this technique was postpartum fever in 1 patient, which was treated with antibiotics and resolved within 7 days. CONCLUSIONS: uterine artery embolization is a superior first-line alternative to surgery for control of obstetric hemorrhage. Use of transcatheter occlusion balloons before embolization allows timely control of bleeding and permits complete embolization of the uterine arteries and hemostasis. Given the improved ultrasonography techniques, diagnosis of some potential high-risk conditions for postpartum hemorrhage, such as placenta previa or accreta, can be made prenatally. The patient can then be prepared with prophylactic placement of arterial catheters, and rapid occlusion of these vessels can be achieved if necessary.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
2/92. Antenatal diagnosis of vesicouterine fistula.BACKGROUND: In pregnancy, vesicouterine fistulas usually are diagnosed postpartum after cesarean deliveries. CASE: An 18-year-old woman, gravida 3, para 2, with two prior cesarean deliveries had pain and apparent rupture of membranes at 23 weeks' gestation. At 26 weeks' gestation, she developed increasing suprapubic pain and irregular contractions. Ultrasonographic findings included a small uterine defect and possible ballooning of membranes into her bladder. Cytoscopy showed ballooning of amnion into the bladder dome. A viable 900-g female infant was delivered by classic cesarean, the fistulous tract was excised, and the rupture sites were repaired. CONCLUSION: Vesicouterine fistulas might be diagnosed antenatally. With continued contractions and associated uterine rupture, cesarean delivery can be done with excision of the fistulous tract and repair of the rupture sites.- - - - - - - - - - ranking = 1.5602595495103keywords = pregnancy, gestation (Clic here for more details about this article) |
3/92. Asymptomatic uterine incarceration at term gestation: a case report.Uterine incarceration is a rare event complicating pregnancy. Herein, we present a unique case of an asymptomatic term pregnancy with uterine incarceration; this patient had had an anterior myomectomy 3 years earlier. She had an asymptomatic antenatal course and incidental identification of uterine incarceration during cesarean section. We also address the importance of early recognition and appropriate management regarding this circumstance.- - - - - - - - - - ranking = 3.1205190990206keywords = pregnancy, gestation (Clic here for more details about this article) |
4/92. Uterine fistula induced by hysteroscopic resection of an embolized migrated fibroid: a rare complication after embolization of uterine fibroids.OBJECTIVE: To describe a case in which hysteroscopic removal of a fibroid that had migrated through the uterine wall induced formation of a uterine fistula. DESIGN: After embolization of uterine fibroids, an investigative clinical, sonographic, and hysteroscopic protocol was followed. SETTING: Gynecologic clinic of a university hospital. PATIENT(S): A 38-year-old woman undergoing embolization of uterine arteries for uterine fibroids. INTERVENTION(S): angiography-guided transcatheter bilateral embolization of uterine arteries, with clinical, sonographic, and hysteroscopic follow-up. MAIN OUTCOME MEASURE(S): Patient morbidity and satisfactory intercourse. RESULT(S): Six months after embolization of the uterine arteries, the patient presented migration of the fibroid through the uterine wall. Hysteroscopic removal of the fibroid induced posthysteroscopic formation of a uterine fistula. CONCLUSION(S): After embolization of the uterine arteries, thorough follow-up examination of the uterine cavity is strictly recommended. diagnosis of a uterine wall perforation can identify an abnormal source of uterine bleeding, and patients should be counseled to avoid pregnancy until the lesion heals completely.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
5/92. Torsion of the pregnant uterus.A 31-year-old woman, with a history of previous cesarean section and right oophorectomy, was admitted for a repeat cesarean section. After the commencement of surgery uterine torsion was diagnosed because of the anterior position of the remaining left ovary and tube, the absence of normal uterovesical peritoneum, and extremely engorged vessels in the lower uterine surface. Posterior classical hysterotomy was performed and a healthy female baby was delivered. Following delivery of the baby and suturing the incision site of the uterus, the contracted uterus was detorted and put back in the pelvic cavity. Extreme uterine torsion of 180 degrees at term is a rare obstetric event. This paper presents a case of uterine torsion at full term pregnancy in which the delivery and repositioning of the uterus was successful.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
6/92. Torsion of a nongravid uterus: an unexpected complication of an ovarian cyst.Torsion of nongravid uterus is rare. Most reports occur during pregnancy. A case related to an adnexal mass, is described and the existing literature is reviewed.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
7/92. urinary retention during the second trimester of pregnancy: a rare cause.Acute urinary retention during pregnancy is rare. Retention secondary to an impacted, gravid uterus is an emergency. Retroversion of the uterus, a history of pelvic inflammatory disease, and large fibroids are predisposing factors. The enlarging gravid uterus and uterine fibroids may trap the uterus inside the pelvic ring, preventing it from ascending into the abdominal cavity; furthermore, a history of inflammatory disease may trap the fundus of the uterus within scar tissue that also may prevent the enlarging, gravid uterus from ascending into the abdominal cavity. The impacted uterus should be manually replaced in the anterior position. Clean intermittent catheterization and placement of a vaginal pessary are temporizing measures. A knowledge of the causes of urinary retention during pregnancy can help prevent spontaneous abortion and other devastating consequences that can arise as a result of a delay in the diagnosis.- - - - - - - - - - ranking = 6keywords = pregnancy (Clic here for more details about this article) |
8/92. A decidualized endometrial cyst in a pregnant woman: a case observed with a steady-state free precession imaging sequence.Decidual changes of the ectopic endometrial stroma during pregnancy are well known among pathologists and obstetricians. However, they appear very similar to endometrial cysts with malignant transformation when imaged. Balanced fast field echo (BFFE) is a steady-state free precession imaging sequence and its contrast is decided by the T1/T2 ratio. The authors report a case of a decidualized endometrial cyst in which mural nodules were isointense with the nomotopic decidualized endometrium on T1- and T2-weighted images and BFFE. Isointensity with the nomotopic endometrium is an MR characteristic that can differentiate a decidualized endometrial cyst from malignant transformation. BFFE is a good alternative sequence during pregnancy because of its shorter acquisition time and lower radiofrequency absorption.- - - - - - - - - - ranking = 2keywords = pregnancy (Clic here for more details about this article) |
9/92. Hydatid of morgagni with torsion diagnosed during cesarean delivery. A case report.BACKGROUND: Hydatids of Morgagni are benign, pedunculated, cystic structures arising from mullerian vestiges below the fallopian tube near the fimbria. They usually are of no clinical significance unless the pedicle becomes twisted and infarction occurs. CASE: A 39-year-old primigravida at 41 weeks and 5 days' gestation underwent primary cesarean delivery for macrosomia and failure to descend during labor. A 4 x 3-cm hydatid of Morgagni with torsion of the pedicle was found on the left fallopian tube. ligation of the pedicle and excision of the infarcted cyst were performed. histology of the specimen demonstrated cuboidal epithelium with extensive hemorrhage and necrosis, consistent with an infarcted hydatid of Morgagni. All pain and symptoms experienced by the patient during the previous day were associated with the onset of labor. No specific left lower quadrant pain was reported. CONCLUSION: Hydatids of Morgagni are common findings at pelvic surgery and usually of no clinical significance. Torsion of a hydatid of Morgagni is rarely reported and most likely is a rare occurrence. In this patient, torsion of the hydatid of Morgagni was possibly pregnancy related, and symptoms associated with torsion were probably masked by labor pain.- - - - - - - - - - ranking = 1.2801297747552keywords = pregnancy, gestation (Clic here for more details about this article) |
10/92. Early diagnosed intramural ectopic pregnancy associated with adenomyosis: report of an unusual case.Intramural pregnancy is the rarest type of ectopic pregnancy and almost always is diagnosed intraoperatively. It constitutes less than 1% of ectopic pregnancies and the world literature contains only 33 cases. We present an additional case of an uncomplicated intramural pregnancy in a patient with extensive adenomyosis, which is the earliest preoperatively diagnosed (sixth week of gestation) case in the literature.- - - - - - - - - - ranking = 7.2801297747552keywords = pregnancy, gestation (Clic here for more details about this article) |
| | Next -> |