Personal experience with the extraction of "lost" intrauterine devices by the Soonawalla method

From 1981 to 1983, 3660 intrauterine contraceptive devices were taken away, in 278 cases by the modified extractor after Soonawalla, because the short tread of the device was broken or drawn into the uterus. The most frequent indication for the removal of the device was irregular bleeding. Prior to extraction, X-ray and ultrasound were used to determine the position of the device in the uterus.     

"Silent" rupture of unscarred gravid uterus with subsequent pelvic abscess: successful laparoscopic management

Intrapartum rupture of an unscarred uterus is rare in current times. However, it is still associated with significant maternal and fetal mortality and morbidity. Unlike rupture or dehiscence of a previous cesarean scar, which is occasionally bloodless, complete rupture of a gravid unscarred uterus frequently results in fetal jeopardy and significant maternal intraperitoneal bleeding, causes acute abdomen, and demands emergency surgical (laparotomy) intervention. Laparoscopy generally has no role in such circumstances due to the generally unstable maternal hemodynamic condition and the necessity of prompt fetal delivery with an abdominal approach. We present a rare case of intrapartum rupture of an unscarred gravid uterus with an atypical insidious clinical course. The diagnosis of complete uterine rupture was made 20 days after the patient's successful vaginal delivery, at which time a large pelvic abscess formed. The condition was successfully managed laparoscopically. Successful vaginal delivery, even with normal lochia, good uterine contraction, and stable vital signs, does not preclude the possibility of uterine rupture. For patients with unusual postpartum pelvic pain, uterine rupture should be considered as one of the possible etiologic factors, and prompt survey should be performed. Laparoscopic intervention may be valuable in such situations.     

Retained products of gestation in miscarriage: an evaluation of transvaginal ultrasound criteria for diagnosing an "empty uterus"

OBJECTIVE: The purpose of this study was to compare clinical outcomes of conservative management versus surgical evacuation of retained products of gestation after misoprostol treatment for first trimester spontaneous miscarriage using less restrictive transvaginal ultrasound criteria for diagnosing "empty uterus," which were managed conservatively. STUDY DESIGN: This was a prospective, randomized, controlled trial. RESULTS: Forty-six patients who had sonographic features previously regarded as significant retained products of gestation after misoprostol treatment, ie, homogenous intrauterine dimension of more than 11 cm 2 in combined transverse and sagittal plane, or those with heterogeneous intrauterine contents were consented to randomization. The short-term complication rates of those managed conservatively were significantly higher than surgical evacuation ([9/24] 37.5% vs [0/21] 0%, P < .05). CONCLUSION: Our previously reported transvaginal ultrasound criteria of homogenous intrauterine dimension of less than 11 cm 2 in combined transverse and sagittal planes for defining "empty uterus," which requires no further treatment, cannot be "relaxed" without incurring additional complications.     

Ultrasonography in the differential diagnosis of "double" uteri

A total of 43 infertile patients with hysterosalpingographic diagnosis of bifid uterus underwent sonography and subsequent laparoscopy/hysteroscopy to evaluate the capacity of ultrasound to demonstrate the peritoneal profile of the malformed uteri correctly. Sonographic visualization was adequate in 39 cases (90.7%) and the following were identified correctly: 1 of 2 didelphic uteri, all of 11 bicornuate uteri, all of 4 complete septate uteri, and all of 22 partial septate uteri. The sensitivity of ultrasound in detecting the presence of a perimetrial fundal notch was 92.3% and its specificity 100%. Thus, a precise differential diagnosis of "double" uteri was possible with this technique, which may in some clinical situations provide an alternative to laparoscopy.     

Office hysteroscopic metroplasty: three "diagnostic criteria" to differentiate between septate and bicornuate uteri

Study objectiveTo evaluate the benefits of adopting 3 simple “diagnostic criteria” in the differential diagnosis between septate and bicornuate uteri, and the relative treatment by hysteroscopy in an office setting.DesignProspective clinical study (Canadian Task Force classification III).SettingUniversity-affiliated hospital.PatientsTwo hundred-sixty patients with a hysteroscopic diagnosis of a double uterine cavity were enrolled.InterventionsOffice hysteroscopic metroplasty was performed without analgesia or anesthesia using 5F scissors.Measurements and Main ResultsThe presence of vascularized tissue, sensitive innervation, and the appearance of the tissue at the incision of a supposed septum during an office hysteroscopic procedure were the criteria used to differentiate a septate from a bicornuate uterus. In 93.1% of the cases, office hysteroscopic metroplasty was successfully performed during the same diagnostic procedure. In 15 of 18 patients scheduled for laparoscopic control of the uterine anatomy, the suspicion of a bicornuate uterus was confirmed. Hysteroscopic follow-up at 3 months showed a regular uterine cavity with a fundal notch less than 1 cm.ConclusionThe study demonstrates the possibility of obtaining complete, safe removal of uterine septae in most cases by office hysteroscopy confirmation, using mechanical instruments, in an office setting. This was achieved by relating the diagnosis and treatment to simple anatomic and physiologic diagnostic criteria.     

Studies on relationship between shape of uterine cavity on hysterosalpingography and menstrual disorder

Eight hundred and twenty five infertility patients were investigated to reassess the association between uterine mild anomaly and menstrual disorder proposed as a new syndrome by S?rensen. A hysterosalpingogram we classified the shape of the uterine cavity into 4 types: Normal uterus, T-shaped uterus, arcuate uterus and others (included septate uterus, bicornuate uterus,--), and also classified the size of the uterine cavity into 3 groups; large uterus, medium-sized uterus and small uterus. After classification of uterine shape and size, menstrual disorder in each patient was reviewed and the correlation between uterine anomaly and menstrual disorder was examined. Five hundred and twenty eight out of 770 patients (68.6%) were assigned to normal uterus, 75(7.9%) to T-shape uterus, 148(19.2%) to arcuate uterus and 19(2.5%) to others. Their incidences of menstrual disorder were 31.4%, 37.2%, 39.2% and 42.1%, respectively, and no significant difference was found among them. There were 55 patients (7.3%) with a large uterus, 655(87.2%) with a medium-sized uterus and 41(5.5%) with a small uterus. The incidences of menstrual disorder were 16.4%, 35% and 34.1%, respectively, and there was significant difference in incidence between large uterus and medium-sized uterus. The uterine fundal depression index (FDI) was used as a parameter to evaluate uterine mild anomaly. The incidences of menstrual disorder were 29.8% in the FDI-0 group, 32.9% in the FDI-1 approximately 10 group, 42.7% in the FDI-11 approximately 20 group, 45.5% in the FDI-21 approximately 30 group and 22.2% in the FDI-over 31 group. However, it was difficult to find a difference in the pregnancy rate or delivery rate among different classifications of uterine shape, size or FDI. From these results, it can be said that mild uterine anomaly is hardly associated at all with menstrual disorder clinically.     

Assisted reproduction in women with uterine anomalies

A retrospective analysis was performed to evaluate the reproductive performance of 17 women with uterine anomalies who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and embryo transfer (ET). Eight women had a unicornuate uterus, and two a didelphic uterus. Seven women with a subseptate uterus underwent metroplasty before assisted reproduction. Ten (58.8%) out of 17 women achieved 11 (18.0%) pregnancies out of 61 embryo transfers in 55 stimulated cycles. The implantation rate per embryo was 8/83 (9.6%) for women with a unicornuate uterus, one of 17 (5. 9%) for those with didelphic uterus and four of 48 (8.3%) for those with subseptate uterus. Pregnancy rates per embryo transfer were 19. 4, 11.1 and 19.0%, respectively. Three out of 11 pregnancies were ectopic, three were miscarriages and five were full-term deliveries, two sets of twins. Delivery rate per embryo transfer was 5.0% in patients with unicornuate or didephic uterus and 14.3% in women who had a subseptate uterus operated prior to assisted reproduction. Women with uterine anomalies treated by IVF or ICSI had low implantation rates. Pregnancy in a subseptate uterus which has been previously operated had a trend to end more frequently in delivery than that in a unicornuate uterus or in a didelphic uterus.     

Torsion of a nongravid leiomyomatous uterus

The torsion of a nongravid uterus is not of frequent occurence. The leading reasons are a presence of an adnexial formation or leiomyomas. In this case report it has been presented a 65-year old patient with a hard abdominal pain. After the gynecologic and ultrasound examination it has been found an uterus myomatosus with three intramural-subseros leiomyomas. By the following laparotomy was confirmed the ultrasound results - the uterus with big intramural-subserous leiomyoma 8-9 cm in a diameter, and two more leiomyomas - 5 cm, a torsion of the body uterus at 180 degree above the vaginal part of the cervix. The adnexes were rotated around the supravaginal (isthmic) part of the uterus, the uterine tubes were hyperemic, swollen, with livid color, and the ovarian were atrophic. Total hysterectomy with bilateral adnexectomy was performed. We suggested that the main reason for this torsion of the uterus was the presence of leiomyomas and the genital descensus played a role as a predisposition.     

Termination of pregnancy by "super coils": morbidity associated with a new method of second-trimester abortion

Follow-up of 15 women, aged 15-30 who underwent second-trimester abortion by "super-coil" showed that 9 women (60%) had some complications between the insertion of the coil and follow-up examination 1 week later. 7 of the women developed fever, 6 while the coils were still in utero. 11 of the women noted rupture of the membranes before the coil was removed. There were 3 major complications, one lacerated uterus requiring an abdominal hysterectomy, one case of periappendiceal inflamation with intrapelvic adhesions, and one case of postabortal anemia. Overall complication rates were higher for this group of patients than for other patients who underwent second-trimester abortion, as determined by the Joint Program for the Study of Abortion. The lack of experience of the operators and environment in which they were performed may have contributed to the high morbidity rate.     

胚泡和内膜发育状态对子宫内膜“着床窗口”形成的影响

本文应用胚泡移植和改进的内膜上皮细胞与胚泡共培养方法研究了胚胎和子宫内膜不同发育状态对子宫内膜对胚泡接受性的影响.实验证明正常胚泡移植到子宫内膜的“着床窗口”出现时间以妊娠d4天上午9时到下午18时.如果被移植的胚泡是取自延缓着床胚泡,则它们的“着床窗口”出现时间有明显缩短,只能到下午14时为止.另外也证明.子宫内膜本身发育状态对内膜的接受性也有影响.以妊娠d5天内膜的胚泡附着数最多.所以.可以认为胚胎和内膜的发育状态都是可以影响内膜“着床窗口”的出现与消失的.     

不同孕期大鼠子宫平滑肌的β肾上腺素能受体效应

在改良高钾Krebs氏溶液中,晚孕组大鼠子宫的异丙肾上腺素IC_(50)明显大于早孕组和中孕组;晚孕组量效关系的回归直线截距明显小于早孕和中孕组。二者表明晚孕期子宫β受体效应弱于早、中孕期。用放射配体结合技术测得晚孕期子宫β受体含量和亲和力低于早孕期和中孕期;荧光法测定表明晚孕期子宫去甲肾上腺素含量减少。作者认为晚孕期子宫β受体效应减弱的原因,主要是由于子宫β受体含量和亲和力的降低,以及支配子宫的肾上腺素能纤维的递质减少。     

Endometrial adenocarcinoma with diffused/scattered "intramural" spreads: report of a case and review of the literature

A case is reported of endometrial adenocarcinoma of the uterus in an 85-year-old patient with an unusual spreading pattern. On macroscopic examination, only a tiny exophytic tumor was found in the uterine cavity, while microscopic examination demonstrated a scattered (scirrhous) spread of the carcinoma cells throughout the myometrium. The tumor occupied about half of the upper uterine corpus. The intramural spread of the tumor could not be seen at the time of macroscopic examination of the uterine cut surface. The tumor cells were attached closely to the serosal membrane, and metastasis to the left ovary was found. Intraoperative cytology detected malignant cells in the ascites. We present here this unusual type of endometrial carcinoma and review our previous report which dealt with pure "intramural carcinomas of the uterine corpus".     

Atypical polypoid adenomyoma of the uterus associated with Turner's syndrome. A report of three cases, including a review of "estrogen-associated" endometrial neoplasms and neoplasms associated with Turner's syndrome

The clinical and pathological features of three atypical polypoid adenomyomas of the uterus that were associated with Turner's syndrome are described. The patients, at least two of whom had been on long-term exogenous estrogens, were in their third decade and presented with abnormal vaginal bleeding. In two cases an exophytic mass protruded through the external os and clinically suggested a malignant tumor. The histological (and in one case, the ultrastructural) findings were similar to those of previously described cases of atypical polypoid adenomyoma. The clinical findings in these cases suggest that some atypical polypoid adenomyomas may be a complication of prolonged estrogenic stimulation. The association between Turner's syndrome and other gynecological neoplasms is reviewed.     

Results of diagnostic hysteroscopy in a 7-year period in the gynecological clinic of "UMBAL-Pleven"

The aim of the authors is to show the data for the reception diagnosis, age, histological results and the conduct after the performed diagnostic hysteroscopies in Gynecological clinic of UMBAL-Pleven. For the fulfillment of this aim was made a prospective study for 7 years' period: from 01/01/1997 to 31/01/2003. The objects of observation were 74 women of age from 16 to 65 years, with performed hysteroscopies for gynecologic complaints. There were performed 74 diagnostic hysteroscopies for the studied period. The hysteroscopic findings were 20 cases with endometrial polyposis, 14--submucosal myoamatic nodes, deforming the uterine cavity, 4--cervical polyp, 19--increased endometrium, 9--Asherman syndrome, 1--bicomous uterus, 1--a suspected section for endometrial carcinoma and 6 cases without pathologic findings. There were performed 59 trial abrasions and the removed materials were sent for histological examination The performed comparative analysis between the hysteroscopic presentation and histological findings showed a coincidence of the diagnosis. It was made the conclusion, that the hysteroscopy is an easy, accessible and inexpensive diagnostic method, which must take its place as one of the basic contemporary diagnostic methods in gynecology.     

A comparison of the reproductive outcome between women with a unicornuate uterus and women with a didelphic uterus.

OBJECTIVE: To compare the reproductive performance of women with a unicornuate uterus with the reproductive performance of women with a didelphic uterus. DESIGN: Retrospective. SETTING: Reproductive endocrinology service of a tertiary referral hospital. MAIN OUTCOME MEASURES: The proportion of pregnancies resulting in spontaneous abortion, preterm delivery, term delivery, and living children was determined for each group. RESULTS: Twenty-nine women with a unicornuate uterus and 25 women with a didelphic uterus were identified. Twenty women with a unicornuate uterus produced a total of 40 pregnancies, whereas 13 women with a didelphic uterus produced a total of 28 pregnancies. The 33% spontaneous abortion rate in the unicornuate group was not significantly different from the 23% rate in the didelphic group. The proportion of pregnancies resulting in preterm delivery, term delivery, and living children was similar in both groups. CONCLUSIONS: The reproductive performance of women with a unicornuate uterus is similar to the performance of women with a didelphic uterus.     

Differentiating Between Septate and Bicornuate Uterus: Bi-dimensional and 3-Dimensional power Doppler Findings

Study ObjectiveTo assess if any difference could be found in uterine vascularization between septate and bicornuate uterus.DesignPilot study (Canadian Task Force classification II-2).SettingUniversity hospital infertility clinic.PatientsOne hundred nine women with complete duplication of the uterine cavity. All had already received the final diagnosis of the type of uterine malformation, either septate uterus or bicornuate uterus, via diagnostic hysteroscopy and laparoscopy. Another group of 10 patients with uterine anomalies and affected by ovarian mass were also evaluated via intravenous contrast medium–enhanced ultrasound examination.InterventionsPatients were evaluated using 2-dimensional and 3-dimensional power Doppler imaging of the uterus.Measurements and Main ResultsSeventy-three patients with septate uterus, with or without cervical and vaginal duplication, and 36 patients with bicornuate uterus were selected for inclusion in the study. Irregular vascular networks were detected between the 2 hemicavities in the patients with septate uterus. All bicornuate uteri showed a peculiar vascular network between the 2 hemicavities: the main recognizable vessels formed a network depicting the Greek letter γ at the level of the uterine midline. Detection of the γ sign can be used to differentiate septate from bicornuate uterus. This finding was also confirmed in patients who underwent intravenous contrast medium–enhanced ultrasound examination.Conclusionspower Doppler provides a new and uninvasive tool for differentiation of septate from bicornuate uterus.     

Twin pregnancy with a fetus in each half of a uterus didelphys.

A rare case of a twin pregnancy with a fetus in each half of a uterus didelphys (double uterus, double cervix and septate vagina) is reported. A longitudinal vaginal septum and two portios were detected during the first labor of this patient. During her second pregnancy ultrasonography was performed in the 16th week, and pregnancy was detected in each half of the double uterus. Both fetuses were of similar size and corresponded to the gestational age. A completely separated double uterus was confirmed by ultrasonography. In the 38th week a female and a male infant were delivered by cesarean section. The follow-up of this pregnancy and the management of the labor are reported.     

磁共振成像与彩色三维多普勒超声在子宫发育畸形诊断中的价值

目的探讨磁共振成像（MRI）与彩色三维多普勒超声在子宫发育畸形诊断中的价值。方法回顾性分析2011年1月至2013年5月经手术确诊的子宫发育畸形患者98例的临床资料,其中65例术前经彩色三维多普勒超声诊断,33例经MRI诊断,24例同时行二维彩超和MRI检查,分析其诊断子宫发育畸形的准确度。结果 98例患者中,纵隔子宫39例,单角子宫17例,双角子宫16例,双子宫11例,无子宫9例,复杂畸形6例。三维彩超和MRI诊断子宫畸形的准确度分别为89.2%（58/65）和93.9%（31/33）,两者比较,差异无统计学意义（P〉0.05）。2例罗伯特子宫患者中,三维彩超和MRI术前均未明确诊断;4例子宫畸形合并阴道畸形患者中,仅1例术前确诊。24例患者二维彩超和MRI诊断的准确度分别为54.2%（13/24）和91.7%（22/24）,两者比较,差异有统计学意义（P〈0.05）。结论经阴道/直肠三维彩超和MRI对纵隔子宫、单角子宫、双角子宫、双子宫及无子宫或幼稚子宫的诊断率较高,三维彩超可作为子宫畸形的首选无创检查方法。但对于复杂的子宫畸形,二者的诊断准确度较低。