Cervical Adhesion Research Articles

Rare abnormal pregnancy implantation: A case report of 39 year old G2P1 with cervical ectopic gestation

The case is that of a 39 year old G2P 1, 1 alive who presented with recurrent bleeding per vagina following 8weeks amenorrhea, Pregnancy confirmed with urine test. She was married and no attempts at termination of pregnancy. Ultrasound scan revealed empty uterus without any adnexea mass but a gestational sac in the cervical canal with an active fetus and vascular flow on Doppler colour interrogation. A diagnosis of cervical ectopic pregnancy was made and she had medical management with initial mifepristone and then intramuscular methotrexate. A subsequent gentle evacuation of the cervical canal was done and trans-cervical catheter inserted for 2 weeks to prevent cervical adhesion. Urine Pregnancy test done after 3 weeks was negative. Conclusion: Cervical ectopic pregnancy is one of the very rare forms of pregnancy implantation that can be associated with devastating outcome but prompt diagnosis and management help improve patient’s prognosis.

Effect of an anti-adhesion agent on vision-based assessment of cervical adhesions after thyroid surgery: randomized, placebo-controlled trial

Many patients experience cervical adhesions after thyroid surgery. To date, however, no studies have objectively measured the effects of anti-adhesion agents on cervical adhesion symptoms. This study evaluated the effects of an anti-adhesion agent on cervical adhesions after thyroid surgery, as determined using a system that measures the extent of marker movement objectively. One hundred patients were randomized in a 1:1 ratio to undergo thyroid surgery with or without the anti-adhesion agent Collabarrier. Using specially manufactured recording equipment, the position of the marker on neck skin was measured before surgery, and 2 weeks, 3 months, and 9 months after surgery. Relative change in marker distance, calculated by subtracting the marker position before surgery from the marker positions 2 weeks, 3 months, and 9 months after surgery, differed significantly in the groups of patients who underwent thyroid surgery with and without the anti-adhesion agent (P < 0.05). A novel measuring system can objectively evaluate the effectiveness of a thyroid anti-adhesion agent. The anti-adhesion agent used significantly reduced adhesions compared with the control group. The trial is registered at www.cris.nih.go.kr (KCT0005745; date of registration, 08/01/2021).

16例人工流产后宫颈粘连分析

目的：对16例人工流产后宫颈粘连进行分析。方法：选取我院自2012年5月~2016年5月收治的人工流产后宫颈粘连的患者16例，患者入院后进行观察、治疗和分析。结果：16例患者经过治疗后，其病情均已痊愈，且治疗后没有出现反诊患者。结论：人工流产后宫颈粘连对女性患者的身心健康有着极大的影响。 Objective: To analyze 16 cases of cervical adhesion after artificial abortion. Methods: We selected 16 cases of cervical adhesion patients after artificial abortion in our hospital from May 2012 to May 2016, and made an observation, treatment and analysis for the patients. Results: 16 cases patients had been recovered after treatment, and there was no patients back to treat again. Conclusion: It has a great impact for women patients’ physical and mental health when they had cervical adhesion after artificial abortion.

Vascular endothelial growth factor C enhances cervical cancer migration and invasion via activation of focal adhesion kinase

Vascular endothelial growth factor C (VEGF-C) is correlated positively with clinical cervical cancer metastasis and survival. Previously we showed that VEGF-C directly activated actin-binding protein moesin, leading to the formation of membrane protrusions. However, whether VEGF-C alters cervical cancer cell adhesion to the extra-cellular matrix is currently unknown. In this study, we investigated the effects of VEGF-C on the formation of focal adhesion complexes, which provide anchoring sites for cell attachment to the extracellular matrix. On cultured cervical carcinoma cell line SiHa cells, VEGF-C enhanced focal adhesion kinase (FAK) phosphorylation. As a result, VEGF-C led to increased formation of focal adhesion complexes and enhanced migration and invasion, which was reversed by siRNA abrogating FAK. VEGF-C resulted in increased interaction of its receptor Flt-4 with non-receptor tyrosine kinase c-Src, leading to c-Src phosphorylation. The specific inhibitor of c-Src kinase, PP2, or the transfection with specific c-Src siRNA largely impaired VEGF-C-enhanced FAK phosphorylation, suggesting that Flt-4/c-Src cascade plays a central role in these processes. These results implied that VEGF-C promotes cervical cancer metastasis by activation of FAK protein through Flt-4/c-Src pathway.

Hysteroscopic Appearance of Endometrial Cavity after Microwave Endometrial Ablation

Study Objective To assess the appearance of the endometrial cavity after microwave endometrial ablation. Design Prospective observational study. Setting GuangDong Women's and Children's Hospital, GuangDong, China. Patients A total of 349 patients who underwent microwave endometrial ablation from January 2000 through August 2008 were followed up for 1 month to 8 years. At follow-up in 2007 and 2008, patients were advised of this clinical study and were randomly selected for participation if they agreed to undergo outpatient hysteroscopy to assess the uterine cavity during follow-up visits. Fifty three patients (median [range] age, 43.1 [33–53] years) were recruited into the study at the time of endometrial ablation. Intervention Outpatient hysteroscopy. Main Results Within the first 3 months after ablation, outpatient hysteroscopy revealed varying amounts of necrotic tissue from the endometrium and superficial myometrium of the uterus. Six months postablation, a granulomatous reaction and fibrosis were present. A fibrotic cavity was also evident, and menstrual flow was reduced or had ceased. One year after ablation, hysteroscopy demonstrated a fibrotic cavity with myofibrous scars. Most patients developed amenorrhea at this time. Two years or more postablation, a second hysteroscopy demonstrated various types of intrauterine adhesions in 28 of the 53 women (52.8%). A cervical adhesion was observed in 1 patient (1.9%), focal adhesions in the fundal area in 12 (22.6%), a narrowed and scarred uterine cavity with bilateral stenotic tubal ostia in 11 (20.7%), and complete obliteration of the cavity in 4 (7.5%). Of these 28 women, 22 had amenorrhea, 3 had vaginal spotting during menstruation, and 2 had hypomenorrhea. Of those without intrauterine adhesions, only 5 had amenorrhea, 10 had vaginal spotting, and 8 had hypomenorrhea. Conclusion The hysteroscopic appearance of the uterine cavity after microwave endometrial ablation varies considerably. In this study, the menstrual outcome was correlated with postablation uterine cavity appearance.

Novel Adjunctive Treatment for Cervical Adhesion with Cross-Type Nelaton Catheter: A Preliminary Report and Literature Review

Intrauterine adhesion remains a common complication post dilatation and curettage (D&C) in reproductive females. Internal cervical orifice adhesion (ICA) is also observed incidentally after D&C. Here, we introduce a novel adjunctive management for ICA with cross-type nelaton catheter. In this study, 20 patients suffering from amenorrhea and ICA after D&C were included. All individuals underwent flexible hysteroscopy to confirm their simple ICA statuses. All women accepted the insertion of simple cross-type nelaton catheter. Two weeks post insertion, the catheter was removed and a second-look hysteroscopy was performed. Three months post catheter removal, the menstruation statuses and the efficiency of nelaton catheter in preventing ICA were evaluated. Nineteen patients had 3-month follow-up. Seventeen individuals (89.4%) had normal menstruation flow as well as the impact internal orifice of cervical canal. Only two patients (10.5%) had hypomenorrhea and fibrotic narrowing of the internal orifice of the cervix, which required resectoscopy to remove the internal cervical adhesions. All patients appeared the competence of endurance for these procedures. The novel cross-type nelaton catheter is a simple, well tolerated, and highly effective method for the management of ICA after D&C.