Search

A 34-year-old, gravida 6, para 2 woman had an uneventful prenatal course until 12 weeks of gestation, but she was diagnosed with a missed miscarriage at 15 weeks of gestation. After a dilation and ...

Acute inversion of the uterus is a rare but serious obstetrical complication, seen in the immediate postpartum period. It is defined as ‘the turning inside out of the uterine fundus into the uterine cavity’. Uterine inversion is associated with significantly high maternal morbidity and mortality. Women can sink into profound shock. Immediate diagnosis and management can reduce maternal mortality.

Objective. To assess the efficacy of a new suture technique in controlling severe resistant uterine atonic postpartum hemorrhage. Patients and Methods. This is a retrospective observational study that included thirteen women with uterine atony and postpartum bleeding that did not react to usual medical management. All these women underwent compressing vertical suture technique in which the anterior and posterior walls of the uterus were attached so as to compress the uterus. The suture is transfixed at the uterine fundus, thus eliminating the risk of sutures sliding off at the uterine fundus (safety pin suture). Results. safety pin uterine compression suture was a sufficient procedure to stop the bleeding immediately in 92.2% of the women. None of the women developed complications related to the procedure. Conclusion. A new safety pin suture is a simple and effective procedure to control bleeding in patients with treatment-resistant, life-threatening atonic postpartum hemorrhage with the advantage of eliminating the risk of the sutures sliding off at the uterine fundus.

This study assessed the clinical application of transvaginal three-dimensional ultrasound (3D TVUS) in the diagnosis of congenital uterine malformation. A retrospective study was performed on 62 patients with congenital uterine malformation confirmed hysteroscopically and/or laparoscopically. The patients were subjected to transvaginal two-dimensional ultrasound (2D TVUS) and 3D TVUS. The accuracy rate was compared between the two methods. The accuracy rate of 3D TVUS was (98.38%, 61/62), higher than that of 2D TVUS (80.65%, 50/62). 3D TVUS coronal plane imaging could demonstrate the internal shape of the endometrial cavity and the external contour of the uterine fundus. It allowed accurate measurement on the coronary plane, and could three-dimensionally show the image of cervical tube, thereby providing information for the diagnosis of some complex uterine malformation. 3D TVUS imaging can obtain comprehensive information of the uterus malformation, and it is superior to 2D TVUS for the diagnosis of congenital uterine malformations, especially complex uterine anomaly.

One of factor in the failure of the breastfeeding process is maternal anxiety. Anxiety during breastfeeding will block the letdown reflex so that milk production decreases. The Efforts to reduce gold can be done with endorphin massage. Other benefits of breastfeeding more often will accelerate uterine involution. The aim of the study was to analyze the effect of endorphin massage on anxiety and the process of involuntary uterine maternal uterine. This type of research is quasi-experimental with a pre-post test with control group design. The population is all normal postpartum mothers in District 1 and 2 District Health Centers in Grobogan District. The sample number of treatment group 13 and control group 13 was taken by simple random sampling. Data analysis with Independent t- test. For the control group, care was taken according to the standards in service, namely counseling for postpartum mothers on how to breastfeed, massage of uterine fundus. The results of the study before treatment most of the respondents experienced moderate anxiety (69%), and average fundal uteri height of 10.5 cm. The independent t test showed that there was an effect of endorphin massage on anxiety level (p value = 0.001) and there was no effect on uterine involution (p value = 0.302). Endorphin massage done by husbands to postpartum mothers contributes very well in reducing maternal anxiety, increasing self-confidence for the need to be socialized to the community, especially postpartum mothers and husbands to always be able to cooperate and support each other for the health and welfare of mothers and babies.

Background: Cystic degeneration of myomas is rare, accounting for only 4% of all cases of myoma degeneration. Case: A 42-year-old woman underwent the excision of a 18 × 10 × 9 cm completely cystic myoma, which weighed 1031 g and was attached to the uterine fundus. There was no significant myometrial invasion or solid component. Conclusions: This is the largest purely cystic myoma reported. It was removed intact without incident.

Intrauterine sonography (hysterosonography) is useful for visualising malignant processes in the myometrium. Since normally no sound-wave source is available for beaming the sound waves in strictly anterograde direction, the authors examined which sections of the fundus of the uterus cannot be assessed, and discussed the possibilities of reducing the area and also the importance of the inaccessible region. It was found that normally a satisfactory assessment would be possible in clinical routine even in the region of the fundus by the combined shifting of the geometrical axis of the sound waves and the use of transducers from which the sound waves emanate in anterograde direction at an angle of 135 degrees.

We read with interest the recent article “Alternate Sequential Suture Tightening: A Novel Technique for Uncontrolled Postpartum Hemorrhage” by Ghosh and Mala [1]. They developed a novel technique of uterine compression suture (UCS) for atonic bleeding where a Hayman suture [2] is performed, but importantly they sequentially tighten the knot, yielding “very tight” compression. In 92% (11/12) of their patients, the UCS alone stopped the bleeding. No patients had untoward sequelae. Their data is promising; however, we have two concerns. First, we wonder if such a tight knot is needed. In the Ghosh technique, the final knot was eventually tightened compared to the initial knot by as much as 3–5 cm, meaning tighter by 3–5 cm compared with an ordinary Hayman suture [2]. In our opinion, the Ghosh suture may be too tight and we wish to describe two supporting pieces of evidence. First, we usually use the Matsubara-Yano (MY) UCS in patients with atonic bleeding (Figure 1(a)) [3] and sometimes even cut the sutures because the knot looks “too tight.” We then reperform the MY UCS, making a looser knot. A knot that is too tight may lead to tissue damage caudal to the suture, that is, the lower uterine segment. This portion would become thin and weak, and a knot that is too tight would forcefully pull this portion in the cephalad direction, easily damaging this area (Figure 1(b)). We sometimes loosen the knot also for fear of possible subsequent uterine ischemia. After placing the UCS and closing the hysterotomy incision, it is our experience that the uterus becomes, more or less, contracted even in patients with an atonic uterus. Uterine contraction may make the knot even tighter. Second, we are concerned about Figure 1(d) in Ghosh and Mala's article [1]. The uterus looks ischemic in the area between two sutures even 1.5 years after the Ghosh UCS, possibly indicating that the suture significantly deprived blood flow to the uterus. Mowat et al. [4] reported a case of uterine necrosis after B-Lynch suture, describing, “there was central necrosis of the anterior body and fundus of the uterus between the two limbs of the B-Lynch suture”: this feature was similar to Ghosh and Mala's figure (Figure 1(d)) [1]. Figure 1 Schematic presentation of the Matsubara-Yano (MY) uterine compression suture (a) and possible drawbacks of the Ghosh suture (b, c). (a) The MY suture consists of two (or three) longitudinal transfixation sutures and two transverse sutures. Upper insets ... As described previously, generally speaking, compression force is related to the ability to induce hemostasis but is also related to adverse events associated with UCS [3]. A tight knot or tight suture, exerting excessive compression, naturally may lead to effective hemostasis at the time but may lead to uterine ischemia afterward, meaning that the hemostatic ability and occurrence of ischemia may have a “trade-off” relationship. Since the incidence rate of uterine ischemia is low [3, 4], the fact that it is not reported by Ghosh and Mala does not entirely rule out its occurrence. We proposed the concept of a removable UCS [5] that has been used clinically [6], removing the compression suture within two days postpartum. Strong compression of the uterus for up to two days postpartum and then removing the suture may be reasonable [5, 6]. Second, since the Ghosh technique is a modified Hayman suture [2], a drawback of Hayman suture [2] and B-Lynch suture [7] persists, that is, “the suture sliding out” (Figure 1(c)). We have previously pointed this out [3] and Hayman wrote, “the suture threatened to slide off the uterine fundus, like braces off a round shouldered man” [2]. This may occur more readily with a tight knot. When the uterus temporarily contracts and the knot becomes tighter, the possibility of “sliding out (off)” becomes higher; there may be no room for the suture other than “sliding out.” Sliding out of the suture makes compression insufficient. Figures 1(b) and 1(c) in Ghosh and Mala's article [1] lead us to consider this possibility. Obstetric practice has surely changed before and after the introduction of the UCS. We have now obtained a powerful tool, the UCS, against postpartum hemorrhage. Every effort should be made to make the UCS better and, thus, we applaud and respect Drs. Ghosh and Mala. The development of a number of UCS techniques shows that there may be no one best UCS. Further study of the UCS and wide discussion are needed.

[Purposes] Evidence-based medicine (EBM) is now the established standard for selecting appropriate treatment, the basic ideas of which cannot be ignored even in the field of Kampo medicines. With this in mind, we conducted a meta-analysis (MA) for those Kampo medicines which had been administered in randomized clinical trials, as a method of establishing the evidence for Kampo medicines, and then examined the resulting data obtained for the present study. Here, we focused on the assessing the usefulness in postpartum control, using Kyukichoketsuin (KCI), with methylergometrine maleate (MME) as control.[Methods] We searched and collected articles published before September 2004 in Igaku Chuo Zasshi (Japana Centra Revuno Medicina) and Medline using keywords such as “Kyukichoketsuin”, etc. First we selected target articles for analysis in accordance with our inclusion criteria and examined the quality of those articles using a score system adopted by Chalmers, in 1981. Then we extracted target data from the articles in accordance with meta-analytic methods, integrated the resulting data using the DerSimonian-Laird method, and implemented sensitivity analysis to them.[Results and Discussion] We selected four articles for our target analysis. All four were of similar quality. When we set post-labor pains as an assessment item, and integrated three of the four articles, KCI showed that it more significantly decreased those pains compared to MME, with an integrated odds ratio of 0.32 (95%CI, 0.17-0.60). The one remaining independent article, however, in which KCI exerted statistically significant effect in height of day-five uterine fundus, indicated no higher significance through integration with the first three articles. Also, even integrating the height of the uterine fundus shown in the articles, on day four as well as the height before integration, had no significance. These results indicate that the effect of KCI for the involution of the uterus may be the same as that of MME. Regarding the volume of breast-milk lactation on day four in comparison between two test drugs, some articles showed more volume in both the KCI and MME. groups, despite reaching no significant decreases in volume, with an integrated odds ratio of -8.20 (95%CI, -16.17--0.23). However, contrary to this, results for the integration of day-five breast-milk lactation volume showed an increase in the KCI group, although without reaching significant difference. Therefore, the effectiveness of KCI for breast-milk lactation could not be generally categorized as less than that of MME.[Conclusion] MA demonstrated that KCI was more effective in decreasing post-labor pains than was MME. We could not implement the comparable study in safety at this time. Therefore, further analysis on KCI including safety may be required to argue total effectiveness on postpartum control.

We report on a 50-year-old female patient affected by breast cancer and a tumorous lesion located in the subserosal and intramural part of the uterine fundus. It consisted of glandular and cystic forms lined with epithelium of the tubal type. We describe the clinical, macroscopic, and histological features of this rare non-neoplastic lesion, classified as florid endosalpingiosis (ES) and belonging to the spectrum of Müllerian lesions. The discussion focuses on its morphological characteristics, the differential diagnosis, and the potential reasons leading to its origin. To the best of our knowledge, this is the fifth case of florid ES of uterus reported in the English literature.

Maternal mortality in Indonesia is still quite high, one reason is postpartum hemorrhage. Efforts to prevent postpartum hemorrhage can be done with the administration of oxytocin. The hormone oxytocin plays a role in the process of return of the uterus to its original shape. Oxytocin is also working spur spending reflex ASI Let Down Reflex (LDR). To examine the effectiveness of massage to stimulate the hormone oxytocin in the mother postpartum primipara This quasi-experimental research designs, sampling techniques with simple random sampling of 60 people, 30 people in treatment group and 30 controls. The research instrument that is the observation sheet. The massage is done every day, from day 1 to day 14 post partum. TFU measurement observations, kind lochea, weight baby day 1, 4, 7, 10, 14. Statistical test with Mann Whitney. Massage to stimulate the oxytocin hormone has a high effectiveness against changes in the uterine fundus on the day 7 and 10 of 0.023 and 0.0001 (p

Background: Hysterectomy is the most common surgical procedure in gynecology, not only in cases of malignancies but also in many benign cases. Many uterine preservation techniques have been introduced as alternatives to hysterectomy. Objective: We aimed to propose a new uterine surgical procedure. In this paper, we compare the utility of this new technique to the limitations of current procedures. Methods: Uterine fundectomy may be considered as a subtotal hysterectomy. In this new technique, the uterine fundus including all pathologic tissue is cut as a reverse trapezoid by monopolar cautery. The upper side of the trapezoid, which includes the whole uterine fundus, is removed, but the fallopian tubes and cornual segment are preserved. A small uterine cavity remains, as well as the endometrial tissue lining it. Results: Patient recruitment for this study began in April 2017 and is expected to end approximately 12 months later. Assessment of the primary outcomes is expected to take place in April 2018. Conclusions: Uterine preservation is particularly critical in developing new surgical approaches that can lead to a positive impact on patient satisfaction. This protocol outlines the first attempt to prospectively test surgical fundectomy in candidates for hysterectomy for benign indications. [JMIR Res Protoc 2017;6(10):e150]

Objective: The aim of this study was to evaluate the effectiveness, side effects and acceptability of postplacental CuT-380A IUD insertion using new technique for suturing to uterine fundus during cesarean section (hang up technique). Method: Prospective cohort study of postplacental IUD CuT-380A insertion during cesarean delivery. Hang-up technique consists of performing a puncture in the center of the fundus wall using straight needle into the uterine cavity and subsequently using chromic catgut no. 1 to tie the IUD using anchor knot and hanging the IUD to the fundus. Our subjects were women who underwent caesarean delivery at dr. Kariadi Hospital between 1st June 2009 to 31st April 2011 and followed up at 12 months follow-up, one woman underwent IUD removal because of severe dysmenorrhea. No perforation or expulsion was reported. Conclusion: Immediate postplacental insertion of IUD CuT-380A using hang-up technique is safe and effective. Typical use effectiveness is high (Pearl Index 0.93) and there were no reported incidents of expulsion or perforation. Acceptance and continuation rate were high, 98.15% and 95.37% respectively. Keywords: anchor knots, cesarean section, hang-up IUD, postplacental IUD insertion

Adenomyosis is a common, non-neoplastic, chronic gynecologic disorder that is detected in 5% to 70% of hysterectomy specimens. It is characterized by the presence of ectopic endometrial glands and stroma within the myometrium, and it occurs mostly in late reproductive age women. Adenomyosis has a propensity to present in the uterine fundus and is rarely seen in the cervix. At present, the most reliable way to diagnose adenomyosis is by pathologic examination of the hysterectomy specimens. Herein, we report a case of infiltrating adenomyosis in the cervix with unusual clinical and pathologic findings.

Background. Uterine inversion is a rare, but life threatening, obstetrical emergency which occurs when the uterine fundus collapses into the endometrial cavity. Various conservative and surgical therapies have been outlined in the literature for the management of uterine inversions.Case. We present a case of a chronic, recurrent uterine inversion, which was diagnosed following spontaneous vaginal delivery and recurred seven weeks later. The uterine inversion was likely due to a leiomyoma. This late-presenting, chronic, recurring uterine inversion was treated with a vaginal hysterectomy.Conclusion. Uterine inversions can occur in both acute and chronic phases. Persistent vaginal bleeding with the appearance of a prolapsing fibroid should prompt further investigation for uterine inversion and may require surgical therapy. A vaginal hysterectomy may be an appropriate management option in select populations and may be considered in women who do not desire to maintain reproductive function.

Rare mullerian anomalies not falling in any present classification are sometimes reported. A 27-year‐old woman came to our hospital with history of secondary infertility. She was found to have a longitudinal vaginal septum, cervical duplication and two endometrial cavities, separated by a complete septum. Laparoscopic examination revealed a relatively intact uterine fundus with both patent fallopian tubes. Hysteroscopic exam confirmed the presence of double vagina and double cervix, as well as complete uterine septum. It was a rare variant of complete septate uterus with double cervix, which could be successfully treated by hysteroscopic operation. Diagnosis and management of this unusual Müllerian anomaly are discussed in the context of a literature review.

A 15-month-old boy was discovered to have internal female genitalia during an operation for bilateral inguinal hernia. The biopsies showed normal testicular tissue and the karyotyping result was 46XY, so the diagnosis of persistent mullerian duct syndrome (PMDS) was made. At the second operation, the uterine fundus and fallopian tubes were excised. Then, he underwent bilateral orchiopexy. We discuss a rare presentation of this disorder, its management, and genetic implications together with a review of the literature.

This study presents 8 patients who each had at least two previous cesarean sections and are experiencing unrelated symptoms but have identical findings in the form of cervical displacement anteriorly and an abnormally highly placed uterine fundus. Displacement is in the form a cervicofundal sign, presented by a Senior Author as a useful new clinical sign to warn the gynecologist or surgeon to take extra care. (J GYNECOL SURG 13:143, 1997)

Pedunculated subserous leiomyosarcoma is a quite rare presentation of leiomyosarcoma. As of 2013, only three cases have been reported in the literature. In this case report, we document two new cases of pedunculated subserous leiomyosarcoma from uterine fundus. These two cases illustrate the difficulty of making a correct differential diagnosis between a pedunculatedsubserous uterine leiomyosarcoma and a malignant ovarian tumor before intervention. A review of the literature confirms that this site remains unusual and making the diagnosis is difficult.

Objective: To acknowledge the rate of expulsion in post placental IUD CuT-380A insertion after vaginal delivery. Method: Postplacental IUD Cu T-380A insertion was performed at least 10 minutes after the placenta has been delivered by inserting IUD Cu T-380A in uterine cavity using index finger, and positioned the IUD in uterine cavity and pushed as high as possible directly to the uterine fundus. Then the IUD-endometrium distances were checked using transvaginal USG on the seventh and forty second day after IUD insertion. Result: From May and August 2012 has been done post placental IUD Cu T-380A set in 38 women, found that average of women age was ≥ 30 years old (34.21%), multi parities (63.16%), and gestation age for 37-42 weeks (100%). In this study found that three expulsion cases. Totally expulsion found in 2 cases, each found in days of 16 with averages distances of IUD and endometrium for 16.8 mm and in days of 19 with average distances of IUD-ED for 13.5 mm after IUD set. While partially expulsion found in 1 case, occurred in days of 11 after IUD set with average distance IUD-ED for 13.2 mm. Conclusion: IUD Cu T-380A set after vaginal delivery that observed for 42 days found that 3 (7.89%) peoples have expulsion. There is significant correlation the distance between IUD and ED in expulsion occurrences. [Indones J Obstet Gynecol 2013; 37-1: 26-31] Keywords: expulsion, post placental IUD Cu T-380A

Objective: To compare IUD-endometrium (ED) distance and the incident of malposition postplacental CuT-380A IUD insertion in vaginal delivery between ring forceps technique and push and push technique. Method: This study was a double-blind randomized control trial, performed in September 2014 until March 2015 at Dr. Kariadi Hospital. Ring forceps and push and push insertion technique groups consisted of 25 subjects in each group. Follow-up was performed at 1-2 weeks, 6-8 weeks and >12 weeks after insertion. Result: The mean of IUD-ED distance in push and push group was shorter (but not statistically significant) than ring forceps group. The IUD-ED distance was at 1-2-week follow-up 4.1 (2.2) vs. 4.9 (3.4) mm; p=0.208, at 6-8-week follow-up: 2.6 (1.8) vs. 3.2 (3.7) mm; p=0.452, and at > 12-week follow-up: 0.9 (0.8) vs. 1.0 (0.9) mm; p=0.427, respectively. Malposition was found in 1-2-week follow-up, but the IUD was changed to the normal position (sagital position in uterine fundus) at 6-8-week and >12-week follow-up. Up to 3 months of follow-up, there was no occurrence of perforation, expulsion or pregnancy in both groups. Most of subjects (56% in the ring forceps, 68% in push and push groups) did not feel painful during IUD insertion. Conclusion: Push and push insertion technique clinically tends to produce IUD-ED distance shorter than ring forceps technique. Both techniques are comfortable, safe and effective. [Indones J Obstet Gynecol 2016; 4-2: 78-87] Keywords: immediate postplacental IUD insertion technique, IUDendometrium distance, IUD malposition, push and push technique, ring forceps technique

SummaryFive women requiring hysterectomy for benign indications and with normal cervical cytology, underwent the new procedure of subtotal (supracervical) vaginal hysterectomy combined with salpingo-oophorectomy in two cases. Using the Doderlein-Kronig approach, an anterior colpotomy was made and the uterine fundus delivered into the vagina. The ovarian and uterine pedicles were ligated in turn before amputating the uterine body from the cervix. The cervical incision was then repaired and the vaginal incision closed. Operative times ranged from 35 to 150 min, one procedure being prolonged by difficulty with bladder dissection following two previous Caesarean sections. Subtotal vaginal hysterectomy is an alternative to abdominal and laparoscopic subtotal hysterectomy, which avoids two of the disadvantages of these techniques, the need for abdominal incisions and the need for laparoscopic expertise.

Objective: Document the safety, effectiveness and acceptability of quinacrine sterilization (QS) as an alternative to surgical sterilization in Libyan women. Methods: This study was initiated 1 October 1998 at the Misurata Central Hospital and Lamis Clinic. Patient intake was completed 30 September 2002. The cut-off date for this analysis was 31 December 2002. A total of 200 women were given 2 doses, each consisting of 252 mg of quinacrine hydrochloride in the form of 7 pellets inserted one month apart. They were placed at the uterine fundus during the proliferative phase of the menstrual cycle using a modified IUD inserter. Women were asked to report any unusual observations or side effects and instructed to use a barrier method or safe period for one month from the time of the first insertion. Follow-up was scheduled at 3, 6 and 12 months after the date of the second insertion and every 6 months thereafter. Results: Sixty-six women have been monitored for up to 3 years and follow-up of all patients continues. There has been no loss to follow-up. No side effects of any consequence have been reported. Thus far, no pregnancies have been reported for this protocol. Conclusions: Findings in this study are consistent with those seen in other countries. QS has been shown to be safe, effective and acceptable among Libyan women.

Applying manual uterine fundal pressure is a maneuver performed to shorten the second stage of labor. This maneuver involves the application of manual pressure to the uppermost part of the uterus (uterine fundus) and directed towards the uterine axis. How often this maneuver is performed in routine obstetric practice is unclear; however, it is much more frequently performed in developing than developed countries. For example, this maneuver was performed in 4% of all vaginal births between 1994 and 1995 in the Netherland but was 'prevalent' in rural central Bangladesh. It has been established that the maneuver may cause adverse events for both mother and neonate, and maternal rib fracture has been reported. We hope to raise clinicians’ index of concern for this issue by reporting a recent case from Japan. Case report

Introduction: Bimanual uterine compression may provide a reasonable treatment option for controlling or arresting postpartum hemorrhage in areas where access to care and advanced medical interventions are limited. Preliminary evidence suggests that correctly performed bimanual uterine compression is unsustainable for more than a few minutes, despite empirical evidence and practice recommendations that support extended compression for optimal effect. The objective of this study was to examine the impact of team-based (pairs) bimanual uterine compression for managing postpartum hemorrhage from uterine atony. Methods: Obstetricians, nurse-midwives, midwifery students, and unskilled birth attendants (N = 30) in Ghana performed bimanual uterine compression using a simulator with objective performance feedback (6 lights) corresponding to pressure sensors on the uterus. For each participant, we tracked the degree and duration of maintained uterine compression. Birth attendants were then paired (15 pairs) and were similarly assessed performing the technique as a team, with 1 attendant providing external compression to the uterine fundus using 2 hands and the other providing internal pressure against the body of the uterus with a single hand. Results: Individuals were unable to fully compress the uterus and maintain compression for more than 150 seconds without fatiguing. All paired teams were able to fully compress the uterus and maintain the compression for the maximum allotted time of 5 minutes. Discussion: Results suggest that bimanual uterine compression is more effective when performed by a team, with a primary attendant maintaining internal lower uterine segment pressure and monitoring the patient's condition and a partner applying external pressure to the uterine fundus. For cases where access to advanced medical care is limited or delayed, team-applied bimanual uterine compression could enhance the ability to control or arrest postpartum hemorrhage and increase the likelihood of maternal survival.

Increased use of less invasive hysterectomy techniques requires awareness of the unique potential complications they pose in patients with continued symptoms after surgery. Retained uterine fundus is rare after vaginal hysterectomy; only 2 other cases have been reported in the English literature. Magnetic resonance imaging (MRI) was not used preoperatively in either case. However, imaging evaluation, in particular with MRI because of its superior soft tissue resolution, can be helpful in suggesting the diagnosis. Herein is presented the case of a 40-year-old woman who had undergone vaginal hysterectomy several years previously, but was experiencing abdominal pain. MRI was performed, which revealed a supravesical mass. Visualization at MRI of intact round ligaments arising from the mass favored the diagnosis of retained uterine fundus and confirmed after surgical excision.

Penetrating trauma during pregnancy is mainly the result of gunshot and stab wounds. When you have to deal with an injured pregnant patient, you have to be aware of the changes in its physiology and anatomy, because subsequent management adaptations are required. Also, the patterns of injury in pregnancy give you much valuable information. Remember there are two patients to treat. When you must proceed with an emergency cesarean delivery? What you have to do on the surgical table? And finally, is there any space for non-operative management?

Objective To study the value of virtual hysterosalpingography (VHSG) in the diagnosis of bicornuate vs. septate uterus. Design Retrospective study of all cases with bicornuate or septate uterus that had VHSG during the last 3 years at our center. Setting Private fertility center and radiology institute with university affiliations. Patient(s) A total of 47 patients (from more than 1,000 studies) with bicornuate uterus (n = 15) or septate uterus (n = 32) were analyzed to determine the ability of VHSG to distinguish both entities. Intervention(s) Virtual hysterosalpingography was performed in patients with bicornuate or septate uterus. Main Outcome Measure(s) Procedure length, discomfort, amount of radiation, and ability to outline the uterine fundus. Result(s) We were able to clearly distinguish bicornuate from septate uterus. In all patients who underwent septoplasty the VHSG diagnosis of septate uterus was confirmed. Virtual hysterosalpingography was well tolerated by all patients; scanning took 5 seconds per patient, and the average radiation was very low (0.9 ± 0.7 mSv). Conclusion(s) Virtual hysterosalpingography seems to be a valuable tool in the diagnosis of common uterine anomalies.

The investigation of the fluid flow for embryo transfer (ET) procedure may find the way to increase the success rate of the assisted reproductive technologies. In this paper, the transferred liquid flow in the uterine cavity during ET procedure is simulated by a two dimensional multiphase flow model, and the discrete phase model is adopted to trace the embryo motion. Through the investigation on the transferred liquid outline and the track of each embryo in ET cases with different parameters, we summarize the effect of transferred liquid viscosity and distance between catheter tip and uterine fundus. According to the numerical results, we recommend the optimizing standard to perform the ET procedure.

SummaryThere has been a dramatic increase in macrosomia at the Second Affiliated Hospital in Changsha, Hunan Province, China, over the past 22 years. Comparisons of maternal and fetal complications were made between 262 pregnancies resulting in neonates weighing 4-0 kg or more and 300 pregnancies resulting in normal weight neonates. Macrosomia was positively associated with the maternal height and weight, height of the uterine fundus, and maternal abdominal circumference. There were more antepartum, intrapartum, and postpartum complications in the mothers of macrosomic infants. Improvements in nutrition and socioeconomic status may not be entirely benign.

This article provides three cases of women with missing IUDs - one patient desired a pregnancy one patient who was nine weeks pregnant and the other patient had a partial protrusion through the uterine fundus. It describes mislocated IUDs and the removal once they have been found. Copyright © 2010 Elsevier Inc. All rights reserved.

We report a case of retained uterine fundus after vaginal hysterectomy that was subsequently removed at laparoscopy. The patient had undergone vaginal hysterectomy 8 years previously and came to our hospital with abdominal pain. Examination revealed a supravesical mass. Laparoscopy was performed and showed the uterine fundus with its cornual attachments. The mass was excised and sent for histopathologic analysis, which confirmed that it was uterine tissue. Retained uterine tissue or myoma tissue has been reported, usually after morcellation. However, to our knowledge, our case is only the second reported case of retained fundus after complete vaginal hysterectomy. Because of adhesions, it is possible that the uterus was not completely removed. In such cases, laparoscopic assistance is extremely useful.

A 37 year old para 0 + 0 presented with abdominal pain and progressive abdominal swelling. She had no menstrual complains. Abdominal examination revealed a large 30 week non-tender, firm and mobile mass. A pelvic / abdominal ultrasound confirmed a 15.7 x 9.9 cm pedunculated fibroid arising from the uterine fundus. A laparoscopic myomectomy was successfully undertaken, and the morcellated fragments weighed 1490 grams. East African Medical Journal Vol. 85 (7) 2008: pp. 362-364

We describe two unusual cases; both patients wish to continue using the Gynefix® despite experiencing difficulty with the device. In case A, the marker string of the Gynefix® perforated the full thickness of the cervix and was visualized on the left lateral aspect of the cervix. Three months later the string had moved again and could no longer be visualized, but an ultrasound scan confirmed fundal implantation of the device. Case B demonstrates repeated late expulsion and failure of implantation of Gynefix®. Appropriateness of ultrasound with reference to measurement of the distance SS (between the peritoneal surface of the uterine fundus and the first copper sleeve of the Gynefix®), failure of implantation and problems with the new Gynefix® introducer are discussed.

Acute puerperal uterine inversion is a rare but potentially fatal obstetric emergency in which the uterine fundus collapses into the uterine cavity. Maternal mortality is high unless the condition is recognised and quickly corrected. The duration of time elapsed from moment of diagnosis to that of correction, along with rapid resuscitation measures are of utmost importance in its prognosis. A recent case managed successfully is described followed by a short review of the literature.

Radiologic Description An oblique axial T2-weighted MR image (Fig. 1) through the horizontal long axis of the uterus shows a muscular septum arising from the fundus and extending into the body region; the overlying junctional zone is continuous over the lateral walls of the uterus. The outer contour of the fundus is flattened, whereas a normal uterine fundus is convex on the outer aspect. The left ovary seen in this image is unremarkable. The right ovary, seen better on a different image (not shown), is also normal in appearance.

Background Hysteroscopic, transcervical sterilization involves placement of microinserts in tubal ostia. As with any contraceptive method, pregnancy can occur. This case reports the outcome when pregnancy occurred after microinsert placement. Case A multiparous woman presented at 16 weeks of gestation. Hysteroscopic sterilization was performed 2 years earlier, although a postprocedure hysterosalpingogram was not done to verify tubal occlusion. The patient had a normal-term pregnancy. Postpregnancy hysterosalpingogram revealed both microinserts were embedded in the uterine fundus and myometrium. Conclusion This case demonstrates how pregnancy can occur after hysteroscopic microinsert placement and details how it might be avoided.

We describe a rare case of a young woman with a large cystic adenomyotic lesion that was treated laparoscopically. The patient presented with severe dysmenorrhoea refractory to common analgaesics. She was initially diagnosed with right-sided ovarian endometrioma. MRI revealed a cystic lesion of 4 cm attached to the right uterine wall. Under laparoscopic vision, the uterine lesion was identified on the right portion of the uterine fundus close to the round ligament. Monopolar diathermy was used to dissect the lesion. When the incision reached the cystic cavity, dark-brown content flowed from the cyst. After resection was complete, the surgical wound was closed with two-layer interrupted sutures. The patient made a good recovery and was discharged the following day. Since patients with cystic adenomyosis are young, a minimally invasive procedure such as laparoscopic excision is considered optimal. The exact topography of the lesion is crucial in determining the site of the incision.