Uterine Size Research Articles

Evaluating the safety of dienogest in women with adenomyosis: A retrospective analysis.

Dienogest (DNG) is highly effective for relieving pain caused by endometriosis and adenomyosis. However, women with severe uterine swelling due to adenomyosis who take DNG usually experience metrorrhagia. This study aimed to examine the safety of DNG usage in women with adenomyosis. This study included 20 women who were prescribed DNG for adenomyosis in our hospital from January 2016 to December 2016. We retrospectively analyzed women's clinical background characteristics (age, the use of the gonadotropin-releasing hormone agonist as pre-treatment of DNG, the uterus size [major axis, minor axis, maximum thickness in the myometrium, and length of the uterine body] by transvaginal ultrasonography [TVUS], hemoglobin level, and the presence of metrorrhagia during treatment). These variables were compared between the DNG continuation and discontinuation groups using the Mann-Whitney U test. Thirteen women continued DNG, and seven discontinued DNG within 12 months because of metrorrhagia. The uterine size was significantly larger in the discontinuation group than in the continuation group. All uterine measurements had high Spearman rank correlation coefficients (ρ > 0.8, P < 0.05). In six of seven cases in the discontinuation group, adenomyosis was in the anterior wall. Measuring the uterus size and locating adenomyosis by TVUS are simple methods of predicting DNG discontinuation. We consider that DNG can be safely administered in women with adenomyosis if the uterine size is <6 cm in the minor axis and the main lesion of adenomyosis is located in the posterior uterine wall.

Postpartum Uterine Involution and Embryonic Development Pattern in Chinese Holstein Dairy Cows.

Understanding the postpartum uterine involution pattern and embryonic development could facilitate bovine reproduction management, improve reproductive efficiency, and diagnosis of the reproductive disorder, which would contribute to the success of the dairy business. This study aimed to investigate postpartum uterine involution and embryonic developmental patterns or postconceptional marks of embryonic fetal development in Chinese Holstein dairy cows using B-mode ultrasonography. The results revealed a significant decline in the involution period with an increase of parity and age. The uterine involution period was shorter in multiparous cows when compared with cows with lower parities. Consistently, cows over 4 years old recovered faster than younger cows (2 or 3 years). Besides, the elder cows (over 4 years) had a relatively larger size of resumed cervix uteri and horns. Postpartum uterine involution pattern analysis revealed that the reproductive tract recovered very fast during the first 16 days postpartum for all the parity. Results of postconceptional marks of embryo development revealed a slow increase in diameter of the gravid uterine horn and crown-rump length (CRL) before day 60. In contrast, this increase was dramatic and rapid after the 60th day. We also established two models to estimate gestational age based on gravid uterine horn diameter or CRL. A formula was established to determine the gravid uterine horn size during postconceptional on day 30th–day 90th (r = 0.8714, P < 0.01). In addition, a significant positive correlation between CRL and gestational age (r = 0.98151, P < 0.01) was built. In conclusion, these results illustrated that parity and calving age had significant effects on uterine involution in Chinese Holstein cows. Crown-rump length and gravid uterine horn diameter are both efficient for evaluating the embryo growth. These current findings broaden the understanding of basic reproductive pattern in Chinese Holstein cows and could benefit bovine reproductive management primarily in postpartum and early pregnant cows to reduce the calving interval and avoid periparturient metabolic diseases.

OBSERVATION OF UTERINE INVOLUTION IN ETAWA CROSSBREED GOATS (Capra hircus) USING TRANSCUTANEUS ULTRASONOGRAPHY

The aim of this study was to observe the uterine involution of Etawa crossbreed (PE) goat using transcutaneous ultrasonography (USG). This study used four postpartum female goats that released placenta normally. The goats were examined on lateral recumbence position. Uterine involution was observed daily. The study began from the first day of postpartum period until there were no more reduction of uterine horns lumen diameter. From the 1st to 7th day of postpartum period, ultrasound imaging of the uterine wall showed caruncle which was hypoechoic, lumen of uterine filled with lochia (the image was hypoechoic to anechoic) and a clearly visible uterine horns lumen which had decreased in diameter from 105.9 ± 0.9 mm to 87.2 ± 4.6 mm. From the 8th day to the 14th day, lumen diameter had decreased from 80.4 ± 3.8 mm to 63.6 ± 3.2 mm. The presence of caruncle was reduced and the amount of lochia was decreased (anechoic). From the 15th day to the 21st day, lumen diameter had decreased from 61.4 ± 2.1 mm to 52.1 ± 2.7 mm, and the remnants of caruncle and lochia were still visible. From the 22nd day to the 26th day, the diameter of the uterine wall had decreased from 49.7 ± 0.6 mm to 41.5 ± 6.7 mm, and the lochia and caruncle were no longer visible. From the 26th to the 30th day, uterine horns lumen diameter had still decreased from 41.5 ± 6.7 mm to 31.7 ± 0.9 mm. Uterine horns lumen diameter size had decreased every day, stabilized on the 30th day, and ceased to decrease on the 31st day, where the diameter size was the same as on the 30th day postpartum (31.7 ± 0.9 mm). It can be concluded that the duration of uterine involution in PE goats, which had normal delivery is 30-31 days.

Systematic evaluation and sequential Meta-analysis of modified Xuefu Zhuyu Decoction combined with Western medicine in treatment of leiomyoma

CNKI, PubMed and other databases were retrieved to extract eligible randomized controlled trial(RCT) about modified Xuefu Zhuyu Decoction(MXZD) combined with Western medicine(trial group) versus Western medicine alone(control group) in the treatment of leiomyoma. Therefore, a total of 25 RCTs were included, involving 2 328 patients. Bias risk evaluation tool in Cochrane Handbook 5.1.0 was used for evaluating the quality of these RCTs. Meta-analysis was performed for the reported indicators, including total efficiency, serum hormone level [progesterone(P), luteinizing hormone(LH), estradiol(E_2), follicle stimulating hormone(FSH)], uterine size, fibroids size and adverse reactions by using Stata 14.0 software. Meta-analysis showed that the total efficiency(RR=1.21,95%CI[1.17,1.25],P&lt;0.05) of trial group was better than that of control group. Serum hormone level(WMD_P=-3.86,95%CI[-4.31,-3.41],P&lt;0.05; WMD_(LH)=-3.64,95%CI[-4.47,-2.82],P&lt;0.05; WMD_(E_2)=-39.99,95%CI[-53.45,-26.52],P&lt;0.05; WMD_(FSH)=-3.79,95%CI[-4.86,-2.72],P&lt;0.05), uterine size(WMD=-50.02,95%CI[-55.98,-44.06],P&lt;0.05), fibroids size(WMD=-15.79,95%CI[-18.11,-13.46],P&lt;0.05) and adverse reactions(RR=0.65,95%CI[0.48,0.88],P&lt;0.05) of trial group were all lower than those of control group, with statistical significances. Trial sequential analysis(TSA) was performed by using TSA 0.9 software, and showed a reliable therapeutic effect of the experimental group. In short, our study indicated that modified Xuefu Zhuyu Decoction combined with Western medicine had a better therapeutic effect on leiomyoma than Western medicine alone, but more high-quality studies are needed to verify this conclusion in the future.

INTERDISCIPLINARY INTERACTION IN MAINTAINING THE REPRODUCTIVE HEALTH IN WOMEN WITH UTERINE LEYOMYOMA

The aim: Optimizing the interdisciplinary approaches in the diagnosis and monitoring the dynamics of uterine leiomyoma treatment by high-intensity focused ultrasound ablation. Materials and methods: In the course of scientific research we conducted a survey 72 women of reproductive age were diagnosed with leiomyoma. All patients underwent bimanual gynecological examination, ultrasound and MRI to determine the condition of the pelvic organs, assess the structure, location, number of myomas, as well as assess the possible acoustic pathway of high-intensity focused ultrasound. During monitoring, dynamic contrasting was used to determine the zone of node necrosis. Methods of control in the postoperative period: ultrasound, MRI of the pelvic organs using paramagnetic, were performed after 1, 3, 6 months. Ultrasound ablation of uterine fibroids was performed using the JC extracorporeal treatment system (Chongqing HAIFU (HIFU) Technology Co. Ltd., China) with a built-in ultrasound system (Italy). Controlling the direct result was based on gray scale changes during real-time ultrasound examination on the monitor of the JC device. Since HIFU is a non-invasive method of treatment, in the future, the diagnosis was limited to using the ultrasound and MRI paramagnetic. Indicators such as: uterine body size were considered as indicators that characterize the effectiveness of treatment; specific volume of myoma; regression of uterine body size; regression of the myoma; regression of the node, calculated on its specific volume, because one patient could have several nodes. Results: Analyzing the obtained results, it should be noted that for a month the average volume of leiomatous hives that were exposed to HIFU, almost did not change and was 122 cm³, while three months after treatment it was - 98 cm. The nodes underwent a significant reduction 6 months after the treatment, their volume averaged 61 cm³. The dynamics analysis results of uterine body volume reduction, which is no less important expected result, showed the following: in the first month after the intervention the uterine volume almost did not change and, compared to the average size before treatment 342cm³, was 300cm³. In three months after treatment, the body volume of the uterus decreased to 264 cm³, and in six months - to 200 cm³. When assessing the node 6 months after the procedure, it was found that during this period there was a significant reduction in the volume of leiomyoma, which was positively correlated with the clinical manifestations of the disease. Conclusions: An interdisciplinary approach with the widespread introduction of modern organ-preserving techniques is an important direction in maintaining the reproductive health of women with uterine leiomyoma. Positive dynamics of leiomatous node volume regression depends on its location, volume and MR type. The terms 1 and 3 months after ultrasound ablation are insufficient for objective radiological evaluation of the treatment outcome, but are important for the choice of further tactics in observing and treating the uterine leiomyoma.

Response of South Indian girls with central precocious puberty to gonadotrophin analogue (GnRHa) therapy - asingle center experience.

To describe the clinical, auxological, biochemical and radiological response to GnRH analogue in female children with central precocious puberty (CPP). The data on 22 female children presenting with the larche<8 years, pubarche<8 years or menarche <9years diagnosed as CPP was collected from the records over afour year period. Assessment included growth parameters, Tanners staging; bone age (BA) by Greulich and Pyle method, ultrasonography of abdomen to assess uterine length and ovarian size and z score derived; biochemical evaluation included serum luteinising hormone (LH), follicle stimulating hormone (FSH) and estradiol (E2); and MRI brain. The children were initiated on injection Leupride 0.9 mg/kg 3 monthly (body weight 30 kg received 22.5 mg). The predicted adult height (PAH) was calculated with Bayley Pinneau method. Treatment was started at the mean chronological age (CA) of 6.09 ±2.1 years and continued till 8.3 ±2.4 years. MRI brain was abnormal in 4 children. Duration of treatment was 2.1 ±0.4 years. The height z scores reduced from 0.5 ±2.4 to 0.18 ±2.4 (p<0.05). A significant reduction in tanner's stage, uterine size and ovarian volume was observed in the study period. BA/CA ratio reduced from 1.27 ±0.4 to 1.07 ±0.3. PAH z score improved from 1.47 ±1.6 to 0.2 ±2.3 (p<0.05). We observed agood clinical and radiological response to GnRHa therapy in girls with CPP and asignificant improvement in PAH. Long term follow up is needed to assess the attainment of final height.

Cost Analysis of Vaginal Hysterectomy as Compared to Laparoscopic Assisted Vaginal Hysterectomy for Non-prolapse Uterus in a Tertiary Institution in South Africa

<i>Background</i>: Many hysterectomies are now performed by laparoscopic assisted vaginal hysterectomy (LAVH) technique. To establish LAVH as a routine procedure remains controversial, partly because of concerns about the cost. We studied hospital charges and cost of LAVH as compared to vaginal hysterectomy (VH) for non-prolapse uterus in clinically similar groups of patients. <i>Study design</i>: This was a cross-sectional analytic study, covering a period of two years. This study was undertaken at the Department of Obstetrics and Gynaecology of the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), to determine the direct hospital costs between the two surgical techniques VH and LAVH respectively. Women admitted for hysterectomy for benign uterine conditions, were enrolled in the study. Criteria for inclusion were uterine size less than 12 weeks gestation, width ≤ 9 cm and length ≤ 14 cm on ultrasound examination. Clinical ovarian pathology and uterine prolapse were criteria for exclusion. Patients were recruited from the unit records and divided into two groups matched with respect to age, parity, and indications for hysterectomy. Vaginal hysterectomy was performed in 60 patients out of the 100 patients included in the study, and 40 patients underwent LAVH. <i>Results</i>: All cases were successfully performed with no need to convert to the abdominal route. The time required for LAVH was significantly longer as compared to VH: 64, 0 v 31,3 minutes respectively (p<0.001). The postoperative hospital stay days and opiate injections required were both not significantly different between the VH and LAVH groups. Longer operating time and, as well as the expenses of the equipment to perform LAVH, were the main sources of additional cost in LAVH. The average hospital charges were significantly higher in LAVH as compared to VH (p<0.001). <i>Conclusion</i>: Both techniques offer the same benefits of shorter hospital stay, less analgesia needed, rapid mobilisation, and early discharge. However, VH was found to be least costly, mainly due to significant less operative time. LAVH is significantly costlier, mainly due to expensive laparoscopic devices and afore-mentioned long operation time.

Beta-human chorionic gonadotropin levels as early predictor for progression to Gestational Trophoblastic Neoplasia after molar pregnancy evacuation at a Philippine tertiary hospital

OBJECTIVE: This study aimed to determine if the beta-human chorionic gonadotropin (hCG) levels during the first 5 weeks after a molar evacuation predict progression to gestational trophoblastic neoplasia (GTN). MATERIALS AND METHODS: This was a retrospective cohort study of complete mole cases managed at a Philippine tertiary hospital from January 2009 to December 2018. Extracted data were analyzed using applicable statistical tools. The level of significance was set at a P < 0.05 using two-tailed comparisons. RESULTS: One hundred and fifty-five complete patient records were available for review. Disease progression in 15.48% of cases while regression in 84.52% were noted. Uterine size was larger in those who eventually had postmolar GTN (t: −3.12, df: 32.64, P: 0.01). Analysis of the receiver operating characteristic curve showed that optimum cut-off levels for predicting GTN at 1, 3, and 5 weeks after evacuation were 4,152 mIU/ml (sensitivity: 50%, specificity: 94.7%, area under the curve [AUC]: 0.75), 804 mIU/ml (sensitivity: 62.5, specificity: 96.9%, AUC: 0.94), and 541 mIU/ml (70.8%, specificity: 97.7%, AUC: 0.96), respectively. CONCLUSION: The level of hCG within the first 5 weeks after molar pregnancy evacuation is predictive of progression to GTN.

Корреляции в патогенезе неразвивающейся беременности

Objective. To improve the quality of life and outcome by consecutive pregnancy in patients based on the analysis of correlations and differences in markers for the diagnosis by early pregnancy loss (EPL) in early gestation period (up to 12 weeks). Patients and methods. 100 patients aged 18 to 40 years diagnosed with early pregnancy loss (EPL) at 7–8 and 9–10 weeks of obstetric term were examined. The types of EPL were identified by ultrasound criteria; correlations and differences in the EPL mechanism during early pregnancy were determined. Time characteristics of the gestational sac (GS) development from conception to miscarriage and the duration of persistence of an empty sac in the uterine cavity before the diagnosis of EPL were recorded. Molecular genetic testing of the chorion in 42 women with EPL was performed by multi-locus quantitative fluorescent polymerase chain reaction (PCR). The method of manual vacuum aspiration under the control of hysteroscopy was developed, followed by the administration of antibacterial, antiviral, and immunomodulatory therapy with Viferon® rectal suppositories at a dose of 1,000,000 IU 1 suppository twice a day at 12-hour intervals for 10 days and Viferon® gel 36,000 IU on the vaginal region of the cervix at a dose of 2 mL twice a day for 7 days. Results. The period of hospital admission for patients with embryonic miscarriage (EM) as the type of EPL prevailed between 8 and 10 weeks, on the average – 9.5 weeks of obstetric term, in contrast to empty sac (ES, 7–8 weeks). The period of the GS development in ES ranged from 17 to 36 days (2.3 to 5.1 weeks); in EM – 4 to 9 weeks (26 to 69 days) in 96% of patients, and the embryo development was from 3–4 to 6–7 weeks from conception (21 to 49 days). There was a 1.2-week difference in the desynchronization of the development of GS and an embryo. A significant positive correlation between gestational age (before diagnosis) and β-hCG levels (26,348 ± 18,289 mIU/mL) in patients without bloody discharge at the time of hospitalization was observed. However, there was a desynchronization of lag in β-hCG levels by an average of 3 times (8661 ± 7701 mIU/mL) in the presence of bloody discharge, although the sizes of GS according to mean sac diameter (MSD) were comparable (28 ± 13 mm and 30 ± 11 mm). There was a complete lack of synchronization of the abnormal development of GS, an embryo, β-hCG levels, and the duration of GS persistence in the uterine cavity after miscarriage. The following correlations occurred in the pathogenesis of EPL: chromosomal abnormalities (45% in EM and 40% in ES), history of gynecological and viral diseases (49% in EM and 41% in ES). Correlational differences in the developmental period of GS according to MSD, an embryo, the period of persistence in the uterine cavity after miscarriage, the uterine size, and mean β-hCG levels (at week 8-10) in EM were at different gestation periods before the onset of manifestation of miscarriage. Conclusion. Determination of correlation dependencies and differences in the results of monitoring diagnostic markers of different types of EPL makes it possible to develop a personalized approach to the choice of gestational sac aspiration, antibacterial, antiviral, and immunomodulatory therapy with Viferon® (interferon α-2b with antioxidant complex) for a successful consecutive pregnancy and its outcome. Key words: anembryonic pregnancy, embryonic miscarriage, correlations, pathogenesis by early pregnancy loss, early pregnancy loss, persistence of empty sac, β-hCG

Uterine parameters of clinical importance in North Indian females of reproductive age – An ultrasonographic evaluation

Introduction: The uterine size is important during planning of assisted reproductive techniques and hysterectomy and there is no established normative data from the women of northern India, this study was undertaken with the objective to report the normal length, width and anteroposterior lengths of non-gravid uterus. Methodology: In a prospective observational study, conducted in Department of Anatomy in collaboration with Departments of Radiology, Obstetrics and Gynecology of King George's Medical University, Lucknow, the ultrasonographic measurements of non-gravid uterus were noted. The ultrasonography was performed on females in dorsal decubitus position having full urinary bladder. Uterine position was identified by placing the probe on suprapubic area Length and anteroposterior diameter of uterus were measured by placing the probe in longitudinal direction (sagittal plane). Length was measured from fundus to external os. The anteroposterior diameter is maximum measurement in mid sagittal plane of body of uterus. The transducer was rotated up to 90 degree to measure the transverse diameter. Transverse diameter is the maximum measurement in transverse plane across the fundus. The volume of uterus was calculated. Results: The study included transabdominal ultrasonographic measurements of 100 females of age range 19-49 years (mean age 34.06 ± 0.35 years). Mean length, transverse diameter, anteroposterior diameters and volume noted were 7.71 (±0.47) cm, 4.63 (±0.33) cm, 3.75 (±0.31) cm and 70.54 (± 9.68) cm3. Conclusion: Normative values of uterine length, width and anteroposterior diameters of one-hundred non-pregnant women of northern India reported. Accurate measurement of uterine parameters is useful in timely management of various pathologies associated with abnormal size of uterus, infertility related procedures; such as in-vitro fertilization (IVF), embryo transfer (ET) and intrauterine device insertion.

Clinical Efficacy and Safety of Fertility-Preservative PUSH Surgery for Diffuse Adenomyosis: Evidence from a 11-Year Prospective Investigation

Background: Women with diffuse adenomyosis frequently have severe symptoms, including dysmenorrhea and infertility. Though it is beneficial for long-term health if the uterus can be preserved, there is no prospective investigations to assess lesion removal, symptom alleviation and even gestations after uterus-preservative surgery. Methods: We applied self-optimized PUSH surgery for 146 patients with diffuse adenomyosis and conducted 2 to 11-year follow-up for 114 patients. We detailed procedures in uterine incision , excision of the lesion, uterus reconstruction, solutions for removing giant lesions, and assessed the clinical efficacy and fertility in follow-up. Findings: The average size and volume of the patients’ uterus decreased significantly after PUSH surgery. Operation-related complications occurred in 2.7% (4/146) of the patients. Among 114 patients who had been investigated for ≥2 years, 107 (93.9%, analytic group) had detailed records that was needed to evaluate the long-term outcomes. In analytic group, 5 cases recurred and 95.3% (102/107) of the patients had normal uterine size two years after surgery. The visual analogue scale (VAS) for dysmenorrhea significantly decreased in 102 cases, from 9.35±1.25 to 0.34±0.76 and 0.56±1.06 in the first and second year after surgery, respectively. Additionally, 97.7% of the 86 patients with severe menorrhagia had their symptoms ameliorated in the second year of follow-up. Of the 23 patients who desired for pregnancy and stopped contraception for ≥2 years, 13 (13/23,57%) individuals conceived with17 pregnancies. Twelve patients had 15 intrauterine pregnancies and 7 patients had 8 living fetus. No uterine rupture or severe complications were found in all gestations. Interpretation: This study demonstrate good performance of PUSH surgery in removing uterine lesions, ameliorating menorrhagia and preserving fertility for women with diffuse adenomyosis. Funding: Shenzhen High-level Hospital Construction Fund(YBH2019-260)，Shenzhen Key Medical Discipline Construction Fund(No.SZXK027), Sanming Project of Medicine in Shenzhen(No.SZSM202011016), Scientific Research Foundation of PEKING UNIVERSITY SHENZHEN HOSPITAL(No.KYQD2021075). Declaration of Interest: The authors declare that they have no competing interests. Ethical Approval: The research protocol was approved by the Ethics Committee of Peking University Shenzhen Hospital (IRB approval number: 20190729).

Minimizing abdominal incision for transverse uterine fundal incision by aspiration of amniotic fluid and reduction of uterine size.

Transverse uterine fundal incision (TUFI) was developed to avoid catastrophic hemorrhage associated with cesarean section of the placenta previa-accreta. Abdominal incisions extend as far as the upper abdomen in patients in the third trimester of pregnancy and require general anesthesia. Instead, we tried to aspirate amniotic fluid (AF) to reduce the uterine size. TUFI was performed in 19 of our patients in the third trimester in whom placenta previa accreta could not be ruled out between June 2012 and August 2016. After the lower abdominal vertical incision, we attempted to exteriorize the uterine fundus. If this was impossible, we inserted an 18-gauge spinal needle into the amniotic space. We aspirated AF until the uterine fundus could be exteriorized. We exteriorized the uterine fundus without extending the incision to the upper abdomen by aspirating 250-670 mL of AF in 12 patients who were between the 33rd and 37th week of pregnancy, and TUFI was performed under spinal anesthesia. AF aspiration was not required in four patients who were in the 30th or 31st week of pregnancy and in two patients with oligohydramnios in the 35th week of pregnancy. In one case, the trial was canceled due to hemorrhagic AF aspiration. No serious complications were observed in mothers or neonates. TUFI could be made by abdominal incision to the left of the umbilicus under spinal anesthesia without anesthesia by reducing the uterine size through AF aspiration, even for patients in the third trimester of pregnancy.

Comparative study of non-decent vaginal hysterectomy with abdominal hysterectomy

Introduction: Hysterectomies are carried out to treat many uterine conditions, and are performed by two principal routes i.e. abdominal and vaginal. However even after many studies, the best route of performing hysterectomy is not clear. Aim: To compare the complications of vaginal and abdominal hysterectomies in treating non-prolapsed cases with good uterine mobility and uterine size less than 12 weeks. Materials and Methods: We carried a prospective, randomized controlled trial on 80 patients requiring hysterectomy for benign diseases at ESI College, Sanathnagar, Hyderabad, Telangana State from May 2016 to September 2017. The sample was categorized into Group A (n=40) in whom non descent vaginal hysterectomy and Group B (n=40) in whom abdominal hysterectomy was performed. The primary outcome measures compared were time of operation, blood loss, post-operative pain, duration in hospital, febrile morbidity and postoperative systemic infections. Results: We found comparable baseline features in both the groups. Mean time of operation, blood loss intra-operatively, was more in Group B (69.82 ± 8.15 minutes, 235 ± 46.89 ml) when compared to Group A (48.36 ± 1.47 minutes, 115 ± 41.35 ml) respectively. Non descent vaginal hysterectomy group showed faster recovery, shorter hospital stay, lesser operative and postoperative morbidity compared to abdominal route. Conclusion: In patients requiring hysterectomy for benign non prolapsed cases, vaginal route may be preferred as it is less invasive, with minimal or no complications, more economical and effective. Keywords: Abdominal hysterectomy, Gynaecology, Intra-operative complications, Non descent vaginal hysterectomy, Postoperative outcome.

Hysterosalpingography Findings and Jimah Ratio of the Uterine Cavity in Women with Infertility in Central Region, Ghana.

Background Infertility affects from 1.3% to 25.7% of couples worldwide and, especially, from 14.5% to 16.4% in Africa. Hysterosalpingography (HSG) is a diagnostic modality that is considered both common and efficient. It is used to investigate abnormalities of the uterine cavity and fallopian tubes. This study assessed the spectrum of findings on HSG among women with infertility in the Central Region (Ghana). Methods We conducted a prospective cross-sectional study to examine 203 infertile women undergoing HSG work-up at the Cape Coast Teaching Hospital. The exclusion criteria were acute infection of the vagina or cervix and active vaginal bleeding or pregnancy. Data were entered with Microsoft Excel and analyzed using SPSS version 21. Results A total of 203 women were enrolled, and eighty-five (41.87%) of the women had at least one or more abnormalities. The mean age was 32.9 years with majority of the women within 30–39 years (61.08%). More than half (50.74%) of the women presented with secondary infertility, while age of women (p=0.004) and duration of infertility (0.034) were found to be in association with the type of infertility. Uterine findings were predominantly capacious uterine cavity (45.1%) and uterine fibroids (33.3%), while fallopian tube findings included bilateral blockage (24.2%), right unilateral proximal blockage (17.7%), loculated spillage (16.1%), and left unilateral proximal blockage (16.1%). The range of normal uterine cavity size, measured as ratio (Jimah ratio) of intercornual diameter to interiliac diameter was 0.2–0.45, with a mean of 0.36. Conclusion Secondary infertility was the commonest indication for HSG in the study, and a significant proportion of infertile women had abnormalities. Abnormalities were higher in the fallopian tubes than the uterus, while capacious uterine cavity, uterine fibroid, and bilaterally blocked tubes were the top three abnormalities found.

PENYULUHAN DAN SOSIALISASI DIASTASIS RECTI ABDOMINIS DI POSYANDU DAHLIA 4 DESA LEWO BARU MALANGBONG GARUT

The incidence of diastasis recti abdominis is reported to be higher during the third trimester of pregnancy and immediately after delivery. International literature shows the prevalence value of diastasis recti abdominis is between 35%-100%. Most women with positive diastasis recti abdominis aged between 26-35 years. The risk factors for diastasis recti abdominis are hormonal changes in pregnancy, increased uterine size, anterior pelvis with or without lumbar hyperlordosis, increased intra-abdominal cesarean section, multiple pregnancies, fetal macrosomia, and genetic defects in collagen structure including congenital disproportion of the collagen ratio III. or I, substantial loss of body mass spontaneously or after bariatric surgery, abdominal surgical procedures.

The application of ultrasonography to select tactics for treatment of women of reproductive age with uterine leiomyoma

Objective. To study the condition of the pelvic organs in women of reproductive age with uterine leiomyoma UL, depending on the type of treatment based on ultrasonographic monitoring.Materials and methods. 299 women of reproductive age were examined. Patients were divided into 3 groups: 1 group consisted of 159 women with uterine leiomyoma (UL) who underwent surgical treatment, 2 group – 120 women with UL who underwent conservative treatment, 3 control group consisted of 20 healthy women of reproductive age. In order to obtain the most complete information about the size of the uterus, the structure and topography of myomas, the features of their vascularization, patients underwent ultrasound before and 3 months after treatment.Results. Ultrasound examination of the average parameters of the uterine body in the main groups showed an excess of these indicators relative to the control group (3.2 times in group 1 and 1.3 times in group 2). Uterine volume was greater in women of group 1 compared with women of groups 2 and 3 (p &lt;0.05). In most cases, in 139 (49.0%) women of the main groups, the localization of fibroids was intramural with central growth, without changing the configuration of the uterus from the outside and was not deformed cavity. Whereas, intramural nodes with centripetal growth deformed the uterine cavity in 39 (14.0%) cases, and centrifugal - in 100 (36.0%) subjects - its contour. Mixed and central types of angioarchitectonics were characteristic of women with the largest uterine sizes. In dynamic ultrasound examination in women after conservative myomectomy who did not receive hormone therapy, the level of myometrial perfusion was higher than in those who received gonadotropin-releasing hormones before and after treatment, which may be more prognostically favorable for UL recurrence. Women in group 2 after receiving conservative treatment had a positive tendency to reduce the volume of the uterus and fibroids.Conclusions. Ultrasound diagnostics can be considered a highly informative, non-invasive method that helps to identify the presence, location, structure, size of the myoma, the presence of concomitant pathology of the pelvic organs, as well as in addition to Doppler color flow mapping and pulsed Doppler blood allows us to detect the presence of tumor blood circulation. Echographic and Doppler evaluation of uterine leiomyoma with peculiarities of vascularization in the diagnostic algorithm helps to differentiate the choice of the method of treatment (conservative or surgical).

Which imaging method is better for the differentiation of adenomyosis and uterine fibroids?

ObjectiveThe paper compares shear wave elastography (SWE), strain elastography (SE) and magnetic resonance imaging apparent diffusion coefficient (MRI ADC) values, to evaluate their efficacy for differentiating between adenomyosis (AM) and uterine fibroids (UF). MethodsPatients who were scheduled for hysterectomy for AM or UFs, with a preliminary diagnosis, were additionally evaluated before surgery by transabdominal and transvaginal ultrasound elastography. SE of patients were evaluated by transvaginal ultrasound, and SWE of patients and control subjects were evaluated by transabdominal ultrasound. Then, the patients with a definitive histopathological diagnosis as AM or UFs were evaluated retrospectively and compared to the control group without myometrial pathology. In addition, MRI images of patients with UFs and AM were examined for ADC values. ResultsThe results of 98 patients in the UF group, 37 patients in the AM group, and 40 volunteers with a healthy myometrium in the control group were compared. There were no statistically significant differences in age and body mass index between the groups (P > 0.05). Uterine size was significantly higher in the UF and AM group than the control group (P < 0.001). A statistically significant difference was found between strain ratio (mean), strain ratio (max), and ADC values between the UF and AM groups (P < 0.001 for all three). There was a statistically significant difference in elastography scores distribution between the groups (P < 0.001). There was a statistically significant difference between the UF and control (P < 0.001) and between the UF and AM (P < 0.001) groups in terms of SWE (kilopascal (kPa)) averages (P < 0.001). We found that none of these discrimination methods were statistically superior to each other in differentiating the UFs from the AM. ConclusionIn the differentiation of myometrial pathologies in gynecological imaging, both SE and SWE are cheaper, provide faster results, are non-invasive and easy to apply, and hence are as promising as the more expensive MRI ADC. Our study is the first to use both modalities of elastography and MRI ADC values together, compare these methods with each other and confirm the results pathologically.

PEMERIKSAAN MRI PELVIS WANITA DENGAN KLINIS ENDOMETRIOSIS

Introduction: The pelvic anatomy is an ideal part of using Magnetic Resonance Imaging (MRI) as it is particularly suitable for detecting abnormalities in soft tissues. Endometriosis is a disease that is 10% suffered by women in the premenopausal or reproductive period, in which a tissue that resembles endometrium outside the uterus is purely a chronic inflammatory action.&#x0D; Materials and Methods: This research is descriptive qualitative with case study approach. MRI Pelvic Women Examination with clinical Endometriosis using protocol sequences: T2 TSE and T1 SPAIR sagittal planes; T2 TSE long axis (LAX) and short axis (SAX); T1 TSE; T1 FLAIR, T1 TSE FS, EP2D Diffusion axial planes; as well as the T2 Haste FS of coronal planes thick slice and T2 Spc3D sequences.&#x0D; Results and Discussion: In the outcome of the images seen cyst endometriosis in the right-left ovarium, hypointense on T2 and hyperintense on T1 and T1 FS. Enlarged uterine size. Seen multiple cysts of hypointense posterior uterine lesions in sequence T2 and hyperintens in sequence T1 SPAIR.Conclusions: MRI Pelvic Women Examination have a good role to diagnose the pathologies of female genetic organs and the anatomy between organs can be clearly distinguished by the giving of vaginal and rectum ultrasound jelly, and full bladder.

A Case Series of Patients with Large Uterine Fibroids and Venous Thromboembolisms

The purpose of this case series is to identify the clinical characteristics of women with uterine fibroids who developed venous thromboembolisms (VTE) and possible risk factors for the development of VTE in this group. We conducted a systematic search of the Medline, Embase, Cochrane and Scopus databases to retrieve case reports and case series that describe women with an enlarged uterus and VTE. The databases were searched up to August 2019. A total of 1485 articles were identified by a librarian. All case series and case reports that reported uterine weight and size of the fibroids were included. A total of 27 articles were included, describing 35 patients who developed VTE in the presence of uterine fibroids. On average, the uterus measured 22.9 ± 5.0 weeks gestational age and occupied a volume of 2715 cm3 (interquartile range 1296.3-3878.8) on imaging. Two-thirds (60%) of VTEs occurred on the left side, and 87% showed signs of venous compression on imaging. Most patients (89%) required surgical management to relieve the compression caused by the enlarged uterus. VTE in cases of large uterine leiomyomas can be associated with mechanical compression, which requires surgical management to relieve compression. There is an obvious increased risk of VTE in patients with venous stasis secondary to uterine compression; however, there is no current evidence evaluating the use of anticoagulation in such patients. Further research is required to determine the role of prophylactic anticoagulation in reducing the risk of VTE in high-risk patients with large uterine fibroids.

Efficacy of the levonorgestrel-releasing intrauterine device is associated with different subtypes of adenomyosis: a retrospective study.

BackgroundAlthough the levonorgestrel-releasing intrauterine device (LNG-IUD) has been widely applied in the treatment of adenomyosis, not all the patients are satisfied with its efficacy. The present retrospective study aimed to investigate the efficacy of LNG-IUD on different subtypes of adenomyosis.MethodsThe study comprised a cohort of 207 patients who received the LNG-IUD at the Women’s Hospital, Zhejiang University School of Medicine, China, from June 2013 to June 2016. Different subtypes of adenomyosis were classified by magnetic resonance imaging (MRI) and patients were subcategorized into three groups (subtype I: intrinsic, n=70; subtype II: extrinsic, n=73; subtype IV: indeterminate, n=64). Multiple variables were compared among the different groups.ResultsPatient demographics, clinical features and the treatment effects of the LNG-IUD were compared between the three subtype groups. The numeric rating scale (NRS) and pictorial blood loss assessment chart (PBAC) score markedly decreased after insertion of the LNG-IUD compared with baseline in all patients in the three subtype groups (P<0.001 for all groups). Compared to the other two subtypes, the efficacy rate was lower and the spontaneous expulsion rate was higher in subtype IV adenomyosis patients than that in other two groups (P<0.05). The independent factor associated with the spontaneous expulsion of the system was suggested to be uterine size before IUD placement and bleeding amount after LNG-IUD treatment in the subtype I [P=0.029, hazards ratio (HR): 3.37, 95% confidence interval (CI): 1.09–6.88] and IV (P=0.045, HR: 1.02, 95% CI: 1.01–1.21) adenomyosis patients respectively.ConclusionsThe LNG-IUD is proved to be an effective approach to treat subtype I and II adenomyosis. However, further study is warranted to explore a more suitable protocol to treat this subtype IV adenomyosis due to the high incidence of treatment failure and expulsion.