Late hemorrhage after transcervical division of a uterine septum: a report of two cases.

The transcervical division of uterine septa is usually described as a simple procedure associated with minimal morbidity. Two cases are presented describing late hemorrhage after this procedure. Approaches to avoiding this complication as well as management principles are described.     

Report on a computer based evaluation of 1,800 cases of abortion]

1800 cases with interruption of pregnancy are subjected to a computer analysis by means of a data-adjusted medical record for patients with interruption of pregnancy, which is in use in our hospital since 1975. The age distribution reveals a frequency peak between the ages of 35 and 38 years. The striving for a 2-children family is evident. Operating complications occurred in 1.1 per cent of the cases only, 0.4 per cent were perforationes and 0.7 per cent were lacerations of the cervix. This is due to the general application of the vacuum aspiration and the preferred performance of the operations up to the 10th gestational week. The great significance of the application of effective contraceptives is emphasized, since 48 per cent of the women had renounced contraceptives without any reason. Over 40 per cent of the women had employed contraceptives previously, but later on they had abandoned such means, 20 per cent of these women without a special cause. The physician's responsibility for the education of the women is stressed.     

Omentum presenting at the vulva after a normal labor and delivery. An unusual late complication of induced abortion

A case is described where omentum prolapsed through a uterine fenestration and presented at the vulva after a normal vaginal delivery. The patient had been aborted three times in the past, and it is postulated that the uterus had been perforated on one of these occasions.     

Laparoscopic excision of uterine adenomatoid tumour: two cases and literature review

Introduction  

Adenomatoid tumours are rare, benign neoplasms of the genital tract, occurring most commonly during the reproductive years. In females, the uterus is the most common site. These tumours can be associated with fibroids and tend to mimic them clinically and radiologically, making pre-operative diagnosis very difficult. We report two cases of uterine adenomatoid tumours that were excised laparoscopically. Intraoperatively, there was no clear line of demarcation between the uterus and the tumours and laparoscopic manipulation of the tumours was difficult due to their friable nature. Simple excision with uterine conservation is the treatment of choice, especially in women who desire future fertility, as degeneration, recurrence, malignant transformation or metastasis has not been reported.     

Acute uterine inversion: a report of two cases

Acute inversion of the uterus is a serious but rare complication of the third stage of labor. The exact frequency of the complication is not known. Two cases seen and managed in the Obstetric Department of a district hospital are reported. The literature on this subject is reviewed; the possible causative factors and management techniques are discussed.     

Pregnancy after uterine rupture: a report of 5 cases and a review of the literature

Management and outcome of 5 cases of pregnancy after uterine rupture are discussed. All women in these cases were delivered by cesarean delivery and no repeat ruptures occurred. After reviewing the literature, it is concluded that women with a previous uterine rupture have a favorable outcome in a subsequent pregnancy. With a rupture in a lower segment scar, an elective cesarean delivery should be performed before labor starts after assessing fetal lung maturity or administration of corticosteroids. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to describe the risk associated with a subsequent pregnancy after a previous uterine rupture, summarize the complications of uterine rupture during a subsequent pregnancy, and to list the treatment plans for a patient in a subsequent pregnancy after uterine rupture.     

medullar adhesive arachnoiditis: a late complication after obstetrical epidural analgesia

A 30-year-old woman, G3P3, was progressively affected by spastic paraparesis with loss of sensitivity and urinary incontinence due to medullar adhesive arachnoiditis occurring five months after an epidural analgesia for repeat cesarean section. Magnetic resonance imaging showed a voluminous subarachnoid cyst and a septated syringomyelic cavitation attributed to metabisulfite, the preservative of epinephrine and to multiple lidocaine injections through the catheter in the postoperative period. Despite two decompressive neurosurgical operations, the neurological state of the patient continues to worsen.     

Uterine perforation as a complication of surgical abortion causing small bowel obstruction: a review

Objective

Small bowel obstruction after unrecognized or conservatively treated uterine perforation is extremely rare. It is a surgical emergency and the delay in diagnosis and treatment has deleterious consequences for the mother. The purpose of this study is to critically review the available literature and ascertain the level of evidence for the mechanisms, diagnosis and management of small bowel obstruction after uterine perforation due to surgical abortion.

Methods

Systematic literature search was conducted in Pubmed (1946 to 2012) and Pubmedcentral (1900 to 2012) including all available English and French language fulltext articles. Three evaluators reviewed and selected all available case reports and case series. Search terms included small bowel obstruction, bowel obstruction, bowel incarceration, bowel entrapment, vaginal evisceration, uterine perforation, uterine rupture, and abortion. The exclusion criteria were (1) complex injuries where small bowel incarceration was present but with bleeding and/or bowel perforation as the leading symptomatology; (2) articles only numbering the patients without details on the topic. Analyses of incidence, risk factors, mechanisms of the disease, time of clinical presentation, diagnostic modalities, treatment, and maternal outcome were included.

Results

Of the 73 articles screened 30 cases of small bowel obstruction were included in the review forming incidence, risk factors, and mechanisms of the disease, diagnosis, therapy, and maternal outcome.

Conclusions

A systematic review defined four mechanisms of small bowel obstruction after transvaginal instrumental uterine perforation with significant variations in clinical presentation and time of presentation. Duration of symptoms depend on the mechanism of small bowel obstruction. Vaginal evisceration is surgical emergency and treatment is mandatory without diagnostic workup. Survival rate during last century is 93 %. Multicentric trials and publication of all such cases are needed to determine algorithms for diagnosis and management of small bowel obstruction caused by instrumental uterine perforation.     

Spontaneous uterine venous rupture during pregnancy. Description of two cases and bibliographical review

Spontaneous uterine venous rupture is a very rare condition (1/10,000 pregnancies). The etiology is still unknown, and it is associated with an increased of venous pressure. The rupture especially occurs on third trimester. The most frequent site of the rupture is the broad ligament. Maternal mortality has decreased to 4% but the perinatal mortality rate is still as high as 31%. The presenting symptoms are commonly unspecific. Clinical presentations are usually hypovolemic shock signs with severe abdominal pain and reduction in hemoglobin levels. In view of these findings an exploratory laparotomy is usually necessary as well as the adequate blood and fluid replacement. Two cases of twin pregnancies on the third trimester with spontaneous uterine venous rupture are reported. Both cases have different evolution. In the first case the evolution was favorable. It wasn't necessary the vein suture because of the bleeding ended by compression. In the second case the diagnostic took place after the fetal death and it was required the vein suture. This rare condition has to be taken into account to de the differential diagnosis in a pregnant woman with severe abdominal pain.     

Combined intra- and extrauterine pregnancy: a rare complication in legal abortion]

A case of combined intrauterine and extrauterine pregnancy as rare complication of legally induced abortion is reported. After several ultrasonic examinations, a concomitant ectopic gestation was suspected and subsequently confirmed on laparotomy and on microscopic examination. The early preoperative diagnosis of combined gestation is nowadays mainly based on its exact localisation by vaginal ultrasound. The ultrasonic signs and the predisponsing factors for the development of combined gestation will be discussed.     

Functional uterine bleeding; a review of ninety-two cases

Ninety-two cases of functional uterine bleeding seen at the Jefferson Davis Endocrine-Menstrual Disorder Clinic during the thirty-month period. July 1, 1952, through Dec. 31, 1954, have been reviewed from a clinical and pathological viewpoint. The possible etiology of functional uterine bleeding is discussed. It is felt that the main problems regarding functional uterine bleeding are: (1) to rule out organic pathological conditions, employing curettage in all patients 35 years of age and over, and in younger women where the diagnosis is in doubt; (2) to provide some means of immediate, or reasonably immediate, hemostasis. It is felt that, given time, most patients will then probably undergo spontaneous cure.When endocrines are used to treat functional uterine bleeding, it is our opinion that the simple and inexpensive type of therapy probably works just as well as the more complicated ones.     

Arteriovenous malformation after uterine curettage: a report of 3 cases

BACKGROUND: Acquired uterine arteriovenous malformation is a rare but potentially life threatening condition and, as such, must be considered in the differential diagnosis of cases of abrupt, profuse vaginal bleeding following uterine curettage. The condition can easily be confused with retained products of conception and gestational trophoblastic disease. CASES: One case was managed surgically, while 2 others were treated with selective embolization. CONCLUSION: A positive medical history, the clinical presentation and features for the the ultrasonic appearance are the main features for the correct differential diagnosis and treatment of traumatic arteriovenous malformation resulting from uterine curettage.