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Study Of 11,914 women who underwent dilatation and curettage over a 7-year period (1995–2002) at Princess Badea Teaching Hospital in Irbid, North Jordan, 23 patients sustained a uterine perforation. In 22 cases, the operator was a trainee. Previous gynaecological surgery had been performed in only 2 of these 23 women.Conclusion Operator inexperience seemed to be the only risk factor in this very common operation. 相似文献
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Ustunyurt E Kaymak O Iskender C Ustunyurt OB Celik C Danisman N 《Archives of gynecology and obstetrics》2008,277(2):151-154
Introduction The aim of this study was to evaluate the criteria of endometrial thickness to detect retained products of conception following
first trimester spontaneous abortion or elective pregnancy termination.
Methods This was a retrospective study on 116 patients who underwent uterine re-evacuation with a diagnosis of retained products of
conception based on clinical and sonographic findings. Pathologic reports of samples obtained during re-evacuation were reviewed
for the presence of gestational tissue. Endometrial thickness determined by transvaginal sonography and certain clinical features
(gestational age and interval between initial curettage and re-evacuation, which may affect presence or absence of gestational
tissue, parity, indication for initial curettage) were noted. The sensitivity and specificity of sonographic measurement of
endometrial thickness for detecting retained products of conception were assessed.
Results Histopathologic reports confirmed the diagnosis of retained products of conception in 66 of 116 patients (56.9%). Percentage
of nulliparity and the time elapsed between initial curettage and re-evacuation were significantly high in patients with retained
products of conception. The sensitivity and specificity of endometrial thickness greater than 13 mm for detecting retained
products of conception were 85 and 64%, respectively.
Conclusion An endometrial thickness of 13 mm or more, detected by transvaginal sonography, has the best diagnostic efficiency for detection
of retained products of conception following first trimester spontaneous abortion or elective pregnancy termination. 相似文献
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Study Objective
To describe a technique for hysteroscopic removal of retained products of conception (RPOC) implanted over an area of adenomyosis.Design
A case report (Canadian Task Force classification III).Setting
RPOC is an unfortunate complication that may occur after the resolution of a normal pregnancy; it is more common after early pregnancy termination or spontaneous miscarriage [1]. Immediate consequences of RPOC include persistent vaginal bleeding, abdominal pain, pelvic infection, fever, and dilated cervix. Moreover, known long-term complications include the formation of intrauterine adhesions (IUAs) with the potential creation of Asherman syndrome resulting in adverse reproductive outcomes caused by subfertility, chronic pelvic pain, menstrual disturbances, and severe pregnancy complications such as abnormal placentation including the placenta accreta spectrum 2, 3. A recently published American Association of Gynecologic Laparoscopists practice report on IUAs suggests that the surgical approach used to treat intrauterine pathology could have an impact with greater risk for IUA formation when blind versus procedures under direct visualization are performed [4].Interventions
A 35-year-old patient who presented with persistent bleeding for over 5 weeks. The patient has a long history of dysmenorrhea and heavy menstrual bleeding. Magnetic resonance imaging revealed the presence of adenomyosis. She had an unfortunate spontaneous abortion at 8 weeks of gestation. On physical examination, she was found to have a dilated uterine cervix with persistent vaginal bleeding; there were no signs of infection. Pelvic ultrasound revealed an intrauterine hyperechogenic vascularized area of 2?×?2, 8?×?2?cm implanted over a focal area of adenomyosis, which is consistent with the presence of RPOC. With the aim of minimizing possible acute complications such as bleeding, infection, and uterine perforation, a hysteroscopic approach was taken to avoid performing a blind dilation and curettage. A secondary benefit of a hysteroscopic approach is a lower incidence of long-term complications such as IUAs and the consequent Asherman syndrome. We describe a hysteroscopic technique in which the use of electrosurgery is limited to minimize thermal damage of the endometrium, highlighting important tips and tricks of the procedure.Conclusion
Hysteroscopic removal of RPOC is a feasible and safe management option of this complication of pregnancy. We strongly suggest avoiding performing blind procedures such as dilation and curettage and favor the adoption of this modality that allows the removal of retained products of conception under direct visualization. 相似文献4.
Erich Cosmi Carlo Saccardi Pietro Litta Giovanni B. Nardelli Salvatore Dessole 《International journal of gynaecology and obstetrics》2010,110(3):262-264
Objective
To compare the accuracy of transvaginal ultrasound and sonohysterography (SHG) in diagnosing residual trophoblastic tissue in postpartum women and to assess the adverse effects and complications of the SHG procedure.Methods
A prospective study of patients with postpartum bleeding enrolled for clinical symptoms and signs of residual trophoblastic tissue. All women underwent transvaginal ultrasound and SHG. Uterine cavity curettage was performed in all women and the material collected was sent for pathologic examination.Results
Among 84 patients, transvaginal ultrasound revealed residual trophoblastic tissue in 60 women, whereas SHG detected residual trophoblastic tissue in 48 and blood clots in 12. Pathologic examination confirmed trophoblastic tissue in 48 patients and blood clots in 12. Fifteen (17.9%) patients experienced adverse effects after SHG. Thirteen (15.5%) experienced postprocedural fever that resolved with antibiotics. Two women (2.4%) had severe complications of infection: 1 required surgery for peritonitis, which revealed salpingitis and a pelvic abscess; 1 experienced fever and mild abdominal pain that resolved with antibiotics after 10 days of hospitalization.Conclusions
Although SHG showed greater accuracy than transvaginal ultrasound in detecting residual trophoblastic tissue, a high proportion of patients experienced adverse effects. 相似文献5.
We describe a case of postpartum haemorrhage due to retained products of conception that failed to resolve after two attempts of evacuation of retained products of conception. A subsequent histology and MRI scan confirmed retained products of conception despite repeated attempts at treatment. We introduce transcervical endometrial resection as an efficient method of removing degenerated retained products of conception refractory to standard treatment. 相似文献
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Backgroundand purpose:Intrauterine adhesion (IUA) and re-adhesion were common problems in women of childbearing age. The aim of our research was to evaluate the efficacy of hyaluronic acid gel on preventing IUA and improving the fertility.MethodsA systematic search for randomized controlled trial (RCT) articles that tested the effectiveness of using hyaluronic acid gel during intrauterine surgery in prevention of IUA and improvement of fertility was performed in PubMed, Medline, Embase, the Cochrane Library and clinicaltrials.gov until December 2020. Data were extracted independently and analyzed using RevMan statistical software version 5.3.ResultsTwelve articles (11 studies) were deemed eligible for inclusion. There was a significantly reduced proportion of IUA after using hyaluronic acid gel during intrauterine operation (OR 0.39, 95% CI 0.29 to 0.52). It has significantly reduced the incidence of moderate-to-severe IUA after using hyaluronic acid gel, but no effect on the mild IUA. In addition, our analysis showed that the hyaluronic acid gel group was associated with a significant increased incidence of pregnancy (OR 1.64, 95% CI 1.08 to 2.50).ConclusionOur analysis confirmed that using hyaluronic acid gel during intrauterine operation seemed to be more helpful for patients with high risk of IUA. However, larger and well-designed studies would be desired in the future to confirm its efficacy and safety in protecting fertility. 相似文献
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Yuki Tamura Mitsuo Santo Yasuhisa Araki Hidehiko Matsubayashi Yukiko Takaya Kotaro Kitaya Masakazu Doshida Kohei Yamaguchi Shimpei Mizuta Chie Takahashi Namhyo Kim Koichiro Okuno Takumi Takeuchi Tomomoto Ishikawa 《Reproductive Medicine and Biology》2021,20(1):71-75
PurposeChromosomal abnormalities are a major cause of spontaneous abortion, and conventional G‐banded karyotyping (G‐banding) is mainly utilized for chromosomal analysis. Recently, next‐generation sequencing (NGS) has been introduced for chromosomal analysis. Here, we aimed to investigate the applicability and utility of NGS‐based chromosomal analysis of products of conception (POC) on chorionic villus samples from spontaneous abortion.MethodsThe results of chromosomal analysis of 7 chorionic villus samples from spontaneous abortion were compared between conventional G‐banding and NGS‐based chromosomal copy number analysis. Age dependency and frequency of each chromosomal aneuploidy were evaluated for 279 cases analyzed by NGS.ResultsExcluding two cases (culture failure and maternal cell contamination), the results were consistent between G‐banding and NGS. For cases analyzed by NGS, the rate of chromosomal abnormality increased in a maternal age‐dependent manner. The frequency of each chromosomal aneuploidy detected by NGS was almost the same as that previously reported. Finally, NGS analysis was possible for difficult cases by G‐banding analysis, such as culture failure, maternal cell contamination, long‐term storage cases, and low cell number.ConclusionsChromosome analysis using NGS not only obtains comparable results to conventional G‐banding, but also can analyze POC more accurately and efficiently. 相似文献
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《Journal of minimally invasive gynecology》2014,21(1):126-130
Study ObjectiveTo evaluate the safety and effectiveness of Oxiplex/AP gel (Intercoat) in reducing intrauterine adhesion formation after hysteroscopic treatment because of retained products of conception (RPOC).DesignProspective double-blind, randomized, controlled pilot study (Canadian Task Force classification I).SettingTertiary medical center.PatientsAll women who underwent hysteroscopic treatment because of RPOC at our institution between September 2009 and June 2012 were invited to participate. After operative hysteroscopy, participants were randomized to either have their uterine cavity filled with Oxiplex/AP gel (study group, n = 26) or not (control group, n = 26).InterventionsDiagnostic office hysteroscopy to assess for adhesion formation was performed after 6 to 8 weeks. Findings were graded according to the American Fertility Society classification. Rates of subsequent pregnancy in the 2 groups were assessed.Measurements and Main ResultsIntraoperative complication rates were similar between the 2 groups. There were no postoperative complications after Oxiplex/AP gel application. Moderate to severe adhesions developed in 1 woman (4%) in the study group and 3 (14%) in the control group (p = .80). During follow-up of 20 months (range, 2–33 months), 7 women (27%) in the treatment group conceived, compared with 3 (14%) in the control group (p = .50).ConclusionIntrauterine application of Oxiplex/AP gel after hysteroscopic removal of RPOC is safe. In this small sample, the difference in the rate of intrauterine adhesions was not statistically significant. A larger study would enable further establishment of the safety and efficacy of use of this gel. 相似文献
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Kemal Ozgur Hasan Bulut Murat Berkkanoglu Kevin Coetzee 《Journal of assisted reproduction and genetics》2015,32(4):533-541
Purpose
To investigate the perinatal outcomes of patients with clinical pregnancies from ICSI treatments who had previously undergone hysteroscopic surgery to correct partial intrauterine septa and compare them to outcomes of patients with no intrauterine anomalies.Method
A retrospective observational analysis of 2024 ultrasound confirmed pregnancies from ICSI treatments performed between January 2005 and June 2012. The patients were grouped according to their intrauterine status, and sub-grouped according to the number of fetal hearts observed; singleton control (n = 1128), twin control (n = 566), singleton septum (n = 217) and twin septum (n = 113). The primary outcomes analyzed were miscarriage, preterm, very preterm, stillbirth, vanishing twin and live delivery rates, as well as low birth weight and very low birth weight rates.Result(s)
The live birth rate (89,9 %) in the singleton control subgroup was non-significantly higher than the live birth rate (85,3 %) in the septum subgroup, with a RR of 1,05 (p = 0,0583, 95 % CI 0,9943–1,1182) for live birth. In contrast the live birth rate (91,3 %) in twin control subgroup was significantly higher than the live birth rate (84,1 %) in the septum subgroup, with a RR 1,09 (p = 0,0282, 95 % CI 0,9988–1,1819). Non-significantly, higher miscarriage and stillbirth rates were the main contributors to the reduced live birth rates. The singleton and twin septum subgroups also had higher rates of premature and very premature delivery and LBWs and vLBW, especially in the singleton septum subgroup.Conclusion(s)
The hysteroscopic correction of intrauterine septa may not eliminate all risks for premature delivery. 相似文献12.
Objective To evaluate the rate and characteristics of postoperative intrauterine adhesions (IUA) that might be formed following hysteroscopic
reproductive surgery from both a gross and a histologic perspective as determined by early and late follow-up diagnostic hysteroscopy.
Methods Retrospective analysis of 61 women wishing a pregnancy and suffering from a significant intrauterine pathology affecting their
reproductive outcome were reviewed. All patients were treated hysteroscopically. Subsequently, they were randomly assigned
to perform a follow-up diagnostic hysteroscopy at a variable intervals from their initial surgery. Multiple hysteroscopic-guided
biopsies from IUA, when present, were obtained in several cases. Twenty patients were in the early group and had follow-up
hysteroscopy performed 2–4 weeks after the initial operation. The late diagnostic group consisted of 41 patients with follow-up
hysteroscopy at about 12 months (8–16 months). The two groups were similar to composition. Postoperatively, none of the early
diagnostic group underwent hysterosalpingography (HSG) whereas all of the late group performed HSG 4 months following the
initial surgery, which showed at least one-third of the cavity free of adhesions. When adhesions were present, no effort was
made to lyse them.
Results At follow-up hysteroscopy, 25% of both groups had no significant adhesions. Grade I adhesions (thin, filmy) occurred in 60%
of the early hysteroscopy patients and in only 12% of the late group (P < 0.05). Grade II adhesions were present in 10% of the early group and in up to 41% in the late group (P < 0.05), whereas Grade III adhesions were present in only 5% of the early hysteroscopy group, but in 22% of the late one
(P < 0.05). Correlation between hysteroscopic and histologic findings were good in most of cases in both groups. Follow-up to
determine the subsequent reproductive outcome revealed similar conception rates in both groups.
Conclusion The IUA that might be formed immediately following hysteroscopic reproductive surgery are histologically different from those
appearing a longer time after the original operation. Routine early follow-up hysteroscopy can influence the prognosis resulting
from the original surgery. 相似文献
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近年来,随着生育年龄的推迟,高龄妊娠不断增多,辅助生殖技术的需求不断增大,其子代安全性问题也越来越受到关注,相关研究亦逐渐增多。对于高龄妇女,如何降低子代出生缺陷、规避风险以达到优生目的的前提是了解高龄自然妊娠及辅助生殖技术可能造成的风险。文章将对高龄妇女自然妊娠与辅助生殖技术的子代安全性进行归纳总结。 相似文献
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Carol Coughlan Stephen Walters William Ledger T.C. Li 《International journal of gynaecology and obstetrics》2014
Objective
To determine whether women with recurrent implantation failure (RIF) after in vitro fertilization (IVF), similar to women with recurrent pregnancy loss, have significantly higher stress levels than women without reproductive failure, and to compare stress levels between women with RIF and women with recurrent pregnancy loss.Methods
In a questionnaire-based study between September 2009 and January 2011, psychological stress was measured among patients attending recurrent pregnancy loss and RIF clinics at the Royal Hallamshire Hospital, Sheffield, UK. Participants completed the Fertility Problem Inventory (FPI), the Perceived Stress Scale (PSS), and the Positive and Negative Affect Schedule (PANAS) on their first visit to their respective clinic. Thirty fertile control women also completed the 3 validated questionnaires.Results
Compared with the control group, women with RIF and recurrent pregnancy loss had significantly higher scores in the FPI (RIF, P < 0.001; recurrent pregnancy loss, P = 0.003) and the PANAS negative affect domain (RIF, P = 0.004; recurrent pregnancy loss, P = 0.001), and lower scores in the PANAS positive affect domain (RIF, P < 0.001; recurrent pregnancy loss, P < 0.001). Whereas the perceived stress score (PSS) of the recurrent pregnancy loss group was significantly higher than that of the control group (P = 0.006), the score of the RIF group was not, although the difference tended toward statistical significance (P = 0.058).Conclusion
The study findings confirm the stressful nature of RIF and recurrent pregnancy loss. 相似文献16.
Hao-Hsiu Hung Jung-Nien Lai Wen-Chi Chen Yung-Hsiang Chen Lu-Ting Chiu Huey-Yi Chen 《Taiwanese journal of obstetrics & gynecology》2021,60(4):685-689
ObjectivePatients with endometriosis may seek traditional Chinese medicine (TCM) to help them conceive. The present study aims to evaluate the effects of TCM on reproductive and pregnancy outcomes in patients with endometriosis.Materials and methodsThe patients with endometriosis taken from the National Health Insurance (NHI) research database between 2000 and 2012 were divided into two cohorts based on the use of TCM treatment. The two cohorts were matched by age and comorbidities and followed up until a new diagnosis of infertility, ectopic pregnancy, or miscarriage. Multivariable Cox proportional hazards models were used to evaluate the hazard ratio (HR) of reproductive and pregnancy outcomes.ResultsA total of 5244 patients with endometriosis were analyzed, including 1748 TCM users and 3496 matched control subjects. The proportion of infertility was higher in TCM users than in non-TCM users (adjusted hazard ratio [HR]: 1.34, 95% confidence interval [CI]: 1.13–1.60). However, there was no significant difference in the proportion of ectopic pregnancies between TCM users and non-TCM users (adjusted HR: 0.82, 95% CI: 0.60–1.13). There was no significant difference in the proportion of miscarriages between TCM users and non-TCM users (adjusted HR: 1.23, 95% CI: 0.95–1.61).ConclusionTCM treatment showed insignificant efficacy in decreasing the risk of ectopic pregnancy and miscarriage in patients with endometriosis. 相似文献
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Zhuoni Xiao Xin Zhou Wangming Xu Jing Yang 《European journal of obstetrics, gynecology, and reproductive biology》2012
Objective
To compare the reproductive outcomes of Yqh+-carrying and control couples undergoing IVF/ICSI treatments.Study design
Retrospective analysis of 72 Yqh+ carriers and 986 Yqh+ non-carriers undergoing their first cycle of ART in a single centre between August 2005 and May 2011.Results
Yqh+ carrying couples had significantly worse reproductive outcomes compared with control couples undergoing IVF treatment. There were a significantly higher cancellation rate (20.69% vs 7.9%; P < 0.05; OR, 3.03; CI, 1.18–7.79) and a significant lower fertilisation rate (50.05% vs 66.01%; P < 0.05; OR, 0.61; CI, 0.49–0.57), implantation rate (8.33% vs 20.87%; P < 0.05; OR, 0.35; CI, 0.14–0.87), good quality embryo ratio (44.70% vs 57.89%; P < 0.05; OR, 0.59; CI, 0.43–0.80) and clinical pregnancy rate (17.39% vs 39.59%; P < 0.05; OR, 0.32; CI, 0.11–0.96) in Yqh+ group compared with control group undergoing IVF treatment. Yqh+ carrying couples had similar reproductive outcomes compared with control couples undergoing ICSI treatment.Conclusions
The Y chromosome polymorphic variant Yqh+ most likely plays a role in infertility. Yqh+ couples with poor reproductive outcomes in IVF treatment can be advised to undergo ICSI to improve their reproductive results in the next cycle. 相似文献18.
Niels H. Lauersen Tiberius Den Constantine Iliescu Kathleen H. Wilson ZoëR. Graves 《American journal of obstetrics and gynecology》1982,144(8):890-894
Vaginal administration of prostaglandin analogues resulted in cervical changes that facilitated dilatation and evacuation in 80 patients in the late first trimester and the second trimester of pregnancy. When 0.5 mg and 1.0 mg of 15(S)-15-methyl-prostaglandin F2α (15-ME-PGF2α) was compared to 30 and 60 mg of 9-deoxo-16, 16-dimethyl-9 methylene prostaglandin E2 (PGE2 analogue), the PGE2 analogue appeared to have more cervical ripening effect than did the 15-ME-PGF2α. Overall, the 30 mg PGE2 vaginal suppository seemed to offer the most optimal combination of effectiveness, sufficient cervical dilatation, and minimal side effects. With the prostaglandins, maximal cervical effect was observed at 4 to 5 hours; this rapid effectiveness allows administration of the prostaglandin to accommodate a 1-day stay for surgical evacuation. The preoperative cervical priming results with the prostaglandins were compared to those obtained with the use of laminaria tents. Although the number of patients who needed further dilatation at the time of operation was less with the laminaria, the incidence of complications and the time for adequate dilatation were higher in that group. 相似文献
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Kunzier Nadia Bennett Hyein Park Joseph Cioffi Rose Calixte Anthony Vintzileos 《The journal of maternal-fetal & neonatal medicine》2016,29(22):3732-3736
Objective: The objective of this study is to compare resource utilization (efficiency) and obstetrical/cost outcomes of single dose misoprostol versus dinoprostone for induction of labor (IOL) at term.Methods: Retrospective cohort of induced deliveries 37–41 weeks gestation presenting with a Bishop score?≤4 using single-dose-50?mcg vaginal misoprostol or 10?mg-dinoprostone vaginal-inserts. Dinoprostone patients were compared (5:1) with misoprostol patients. The primary outcome variable was length of L&D stay (proxy for resource utilization). Baseline characteristics, clinical outcomes, and costs were compared.Results: Three-hundred thirty-one patients were included, 276 received dinoprostone and 55 received misoprostol. The misoprostol group had statistically significant decreased time to active labor [median 8?h (1.6,24) versus 12(0.8,52)], time-to-delivery [median 11?h (4,31) versus 17(2.8,56)] and L&D stay [median 16?h (13,28) versus 24(18,30)]. Differences remained significant after adjustment for race, method of delivery, birth weight, gravidity/parity, gestational age, and BMI (adjusted p values?<0.001, <0.01, and?<?0.05, respectively). There were no statistical differences in Apgar scores, tachysystole rate, cesarean section rate, and composite maternal/neonatal morbidity. A policy of using misoprostol would result in annual cost savings of approximately $242 500 at our institution as compared with dinoprostone.Conclusion: Single-dose misoprostol is more efficient in IOL at term with respect to L&D utilization and cost and its use is not associated with increased adverse obstetrical outcomes. 相似文献