Anterior Wall Of Uterus Research Articles

A Rare Case Report of Caesarean Scar Ectopic Pregnancy

Caesarean scar pregnancy is rarest pregnancy, increasing incidence due to increasing in number of caesarean deliveries. It is defined as blastocyst implants on a previous caesarean scar Herman A. Early diagnosis can be done by using ultrasound with empty uterus and cervix, mass in the anterior wall of uterus in scar area. Early diagnosis leads to prompt management and improves the outcome by allowing preservation of future fertility and decreases maternal morbidity and mortality, this is possible with ultrasound imaging. When ultrasound is inconclusive or equivocal then MRI has important role in diagnosis before therapy or intervention. Here we are presenting a case of G11P2+(1)L2A7 with previous two caesarean deliveries, diagnosed as caesarean scar ectopic pregnancy with the help of sonography. Patient underwent laparotomy and on histopathology report, caesarean scar pregnancy was confirmed.

Atypical Polypoid Adenoma – A Histopathological Enigma

Atypical polypoid adenomyoma is an infrequent intrauterine polypoidal lesion. As per WHO classification of female genital tumors published in 2020, APA is classified as a mixed epithelial and mesenchymal tumor. The epithelial component comprises endometrioid-type glands with complex architecture, mild cytological atypia and fibromyomatous stroma with morular metaplasia. We present a case of a 32-year-old female with primary infertility; hysteroscopy showed a smooth polypoidal lesion over anterior wall of uterus. Complete transcervical resection of the lesion was done. Histopathology showed all the prementioned features of atypical polypoid adenomyoma and there was no other associated pathology. Since the patient desired fertility preservation, a conservative management plan with follow up was done. This lesion mostly involves women of fertile age group, hence differentiation from pre-malignant/malignant lesions is of utmost importance as fertility preservation can be done for this lesion. In older patients where fertility preservation is not required hysterectomy is advised in view of risk of recurrence.

Flexible fetoscope in the treatment of twin-to-twin transfusion syndrome.

Twin-to-twin transfusion syndrome (TTTS) could be treated with fetoscopic laser photocoagulation. For patients with placenta located on the anterior wall of uterus, surgical procedures are difficult. To solve this problem, a flexible fetoscope was designed in our department. The flexible fetoscope was made up of polyurethane, fiberglass and stainless steel coils. The specular body was soft and could bend encountering obstacles, which reduced the possibility of injury to the fetus and placenta. The distal tip of the body could curve from -180° to +270° with the control of the handweel. Three pregnant women of TTTS with anterior placenta was operated with this instrument. All pregnant women were treated smoothly and gave live twins birth at term. Through angiography, it was demonstrated that the vascular connections on the surface had been coagulated. The flexible fetoscope was a novel instrument in treating TTTS, especially for the anterior placenta.

Bladder Bleeding Due to Placenta Percreta: Report of Four Cases and Management Discussion

Abstract Placenta percreta with bladder bleeding can occur during gestation or postpartum, posing a great threat to both mother and fetus. But it is rare and lacks standard management strategies. We reported four cases suffering from bladder bleeding caused by placenta percreta even with hemorrhagic shock admitted between January 1st, 2011 and December 31th, 2020 in The First Affiliated Hospital of Zhengzhou University. Clinical information, including age, gravidity and parity, ultrasound and magnetic resonance imaging manifestations, onset gestational age, bladder bleeding volume, clinical manifestations under bleeding, diagnosis, hemostatic methods, hospital stay, treatment cost, and prognosis, are presented. Two cases had bladder bleeding during the second trimester, respectively on the 22+3 and 23+5 weeks. Pregnancy was terminated timely. The other two cases had bladder bleeding on the 2nd day post near-term cesarean section when activity. All the four cases achieved successful hemostasis following angiography and concomitant embolization for iliac vessels, and one of them received electrocoagulation hemostasis under cystoscopy, but failed. They all had favorable clinical outcomes and had no long-term complications. The neonatal outcome in the two cases that bladder hemorrhage occurred after near-term c-section was good. The newborns did not survive in two cases in which bladder hemorrhage occurred at the second trimester of pregnancy. Timely termination of pregnancy is recommended when such a condition develops during gestation. Diagnosis of bladder bleeding is relatively easy, for it is characterized by fast speed and large volume, with concomitant distension of the lower abdomen, blood discharge from the urethral orifice, or the indwelling catheter. Interventional embolization is an effective means to treat bladder bleeding caused by placenta percreta, while electrocoagulation hemostasis under cystoscopy must be applied with great caution. For the pregnant women with a high risk of placenta percreta, timely and accurate diagnosis should be achieved during the gestational age, and bladder bleeding should be concerned when placenta penetrates through the anterior wall of uterus.

A case-control study to compare the outcome of women treated by two minimally invasive procedures-ultraminilaparotomy myomectomy and laparoscopic myomectomy

ObjectiveUltraminilaparotomy myomectomy (UMLT-M with less 4 cm transverse skin incision) and conventional 3-port wound laparoscopic myomectomy (LM) approaches were proposed as alternative minimally invasive procedures in the management of women with symptomatic uterine myomas but few studies have compared the outcomes of both procedures. Materials and methodsBetween January 2002 and December 2003, 71 patients undergoing UMLT-M were compared with those 71 women undergoing LM. The last data collection for all patients was done on 31 December 2016. The parameters for comparison included the characteristics of the uterine myomas, surgical parameters, morbidities, and outcomes. Surgical parameters included the operative time (minutes), estimated blood loss (milliliters), time for removal of drainage, percentage of blood transfusion and co-morbidities. ResultsMean operative time in the LM group was significantly longer than that in the UMLT-M group (208.7 ± 65.9 vs. 98.0 ± 28.2 min, p < 0.001). Intra-operative blood loss was significantly higher in the LM group than that in the UMLT-M group (210.9 ± 184.5 vs. 111.7 ± 108.4 ml, p < 0.001). However, more patients had postoperative fever in the UMLT-M group (39.4% vs. 8.5%, p < 0.001). The recurrence rate of myoma at 5-year follow-up was significantly different between two groups (35.2% of UMLT-M vs. 57.7% of LM, p = 0.007), but there was no difference when follow-up time was over ten years. The location of the myoma recurrence was different between two groups with higher recurrence rates in the fundal and lateral sides of uterus in the UMLT-M group and in the anterior wall of uterus in the LM group. However, the overall symptom control, the need of repeated myoma-related surgery and subsequent pregnancy outcome of both groups seemed to be similar in both groups. ConclusionsMore operative time and more blood loss reflected that LM demanded skills, experience and equipment. Therefore, UMLT-M might be a feasible alternative choice in the management of uterine myomas, since it is an easy-to-perform and familiar technique, especially in the absence of suitable equipment or skilled operator. A large and randomized study is needed to confirm the above findings.

A Rare Pancreatic Tumor in a 52-Year-Old Chinese Woman

Question: A 52-yearold Chinese woman without any significant past medical history presented with 1 month of postmenopausal bleeding without abdominal pain, fever, jaundice, weight loss, or other symptoms. General physical examination did not reveal any abnormality. Abdominal examination showed a large (10 cm), firm, fixed mass with well-defined borders in the suprapubic area. Routine laboratory tests and tumor markers including CA 19-9 and CA-125 were within normal range. Computed tomography (CT) showed an approximately 10 10-cm hysteromyoma arising from the anterior wall of uterus and the other mass of 4 cm in diameter within the endometrial cavity (Figure A). The latter one was proved to be grade I endometrial carcinoma by endometrial biopsy. Simultaneously, a 2.9 3.4-cm heterogeneous enhanced mass in the pancreatic head was accidentally discovered in the preoperative CT examination (Figure B). Exploratory laparotomy was performed. Intraoperatively, the tumor in the pancreatic head was found to directly invade the superior mesenteric vein and could not be resected. Hysterectomy and bilateral adnexectomy were performed after pancreatic tumor biopsy with prostatic trocar. What is the most likely diagnosis of the pancreatic mass? Is it a primary or a secondary tumor? Look on page 659 for the answer and see the GASTROENTEROLOGY web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.