Obstetric Pathology Research Articles

Simulation-based clinical learning for the third year medical student: Effectiveness of transabdominal and transvaginal ultrasound for elucidation of OB/GYN scenarios.

Point-of-care ultrasound (POCUS) is gaining recognition as a teaching modality that acts as an integrative learning tool during medical student transition to clinical rotations. This study aimed to determine if the use of ultrasound simulation enhances understanding of Obstetrical and Gynecological (Ob/Gyn) anatomy and pathology in third-year medical students (M3), and if M3 students found the simulator useful. M3 students taking the OB/Gyn clerkship were invited to participate. Baseline knowledge of pelvic ultrasound anatomy and pathology was assessed with a multiple-choice question test. Participants received a one-hour OB/Gyn ultrasound simulation training session. A post-test assessed knowledge after the intervention. Survey data was collected regarding learning styles and learner satisfaction. Following simulator-based training, the median correct number of responses to the knowledge questions increased from 11 of 18 to 14 of 18 correct (P < .001). Statistically significant increases were also observed in comfort level with OB/GYN ultrasound (P < .001). All 68 students answered that the ultrasound simulator was helpful and enjoyed using the simulator. This study suggests that ultrasound simulators are useful for improvement in knowledge, comfort level, and ability to identify pathology in Ob/Gyn scenarios in M3 students.

Severe metrorrhagia in patients with advanced gynecologic cancer: endovascular treatment benefits in acute and chronic setting.

Interventional radiology plays an established role in the management of many conditions of the female reproductive tract. Since in benign gynecological and obstetric pathologies, as myomas and postpartum hemorrhages, uterine arteries embolization has been already evaluated, this manuscript aims to report on a single-center experience concerning the endovascular management of metrorrhagia caused by gynecological malignancies. Single-center retrospective analysis of thirty patients affected by gynecologic cancer treated with endovascular embolization between January 2016 and December 2018 for acute or chronic metrorrhagia. All patients were in advanced oncological stage (III or IV) with loco-regional spread of the tumor or invasion of pelvic structures, with a poor performance status. They were not suitable for surgery. On initial CT angiography, contrast media extravasation was confirmed in two patients (6.6%), while on DSA examination, tumor stain was displayed in 28 patients (93.4%). In two patients (6.6%) a pseudoaneurysm was reported. Endovascular treatment of metrorrhagia in oncologic patients could be a valid therapeutic alternative, especially when in elderly patients with poor clinical conditions not suitable for surgery. A bilateral and superselective embolization using non-resorbable embolic agents should be performed, except for those cases in which there is infiltration of major vessels causing pseudoaneurysms or fistulas that require embolization.

CHANGES IN BIOCHEMICAL COMPOSITION OF BLOOD IN THE TREATMENT OF POSTPARTUM ENDOMETRITIS IN COWS

Postpartum complications are recorded in 40–80 % of cases of calving animals. A prerequisite for this is a metabolic disorder that affects the morpho biochemical status of the body. The use of drugs based on probiotic microorganisms for the treatment and prevention of obstetric and gynecological pathology is a promising direction. Therefore, the aim of our research was to study the changes in hematological parameters in the treatment of acute postpartum endometritis in cows with the use of a new probiotic drug. We developed drug Fometrin suppositories is a light yellow color, with a content of dry biomass of probiotic cultures of cells. Fometrin the drug were injected 3 or 4 candles of the first and second experimental groups of cows, respectively, 1 per day, intrauterine, for 5–7 days, also used the PDE to 20 ml and Uteroton 10 ml, 3 times in 48 hours. For treatment of control animals used Ichglukovit, Oksilat and PDE in accordance with the instructions for use. As a result, the largest number of recovered animals (80 %) was in the second experimental group, the independence period was 28 % and the service period was 31 % and the index of insemination by 15 % than in control. The use of endometritis therapy regimen with the drug Fometrin in comparison with traditional treatment, manifested a decrease in the content of leukocytes by an average of 26.9 % and an increase in the number of segmental neutrophils by an average of 36 %, as well as a more optimal level of nonspecific resistance of the body, determined by the ratio of lymphocytes to rod neutrophils, to the end of the experiment. After treatment there was an increase in iron content on average by 20.5 % and cholesterol by 27.6 % in the experimental groups of cows and the most pronounced changes in the indices of protein and mineral metabolism in the organism of animals second experimental group.

American Surgical Association Statement of Solidarity on Condemning and Eliminating Racism

The American Surgical Association Council prepared the submitted statement in response to the George Floyd killing and our responsibility as leaders in academic surgery to condemn and eliminate racism.

DECIDE: A Decision-Making Model for More Effective Decision Making by Health Care Managers.

The purpose of this article is to describe a step-by-step process for decision making, and a model is developed to aid health care managers in making more quality decisions, which ultimately determines the success of organizations. The DECIDE model is the acronym of 6 particular activities needed in the decision-making process: (1) D = define the problem, (2) E = establish the criteria, (3) C = consider all the alternatives, (4) I = identify the best alternative, (5) D = develop and implement a plan of action, and (6) E = evaluate and monitor the solution and feedback when necessary. The DECIDE model is intended as a resource for health care managers when applying the crucial components of decision making, and it enables managers to improve their decision-making skills, which leads to more effective decisions.

Standing up to stigma in epilepsy.

This article explores the nature of stigma and discusses how stigma negatively affects both adults and children with epilepsy.

Acceptance Was the Key

A psychiatric nurse confronts the stigma of his own depression.

State of pregnant women’s mental health with obstetric pathology and aggravated reproductive anamnesis

Pregnant women with obstetric pathology and aggravated reproductive anamnesis often have mental changes in mental state that need correction.&#x0D; Disorders of the reproductive system, which were provoked by psychological factors, were formed because of bidirectional interaction of mental/characterological disorders and endocrinological/somatic diseases [1]. According to WHO requirements, pregnant women with obstetric pathology and aggravated reproductive anamnesis should be assessed psycho-emotional state with subsequent further examination [2-5]. To determine the state of pregnant women’s mental health, in our research we used psychological methods and tests, which complemented each other in terms of information. Research materials and methods. All pregnant women with an aggravated reproductive anamnesis were divided into three groups: 1 group - pregnant women with uterine scar. II group – women whose pregnancies are due to the use of assisted reproductive technologies (ART). III group – pregnant women with abnormalities of labor&#x0D; Management of all pregnancies were at the Kyiv City Maternity Hospital № 1.

ACUTE APPENDICITIS AND ASSOCIATED PATHOLOGIES IN FEMALES

In females with right lower quadrant acute abdominal pain, gynecological & obstetric pathologies are the main disorders that should be eliminated from the diagnosis of acute appendicitis. This study included pathologic findings in 120 appendectomies in Al-Sadr Teaching Hospital in which exploration was performed as emergency acute appendectomies in 52 cases, while other pathologic processes related to gynecological diseases are distanced from appendicitis intraoperatively. There is a high percentage of coexistence with ovarian cyst in all its types whether twisted, ruptured, hemorrhagic or corpus luteal cyst. Other conditions included: ectopic pregnancy, uterine fibroid, Pelvic Inflammatory Disease (PID), Tubo-Ovarian Abscess (TOA), benign cyst adenoma & endometriosis. Also rarely, meckel's diverticulum that was either incidental finding or discovered by imaging techniques.

Management of Gestation with Abnormal Invasive Placenta Complicated by an Extra-preterm Premature Rupture of Membranes in a Tertiary Perinatal Centre

Aim. Assessment of methods for prolonging gestation after an extra-preterm premature rupture of membranes (PROM) in a patient with abnormal invasive placenta and the efficacy of a multidisciplinary approach for treatment of a combined obstetric pathology in a tertiary perinatal centre.Results. A clinical case is reported of PROM at 22+6 weeks’ gestation in a patient with two caesarean scars on the uterus and abnormal invasive placenta. In a tertiary perinatal centre, pregnancy was prolonged to 36+3 weeks’ term. The period between PROM and delivery was 96 days. A planned caesarean section and metroplasty were performed in the setting of temporary balloon occlusion of common iliac arteries. Blood loss was 75 mL/kg. Placenta increta without chorioamnionitis was confirmed histologically. The patient stayed in the intensive care unit for two days and was discharged home on the 8th day. The newborn was assigned the Apgar score of 6/6. For two days, ventilatory support was rendered in a neonatal intensive care unit. The newborn was diagnosed with congenital pneumonia, the first-degree hypoxic-ischemic damage of the central nervous system and transferred to the second phase of nursing.Conclusions. A multidisciplinary approach and high technology facilities in the setting of a tertiary perinatal centre allow to reduce perinatal losses and provide high-quality care to patients with an increased risk of massive blood loss with the capacity to manage organ-preserving operative delivery with full rehabilitation in the postoperative period.

Rotura de seudoaneurisma de la arteria uterina posterior a cesárea

La hemorragia posparto es una causa importante de mortalidad materna. La rotura del pseudoaneurisma de la arteria uterina es una lesión vascular con prevalencia desconocida que produce hemorragia posparto secundaria sin causa evidente. Puede ser potencialmente mortal, si no es diagnosticada y tratada adecuadamente. La etiología incluye traumatismo vascular durante la cesárea, parto vaginal, legrado o histerotomía. Su presentación clínica tiene variedad de síntomas que a menudo se asocian con otras patologías ginecológicas / obstétricas más frecuentes, con y sin sangrado vaginal, y puede abarcar desde ausencia de síntomas hasta hemorragia posparto severa con choque hipovolémico. Para evitar la hemorragia mortal, se debe hacer un diagnóstico rápido y preciso que muestre la naturaleza vascular de esta lesión. El diagnóstico está basado en estudios de imágenes no invasivos. En casos seleccionados adecuadamente, la embolización angiográfica es un método seguro y eficaz para controlar la hemorragia en pacientes hemodinámicamente estables y debe ser una opción antes de recurrir a la cirugía. Se describe un caso de rotura de pseudoaneurisma de arteria uterina posterior a cesárea.

Parâmetros maternos e perinatais após intervenções não farmacológicas: um ensaio clínico randomizado controlado

Resumo Objetivo Analisar os efeitos do banho quente, de exercicios perineais com bola suica ou de ambos durante o trabalho de parto em parâmetros maternos e perinatais. Metodos Ensaio clinico randomizado controlado incluindo 101 gestantes de baixo risco admitidas em dois centros obstetricos entre junho de 2013 e fevereiro de 2014 com idade minima de 18 anos, gestacao a termo, feto unico em apresentacao cefalica, dilatacao cervical entre 3 e 8 cm, escala de dor ≥5, sem patologias clinicas ou obstetricas ou doenca mental, nao usuarias de drogas psicoativas ou de corticosteroides naturais ou sinteticos, e que nao fizeram uso de produtos de tabaco, cafeina e analgesicos duas, quatro e seis horas antes de serem incluidas no estudo. Os arâmetros maternos e perinatais foram avaliados antes e 30 minutos apos as intervencoes, incluindo: pressao arterial materna, frequencia cardiaca e respiratoria, contratilidade uterina, dilatacao cervical, frequencia cardiaca fetal, linha de base, variabilidade, aceleracoes e desaceleracoes usando cardiotocografia e escala de Apgar (no 1o e 5o minutos apos o nascimento). Os participantes foram alocados aleatoriamente em tres grupos: A) banho quente (33); B) bola suica (35); e C) intervencoes combinadas (33). Resultados Em relacao aos parâmetros maternos, a pressao arterial sistolica foi mantida abaixo de 100 mmHg, com um pequeno aumento no grupo B. A pressao arterial diastolica diminuiu em todos os grupos, mantendo-se, contudo, acima de 70 mmHg. A frequencia cardiaca apresentou diminuicao nos grupos B e C e esteva acima de 80 bpm. A frequencia respiratoria ficou acima de 20 rpm em todos os grupos apos as intervencoes, enquanto a dilatacao cervical foi de 5,0 cm em media antes das intervencoes com aumento de 1,3 cm apos as intervencoes em todos os grupos. Em relacao aos parâmetros fetais, 90% dos fetos em todos os grupos apresentaram frequencia cardiaca normal nos dois periodos avaliados, aceleracoes transitorias estiveram presentes em mais de 80% dos fetos em todos os grupos em ambos os periodos analisados. Nao foi constatada desaceleracao antes da intervencao em aproximadamente 58,4% dos casos. Observou-se desaceleracoes em 52,5% dos casos, principalmente nos grupos A e B. A variabilidade foi normal em mais de 80% dos casos, e um valor <7 na escala de Apgar no primeiro minuto apos o nascimento so foi observado em 14 casos. Nao foram encontradas diferencas significativas na pressao arterial e frequencia cardiaca materna e fetal, incluindo a ocorrencia de aceleracoes transitorias, variabilidade ou desaceleracoes e valores na escala de Apgar tanto na analise inter e intragrupo quanto nos periodos avaliados. Ao comparar os parâmetros maternos antes e 30 minutos apos as intervencoes, observou-se aumento na frequencia respiratoria (p=0,037) e na dilatacao cervical (p<0,001) em todos os grupos de intervencao. Na analise intergrupo, a progressao do trabalho de parto estimulada dos grupos A (p=0,041) e C (p=0,021) em relacao as contracoes uterinas aumentou em comparacao com o grupo B. Conclusao As intervencoes isoladas ou combinadas sao uma forma segura de assistencia ao parto uma vez que elas nao afetam negativamente os parâmetros maternos e perinatais.

FEATURES OF DEPRESSIVE DISORDER IN WOMAN DURING PREGNANCY

Purpose of the article is to show features of depressive disorder during pregnancy and how it can be different according to various personal indicators. Pregnancy and depression often go hand in hand. This condition affects about every tenth pregnant woman. According to recent research, sudden surges and changes in the hormonal background that accompany the entire pregnancy can really affect brain biochemistry, which in turn can lead to real clinical depression. The procedure of research registered at the women's consultation and obstetric ward and pathology department of pregnancy in Maternity hospital No. 3 (Kyiv). It lasted for 5 months. The group of pregnant women consisted of 100 people aged 18 to 42 years. Among them were 35 women in 1 trimester of pregnancy, 40 women in 2 trimester of pregnancy, 25 women in 3 trimester of pregnancy. To identify the presence and severity of depression among pregnant women, we used the following methods: Hamilton Depression Scale, Behterev Depression Questionnaire (female version). Anxiety and depression in women during pregnancy require early detection and correction due to their significant negative impact on pregnancy, childbirth, postpartum and further psychophysical development and social adaptation of children. Different indicators of age and trimester affect the level of expression of the depressive disorder. If woman had problems with conception or she was treated for infertility, the probability of her depression in her pregnancy increases by 10 times. Depression may be more likely to eclipse pregnancy and women who have suffered mental illness, anxiety, or depression before conception. This disorder may also occur in problematic relationships, as well as in situations where relatives have had a depression or mental illness, a woman has already had a miscarriage or her current pregnancy is a high-risk group. Depression during pregnancy has significant implications for pregnancy outcomes and maternal and child health. There is a need to identify which family, physical and mental health factors are associated with depression during pregnancy.

CESAREAN SCAR DEFECT (ISTHMOCELE). WHEN AND HOW TO TREAT?

Cesarean Scar Defect has been linked to Obstetric and Gynecological pathology, with the high number of patients undergoing C-section end the frequency with which it is expected to have symptomatology, this prospective study try to find the frequency of Isthmocele, its symptomatology and with analysis of the literature propose factors to decide the best treatment. We confirmed the frequent of his presence, found that his symptomatology is based in spotting, dysmenorrhea and polymenorrhagia and found that the more symptomatic (RELEVANT) cases had cesarean scar defects bleeding producers and that the rest of symptomatic cases have cesarean scar defects bleeding collectors that often those not affect the daily life of the patient and don’t require treatment. Finely we propose bases to take in count to decide treatment.

Autologous Facial Fat Transfer: Soft Tissue Augmentation and Regnenerative Therapy.

Soft-tissue contour deficiencies depend on various origins including esthetics, congenital and post trauma asymmetries, post tumor defects, and chronic wound sequelae. Reconstructions or repairs are still a challenge today. Fat grafting is an old reconstructive technique dating back to 1893, but it has only recently become popular, especially among plastic surgeons. Being generally disregarded by medical practitioners for many years, adipose tissue has come into the spotlight because it is omnipresent and easily obtainable in substantial quantities with little patient discomfort and no relevant donor-site morbidity. Particularly, adipose tissue contains more multipotent cells per cc than bone marrow does. For example, 1 g of adipose tissue yields ∼5 × 10 stem cells, that is, 100-fold higher than the number of mesenchymal stem cells in 1 g of bone marrow. In reconstructive surgery, both adipose tissue aspiration and fat transfer have become typical surgical procedures. It is quite easy to harvest an abundant volume of tissue, obtaining a large amount of isolated stem and therapeutically active cells without needing cell expansion in tissue culture facilities. This procedure will likely mark the beginning of a new era in both regenerative medicine and facial-craniofacial reconstructions.

Distribution of obstetric pathology of cows in the leading agricultural enterprises of Khmelnytsky region

There is a problem in the farms of the Khmelnytsky region of reducing the reproductive capacity of cows. Our analysis in the region showed that in the studied cows of the Native Land Branch of PJSC “Grain Products MHP” and PE “Demetra-2010” the length of the service period and the postpartum period are somewhat longer. The service period during all three lactations was smaller in cows of the Branch “Native land” of PJSC “Grain product MHP” by 11.9 days for animals of PE “Demetra-2010”, the average period indicator was 169.3 ± 65.04 and 181.2 ± 31.11 days, respectively. In a retrospective analysis which was conducted by us in the leading farms of the Khmelnytsky region, it was found that the share of obstetric diseases in the structure of non-communicable cow pathology was 21.9 % in the Branch “Native Territory” of PJSC “Zernoproduct MHP” and 22.5 % in PE “Demetra 2010”. At the diagnostic stage of obstetric examination, the spread of obstetric pathology in cows during periods of dryness, calving and post-calving was analyzed. In the period of dryness, there were 8.1 % (7.5–9.9 %) cases of sedimentation, 3.9 % (2.3–4.5 %) udder edema. In the course of the farm surveys, the pathological course of childbirth was recorded in 3360 animals, accounting for 54 % of the total number of surveyed and 88.5 % of feral animals. Namely, in 1417 cows (22.8 %) observed pathology of the third stage of childbirth (delay of litter), in 963 cows (15.5 %) observed weakness of the generic activity. In 723 cows (11.6 %), birth trauma was reported. Postpartum complications in the cows surveyed in the Khmelnytsky region were observed postpartum sepsis (0.3 %), infected wounds after caesarean section (0.2 %) and vulva (0.1 %) postpartum vulva-vaginitis (7.1 %), subinvolution uterus (11.2 %) and endometritis (21.6 %). It was found that cows of the dry period were diagnosed with subclinical mastitis, which fluctuated within 13.3 %, respectively. Whereas clinical mastitis in the dry season on average on farms sick 7.4 % of animals. Prospective in the study of the etiology of metabolic and obstetric diseases will be the study of individual indicators of quality and safety of feed, clinical and laboratory studies of pathology of the reproductive system, which will become the basis for early diagnosis of these diseases.

Adjuvant chemotherapy in rectal cancer: state of the art and future perspectives.

The value of adjuvant chemotherapy in rectal cancer is controversial with opinions varying from 'not be used' since randomized trials have not shown significant gains to 'be used as in colon cancer' as the need is the same and colon and rectal cancers are quite similar. This review will look upon data critically and with open eyes. With the exception of one randomized phase II trial (ADORE) revealing a significant gain in disease-free survival using one more effective regimen (mFOLFOX) than bolus 5-fluorouracil leucovorin, no new data have been presented. However, bringing up aspects in previous trials, either considered irrelevant for the present situation or overall negative, of what adjuvant treatment can achieve, a small reduction (hazard ratio about 0.8) in the risk of recurrence is present. This reduction is not fundamentally different from that in colon cancer considering that adjuvant treatment for rectal cancer cannot be initiated as rapidly as it can after a colon cancer diagnosis. Adjuvant chemotherapy after rectal cancer surgery reduces recurrence risks but the benefit is limited and for most patients not clinically relevant. Neoadjuvant therapy can be more effective but results from randomized trials are not yet available.

ГІПЕРГОМОЦИСТЕЇНЕМІЯ ЯК ПАТОГЕНЕТИЧНИЙ ФАКТОР АКУШЕРСЬКИХ УСКЛАДНЕНЬ

The study of the influence of various levels of the hyperhomocysteinemia with mutation in methylenetetrahydrofolate reductase (МТНFR) on the system of the hemostasis was carried out. 84 patients were examined with various obstetrical pathology in the anamnesis. The genetic form of the hyperhomocysteinemia with various degrees of severity has been revealed in 21 (25%) patients. At the stage of planning of pregnancy and in the I-st trimester the thrombophilia manifestations were revealed: increasing the activity thrombocytes, the quantity of markers of thrombophilia D-dimer, ТАТ, F1+2. Thrombophilia augmented with terms of preeclampsia and the degree of severity of the hyperhomocysteinemia. The offered pathogenetic algorithm of treatment of thrombophilia state of patients using the low-molecular weight heparin (clexane), a folic acid, vitamin В6, В12 antioxidants has given the significant positive effect. It is necessary to carry out the studies of the hemostasis on latent thrombophilia and to carry out, if necessary, the antitromboembolitic therapy to establish the ethiopathogenetics of obstetrical complications. It will enable to exclude the further perinatal losses.

Anais Cerci Forceps: A Novel Instrument for Shaping the Nasal Dome Before Transdomal Suture Placement.

One of the most important components of an attractive nasal tip is the cephalocaudally conical form of the dome at the sagittal plane. With respect to this fact, the author tried to design a new forceps which holds the dome in a convex shape on a transverse plane and cephalocaudally conical in shape on the sagittal plane. Before grasping the dome in the desired position with Anais Cerci forceps, some degree of lateral steal is suggested and can be performed to increase the tip rotation and projection. With the help of its specific shape and template forming function, this novel instrument may also help to prevent the excess strain of transdomal suture which is crucially important to prevent the formation of pinching. This newly designed forceps can also help to provide the opportunity of the required acute angle between two domes. Slight oblique grasping of the dome reciprocally provides nice acute angle between 2 domes. Additionally, this forceps may also help to provide formation of symmetrically and reciprocally designed dome curvatures. In several secondary rhinoplasty cases with highly destroyed lower lateral cartilages, septal, auricular or costal cartilages are used for alar reconstruction. Mimicking the lower lateral cartilage anatomy from a straight cartilage graft piece is not an easy way of restoration. In such cases, Anais Cerci forceps may facilitate reshaping of the dome from an amorphous cartilage graft.

Abnormal Placentation and Umbilical Cord Insertion.

In the last decades, abnormal placentation and umbilical cord insertion have become an increasingly relevant and feared pathology in obstetrics with increased morbidity and mortality for mother and child. In addition to several increasingly common risk factors, such as assisted reproduction, the main reason for the increased occurrence is the greater frequency of Cesarean sections. Correct diagnosis, which is primarily determined sonographically, is essential for targeted perinatal management. In particular, the diagnostic criteria and current management recommendations are described in the following article.