Endometrial Canal Research Articles

An in-vivo study of the safety of copper-containing intrauterine devices in 3.0 Tesla magnetic resonance imaging

PurposeThe aim of this study is to prospectively evaluate whether women with copper-containing intrauterine devices (Cu-IUD), currently listed as MR conditional, can safely undergo 3.0 Tesla (3 T) magnetic resonance imaging (MRI).Methods73 women, age 18–54 years old, with a Cu-IUD who were undergoing MRI for any reason were included consecutively. Pre- and post-MRI standard pelvic ultrasound examinations were completed to determine the appropriate pre- and post-MRI positioning of the Cu-IUD. Displaced IUDs were defined by IUD crossbars not in the fundal portion of the endometrial cavity, a visualized tip in the mid or lower uterus, any part of the device located in the cervical canal or outside of the endometrial canal, a fractured device, or a non-visualized IUD. Additionally, a questionnaire was completed by participants to determine the level of pre- and post-MRI pelvic pain.ResultsThere were zero observed displaced Cu-IUDs on post-MRI pelvic ultrasounds (p = 0/70, 95% CI 0, .043). Three participants were dropped from the study due to malpositioned IUDs on pre-MRI pelvic ultrasound. Six patients reported new or worsening pelvic pain/discomfort during or after their MRI examination.ConclusionOur results suggest that performing 3 T MRI using a low SAR setting does not cause displacement of Cu-IUDs, with zero out of 70 patients demonstrating IUD displacement.Graphical

Sonographic Relation between Adnexal Masses and Endometrial Thickness in Infertile Females with Hormonal Imbalance

Objective: To determine the sonographic relation between adnexal masses and endometrial thickness in infertile females with hormonal imbalances.
 Study Design: Cross-sectional analytical study.
 Place and Duration of Study: Department of Radiology, Gilani Ultrasound Center, Jamiat Hospital & Green Town Clinic, Lahore Pakistan, from Mar 2019 to Jan 2020.
 Methodology: In this study, 150 infertile females with adnexal masses, aged 18 to 45, were included. Data were collected according to the age, adnexal masses, endometrium thickness, and type of infertility hormonal levels. The endometrium thickness was measured in the sagittal plane at the thickest echogenic area from one basal endometrial interface across the endometrial canal to the other basal surface.
 Results: The mean age was 32.55±6.33 years. Out of 150 patients, 97 patients with abnormal and 53 were with normal hormonal levels. Follicular cysts (33%), Polycystic ovarian syndrome (29.9%) and 23.7% hemorrhagic cysts were found with abnormal hormonal levels.
 Conclusion: There was a significant correlation between adnexal masses and endometrial thickness in infertile females with abnormal hormonal levels.

Effect of dual trigger with chorionic gonadotropin hormone and follicle-stimulating hormone on endometrial thickness in infertile women who had superovulation with an aromatase inhibitor

Beginning in October 2020 and ending in April 2021, researchers from Al-Nahrain University's High Institute for Infertility Diagnosis and Assisted Reproductive Technologies compared the success rates of two different methods of diagnosing and treating infertility. The major purpose of the research was to assess the impact of a combined trigger (follicle-stimulating hormone [FSH] and human chorionic gonadotropin [hCG]) on endometrial receptivity (endometrial thickness, endometrial pattern, sub-endometrial blood flow). A total of 100 females took part in the study. All patients gave their informed written consent, and the study was approved by the Al-Nahrain University Ethics Committee. Procedure Time To confirm ovulation, measure and analyze the endometrial pattern, and examine the sub-endometrial blood flow, a vaginal ultrasound was done 36 to 48 hours following trigger ovulation. All four hormones (FSH, LH, Progesterone, and E2) were tested in the blood at the same time to determine whether a couple was fertile, a complete medical history, and physical examination whereas performed on each member of the pair. An ultrasound vaginal probe was used to do the transvaginal examination. Patients were placed in the dorsal lithotomy position with an empty bladder for early follicular US (CD 2-3) to assess the number of antral follicles, measure endometrial thickness, and rule out ovarian cysts or other pathology. A second ultrasound was performed during the middle of the cycle (CD9-14) to determine whether a mature follicle had been found. A multiplanar image of the uterus was acquired after an ultrasound scan was swept across the mid-sagittal plane. Endometrial thickness in the median longitudinal plane of the uterus was calculated as the largest distance from one basal endometrial interface via the endometrial canal to the opposite endometrial-myometrial interface of the anterior-posterior uterine wall. A statistically significant difference was found between Group A's average E2 concentration of 69.62 pg/mL and Groups B and C's concentrations of 53.32 and 36.65 pg/mL. (P 0.001). In group C, there was a statistically significant difference in E2 levels on the day of the trigger and the day of the IUI (P = 0.036). On the day of IUI compared to the day of trigger, no statistically significant differences were seen between the study groups for any of the other hormonal indicators (P > 0.05). There were no significant differences (P > 0.05) in any of the baseline clinical measures between the research groups. All clinical indicators were comparable across groups (P > 0.05). There were no statistically significant differences (P > 0.05) between the research groups on any other clinical indicators. When comparing groups, A, B, and C on the decline in RI between the trigger and IUI days, group A significantly outperformed the others (P = 0.003). There was no statistically significant difference (P > 0.05) in any of the other clinical parameters between the IUI and trigger groups on the day of IUI.

GSOR4 Presentation Time: 9:15 AM: Predicting the Benefit of Hybrid Intracavitary + Interstitial Needle Applicators in Patients with Locally Advanced Cervical Cancer

<h3>Purpose</h3> The purpose of this study is to determine whether pre-treatment and brachytherapy (BRT) characteristics are associated with benefit from hybrid intracavitary + interstitial needle (IC/IS) applicator, as opposed to IC applicator, use in patients with locally advanced cervical cancer (LACC). <h3>Methods</h3> 53 LACC patients treated with IC/IS BRT from August 2014 to March 2020 using HDR were included. Patient variables included pre-treatment characteristics (age, histology, grade, T Stage, N Stage, max lateral, A-P, S-I, and overall tumor dimensions, tumor symmetry, max distance from endometrial canal, tumor volume, tumor max SUV on PET) and BRT characteristics (max lateral, A-P, S-I, and overall tumor dimensions, tumor symmetry, max distance from tandem, GTV and high-risk CTV (CTV HR) volumes). For each patient, an IC plan prescribed to match the IC/IS plan (CTV HR) coverage and optimized based on volumes was created. In addition, a standard loading IC plan prescribed to point A was also created. These plans were compared to the IC/IS plan. Benefit for IC/IS was defined by organ at risk (OAR) D2cc's transitioning from unacceptable to acceptable based on American Brachytherapy Society (ABS) guidelines. Patients were then placed into 3 categories: those having 0, 1, or 2 or more organs that benefited from IC/IS. Wilcoxon rank sum and Fisher's exact tests, proportional odds models, and linear regression models were used to determine which characteristics were associated with benefit from IC/IS. <h3>Results</h3> Analysis showed that 33 (62%) patients showed benefit from IC/IS compared to optimized IC plans. IC/IS resulted in an average decrease in EQD2 to normal structures of 11.4 Gy (bladder), 6.2 Gy (rectum), 5.7 Gy (sigmoid), and 4.4 Gy (small bowel). No pre-treatment characteristics were associated with an increase in the number of organs benefiting from IC/IS. Increasing BRT max S-I and overall dimension as well as GTV and CTV HR volumes were associated with increased organ sparing with IC/IS. The bladder had the greatest reduction in dose from IC/IS with greater than 10 Gy benefit with S-I extension or max tumor dimension greater than 5 cm, GTV greater than 27 cc, and CTV HR greater than 35 cc. Standard IC plans prescribed to point A had inferior coverage of the CTV HR compared to IC/IS plans above 2.9 cm max distance from tandem, 5.3 cm max lateral dimension, 4.1 cm max A-P dimension, 5.4 cm max S-I dimension, and 5.6 cm overall dimension. Standard IC plans prescribed to point A also began to treat the CTV HR inferiorly to IC/IS plans above a GTV and CTV HR of 37.4 and 43.1 cc, respectively. <h3>Conclusions</h3> Various BRT characteristics are significantly associated with benefit from IC/IS, and our data suggests patients having tumors with max overall dimensions > 5 cm, CTV HR > 35 cc and GTVs > 27 cc at the time of BRT would benefit from IC/IS. However, further analysis using independent data is needed to confirm these thresholds.

Uterine Necrosis After Uterine Artery Embolization (UAE) - Rare Entity with a Dilemma

ABSTRACT Uterine artery embolization (UAE), a minimally invasive procedure used for controlling and managing profuse bleeding in conditions like uterine fibroids, and uterine hemorrhage, in cases of intractable postpartum hemorrhage (PPH). A wide array of complications due to UAE includes pulmonary embolism, uterine ischemia, necrosis, sepsis, and death. A 27 years old married woman (parity 1+2) presented with complaints of a mass protruding of the vagina with dirty brown vaginal discharge. Following UAE was done for postpartum hemorrhage (PPH) she had developed fever and burning micturition on which ultrasound was done to show an anteverted, enlarged, bulky uterus, with multiple endogenic foci, with endometrial canal and adjacent myometrium suggestive of infective pathology. In this case report complications of UAE for the management of PPH were discussed, however, research is required to comprehend the causes of uterine necrosis following uterine artery embolization and its management. Keywords: Uterine Artery Embolization; Postpartum Hemorrhage; Uterine Necrosis; Pathology.

Preferential HER2 Expression in Lymphovascular Invasion of a Uterine Carcinosarcoma, a Case Report

Abstract Introduction/Objective Uterine carcinosarcoma (UCS) is a rare, highly aggressive cancer accounting for &amp;lt;5% of reported uterine cancer cases. Commonly, myometrial invasion and lymphovascular invasion (LVI) are found at diagnosis, and recurrence rates of &amp;gt;40% are seen after therapy accounting for poor prognosis and high rate (16%) of death. Histologically, it is composed of both carcinoma and sarcoma components. HER2-targeted therapy without adjunctive chemotherapy for the treatment of UCS has generally not shown beneficial clinical responses, but a more recent phase II clinical trial revealed that the addition of Trastuzumab, a HER2-targeted monoclonal antibody, to carboplatin-paclitaxel chemotherapy showed an increase in progression free survival. Methods/Case Report Immunohistochemical (IHC) staining for HER2 was performed on histologic sections of UCS, areas of LVI, and lymph node metastasis (LNM). Confirmatory HER2 fluorescent in situ hybridization (FISH) studies were performed on the primary UCS and the LVI portion. A 67-year-old female presented with postmenopausal uterine bleeding. CT showed an enlarged uterus, widened endometrial canal, and enlarged lymph nodes. Initial endometrial biopsy showed UCS. Exploratory laparotomy with total abdominal hysterectomy, bilateral salpingo-ophorectomy, omentectomy, and lymph node dissection was performed with pathology confirming UCS with 86% myometrial invasion and LVI. Results (if a Case Study enter NA) NA Conclusion HER2 expression in this patient was solely seen in foci of LVI and within LNM. This finding suggests inclusion of histologic sections with LVI and LNM when evaluating for the presence of HER2 expression in uterine carcinosarcoma with reflex FISH testing when indicated may be helpful to provide additional treatment opportunities for patients. Further studies need to be performed to determine if this finding in generalizable to carcinosarcoma and endometrial serous carcinoma samples.

A rare, ectopic (intravesical) location of a missing intrauterine contraceptive device, a case report

Ectopic location of Intrauterine Contraceptive Device (IUCD) or its migration from the normal position in the uterine fundus is a frequently encountered complication. It varies from uterine expulsion to displacement into the endometrial canal to uterine perforation or intravesical migration, which is an extremely rare case. Ultrasonography was used in the diagnoses of this reported case of an ectopic intravesical IUCD.

A new development in ultrasound-compatible gynecologic brachytherapy simulators

PurposeGynecologic brachytherapy is an essential component in the curative treatment of cervical cancer. With the decline in brachytherapy utilization, gynecologic brachytherapy simulators are being used to provide a mechanism to enhance proficiency-based resident training. However, most models that have been used lack procedural fidelity as they are either repurposed from OB/GYN basic models or from physics phantoms. Therefore, we set out to develop a high-fidelity, ultrasound- and CT-compatible gynecologic brachytherapy training simulator. Methods and MaterialsBased on prior experience with gynecologic training simulators on the market, we developed a wish list for an ultrasound-compatible brachytherapy training model. A custom simulator was developed based on an existing pelvic ultrasound trainer. Features included a cervical os and endometrial canal as well as a palpable and hypoechoic cervical tumor. ResultsThe model took about 3 months from the initial meeting with the developer to completion. The properties of the material were equivalent to water for ultrasound, CT, and also MRI and the model did not show signs of degradation after multiple tandem insertions. ConclusionsA high-fidelity ultrasound-compatible simulator was effectively developed and utilized to improve resident training to perform brachytherapy implants with a derivative benefit in the long term of improving survival for women with advanced gynecologic malignancies through having access to more proficient brachytherapists. Future directions include enhancing the model to allow for repetitive needle insertion and suturing for interstitial training as well as creating variations in anatomy (e.g., retroverted uterus, bulky tumors, etc.) for more advanced technical training.

EVALUATION OF THE ENDOMETRIAL CHANGES IN FEMALES DIAGNOSED WITH THE UTERINE LEIOMYOMAS

The female genital tract includes the uterine corpus and cervix. The uterus consists of the endometrium and myometrium which are continuously stimulated by hormones, denuded monthly of its endometrial mucosa and inhabited periodically by foetuses. Together with the lesions that affect the cervix, the lesions of the corpus of the uterus and the endometrium account for most patient visits to gynaecologists. Many treatment options are available nowadays including medical and conservative surgical procedures. Hence based on above findings the present study was planned for Evaluation of the Endometrial Changes in Females Diagnosed with the Uterine Leiomyomas.&#x0D; The present study was planned in Department of Obstetrics and Gynaecology, Madhubani Medical College and Hospital, Madhubani, Bihar. In the present study 50 cases of the females diagnosed with the uterine leiomyomas were enrolled. Gross examination was performed with respect to size and weight of uterus, location of fibroids and endometrial polyp if any was noted. Tissue bits from the fundic endometrium, tissue from both sides of endometrial canal &amp; endometrium subjacent to sub mucosal leiomyoma were taken for histopathological examination, processed and sections of 5 micron thickness stained with haematoxylin and eosin.The data generated from the present study concludes that Different patterns are seen in the endometrium of leiomyomatous uteri as a result of mechanical or hormonal factors such as dilated/ distorted glands, glands parallel to long axis of myometrium, glands separated by muscle fibres, focal total or subtotal glandular atrophy and polyposis which are statistically significant in identifying uterine leiomyoma. Further, total and subtotal endometrial glandular atrophy showed significant association with submucosal leiomyoma.&#x0D; Keywords: Leiomyoma, Endometrium, Menorrhagia, etc.

Use of hysteroscopy in diagnosis and follow-up of acquired uterine enhanced myometrial vascularity

To describe the role of hysteroscopy in diagnosis and subsequent follow-up of uterine enhanced myometrial vascularity (EMV). Uterine EMV, previously known as arteriovenous malformation (AVM), is a rare but cannot-miss finding often associated with prior pregnancy or uterine surgery and is typically suspected when a vascular mass is found on ultrasound. Color Doppler imaging will demonstrate high-velocity, low-impedance flow, with more significant shunts demonstrating higher peak systolic velocity (PSV). If not already diagnosed by ultrasound, accurate recognition during hysteroscopy is mandatory prior to any uterine instrumentation, as biopsy or curettage can lead to unanticipated massive hemorrhage. While many cases of EMV may resolve spontaneously, actively bleeding patients may require treatment with embolization, a procedure that may decrease ovarian reserve and impair fertility, though favorable reproductive outcomes have been reported. Others have reported success with hysteroscopic management using a bipolar electrosurgical loop. Case report. Academic hospital system. We describe a 22-year-old G2P1011 who presented to the emergency department with heavy vaginal bleeding and a negative urine human chorionic gonadotropin 9 weeks following a first-trimester termination of pregnancy. Her ultrasound demonstrated a heterogeneous 2.6×2.3×2.6 cm vascular mass in the endometrial canal that was initially interpreted as retained products of conception. Unfortunately, PSV in the lesion was not measured. During observation, bleeding continued, and her hemoglobin dropped from 8.3 g/dL to 6.9 g/dL the next morning. She was transfused 2 units of blood and taken to the operating room for hysteroscopic evaluation and possible uterine curettage. Hysteroscopy revealed a large pulsating 2cm bluish vascular mass that was recognized as a uterine EMV and the procedure was terminated with the plan for embolization. Given fertility concerns, the diagnosis was confirmed with MRI/MRA, which identified a 2.7cm mass-like process with early post-contrast enhancement in the arterial phase. An angiogram demonstrated bilaterally enlarged tortuous uterine arteries perfusing a hypervascular EMV that was treated with selective bilateral uterine artery embolization. Further bleeding or evidence of EMV. Follow-up office hysteroscopy at 2 weeks demonstrated a 2 cm raised area of tissue without pulsations. At 6 weeks post-procedure, bleeding had ceased, and office hysteroscopy revealed only a small 0.5 cm calcified nodule with a circumferential pseudo-decidual reaction. Hysteroscopy may be used to diagnose EMV when ultrasound is not conclusive. Recognition of the pulsating vascular appearance of EMV on hysteroscopy is critical in preventing hemorrhage from inappropriate curettage. Resolution of the lesion following embolization can be readily demonstrated with office hysteroscopy.

Laparoscopic-Assisted Hysteroscopic Resection of Cesarean Scar Ectopic

Video Objective In this video, we attempted to mitigate the risk of hemorrhage during a hysteroscopic resection of a cesarean scar ectopic through temporary laparoscopic ligation of the uterine pedicles and utero-ovarian arteries. Setting The patient is a 28 y/o G4P2011 at 5 weeks gestation with history of a prior cesarean delivery who presented to the emergency department with vaginal bleeding. Transvaginal ultrasound findings showed an empty endometrial canal, however, a gestational sac and yolk sac were seen implanted within the myometrium at the lower uterine segment. These findings were consistent with a cesarean scar ectopic pregnancy, for which the patient received combined medical and surgical management. Interventions Diagnostic and operative laparoscopy were performed to obtain temporary occlusion of the uterine and utero-ovarian arteries, followed by operative hysteroscopy to resect the cesarean scar pregnancy tissue. Conclusion Temporary occlusion of the uterine and utero-ovarian arteries seems to be an effective and safe technique in reducing blood loss and should be strongly considered prior to operative management of cesarean scar pregnancies.

Peritonitis Due to Perforated Uterine Actinomycosis

Actinomyces spp are commensal anaerobic, gram-negative bacilli that have been infrequently associated with pelvic inflammatory disease due to long-standing intrauterine devices (IUD). Actinomycosis can present with non-specific abdominal pain and progress to peritonitis. We present a case of peritonitis initially attributed to colonic perforation, and later found to have been due to pelvic Actinomycosis with uterine perforation. A 65 year-old female with a history of coronary artery disease, hypertension, and depression presented to the emergency department with a stabbing pain in her pelvis, with radiation to the left lower quadrant. This pain was intermittent over the past six months, and became more constant the day prior to admission. She denied fevers, chills, nausea, vomiting, constipation, diarrhea, hematochezia, melena, vaginal bleeding, chest pain, or dyspnea. On physical exam, vitals were stable. She had abdominal distension, guarding, and rebound tenderness. Laboratory work-up was remarkable for leukocytosis (14.2 x 103/uL) with 80% neutrophils and anemia (Hgb 10.6 g/dL and Hct 34%). A CT abdomen revealed free intraperitoneal air. It was also suggestive of colonic pneumatosis, with small amounts of intraperitoneal fluid. Non-specific findings of low-density material and small amounts of gas in the endometrial canal were also noted. The patient underwent an exploratory laparotomy, which revealed light tan fluid and fibrinous exudate throughout the abdomen. There was no evidence of enteric leak. A punched out, necrotic, 4 mm round full-thickness perforation was found in the anterior uterine fundus. Purulent material was expressed from the defect. A subtotal hysterectomy was performed. Intra-operative pelvic pus cultures grew Actinomyces spp. The patient was discharged on a total of three months of amoxicillin-clavulanate, and has continued to do well on follow-up. It was concluded that Actinomycesspp. were likely introduced to the uterus six months prior, when the patient underwent an endometrial biopsy for evaluation of post-menopausal bleeding. This is in contrast to the association of pelvic actinomycosis with longstanding IUDs. Because the mainstay of treatment is with antibiotics, it is important to recognize actinomycosis as a potential etiology when evaluating peritonitis in a patient with uterine instrumentation.1591 Figure 1. A 4 mm necrotic perforation (arrow) was found in the anterior uterine fundus.

Pictorial essay of ultrasound-reconstructed coronal plane images of the uterus in different uterine pathologies.

Imaging in the major planes (horizontal, coronal, and sagittal) of the uterus is important for determining anatomy and allowing the findings to be standardized, and for evaluating and diagnosing different pathological conditions in clinical practice. Examination of the coronal plane is an important step in identifying uterine pathologies and their relationships to the endometrial canal. Three-dimensional (3D) ultrasound reveals the normal anatomy better and improves the depiction of abnormal anatomy, as the coronal plane of the uterus can easily be obtained using 3D reconstruction techniques. Our pictorial essay demonstrates that adding 3D ultrasound to a routine gynecological workup can be beneficial for clinicians, enabling a precise diagnosis to be made. In addition, the volumes obtained and stored by 3D ultrasound can allow students or residents to become more familiar with normal and abnormal pelvic structures. Clin. Anat. 31:373-379, 2018. © 2017 Wiley Periodicals, Inc.

Primary cervico-uterine anastomosis in a patient with agenesis of the uterine isthmus

To describe a primary cervico-uterine anastomosis procedure performed on a 15-year old girl with agenesis of the uterine isthmus. A 15-year-old girl, G0, was referred for primary amenorrhea, pelvic pain of three-year duration, and suspected Müllerian anomaly. MRI exam showed a uterine body with hematometra, a normal cervix, normal ovaries, and free fluid in the pelvis. Both kidneys and renal collecting systems were normal. After options were discussed, a two-staged approach was planned: (1) use laparoscopy and vaginoscopy to determine the feasibility of primary anastomosis, and (2) if feasible, perform primary anastomosis via laparotomy. The laparoscopy showed hyperemic pelvic organs, an enlarged, soft uterine body with a blind end, as well as extensive superficial endometriotic implants involving the pelvis, upper abdomen, and the diaphragm. An incision was made at the uterine fundus to evacuate 80 mL of old blood. Vaginoscopy (using a hysteroscope) confirmed a normal appearing cervix, which was sounded to 4 cm. The cervix easily reached the lowest point of the uterine body when pushed cephalad. Six weeks later a laparotomy was performed via a Pfannenstiel incision. Dilute Vasopressin was used to facilitate the dissection of the pelvic peritoneum between the bladder and the lower uterine body and to minimize bleeding when blind ends of the uterus and the cervix were trimmed. The cervical canal was dilated to French #15 using a metallic dilator; the lowermost point of the endometrial canal was identified by passing a metallic uterine sound through an incision at the uterine fundus. The anastomosis was completed in two layers as shown in the video. For the first layer, two 2-0 V-Loc™ 180 sutures were combined into one; for the second layer, two regular 2-0 Vicryl® sutures were used in two half circles, anteriorly and posteriorly, respectively. An inflated #12 Foley catheter was kept in the uterine cavity for five days to keep the cervical canal open. Postoperative pelvic MRI showed the uterine body and the cervix were connected. Second-look laparoscopy showed decreased endometriotic implants and no blood in the pelvis. Second-look hysteroscopy confirmed normal cervical canal connected to a normal uterine cavity. The site of anastomosis was barely recognizable were it not for residual suture material. The patient had monthly periods and was pain free nine months after the anastomosis. 1) Agenesis of the uterine isthmus is a rare Müllerian anomaly. 2) Primary anastomosis restores the normal anatomy, alleviates symptoms, and may confer normal reproductive function in the future. 3) Neither the ASRM nor the ESHRE/ESGE classification system has a category to include this anomaly. 4) Recognizing this distinct anomaly, assigning it to a separate category in the classification system raises awareness of this unique anomaly.

Embryo Implantation in the Region of a Previous Caesarean Section Scar and Scar Dehiscence in Second Trimester: A Rare Case Report.

The first case of a Caesarean scar site ectopic pregnancy was reported in 1978 [1]. Implantation of a pregnancy within a caesarean fibrous tissue scar is considered to be the rarest form of ectopic pregnancy and a life-threatening condition. This is because of the very high risk of uterine rupture and the maternal complications related to it. The most probable mechanism that can explain scar implantation is that there is invasion of the myometrium through a microtubular tract between the caesarean section scar and the endometrial canal. A recent case series estimates an incidence of 1:2226 of all pregnancies, with a rate of 0.15 % in women with a previous caesarean section and a rate of 6.1 % of all ectopic pregnancies in women who had at least one caesarean delivery [2].Although expectant and medical management have been reported in early pregnancy, termination of a caesarean scar pregnancy by laparotomy and hysterotomy, with repair of the accompanying uterine scar dehiscence, may be the best treatment option in later weeks of pregnancy.

Iatrogenic Endometriosis and Intrauterine Adhesions after Myomectomy

ABSTRACT Aims To report a case of iatrogenic endometrioses as a result of improper closure of endometrial cavity during myomectomy. Case Report A 30-year-old para 1 has been self-referred to our institution for medical care. A fibroid protruding the endometrial canal was removed 8 months prior to this hospital admission. In less than a month after initial myomectomy, she began experiencing severe pelvic pain more accentuated during menstruation. The pain became progressively worse. The magnetic resonance imaging results are suggestive of ovarian endometrioma. She underwent total abdominal hysterectomy and bilateral salpingo-oophrectomy. Cut surface of uterine cavity shows obliteration of endometrial canal with hourglass constriction. Conclusion Closure of endometrium during myomectomy should be carefully done; keeping an account on patency of endometrial canal is essential to prevent iatrogenic endometriosis. How to cite this article Yousuf F. Iatrogenic Endometriosis and Intrauterine Adhesions after Myomectomy. J South Asian Feder Obst Gynae 2016;8(3):236-238.

Uterine Lipoleiomyoma : A Case Report

Uterine lipleiomyoma is a rare variant of leiomyoma with reported prevalence of 0.03% to 0.2%. Lipoleiomyomas of the uterus are typically found in postmenpausal women and in most cases are asymptomatic and are associated with ordinary leiomyomas. This rare tumor is composed of an admixture of mature adipocytes and benign smooth muscle cells. The histogenesis for this tumor is still controversial. We report a case for a fifty- seven year old postmenopausal female presented to the gynecological department with pelvic pain and heaviness. Abdominopelvic ultrasound and MRI showed a pelvic mass. The patient underwent total abdominal hysterectomy and found to have myometrial mass measured 11x11x6.5 cm which was obliterating the endometrial canal. The histopathological diagnosis was consistent with lipoleiomyoma. The uterus showed multiple small leiomyomas. We report this case because of its rarity.

A Painful Vaginal Mass in an Adolescent With Ehlers-Danlos Syndrome: A Case Report

the unusual case of an adolescent with recurrent idiopathic hematometrium and our approach to management. Case: A 16-year-old sexually active female presented to the Emergency Department with severe abdominal pain. She had been contracepting with Depo Provera for 6months and was amenorrheic. She had a remote history of chlamydia, as well as a recent asymptomatic chlamydial infection diagnosed and treated 6 months prior to presentation. Pelvic ultrasound revealed a “dilated endometrial canal filled with echogenic debris,” measuring 5.5x5.2x4.6cm. She was taken to the Operating Room for suction dilation and curettage.

Myometrial cavernous hemangioma with pulmonary thromboembolism in a post-partum woman: a case report and review of the literature

IntroductionCavernous hemangiomas of the uterus are rare benign vascular lesions. Nine cases of diffuse cavernous hemangioma of the gravid uterus have been reported, most of which diffusely involved the myometrium. These vascular malformations are clinically significant, and may cause pronounced bleeding resulting in maternal or fetal demise. Thrombosis of cavernous hemangiomas of the uterus has been previously reported. We here report the first case in which a thrombosed cavernous hemangioma of the myometrium resulted in a fatal pulmonary embolism in a post-partum woman.Case presentationA 25-year-old obese African-American woman who had one pregnancy and was delivered of twins by cesarean section was admitted 1 week after the successful delivery. The 12-day clinical course included ventilator-dependent respiratory failure, systemic hypertension, methicillin-resistant Staphylococcus aureus in the sputum, leukocytosis and asystole. A transabdominal ultrasound examination showed heterogeneous thickened and irregular products in the endometrial canal. The laboratory values were relevant for an increased prothrombin time, activated partial thromboplastin time, ferritin and a decrease in hemoglobin. The clinical cause of death was cited as acute respiratory distress syndrome. At autopsy, a 400g spongy, hemorrhagic uterus with multiple cystic spaces measuring approximately 0.5 × 0.4cm filled with thrombi within the myometrium was identified. Immunohistological examination with a CD31 stain for vascular endothelium associated antigen confirmed several endothelium-lined vessels, some of which contained thrombi. These histological features were consistent with cavernous hemangioma of the myometrium. A histological examination of the lungs revealed multiple fresh thromboemboli in small- and medium-sized pulmonary arteries in the right upper and lower lobes without organization, but with adjacent areas of fresh hemorrhagic infarction.ConclusionThis case underscores the importance of a high index of suspicion in a pregnant or post-partum woman presenting with respiratory symptoms. Thrombosis of the cavernous hemangiomas of the gravid or post-partum uterus is a rare entity. This case is of interest because it indicates that this condition can be fatally complicated by embolization of the thrombi in the cavernous myometrial hemangiomas. Although delivery by conservative methods, as well as cesarean section, is possible without resorting to hysterectomy, occasionally, the consequences could be fatal as in this case.

Migration of Intrauterine Devices: Radiologic Findings and Implications for Patient Care

Intrauterine devices (IUDs) are a commonly used form of contraception worldwide. However, migration of the IUD from its normal position in the uterine fundus is a frequently encountered complication, varying from uterine expulsion to displacement into the endometrial canal to uterine perforation. Different sites of IUD translocation vary in terms of their clinical significance and subsequent management, and the urgency of communicating IUD migration to the clinician is likewise variable. Expulsion or intrauterine displacement of the IUD leads to decreased contraceptive efficacy and should be clearly communicated, since it warrants IUD replacement to prevent unplanned pregnancy. Embedment of the IUD into the myometrium can usually be managed in the outpatient clinical setting but occasionally requires hysteroscopic removal. Complete uterine perforation, in which the IUD is partially or completely within the peritoneal cavity, requires surgical management, and timely and direct communication with the clinician is essential in such cases. Careful evaluation for intraabdominal complications is also important, since they may warrant urgent or emergent surgical intervention. The radiologist plays an important role in the diagnosis of IUD migration and should be familiar with its appearance at multiple imaging modalities.