Incidence Of Uterine Perforation Research Articles

Complications When Infusing Massive Distending Medium in Hysteroscopic Surgery: A Review of Preventions and Cures for Operative Hysteroscopy Intravascular Absorption Syndrome (OHIA)

Objectives: Hysteroscopic surgery, as a minimally invasive gynecological diagnosis and treatment technique, has advantages including less trauma, quick recovery, and short hospital stay that are very common in clinical practice; however, certain problems remain. Using large amounts of distending medium can induce a series of body changes such as diluent hyponatremia, pulmonary edema and hypothermia. According to the 2021 Chinese Expert Consensus on anesthesia management for hysteroscopic diagnosis and treatment, the most common complication of hysteroscopic surgery was uterine perforation (0.12%), followed by operative hysteroscopy intravascular absorption syndrome (OHIA) (0.06%), intraoperative bleeding (0.03%), air embolism syndrome (0.03%), bladder or bowel injury (0.02%), and endometritis (0.01%). The incidence of uterine perforation and endovascular absorption syndrome was higher than others. With advances in both medical technology and devices, the incidence of uterine perforation has gradually decreased. Severe adhesions, multiple endometrial polyps, large uterine fibroids, etc., increase the difficulty of surgery, thus increasing operation time and the amount of fluid perfusion during surgery. OHIA has become the most important concern of clinicians during hysteroscopic surgery. At present, the prevention and treatment of OHIA remains to be further studied; accordingly, this article seeks to provide a review of current treatment modalities of OHIA during hysteroscopic surgery. Mechanism: Medline, Web of Science, and Ovid databases were searched using the following terms: distending medium, operative hysteroscopy, intravascular absorption syndrome; complications of hysteroscopic surgery. Findings in Brief: Shortening the operation time, reducing the volume of distending medium, decreasing infusion pressure, and using a bipolar scope can reduce the occurrence of OHIA during hysteroscopic surgery. Conclusions: Effective means of controlling and limiting OHIA during hysteroscopic surgery include: exploring the appropriate temperature of perfusion fluid; mastering the advanced monitoring methods; promoting the advanced surgical energy and perfusion system; and improving the surgical team’s understanding, diagnosis and treatment level of hysteroscopic surgical complications for the safety of perioperative patients’ vital signs.

An unusual case report of bladder perforation after intrauterine device insertion: Diagnosis and retrieval by flexible hysterofibroscopy

Uterine perforation is an uncommon complication of intrauterine device insertion, with an incidence of uterine perforation by IUCD ranged from 0.4 to 1.6 per 1000 insertions. Perforation may be complete, with the device totally in the abdominal cavity, or partial, with the device to varying degrees within the uterine wall. We hereby describe a case report of a 36-year-old lady who presented with abdominal pain and her imaging with an ultrasound revealed a perforation of the uterus and partially migrated to the urinary bladder lumen. The IUCD was easily removed by grasping the tip of the vertical arm with the forceps of the flexible hysterofibroscope and directly pulling it out appropriately. Most cases are due to traumatic perforation that occurs at the time of insertion. However, “secondary” perforation can also occur by gradual erosion. Most of the uterine perforations by IUCD are uncomplicated, with the device lying in a quiescent state in the abdomen.

1262 The Role of Ultrasound in the Management of Third Stage of Second Trimester Delivery: A Retrospective Cohort Study

Study Objective The use of intraoperative sonographic guidance for second trimester elective dilation and curettage (D & E) procedure reduces the incidence of uterine perforation. Nevertheless, the role of intraoperative sonographic guidance during curettage procedure following second trimester medical induction has not been evaluated. We aim to evaluate the effect of intraoperative sonographic guidance during curettage procedure following second trimester uterine evacuation. Design A retrospective cohort study. Setting A Gynecology department at a tertiary university‐affiliated medical center. Patients or Participants Patients undergoing second trimester medical induction up to 23 6/7 weeks estimated gestational age who underwent uterine curettage after delivery of the fetus. Interventions Women undergoing curettage procedure under continuous ultrasound guidance were compared with those undergoing curettage without ultrasound guidance. Measurements and Main Results One hundred ninety four patients underwent a curettage without intraoperative sonographic guidance, while 79 underwent the procedure utilizing intraoperative sonographic guidance. The overall rate of composite adverse outcome was higher among those undergoing curettage under intraoperative sonographic guidance as compared with no sonographic guidance (39.2% vs. 20.6%, P=0.002). Placental morbidity (12.6% vs. 5.6%, P=0.04) and infectious complications (7.5% vs. 2.5%. P=0.05) were more frequent among those undergoing curettage using intraoperative sonographic guidance. In a multivariate logistic regression analysis, intraoperative ultrasound guidance was the only independent factor positively associated with an adverse outcome (P=0.001). Procedure time was longer when ultrasound guidance was used; 9:52 min. vs. 6:58 min. (P Conclusion Intraoperative ultrasonography guidance during curettage after second trimester uterine evacuation is associated with a higher complication rate than no guidance.

Clinical effect of mifepristone combined with misoprostol for termination of pregnancy in high risk pregnant women

Objective To explore the clinical effect of mifepristone combined with misoprostol for termination of pregnancy in high risk pregnant women and provide reference for clinical treatment. Methods 182 cases of high-risk maternal were divided into observation group and control group by the random number table method, each group 91 cases.The control group was treated with conventional abortion termination of pregnancy, the observation group was treated with the artificial abortion before oral administration of mifepristone tablets and misoprostol tablets.The operation time, the amount of blood loss, the degree of pain, the degree of cervical softening and the occurrence of complications of induced abortion were compared between the two groups. Results The operation time of the observation group was (2.21±1.41)min, intraoperative bleeding was (15.29 ±4.06)mL, which were significantly less than those of the control group (t=7.122, 8.256, all P<0.05); The pain degree grade I in the observation group was 58.24%, which was significantly higher than that in the control group, grade III accounted for 5.49%, which was significantly lower than the that in the control group (χ2=44.887, 44.121, all P<0.05), the observation group of cervical softening full was 59 cases, full softening rate was 64.84% and the control group in the cervical softening full was 41 cases, softening full rate was 45.05%.Fully softening rate in the observation group was significantly higher than that in the control group (χ2=7.191, 8.411, P<0.05), the control group, the incidence of uterine perforation in 2 cases, the occurrence of artificial abortion syndrome 7 cases, the incidence of complications for 9.89%, the observation group had no uterine perforation occurred, 1 case of artificial abortion syndrome and complications occurred rate was 1.10%.The incidence of complications in the observation group was significantly lower than that in the control group (χ2=6.772, P<0.05). Conclusion Mifepristone combined with misoprostol for high-risk maternal termination of pregnancy could significantly shorten the artificial abortion operation time, reduce intraoperative blood loss, reduce the patient pain, reduce the incidence of complications. Key words: High risk maternal; Termination of pregnancy; Mifepristone; Misoprostol

Management of complete vagino-uterine septum in patients seeking fertility: Report of two cases and review of literature

Abstract Septate uterus is the most common congenital uterine anomaly encountered clinically. It is associated with infertility and adverse pregnancy outcomes including miscarriages and preterm births. Over the past few decades, the diagnosis and surgical management of uterine septum has changed significantly. Here, we present two women with complete vagino-uterine septum presenting with infertility. The diagnoses of septate uterus were made through three-dimensional ultrasound and magnetic resonance imaging, and they were treated with thin-gauge bipolar electrocautery (VERSAPOINT) through hysteroscopy. A literature review of the approach to managing complete vagino-uterine septum suggests the use of combinatorial imaging modalities such as hysterosalpingography, three-dimensional ultrasonography, and magnetic resonance imaging to accurately define the anatomy. Furthermore, compared with open surgery, treatment through hysteroscopic approaches are associated with shorter operating times and good fertility outcomes. With the use of concomitant laparoscopic and ultrasound monitoring, the incidence of uterine perforation and visceral injury may be reduced. However, referral to a center with such expertise is essential.

EP-1906: Incidence of uterine perforation and tandem tenting in CT-guided intracavitary radiotherapy for cervical cancer

EP-1906: Incidence of uterine perforation and tandem tenting in CT-guided intracavitary radiotherapy for cervical cancer

Endometrial Ablation and Prior Cesarean History: A Subanalysis on Patient Safety

Study Objective: To evaluate the safety of Thermal Balloon endometrial ablation in patients with prior low transverse cesarean section(s). Design: This is a subanalysis of our previously published prospective, single arm cohort study on treatment outcomes following ThermachoiceIII ablations. Time endpoints were 2 weeks, 3 and 6 months post ablation. Outcome measure: Incidence of uterine perforation, vesicouterine fistula or other transmural thermal injury possibly related to defective lower uterine structure. Vesicouterine fistulas were screened for by patient questionnaire. Positive screens were to be confirmed by in office cystoscopy. Setting: Inner city community based, group practice. Patients: Patients recruitment: November 2006 to November 2007. Prior inclusion/exclusion criteria have been described previously. 41 had history of prior C/S.Tabled 1Patients with prior Low Transverse cesareansN (%)C/S X118 (44)C/S X214 (34)C/S X39 (22)C/S >30 Open table in a new tab These patients underwent C/S scar measurements preablation. Those with measurements under 10mm underwent Thermal balloon catheter placement and insufflations under transabdominal sonographic guidance. Measurements and Main Results: Sonographic values are in Table 2.Tabled 1Sonographic measurements of C/S scars per cesarean groupA-P demensionC/S X115 (11-16)C/S X212 (11-14)C/S X310 (8-12)C/S X4NA Open table in a new tab No vesicouterine fistulas/uterine perforations were noted in the cesarean cohort, up to 6 months. Serious adverse events did not differ between the cesarean cohort and the remainder. Conclusion: Thermal Balloon ablation can be accomplished safely in patients with prior cesarean sections. Measurement of the C/S scar and balloon catheter placement under sonogram guidance may be considered in these patients as a conservative measure to aid in perforation prevention. Discussion: A recent case report documented a vesicouterine fistula 2 weeks after radiofrequency ablation. Prior to this report, no cases had been reported to the MAUDE database, although one uterine perforation/thermal injury in a patient with prior cesarean section had been reported for the thermal balloon. Although it is known that multiple C/Ss thin the lower uterine myometrium, we have demonstrated a practice protocol that may be adopted to allow safe completion of thermal balloon ablation.

Safety of intrauterine contraceptive device (copper T 200 B) in women with cardiac disease

Background Women with cardiac disease have need for effective long-lasting reversible contraception. Women with cardiac disease are at increased risk for bacterial endocarditis. There is limited research regarding the use of intrauterine contraceptive devices (IUD) in women with cardiac disease. Study Design In a prospective study, the IUD copper (Cu T200B) was inserted in 40 women with cardiac disease. Infective endocarditis prophylaxis was given 1 h before IUD insertion. The IUD was inserted under aseptic conditions. Ten milliliters of venous blood was obtained for culture of aerobic and anerobic bacteria within 1 h of insertion of the copper T IUD. Women were contacted for follow-up at frequent intervals. Results There was no incidence of uterine perforation, hemorrhage or spontaneous expulsion of the IUD. All blood cultures were sterile. There were no cases of infective endocarditis. Four women (10%) had menorrhagia at the 6-month follow-up which responded to medical management. One woman had PID for which antibiotics were given. Five women had mild cramps and five had spotting after insertion of the IUD. Patient adherence was excellent as none returned for removal for reasons other than desire for another pregnancy. Conclusion The Cu T200B IUD is a reasonably safe and effective method of temporary contraception in women with cardiac disease who are not receiving anticoagulant therapy.

Intravesical stone formation on intrauterine contraceptive device

Since more than 30 years, intrauterine contraceptive devices (IUCD) have been used for a contraceptive opportunity. Although they are termed to be a safe and effective method for contraception, they also have some type of complications and uterine perforation, septic abortion, pelvic abscess are the serious complications of these devices. The incidence of uterine perforation is very low, but in the literature nearly 100 cases were reported about the extra uterine localization of IUCD. Migration may occur to the adjacent organs. We here in describe a case of a 31 year-old woman who had an IUCD with stone formation in the bladder. In the literature all of the cases were reported as IUCD migration, but although it seems technically impossible, IUCD placement into the bladder should also be considered in misplaced IUCDs.

Hysteroscopy in 2001: a comprehensive review.

Keywords: diagnostic hysteroscopy; endometrial ablation; hysteroscopic metroplasty; hysteroscopic myomectomy; outpatient hysteroscopy

Intravesical migration of copper-T

This article presents a case of intravesical migration of cooper-T (Cu-T) in a 33-year-old woman who complained of lower abdominal pain for the past 5 years and of development of hematuria recently. Her medical history revealed that she had postpartum Cu-T insertion 13 years earlier and a removal due to menorrhagia a few months later. However the Cu-T thread was thought to be missing although an X-ray confirmed it to be still inside the uterus. Pelvic ultrasound of the patient showed a misplaced Cu-T with one limb perforating the bladder and the other embedded in the utero-vesical interface. Such an incidence of uterine perforation with an intrauterine contraceptive device (IUCD) ranges from 1/1000 to 3/1000 with migration usually to adjacent organs like appendix colon omentum or peritoneal cavity. Although this complication is rare with only 20 cases reported so far it is usually symptomatic causing suprapubic pain irritative voiding symptoms and hematuria and menouria. Removal of misplaced IUCDs has been advised as well as regular follow-up of IUCDs for visible threads and teaching patients about early detection of misplaced IUCDs. Sonography hysteroscopy and laparoscopy could aid in the exact placement and sometimes in the removal of misplaced devices.

Management of uterine perforations in connection with legal abortions

The incidence of uterine perforation while performing legal abortions was evaluated in the Stockholm area. Among 84,850 legal abortions performed during 1982-1992 there were 145 cases of uterine perforation, 0.17%. In about half of these cases an immediate exploration of the abdomen was decided upon and in 18 patients there were significant bleeding and/or lacerations to organs situated in the pelvis. No case of intestinal perforation was encountered. It is likely that many of these injuries would have healed just as well unattended. Based on this study, the authors advocate a conservative approach in dealing with uterine perforation in connection with vacuum aspiration for legal abortion.

Laparoscopy as a diagnostic and therapeutic technique in uterine perforations during first trimester abortions.

AbstractLaparoscopic analysis of uterine perforation during first trimester medical termination of pregnancy was done in 10 cases out of the 12 perforations in 2,967 MTPs. Incidence of uterine perforation was 3 per 1,000. In 9 out of 10 cases, a laparotomy was avoided due to laparoscopic aid and MTP was completed under laparoscopic vision. Fundus was the commonest site of perforation with no relevance of uterine position. The procedure is safe when performed in indicated cases and an exact diagnosis of the extent of perforation injury can be obtained. This procedure avoids an exploratory laparotomy.