History Of Myomectomy Research Articles

Abdominal wall endometriosis: A challenging iatrogenic disease.

Introduction and importanceAbdominal wall endometriosis is a rare clinical condition associated with abdominal pain and psychologic disorders. It's pathophysiology remains unclear. Clinical history and imaging findings are necessary for the diagnosis. Its management is challenging, and requires close collaboration between gynaecologists and visceral surgeons specially in complex procedures. The aims of our study are to present risk factors, clinical presentation, imaging findings and management features. It was a retrospective descriptive study including fifteen patients presenting abdominal wall endometriosis. Data about age, medical history, imaging findings, surgical procedures and outcome are reported.Cases presentationFifteen women were included in our study. The most common symptom was cyclic abdominal pain. Twelve of them had history of caesarean section, and three had history of myomectomy. All patients underwent ultrasound and MRI. We performed surgical excision to all cases. One patient needed large excision with abdominoplasty procedure.Clinical discussionAbdominal wall endometriosis is a rare clinical condition with unclear pathophysiology. It occurs frequently after gynaecologic or obstetric surgery. Most reported complaint was catamenial abdominal pain with abdominal wall mass. Ultrasonography, computed tomography and MRI are useful for diagnosis, specially to eliminate differential diagnoses. Abdominal wall endometriosis management is based on surgery. Excision goals are to remove the mass and to confirm histological diagnosis of parietal endometriosis.ConclusionParietal endometriosis is a rare and challenging condition with unclear pathophysiology. It requires specific management. This pathology will be encountered more frequently considering the increasing rate of caesarean section.

A predictive model for calculating the likelihood of recurrent uterine fibroids after surgical intervention

Aim. To develop a predictive model for calculating the likelihood of recurrent uterine fibroids after myomectomy.Materials and Methods. We consecutively recruited 149 women aged 19 to 45 years who underwent myomectomy. Prediction of uterine fibroids was carried out using multivariate analysis including a classification tree (IBM SPSS Statistics). To construct a classification tree for predicting recurrent uterine fibroids, the following patient-related parameters were used as the input features: age, family history, nulliparity, past medical history of myomectomy, obesity, rapid fibroid growth, multiple fibroids at myomectomy, BCL-2, Ki-67, and VEGF expression.Results. When analyzing the resulting classification tree, we can conclude that the most significant factors defining the recurrence of uterine fibroids are low parity, multiple fibroids at myomectomy, intensive VEGF expression, and weak expression of BCL-2.Conclusion. Our original model allows the identification of the most significant predictors of recurrent uterine fibroids and might be proposed as a useful tool for clinical practice.

HYSTEROSCOPIC CORRECTION OF INTRACAVITARY LESIONS DOES NOT AFFECT THE ENDOMETRIAL VOLUME AND SUBENDOMETRIAL VASCULARITY BEFORE ICSI

To evaluate the endometrial volume and subendometrial blood flow measured by three-dimensional power Doppler (3DPD) at the day of ovum pick-up after hysteroscopic correction of intracavitary lesions. A prospective cohort study enrolled 106 women undergoing their first ICSI cycles. All women had a history of previous hysteroscopic surgery for correction of intracavitary lesions within six months before ICSI trial. Fifty-five (51.9%) women had a history of polypectomy; 29 (27.4%) metroplasty, 12 (11.3%) adhesiolysis and ten (9.4%) had a history of myomectomy. A control group of 122 women with normal uterine cavity diagnosed by office hysteroscopy were included. On the day of ovum pick-up; endometrial volume and subendometrial blood flow was assessed using 3DPD, and vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated and compared between both groups. Additionally, pulsatility index (PI) and resistance index (RI) of uterine vessels were assessed. The endometrial volume was comparable between both groups (4.28 ± 1.62 vs. 4.78 ± 1.44, p=0.055). Additionally, no significant differences in subendometrial VI, FI and VFI between both groups (p= 0.44, 0.13, 0.717 respectively). Finally, the uterine PI and RI were comparable between both groups (0.83 ± 0.06 vs. 0.84 ± 0.05 and 2.39 ± 0.57 vs. 2.38 ± 0.50, p= 0.981 and 0.577 respectively) Hysteroscopic correction of intracavitary lesions does not affect the endometrial volume and subendometrial vascularity before ICSI cycles

Predictors of Spontaneous Conception Following Myomectomy among Women with Infertility at Federal Medical Centre Yenagoa, Nigeria


 Background: Uterine fibroid or leiomyoma (myoma) is the commonest uterine neoplasm in women, and it has been associated with infertility. Though it’s not regarded as a direct cause, surgical removal (myomectomy) has been reported to increase the spontaneous conception rate in women with infertility.
 Objective: The objective of this study was to determine the factors associated with conception after myomectomy in women with infertility. It would determine the pregnancy rate, demographic, and surgical factors (pre and postoperative factors).
 Materials and Methods: This was a retrospective observational study of 107 women who had myomectomy during the study period, out of these, 68 were done for infertility. The case notes of these women were retrieved, and information related to demographic factors obtained was: maternal age, parity, address, tribe, educational level, and occupation. The preoperative surgical factors obtained were previous history of myomectomy, indication for myomectomy, the size, number and location of myomas, and the caliber of the surgeon. Postoperative surgical data collected include conception, interval between myomectomy and conception, pregnancy outcome, mode of delivery, and fetal sex and birth weight. Categorical variables were compared with chi square and odds ratio, and the degree of association for quantitative variables was determined using Pearson’s correlation coefficient. Predictor variables were determined using simple logistic regression, and multivariate analysis.
 Results: The infertility rate among the women who had myomectomy was 63.6%, the conception rate was 14.7%, and the mean myomectomy to pregnancy interval was 9.20 ± 1.24 months. The factors that favor conception were: younger women P = 0.003, uterine size ≤ 16 weeks odds ratio = 3.50(0.14, 84.20), high parity (p = 0.002), solitary fibroid odd ratio = 2.65(0.44, 16.04), tertiary education P = 0.0001 and surgery by consultants P = 0.004. Others were absence of submucous myomas, and pelvic pathology at laparotomy. Using multivariate analysis, the most significant predictors for conception were age and parity, accounting for 10.7%, and all the factors put together could only explain 36.5%.
 Conclusion: The conception rate following myomectomy in Yenagoa was relatively low, and the most important predictors were maternal age and parity. The bulk of the factors (65.5%) that determine conception are outside the scope of our study; these could be male factor infertility, factors within the tubal lumen, unidentified uterine synechia, and ovarian failure.

Grossesse après les premières procédures d’embolisation des fibromes utérins en Afrique subsaharienne en Côte d’Ivoire

ObjectiveTo report the obstetrical outcome of patients wishing to conceive after embolization of uterine fibroids in Côte d’Ivoire. Materials and methodOver a 72-month period from February 2012 to February 2018, a prospective observational and descriptive longitudinal study focused on 181 non menopausal patients who had symptomatic uterine fibroids for which they had benefited from embolization of the uterine arteries. Among them, some were selected taking into account the inclusion criteria and were regularly monitored by their obstetrician-gynecologist. ResultsThe mean age of the 65 patients was 40.7 years and 16.3% of them had a history of myomectomy. The mean uterine volume and size of dominant myomas before and six months after embolization were 849.5cm3, respectively; 67.7cm and 584cm3; 45.4cm (all these measurements are in centimeters), i.e. a reduction rate of 33% and 43%. Of the 65 patients, eleven of them with an average age of 36.7 years were able to conceive, a rate of 16.9%. Among these 11 patients, 8 had had one pregnancy and three had had two each, for a total number of 14 pregnancies. The mean time from uterine fibroid embolization to pregnancy was 34 months with extremes ranging from 06 to 60 months. Among the obstetric complications, there was one case of placenta accreta which required hysterectomy and two cases of placenta previa which had progressed well after cesarean delivery. ConclusionThe onset of pregnancy is possible after embolization of uterine fibroids. This less invasive procedure than myomectomy can also be offered to patients with a desire for motherhood. However, there is little agreement on fertility status after UFE and fertility rates after UFE have not yet been effectively quantified. Also, the decision to favor EFU over myomectomy in women wishing to maintain their fertility remains limited by the small size of our sample. We should analyze more patients who are trying to conceive after UFE and use longer follow-up.

An examination by year of cases applied with caesarean hysterectomy because of placenta percreta in a tertiary centre: a retrospective cohort study.

To examine cases applied with caesarean hysterectomy because of placenta percreta by comparing changes in treatment strategies and complications according to year. A retrospective examination was made of 93 patients applied with caesarean hysterectomy with a diagnosis of placenta percreta in 5-year periods of 2005-2009, 2010-2014, and 2015-2019. Demographic characteristics were recorded, and previous caesareans, history of myomectomy and curettage, gestational weeks, and infant birthweight. Intraoperative and postoperative findings were recorded as operating time, length of stay in hospital and Intensive Care Unit (ICU), transfusion requirement, the amount of erythrocyte suspension (ES) and fresh frozen plasma (FFP) transfused, and requirement for massive transfusion. Anaesthesia type, complications, and the preferred skin-uterus incision were also recorded. The 93 patients comprised 8 cases in the period 2005-2009, 23 in 2010-2014, and 62 in 2015-2019. The number of previous caesarean procedures was observed to increase in parallel with these case numbers. A significant increase was observed in the gestational week of birth, and infant birthweight, and a decrease in operating times. In later years there was seen to be a lower amount of ES and FFP transfused and fewer patients with massive transfusion. Preoperative diagnosis of placenta percreta, the highest preference for general anaesthesia, selection of midline vertical skin incision and uterine fundal incision were greatest in the period 2015-2019. In cases with placenta percreta, of which there is an increasing incidence, maternal and infant outcomes can be optimised with prenatal diagnosis and planned caesarean hysterectomy by a multidisciplinary team with optimal prenatal preparation.

Uterine Leiomyomas Surgery: Assessment of Five Years in the Gynecology Department of Hôpital du Mali

Uterine leiomyomas (myomas) are the most common benign tumors of the female genital tract. They affect 20% to 25% of women of childbearing age and are 3 to 9 times more common in black women. We initiated this study in order to report the socio-demographic aspects and the indications for leiomyomas surgery at Hôpital du Mali. This was a retro-prospective descriptive study, conducted in the gynecology department of Hôpital du Mali from January 1, 2015 to December 31, 2019. Any patients, regardless of their age, in whom a leiomyomas had been detected and surgically treated were included. We had collected 180 cases of surgery for leiomyomas out of 950 surgical procedures, with a frequency of 18.94%. The 36 - 45 age group represented 45% of our patients with an average age of 35 years. Nulligravida accounted for 48.9% and nulliparous (60%). The main reason for consultation was the desire to become pregnant (53.33%). A history of myomectomy was found out in 15.55% of patients. Pelvic ultrasound figured out 64.44% interstitial myomas. Myomectomy was performed in 88.88% of cases and hysterectomy in 11.12% of cases. Among our patients 39.37% had become pregnant. Operative complications were dominated by anemia 14.44%. Leiomyoma was the histological tissue found in all cases of myomectomy. The average duration of hospitalization was 3 days. Conclusion: Leiomyomas surgery is the first scheduled gynecological surgical activity. Laparotomy remains the primary route of entry. The indications are dominated by the desire for pregnancy.

Impact of history of myomectomy on preterm birth risk in women with a leiomyomatous uterus: a propensity score analysis

BackgroundTo evaluate if women with a history of myomectomy have a modified preterm birth risk compared to women with myomas during pregnancy.MethodsRetrospective cohort study including all women with a history of myomectomy (operated group) or uterine myomas during pregnancy (unoperated group) who delivered in a tertiary center between January, 2011 and December, 2017. The operated group included women who had a myomectomy history with or without myomas during the ongoing pregnancy. The unoperated group included women with uterine myoma(s) seen on at least one ultrasound during pregnancy without history of myomectomy. The primary outcome was preterm birth < 37 weeks, and the secondary outcome spontaneous preterm birth < 37 weeks. To control for confounding factors, a propensity score approach was used. Two sensitivity analysis were performed, one repeating the analysis using the propensity score after excluding operated women with persistent myomas and one using a classical multivariable logistic regression model.ResultsThe cohort included 576 women: 283 operated women and 293 unoperated women. The rate of preterm birth was similar in the two groups: 12.6% in the unoperated group and 12.0% in the operated group (p = 0.82). No difference in preterm birth risk was shown between unoperated and operated women in the cohort matched on the propensity score: OR 0.86; 95%CI [0.47–1.59]. These results were consistent for spontaneous preterm birth (OR 1.61; 95%CI [0.61–4.23]) and for the sensitivity analyses.ConclusionIn women with a leiomyomatous uterus, a history of myomectomy is not associated with a reduced preterm birth risk.

Nationwide population-based cohort study of adverse obstetric outcomes in pregnancies with myoma or following myomectomy: retrospective cohort study

BackgroundOur objective was to evaluate risks of adverse obstetric outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy.MethodsWe analyzed the national health insurance database, which covers almost the entire Korean population, between 2004 and 2015. The risks of adverse pregnancy outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy, compared to those in women without a diagnosed myoma, were analyzed in multivariate logistic regression analysis.ResultsDuring the study period, 38,402 women with diagnosed myoma(s), 9890 women with a history of myomectomy, and 740,675 women without a diagnosed myoma gave birth. Women with a history of diagnosed myoma(s) and women with a history of myomectomy had significantly higher risks of cesarean section (aOR 1.13, 95% CI 1.1–1.16 and aOR 7.46, 95% CI 6.97–7.98, respectively) and placenta previa (aOR 1.41, 95% CI 1.29–1.54 and aOR 1.58, 95% CI 1.35–1.83, respectively), compared to women without a diagnosed myoma. And the risk of uterine rupture was significantly higher in women with previous myomectomy (aOR 12.78, 95% CI 6.5–25.13), compared to women without a diagnosed myoma, which was much increased (aOR 41.35, 95% CI 16.18–105.69) in nulliparous women. The incidence of uterine rupture was the highest at delivery within one year after myomectomy and decreased over time after myomectomy.ConclusionsWomen with a history of myomectomy had significantly higher risks of cesarean section and placenta previa compared to women without a diagnosed myoma.

Intravenous Leiomyoma with Intracardiac Extension: A Rare Late Presentation After Hysterectomy

Intravenous leiomyoma is a rare, benign smooth muscle tumor arising from intrauterine venules or the myometrium. It can rarely present as intracardiac mass long after hysterectomy. In this case report we describe a 40-year-old female with previous history of hysterectomy, presenting with an intracardiac mass which was successfully managed with single stage tumor resection under cardiopulmonary bypass. Subsequent histopathology showed features of leiomyoma. The diagnosis of intravenous leiomyoma with cardiac extension should be kept in a female patient presenting with intracardiac mass with previous history of myomectomy or hysterectomy.

Endometriosis Is Associated with Abnormal Placentation and Surgical Morbidity at the Time of Cesarean Section

Study Objective Determine whether patients with endometriosis have a greater likelihood of morbidity at cesarean section. Design Retrospective cohort study Setting Academic hospital Patients or Participants Patients with a singleton pregnancy resulting in primary cesarean delivery between 01/01/2015-12/31/2018. Women with history of surgically-confirmed endometriosis were matched 1:3 to women never diagnosed with endometriosis on delivery year and whether the cesarean was indicated for myomectomy history. Endometriosis was sub-categorized into rASRM stage I/II or stage III/IV by operative findings. Composite morbidity was defined by any transfusion, hysterectomy, or organ injury at cesarean. Additional outcomes included placenta previa, accreta, total surgical time for cesarean, and time from incision to hysterotomy. Multivariable logistic regression models adjusting for age, race, gravidity, IVF conception, and operative hysteroscopy quantified odds ratios(OR) and 95% confidence intervals(CI). Interventions N/A Measurements and Main Results Study population included 384 patients (rASRM stage I/II=44, III/IV=52, no endometriosis=288). Composite morbidity was clinically and statistically significantly greater (17% versus 6%; OR=3.90,CI=1.37-11.05) for stage III/IV patients compared to women without endometriosis. The stage III/IV group also had higher odds of previa (13% versus 3%; OR=4.94,CI=1.45-16.78) and trended towards increased accreta (11% versus 1%; OR=10.18,CI=1.85-55.88) compared to women without endometriosis. Odds of composite morbidity and abnormal placentation were similar comparing stage I/II endometriosis patients to women without endometriosis. Time from skin to uterine incision did not differ between either endometriosis group and women without endometriosis, while stage III/IV patients were more likely to have a surgical time >1 hour (OR=2.49,CI=1.21-5.11). Conclusion Among patients who had a singleton pregnancy resulting in primary cesarean delivery, women with a history of stage III/IV endometriosis had greater odds of placenta previa, and surgical morbidity compared to patients without endometriosis. These findings suggest that one or more characteristics of rASRM stage III/IV may be related to abnormal placentation and morbidity at cesarean delivery, and endometriosis phenotypes should be better documented and further explored.

Florid Cystic Endosalpingiosis and Adenomyosis of the Uterus Mimicking Malignancy

A 46-year-old nullipara woman presented with a large abdominal mass. She had a history of myomectomy by laparotomy, uterine embolization, and hysteroscopic resection of an International Federation of Gynecology and Obstetrics II myoma. A pelvic ultrasonography showed a large uterus (17.1 × 11.1 × 12.0 cm) associated with a right anechoic multilobed mass measuring 16.5 × 7.2 cm. The woman refused magnetic resonance imaging because of claustrophobia. The risk of ovarian malignancy algorithm score was 13.3%, showing a high risk of ovarian cancer.

Twin pregnancies with uterine fibroids are not at increased risk for obstetric complications: single center cohort study

BackgroundTwin pregnancies with uterine fibroid(s) (UFs) may not be at increased risk for obstetric complications compared to those without UFs. However, there was no reported comparison study with obstetric outcomes and complications of twin pregnancy after myomectomy. We aimed to compare the pregnancy outcomes in twin pregnancies with or without uterine fibroid(s), and also compared in patients with previous myomectomy history in Korean women.MethodsA cohort of twin pregnancies delivered in a single institution between January 2011 and March 2019 were retrospectively analyzed. UFs group was defined by the presence of UFs during pregnancy (≥1 fibroid, measuring ≥2 cm or multiple fibroids regardless of the size). Previous myomectomy group included patients with history of abdominal or laparoscopic or hysteroscopic myomectomy of ≥1 fibroid, measuring ≥2 cm or multiple fibroids whatever the size. Patients with monochorionic monoamniotic twins, myoma less than 2 cm in size, missed abortion or intrauterine fetal death (IUFD) of one fetus before 14 weeks, history of previous conization, and uterine anomalies were excluded. Pregnancy outcomes and obstetric complications were compared.ResultA total 1388 patients were included in this study, 191 (13.8%) had UFs and 89 (6.4%) had a history of myomectomy. Maternal age was younger in non-UFs group and primiparity was more common in UFs group (p < 0.001, and p = 0.019). No significant differences were found in the gestational age at delivery (p = 0.657), delivery before 37 weeks (p = 0.662), delivery before 34 weeks (p = 0.340), and sum of birth weight of twin (p = 0.307). There were also no statistical differences in rates of obstetrical complications, such as preeclampsia, gestational diabetes mellitus, placenta previa, placenta abruption, cerclage, small for gestational age, IUFD, postpartum hemorrhage and peripartum transfusion or ICU care. These obstetrical outcomes and complications showed no statistical differences between UFs group and previous myomectomy group.ConclusionIn patients with twin pregnancies, the presence of UFs or history of previous myomectomy did not relate to negative effects on pregnancy outcomes and obstetrical complications.

Giant Parasitic Fibroid Mimicking Gist: A Clinical Dilemma

ABSTRACTBackgroundParasitic fibroids are a rare type of fibroids without direct uterine attachment. They pose a diagnostic dilemma and often present atypically.Case descriptionWe report a rare case of large secondary parasitic fibroid in a 24 year unmarried female who presented with history of lump abdomen for 6 months. She had history of laparoscopic myomectomy done 2.5 years back for the same complaint with histopathology report suggestive of leiomyoma. On examination, it was found to be subserosal pedunculated fibroid. All the tumor markers were negative except CA 125 which was 225 IU/mL. Exploratory laparotomy was done. Uterus was normal size and seen separately. Bilateral tubes and ovaries were normal. A mass of size 30 × 22 × 15 cm, firm in consistency occupying all the quadrants of abdomen, was observed. It had no attachment to the uterus or to the bowel. Mass weighing 6.5 kg was removed completely and sent for histopathology. HPE report confirmed leiomyoma. Her postoperative period was uneventful.ConclusionIf the patient had prior history of myomectomy and mass is separate from the uterus with its blood supply away from uterus, diagnosis of parasitic leiomyoma should be considered.Clinical significanceDuring morcellation procedures, a thorough inspection and washing of peritoneal cavity must be carried out, and endoscopic bag should be used to prevent secondary parasitic leiomyoma.How to cite this articleKurude VN, Gitte V, Raheja A,et al. Giant Parasitic Fibroid Mimicking Gist: A Clinical Dilemma. J South Asian Feder Menopause Soc 2020;8(1):49–51.

Tracing the Journey of Endometrium, from Womb to Arm: Deltoid Endometriosis.

Endometriosis is an enigma. Extrapelvic endometriosis is even more challenging, as theories of origin are difficult to explain. Very few cases of skeletal endometriosis have been reported in the literature. We managed a case of 39-year-old nulliparous woman, who presented to the department of plastic surgery with complaints of a painful nodule measuring about 2 cm, in left upper arm since past 8 years. She had history of myomectomy 8 years back, while she was undergoing treatment for primary infertility. Differential diagnosis of extrapelvic endometriosis was made based on clinical history of cyclical pain and swelling, and she was referred to gynecology for hormonal treatment. MRI and FNAC were inconclusive. She underwent excision biopsy of the lesion. Histopathology confirmed intramuscular endometriosis of left deltoid with positive margins. Postoperatively, she was started on dienogest 2 mg once daily and LNG IUS was inserted. Both were withdrawn a year later, due to side effects. It has been more than 6 months since removal of LNG IUS, and currently she is asymptomatic. To the best of our knowledge, this is the third case of deltoid endometriosis reported till date.

PREGNANCY WITH UTERINE MYOMA AND AFTER MYOMECTOMY: RESULTS OF THE COHORT STUDY

Objective - to identify risk factors, complications, and pregnancy outcomes in patients with uterine fibroid (myoma) and after myomectomy. Material and methods. Investigated 100 pregnancy and delivery stories, where 1st group consists of 40 patients with uterine myoma from 3 to 12 cm, 2nd group - 30 patients with a history of myomectomy, 3rd group - control of 30 patients. Results. The average age of patients from group 1 is 34.9 years, group 2 - 35.7 years. Both in group 1 and group 2 there is a large percentage of surgical interventions on the uterus: a history of abortion (35%/20%) and miscarriage (15%/36.6%). Significant sizes of fibroids contribute to incorrect fetal position - breech presentation (17.5%/3.3%), transverse (2.5%), oblique (2.5%). The presence of fibroids is associated with certain complications: the growth of the placenta in the myomatous node (5%), disorder of blood supplying and ischemic changes of the nodes during pregnancy (2.5%), late postpartum hemorrhage (2.5%), fetal distress (12.5%). Surgical delivery by Cesarean section (85%) is the method of choice for uterine myoma, based on a combination of another relative indications. Caesarean section in such patients is associated with an increase in the volume of surgical intervention, in the form of conservative myomectomy according to indications (58.8%), which may be a factor in pathological blood loss (2.5%). Pregnancy and delivery after myomectomy is accompanied by the occurrence of specific complications: scar failure after myomectomy, the threatening of uterine rupture in the scar (6.7%), adhesions in the pelvis III-IV degrees (16.7%).

Clinicopathologic evaluation of uterine smooth muscle tumors of uncertain malignant potential (STUMP): A single center experience

ObjectiveTo investigate the clinical outcomes and histopathological features of uterine smooth muscle tumors of uncertain malignant potential (STUMP). MethodsThe study analysed cases diagnosed with uterine STUMP in a tertiary center, between January 2003 and September 2018. We investigated the clinical, operative and histopatholologic data of the cases. Follow-up information and clinical outcomes were also examined. Results28 cases with uterine STUMP were studied. The mean age of the patients was 44.5 ± 9.0 years and the median parity was 2 (0–6). The mean tumor diameter was 6.3 cm (range 2–27 cm) and most (78.6%) of the tumors were located intramurally. In 25% of the cases diagnosis was after myomectomy, while in the others diagnosis was after hysterectomy. Of the patients who wanted to preserve the uterus and their fertility and who did not therefore undergo a subsequent hysterectomy, one patient became pregnant without any complication. One case with a history of myomectomy, presented as STUMP. The median follow-up time was 45.4 months (range 5–180). Recurrence occured in one case (3.7%) 33 months after diagnosis. Distant metastasis occurred in the lungs and the pathology of the biopsy was liposarcoma, and the patient died of the disease 62 months after diagnosis. ConclusionUterine STUMP is a rare condition, and diagnosis can be difficult, often with unusual combinations of findings. Prognosis for the patient is unclear and their is a risk of recurrence with the tumors. To reduce mortality, regular follow-up and a centralised approach are recommended.

Term pregnancy not requiring cerclage placement or tocolytic therapy in a patient with a unicornuate uterus and history of myomectomy

The authors present the case of a 28-year-old nulliparous woman, who successfully carried a term pregnancy in a unicornuate uterus with a solid non-communicating rudimentary horn, and a history of myomectomy, without cerclage placement or tocolytic therapy. The patient was admitted to the present clinic for uterine fibroids and menorrhagia. The patient underwent laparotomy, during which a myomectomy was performed. Twelve months after the surgery, the patient conceived spontaneously. Routine obstetric ultrasounds revealed normal intrauterine fetal development. Cerclage and tocolytic therapy were not indicated at any stage of the pregnancy. A live female neonate was delivered via cesarean section at 39 weeks’ gestation.

Uterine rupture among mothers admitted for obstetrics care and associated factors in referral hospitals of Amhara regional state, institution-based cross-sectional study, Northern Ethiopia, 2013-2017.

BackgroundMaternal morbidity and mortality have been one of the most challenging health problems that concern the globe over the years. Uterine rupture is one of the peripartum complications, which cause nearly about one out of thirteen maternal deaths. This study aimed to assess the prevalence and associated factors of uterine rupture among obstetric case in referral hospitals of Amhara Regional State, Northern Ethiopia.MethodsInstitution based cross sectional study was conducted from Dec 5-2017-Jan 5–2018 on uterine rupture. During the study randomly selected 750 charts were included by using simple random sampling method. Data were checked, coded and entered into Epi info version 7.2 and then exported to SPSS Version 20 for Analysis. Binary Logistic regression was used to identify the predictors of uterine rupture and 95% Confidence Interval of odds ratio at p-value less than 0.05 was taken as a significance level.ResultThe overall prevalence of uterine rupture was 16.68% (95% CI: 14%, 19.2%). Distance from health facility >10km (Adjusted Odds Ratio (AOR) = 2.44; 95%CI:1.13,5.28), parity between II and IV (AOR = 7.26;95% (3.06,17.22)) and ≥V (AOR = 12.55;95% CI 3.64,43.20), laboring for >24hours(AO = 3.44; 95% CI:1.49,7.92), with referral paper(AOR = 2.94;95%CI:1.28,6.55) diagnosed with obstructed labor (AOR = 4.88;95%CI: 2.22,10.70), precipitated labor (AOR = 3.59;95%CI:1.10,11.77), destructive delivery (AOR = 5.18;95%: 1.22,20.08), No partograph (AOR = 5.21; 95% CI: 2.72,9.97), CPD(AOR = 4.08;95%CI:1.99,8.33), morbidly adherent placenta (AOR = 9.00;95%:2.46,27.11), gestational diabetic militias (AOR = 5.78; 95%CI:1. 12,20 .00 ), history of myomectomy(AOR = 5.00;95%CI:1.33,18.73), induction and augmentation of labor (AOR = 2.34;95%:1.15,4.72) obstetric procedure (AOR = 2.54;95%: 1.09,5.91), previous caesarian deliveries 4.90 (2.13,11.26) were found to be significantly associated with uterine rupture.ConclusionThis finding showed that the prevalence of uterine rupture is higher. A more vigilant approach to prevent prolonged and obstructed labor, use of partograph, quick referral to a well-equipped center and prevention of other obstetrics complications need to be focused on.

Leiomyomatous uterus and preterm birth: an exposed/unexposed monocentric cohort study

The risk of preterm birth may increase in the presence of uterine leiomyomas during pregnancy. Whether myomectomy abrogates this risk has never been studied. Our aim was to evaluate the association between the presence of uterine leiomyomas during pregnancy and preterm birth and, if an association exists, to evaluate its persistence in case of a history of myomectomy. This exposed/unexposed monocentric retrospective cohort study included all women with singleton pregnancies delivering >22 weeks in a tertiary university hospital maternity unit from January 2011 through September 2015. Women with a leiomyomatous uterus were compared to women with no myomas. Women in the leiomyomatous uterus group were women with uterine leiomyoma(s) during pregnancy (≥1 leiomyoma, measuring ≥20 mm or multiple leiomyomas whatever the size) seen on at least 1 obstetric ultrasound without history of myomectomy, or women with a history of myomectomy (removal of ≥1 leiomyoma, measuring ≥20 mm or multiple leiomyomas whatever the size) by hysteroscopy, laparoscopy, or laparotomy with or without persistent leiomyomas. The association between leiomyomatous uterus and preterm birth was assessed through univariate and multivariable logistic regression. Among the 19,866 women in the cohort, 301 (1.5%) had a leiomyomatous uterus (154 unoperated women and 147 operated women). The rate of premature delivery was 12.0% in the leiomyomatous uterus group and 8.4% in the nonleiomyomatous uterus group. After adjusting for the risk factors for preterm birth, leiomyomatous uterus was significantly associated with preterm birth (adjusted odds ratio, 2.5; 95% confidence interval, 1.7-3.7). This association was significant for unoperated women (adjusted odds ratio, 2.7; 95% confidence interval, 1.6-4.6) as well as operated women (adjusted odds ratio, 2.3; 95% confidence interval, 1.3-3.9) when compared to the nonleiomyomatous uterus group. Uterine leiomyomas are associated with preterm birth and this association persists after myomectomy.