Wall Of Uterus Research Articles

Clinical practice guidelines for endometriosis in Japan (The 3rd edition).

Clinical practice guidelines for endometriosis in Japan (The 3rd edition).

Nanotechnologies in Obstetrics and Cancer during Pregnancy: A Narrative Review.

Nanotechnology, the art of engineering structures on a molecular level, offers the opportunity to implement new strategies for the diagnosis and management of pregnancy-related disorders. This review aims to summarize the current state of nanotechnology in obstetrics and cancer in pregnancy, focusing on existing and potential applications, and provides insights on safety and future directions. A systematic and comprehensive literature assessment was performed, querying the following databases: PubMed/Medline, Scopus, and Endbase. The databases were searched from their inception to 22 March 2022. Five independent reviewers screened the items and extracted those which were more pertinent within the scope of this review. Although nanotechnology has been on the bench for many years, most of the studies in obstetrics are preclinical. Ongoing research spans from the development of diagnostic tools, including optimized strategies to selectively confine contrast agents in the maternal bloodstream and approaches to improve diagnostics tests to be used in obstetrics, to the synthesis of innovative delivery nanosystems for therapeutic interventions. Using nanotechnology to achieve spatial and temporal control over the delivery of therapeutic agents (e.g., commonly used drugs, more recently defined formulations, or gene therapy-based approaches) offers significant advantages, including the possibility to target specific cells/tissues of interest (e.g., the maternal bloodstream, uterus wall, or fetal compartment). This characteristic of nanotechnology-driven therapy reduces side effects and the amount of therapeutic agent used. However, nanotoxicology appears to be a significant obstacle to adopting these technologies in clinical therapeutic praxis. Further research is needed in order to improve these techniques, as they have tremendous potential to improve the accuracy of the tests applied in clinical praxis. This review showed the increasing interest in nanotechnology applications in obstetrics disorders and pregnancy-related pathologies to improve the diagnostic algorithms, monitor pregnancy-related diseases, and implement new treatment strategies.

Clinical and morphological features of the cesarean scar pregnancy

The features of timely diagnosis and possible risks of the cesarean scar pregnancy are demonstrated on the example of a clinical case. This article presents analysis of pregnancy and childbirth of patient Sh., who was in the Obstetrics Department of the Kyiv City Maternity Hospital No. 1, as well as the results of a detailed morphological study of tissue characteristics during pregnancy in the scar on the uterus.A complete presentation of the chorion with localization in the area of the postoperative scar and a defect in the uterine wall was established at the first and second ultrasound screening. The woman was informed about pregnancy risks, but she insisted on prolonging the pregnancy. A planned surgical intervention was performed in the period of 36–37 weeks. A bottom caesarean section was performed and a girl weighing 3610 g, height 55 cm was removed. Intraoperatively confirmed deformation with a defect of the front uterus wall in the area of a postoperative scar measuring 10 × 12 cm, filled with placental tissue in the form of aneurysmal altered vessels. It was confirmed that placenta grew into the wall of the uterus over the entire area of its location, which occupied the entire lower segment on the entire circumference of the uterine body. At the same time, a significant deformation of the front and back walls of the uterus was noted. Morphological examination revealed hypoxic degenerative changes in the placenta, from the side of the parietal plate, with sclerosis, hyalinosis and deposition of fibrinoid in the villi, as well as the presence of hemorrhages, petrifications and the formation of conglomerates and bridges between them.Conclusions. It was founded the leading role in the mechanism of formation of atypical localization of pregnancy in the area of the scar after previous cesarean section was altered uterus tissue, where implantation occurred. There is a high probability of transition from ectopic pregnancy to scarring from liquid forms of ectopic pregnancy in the category of more frequent pathologies due to the increase in the frequency of cesarean sections.

Caesarean Section of a Dog Using Propofol and Isoflurane to Achieve Anesthesia: A Case Report

A pregnant German Shepherd bitch was brought to the University of Nairobi Veterinary Teaching Hospital with a history of prolonged gestation period. On radiography, I found an oversized puppy in the abdomen. Cesarean section to deliver the puppy was recommended as the bitch could not deliver the puppy per-vaginally. Surgery was done under general anesthesia using 1% propofol at 5mg/kg body weight and 2.5% isoflurane for maintenance. One oversized puppy was removed but died soon after delivery. Also removed was another small, mummified puppy. Following the delivery of the puppies, closure of the uterus and abdominal wall incisions was done routinely. In conclusion, this was a case of dystocia where the bitch could not normally deliver due to an oversized puppy, and a cesarean section was deemed the most appropriate management method. The anesthesia protocol used in this case has been proven to be ideal for use in cases of canine cesarean section. In this case, the puppy that died soon after delivery could have been caused by asphyxia (fetal hypoxia) caused by inhalation of fetal fluids occurring due to delayed delivery.

Efficacy of the Mercedes-Benz closure technique for vaginal reconstruction in female robot-assisted radical cystectomy.

Vaginal reconstruction using the posterior vaginal wall is required following radical cystectomy in women with resection of the uterus, adnexa, and anterior vaginal wall. Roll closure and clamshell closure are two widely known techniques. Of these, clamshell closure is recommended because roll closure has a high likelihood of breakdown or a resultant canal that is too narrow for sexual intercourse. In clamshell closure, however, folding the posterior vaginal wall anteriorly can be difficult. Therefore, we devised Mercedes-Benz closure, in which the vaginal wall is sutured from three directions to form a Mercedes-Benz shape, for anastomosis without tension on the vaginal wall. The present study was performed to investigate the efficacy of this alternative surgical technique for vaginal reconstruction. Twenty-six patients who underwent vaginal reconstruction following robot-assisted radical cystectomy were divided into two groups: 15 underwent clamshell closure and 11 underwent Mercedes-Benz closure. The patients' characteristics and surgical outcomes were compared between the two groups. There were no significant differences in clinical characteristics, including age, body mass index, and prior abdominal surgery between the two groups. The median vaginal reconstruction time tended to be longer in the Mercedes-Benz closure group than in the clamshell closure group (35.0 vs. 27.0 min, p=0.102). No complications associated with vaginal reconstruction were identified. The surgical outcomes were comparable between Mercedes-Benz closure and clamshell closure. If vaginal reconstruction with clamshell closure is difficult, Mercedes-Benz closure is a valuable alternative technique.

Effect of menstrual cycle on outer hair cells (OHC’s) and efferent auditory pathway in females – An Indian study

Menstrual cycle occurs in females every months for ones where the endometrium which is the thick lining of the uterus wall where the fertilized egg is attached during pregnancy, this will shed every month. Sodium, chloride, and water reabsorption capacity increases by high-level progesterone during this period. When there is a change in water and sodium reabsorption which may in term affect the functioning of the auditory system especially peripheral auditory system. Otoacoustic emissions (OAE’s) arise from outer hair cells (OHC’s) which is situated on the basilar membrane that is seen inside the inner ear. The changes in the hormonal levels during the menstrual cycle has a clinically less significant effect on the suppression of TEOAE’s, one of the type of OAE. The current study targeted the testing during three different phases of the menstrual cycle (Day 1 to Day 28) - Follicular phase, Ovulation phase and Luteal phase. The amount of suppression (3dB) caused during different phases of the menstrual cycle for each individual frequencies was compared and analyzed. The study shows that TEOAE, CSTEOAE’s and suppression did not exhibit any statistically significant differences at all the frequencies between the different phases of the menstrual cycle. There are no significant correlation findings between menstrual cycle and outer hair cell function, and menstrual cycle and efferent auditory pathway functioning, considering the complaints of hearing and balance problem during the menstrual cycle period by.

Phase I Clinical Trial Using [99mTc]Tc-1-thio-D-glucose for Diagnosis of Lymphoma Patients

Similar to [18F]-FDG, [99mTc]Tc-1-thio-D-glucose ([99mTc]Tc-TG) also binds to GLUT receptors. The aim of this Phase I study was to evaluate the safety, biodistribution and dosimetry of [99mTc]Tc-TG. Twelve lymphoma patients were injected with 729 ± 102 MBq [99mTc]Tc-TG. Whole-body planar imaging was performed in 10 patients at 2, 4, 6 and 24 h after injection. In all 12 patients, SPECT/CT (at 2 h) and SPECT (at 4 and 6 h) imaging was performed. Vital signs and possible side effects were monitored during imaging and up to 7 days after injection. [99mTc]Tc-TG injections were well-tolerated and no side effects or alterations in blood and urine analyses data were observed. The highest absorbed dose was in the kidneys and urinary bladder wall, followed by the adrenals, prostate, bone marrow, lungs, myocardium, ovaries, uterus, liver and gall bladder wall. [99mTc]Tc-TG SPECT/CT revealed foci of high activity uptake in the lymph nodes of all nine patients with known nodal lesions. Extranodal lesions were detected in all nine cases. In one patient, a lesion in the humerus head, which was not detected by CT, was visualized using [99mTc]Tc-TG. Potentially, [99mTc]Tc-TG can be considered as an additional diagnostic method for imaging GLUT receptors in lymphoma patients.

Prevalence, Predictors, and Oncologic Outcomes of Pelvic Organ Involvement in Women Undergoing Radical Cystectomy.

In women, radical cystectomy includes removal of the bladder, uterus, fallopian tubes, ovaries, and anterior vaginal wall, yet contiguous extension of urothelial carcinoma to all pelvic organs is rare and routine removal may be unnecessary. To study pelvic organ involvement in women at radical cystectomy and investigate oncologic outcomes. Women with bladder cancer who underwent radical cystectomy at the Mayo Clinic and University of Toronto (1980-2018) were evaluated. Cancer-specific survival (CSS) was estimated with the Kaplan-Meier method; comparisons were made with the log-rank test. Associations with CSS were evaluated with Cox proportional hazard modeling. A total of 70 women with pT4a and 83 with pT3b cancer were studied. Organs involved were vagina (n = 41 of 70; 58.6%), uterus (n = 26 of 54; 48.1%), cervix (n = 15 of 54; 27.8%), fallopian tubes (n = 10 of 58; 17.2%), and ovaries (n = 7 of 58; 12.1%); 22 of 58 patients (37.9%) had >1 organ involved. Of 70 with pT4a cancer, 64 were available for survival analysis by 3 pelvic organ groups: vaginal only, vaginal and/or cervical/uterine, and vaginal and/or cervical/uterine and/or fallopian tubes/ovarian involvement. Three-year CSS for vaginal involvement only was 39%; it was 14% if cervical/uterine involvement, and <1% if fallopian tube/ovarian involvement was included (P = .02). Among 20 women with pT4aN0/Nx and vaginal involvement only, 3-year CSS for vaginal involvement was 50%, whereas among 48 women with pT3bN0/Nx cancer, 3-year CSS was 58%, P = .70. Isolated vaginal involvement should be separated from uterine and/or adnexal extension of urothelial carcinoma at pathologic staging. Direct ovarian extension is rare and routine removal may be unnecessary.

A Preliminary Exploration Using Imaging Methods to Predict the Possibility of the Recurrence of Serous Ovarian Cancer in Patients Undergoing Total Resection.

BackgroundThe purpose of our research was to explore the value of preoperative CT and MRI examinations and clinical indicators in the prediction of recurrence of ovarian serous carcinoma in patients who underwent satisfactory staging surgery.ProcedureDetailed inclusion and exclusion criteria were installed to screen all patients collected and the eligible patients were divided into two groups. The CT and MRI features and some clinical characteristics of two groups were analyzed, in addition, the apparent diffusion coefficient (ADC) value in tumor solid region was measured. Univariate analysis was used in this study.ResultsThere were 78 patients with histologically proven ovarian serous carcinoma. According to the strict inclusion and exclusion criteria, we retained 29 patients (recurrence group: 11 patients, no recurrence group: 18 patients). For the peritoneal implantation metastasis in CT or MRI images and Ki67 proliferation index (Ki67 PI), the differences between two cohorts were statistically significant (P < 0.05). The rate of peritoneal metastasis in the recurrence cohort (10/11, 91%) was higher than that in the no recurrence cohort (7/18, 39%). Patients with high Ki67 PI expression had lower recurrence risk than those with low Ki67 PI expression, HR=0.172 (95%CI: 0.050-0.589, P=0.005), and patients without peritoneal planting had lower recurrence risk than those with it, HR=9.373 (95%CI: 1.194-73.551, P=0.033). For FIGO III patients, ipsilateral fallopian tube involvement was statistically significant between the two groups (P < 0.05). The differences in the other preoperative imaging characteristics of ovarian serous cancer, including the volume; capsule of the mass; main components; ADC value; cystic change; bleeding; degree of enhancement of the mainly solid region in 3 periods; and range of tumor involvement in the ovary, uterus, bladder, bowel, and pelvic wall, were not statistically significant. In addition, the differences in the other clinical indicators (i.e., age, FIGO stage) between the two cohorts were not statistically significant.ConclusionsIn CT and MRI examinations before surgery, peritoneal implantation metastasis was suggestive of the possibility of the recurrence of serous ovarian carcinoma in the near future. In addition to that, ipsilateral fallopian tube involvement and Ki67 PI may also indicate the possibility of recurrence (the former was only applicable to FIGO III patients).

Spontaneous Rupture of an Unscarred Uterus in the Second Stage of Labour: A Case Report and Review of Literature

Background: Uterine rupture is a rare, but severe pregnancy complication. It is mostly associated with history of uterine surgery, especially previous cesarean section but can rarely occur in unscarred uterus. Diagnosing this condition in the absence of uterine scar requires a high degree of suspicion and fetal heart tracing abnormalities remain the most common symptom. Case Report: 21-year-old G2P1 was admitted in latent labour. Pitocin was used for augmentation. Fetal heart tracing was in category 1 except an episode of bradycardia accompanied by uterine tachysystole that was resolved by resuscitative measures and turning off Pitocin. Later in the labour course, the FHT showed recurrent late and variable decelerations, cervix was found to be fully dilated at the time. Pushing was started and following a prolong deceleration, cesarean section was performed that showed a uterine rupture in the posterior wall of uterus. Conclusion: Although rare, uterine rupture should be considered as a diagnosis even in the absence of uterine scar as the main risk factor.

VCA in the Era of the COVID-19 Pandemic.

VCA in the Era of the COVID-19 Pandemic.

Comparison of Pain Scale, Hemodynamics, and Side Effects of Percutaneous and Intravenous Fentanyl in Post Sectio Caesaria Patients at Bunda Hospital

This is novel research about comparison pain scale, hemodynamics, and side effects of percutaneous and intravenous fentanyl in post sectio cesarean patients. Sectio cesarean is a method of delivering a fetus through an incision in the abdominal wall (laparotomy) and the uterus wall. This method induces pain in the incision, so patients feel complicated or afraid to mobilize. Fentanyl is one of the opioid analgesics, which is the main choice in section caesarian surgery because safe for breastfeeding, is more potent than morphine, and acts as balanced anesthesia—comparing the use of percutaneous fentanyl with intravenous fentanyl with pain scale parameters, hemodynamics, and side effects in sectio caesarian patients at Bunda Mother and Child Hospital Jakarta. Before conducting this research, an observational study first makes an ethical approval. Data were taken prospectively and collected simultaneously to compare percutaneous and intravenous fentanyl performed on post sectio cesarean patients with the physical status of the American Society of Anesthesiologists (ASA) I–II at Bunda Mother and Child Hospital Jakarta from September to November 2020. Comparative data observed were pain scale parameters, hemodynamics, and side effects after percutaneous fentanyl therapy or intravenous fentanyl therapy. Data were processed using SPSS 22 version and Microsoft Excell 2016. In conclusion, intravenous fentanyl is more effective in reducing pain scale and has more minor side effects than percutaneous fentanyl. There is no significant difference in hemodynamic parameters (p-value &gt;0.05).

Pathological complete response after neoadjuvant chemotherapy with FOLFOX for locally advanced sigmoid colon cancer with diverticulitis: A case report

Introduction and importanceThe standard treatment for locally advanced colon cancer (LACC) without distant metastasis is curative surgery followed by adjuvant chemotherapy, but the long-term outcomes of this strategy are not satisfactory. Neoadjuvant chemotherapy (NAC) is a promising novel option to overcome this issue. Tumor regression is an expected effect of NAC for LACC, but pathological complete response (pCR) is rare. In this report, we present a rare case of pCR after NAC with FOLFOX for LACC in the sigmoid colon.Presentation of caseA 66-year-old woman presented to our hospital with fever and abdominal pain. The diagnosis was LACC in the sigmoid colon with possible invasion of the uterus and pelvic wall, stage IIIC (T4bN1bM0). Furthermore, the tumor was complicated by diverticulitis. A colostomy was performed, followed by NAC with FOLFOX. Six cycles were completed without significant adverse events, and the lesion shrunk remarkably. We performed a curative sigmoidectomy without any postoperative complications. Pathological examination revealed no viable cancer cells, indicating pCR.DiscussionTo the best of our knowledge, this is the first report of pCR after NAC for LACC complicated by diverticulitis. Colostomy before NAC, regimen, and cycle of NAC may be the key to this favorable course.ConclusionWe present a rare case of pathological complete after neoadjuvant chemotherapy with FOLFOX for locally advanced colon cancer in the sigmoid colon complicated by diverticulitis. Our experience may be valuable in determining the optimal treatment strategy for LACC complicated by diverticulitis.

Pathomorphological features of the uterus’ wall structure in case of fetuses with a gestational term of 37-40 weeks from mothers with a chronic infection of the lower genital tracts

In the following article we have provided a data towards a comprehensive research of the pathomorphological features of the uterus’ wall structure in case of fetuses from mothers with HILGT comparing to ones in case of fetuses from healthy mothers.&#x0D; The research methods: macroscopic, organometric, histological, immunohistochemical, morphometric, statistical.&#x0D; On the basis of the organometric research we have revealed a probable decrease of the weight, length and thickness indexes likewise one of the main components of the uterus wall in case of fetuses from mothers with a complicated pregnancy comparing to ones in case of fetuses from healthy mothers.&#x0D; By applying histological method we have revealed an increased growth of the connective tissue both in the endometrium and myometrium in case of fetuses from mothers with HILGT relatively to one in case of fetuses from mothers with a physiological pregnancy. Moreover, the massive growth of the collagen fibers leads to the disorder in the strucutral organization of the muscle component. The uterus’ endometrium in case of fetuses from the main group could be characterized by a few glands without features of the functional activity comparing to one in case of fetuses from the group of comparison. In the structure of the connective tissue in case of uterus of fetuses from mothers with a complicated pregnancy we have revealed mainly the collagen of the III type, while the collagen of the I type could be revealed in the form of small loci of reduced intensity of glow.&#x0D; By applying the immunohistochemical method we have revealed an increase of the apoptotic index in the endometrium of fetuses from mothers with a chronic infection of the lower genital tracts comparing to one in case of fetuses from healthy mothers. By applying MCAT to endotheline-1 we have revealed an increased glow of the endtheliocytes in the vessels both of arterial and venous types, in case of fetuses from the main group comparing to one in case of fetuses from the group of comparison. In the uterus of fetuses from mothers with HILGT we could observe a decreased hormon producing activity comparing to one in case of fetuses from mothers with a physiological pregnancy. All changes, that were revealed in the uterus of fetuses from mothers with an infectious pathlogy declare an existance of the severe disorder in the implementation and formation of main organ’s components, as well as are caused mainly by a chronic hypoxia as well as influence of the infectious agent. All pathomorphological features of the uterus wall structure in case of fetuses from mothers with HILGT, that were revealed, could contribute subsequently to the complications in the pregnancy’s onset as well as could lead to the disruption of one.

Case Report: Acute abdomen presentation revealing a metastatic invasive mole with uterine rupture

Gestational trophoblastic neoplasia refers to the aggressive subset of gestational trophoblastic disease, including invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. These tumors may have atypical clinical presentations that can mislead the diagnosis. The reported case is a 48-year-old woman in perimenopause, without any history of vaginal bleedings nor molar pregnancy, who presented to the Emergency Department with acute abdominal pain. Serum beta human chorionic gonadotropin (β-HCG) was highly elevated at 261 675.23 mIU/ml. A complicated invasive mole was suspected, and an abdominal computed tomography was performed, showing a moderate hemoperitoneum associated to complex cystic and solid uterine mass, with a common left iliac adenomegaly and multiple pulmonary nodules. MRI showed a multiloculated cystic uterine mass with zones of hemorrhage recalling an invasive mole with perforation of the posterior uterus wall, associated to a high abundance hemoperitoneum. The diagnosis of a metastatic invasive mole complicated of uterine rupture and hemoperitoneum was retained. A surgical intervention was decided immediately and a subtotal hysterectomy with bilateral annexectomy was done. Pathologic examination of the specimen was positive for an invasive mole. The patient was proposed for chemotherapy. This case study will increase awareness of unusual clinical presentations of gestational trophoblastic neoplasia We believe that our case will contribute to the literature not only because of the rarity of this entity in perimenopausal period, but also due the atypical clinical presentation as acute abdomen without vaginal bleeding nor history of molar pregnancy evacuation

Immunohistochemical features of the uterus structure in case of fetuses with a gestational term of 29-36 weeks from mothers with the chronic infection of the lower genital tracts

In the following article we present results of the research on the uterus’ wall structure in case of fetuses from mothers, whose pregnancy was complicated by the chronic infection of the lower genital tracts (HILGT), comparing to one in case of fetuses from healthy mothers. The main aim of our research was to disclose immunohistochemical features of the uterus’ wall sructure in case of fetuses with a gestational term of 29-36 weeks. The research methods: macroscopic, organometric, histological, immunohistochemical, morphometric, statistical. All fetuses have died intranatally as a result of an acute violation of utero-placental or placenta-fetal circulation.&#x0D; The organometric research has revealed a fact of decrease of the following indexes: namely, the ones of weight, length and thickness of the uterus’ wall in case of fetuses from mothers with a complicated pregnancy. Moreover, the decrease of the thickness’ index is primarily connected with a fact of thinning of the endometrium as a strucutral component of the wall. Staining by picrofuxin according to Van-Gieson has revealed an increase growth of the connective tissue both in endometrium and in myometrium of the uterus wall in case of fetuses from the main group. Moreover, in the muscular component, as a result of the aforementioned phenomenon, we can notice a violation or even in some places a complete lack of the structural organization of muscular fibers. The immunohistochemical research has revealed an increase of an apoptotic index in the endometrium of fetal organs of mothers with a compicated pregnancy comparing to indexes in case of fetuses from healthy mothers, which also contributes to the thinning of the layer as well as atrophic changes in it. In addition, in the strucutre of the connective tissue of the uterus of fetuses from the group of comparison the collagen of the I type prevails, while in case of fetuses from the main group the collagen of the III group prevails. Alongside with aforementioned features in case of fetuses from mothers with HILGT we can emphasize an increased glow of the endotheline-1 in vessels both of arterial and venous types.&#x0D; All changes in the connective tissue structure in the uterus of fetuses from mothers with a complicated pregnancy, that were described above, could contribute to the violation of the organ’s maturing as well as stabilization of its functional activity in the future life. The increased endotheline producing leads to the violaton of the blood supply, as well as could enhance collagenogenesis. The prevalence of the collagen of the III type in a structure of the connective tissue is a manifestation of the chronic hipoxia, under the condition of which the organogenesis of fetuses takes place in case of this pathology as well as leads to the violation of the spatial organization of the uterus’ main structural components. All features of the uterus wall structure in case of fetuses from mothers with HILGT, that have been established above, are prescribed by the chronic hipoxia and replication of the viral agents in the embryonic tissues as well as it could lead to make an implantation and pregnancy more difficult, likewise it could be a reason of development of pregnancy weakness in the following ontogenesis.

Laparoscopic Resection of Deep Infiltrative Endometriosis of the Bowel and Bladder

<h3>Study Objective</h3> To show a systematic approach to perform resection of deep infiltrating endometriosis of the bowel and bladder in the setting of posterior cul-de-sac obliteration and intentional cystotomy creation. <h3>Design</h3> Step-by-step video demonstration of the technique. <h3>Setting</h3> A university tertiary care hospital. <h3>Patients or Participants</h3> A 28-year-old gravida 0 with a history of several years of severe dysmenorrhea, pelvic pain, and dyspareunia. She had been managed with hormonal medical therapy and physical therapy with little improvement in her symptoms. Pelvic ultrasound and MRI was significant for 0.8 × 1 cm rectal nodule located between the posterior wall of the uterus and anterior wall of the rectum, suggestive of deep infiltrating endometriosis. <h3>Interventions</h3> Studies have shown that surgery can improve pain in the context of deep infiltrating endometriosis. Moreover, deep infiltrating endometriosis has been associated with infertility with retrospective and prospective nonrandomized studies showing that resection improves spontaneous conception rates. Laparoscopy with resection of deep infiltrating endometriosis is performed using a conservative fertility sparing endometriosis surgery with bowel discoid resection. Deep infiltrating endometriosis of the bladder is performed with repair of therapeutic cystotomy. <h3>Measurements and Main Results</h3> We describe three phases of deep endometriosis nodule excision. First, opening pelvic avascular spaces, restoring anatomy, and identifying important anatomical structures. Second, resection of deep infiltrative endometriosis lesions with relevant vital structures properly identified and lateralized. Third, ensure integrity of our repair and hemostasis. At postoperative follow up, the patient reported improvement in pain symptoms. She had no bowel or bladder dysfunction postoperatively. <h3>Conclusion</h3> Management of deep infiltrating endometriosis begins in the preoperative period and continues beyond the immediate postoperative period. Appropriate preoperative evaluation, systematic and skilled intra-operative surgical technique, and appropriate postoperative follow up are important steps necessary to perform safe and effective fertility sparing endometriosis surgery.

Flexible fetoscope in the treatment of twin-to-twin transfusion syndrome.

Twin-to-twin transfusion syndrome (TTTS) could be treated with fetoscopic laser photocoagulation. For patients with placenta located on the anterior wall of uterus, surgical procedures are difficult. To solve this problem, a flexible fetoscope was designed in our department. The flexible fetoscope was made up of polyurethane, fiberglass and stainless steel coils. The specular body was soft and could bend encountering obstacles, which reduced the possibility of injury to the fetus and placenta. The distal tip of the body could curve from -180° to +270° with the control of the handweel. Three pregnant women of TTTS with anterior placenta was operated with this instrument. All pregnant women were treated smoothly and gave live twins birth at term. Through angiography, it was demonstrated that the vascular connections on the surface had been coagulated. The flexible fetoscope was a novel instrument in treating TTTS, especially for the anterior placenta.

Maternal death due to ruptured uterus consequent to abruptio placentae: 2 case reports

BackgroundAbruptio placentae is a complication of pregnancy that can lead to uterine rupture, increasing maternal and fetal mortality, especially when there is a lack of medical outreach in remote areas.Case presentationWe present two maternal deaths due to uterine rupture in a term pregnancy consequent to abruptio placentae. In one case, the uterus ruptured at the previous lower segment Caesarean section (LSCS) scar site and in another over the lateral wall of Couvelaire uterus. In both cases, the fetus was partially lying outside the uterus in the peritoneal cavity, and there was a massive retro-placental clot.ConclusionsEarly identification of high-risk factors, followed by institutional delivery, may reduce maternal and fetal mortality due to abruption followed by uterine rupture.

Bladder Bleeding Due to Placenta Percreta: Report of Four Cases and Management Discussion

Abstract Placenta percreta with bladder bleeding can occur during gestation or postpartum, posing a great threat to both mother and fetus. But it is rare and lacks standard management strategies. We reported four cases suffering from bladder bleeding caused by placenta percreta even with hemorrhagic shock admitted between January 1st, 2011 and December 31th, 2020 in The First Affiliated Hospital of Zhengzhou University. Clinical information, including age, gravidity and parity, ultrasound and magnetic resonance imaging manifestations, onset gestational age, bladder bleeding volume, clinical manifestations under bleeding, diagnosis, hemostatic methods, hospital stay, treatment cost, and prognosis, are presented. Two cases had bladder bleeding during the second trimester, respectively on the 22+3 and 23+5 weeks. Pregnancy was terminated timely. The other two cases had bladder bleeding on the 2nd day post near-term cesarean section when activity. All the four cases achieved successful hemostasis following angiography and concomitant embolization for iliac vessels, and one of them received electrocoagulation hemostasis under cystoscopy, but failed. They all had favorable clinical outcomes and had no long-term complications. The neonatal outcome in the two cases that bladder hemorrhage occurred after near-term c-section was good. The newborns did not survive in two cases in which bladder hemorrhage occurred at the second trimester of pregnancy. Timely termination of pregnancy is recommended when such a condition develops during gestation. Diagnosis of bladder bleeding is relatively easy, for it is characterized by fast speed and large volume, with concomitant distension of the lower abdomen, blood discharge from the urethral orifice, or the indwelling catheter. Interventional embolization is an effective means to treat bladder bleeding caused by placenta percreta, while electrocoagulation hemostasis under cystoscopy must be applied with great caution. For the pregnant women with a high risk of placenta percreta, timely and accurate diagnosis should be achieved during the gestational age, and bladder bleeding should be concerned when placenta penetrates through the anterior wall of uterus.