1
|
Dai H, Gan L, Li J, Yu J, Lei X. Lung ultrasound diagnosis of pulmonary edema resulting from excessive fluid absorption during hysteroscopic myomectomy: a case report. BMC Anesthesiol 2024; 24:331. [PMID: 39289607 PMCID: PMC11406752 DOI: 10.1186/s12871-024-02694-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 08/23/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Hysteroscopic surgery is a safe procedure used for diagnosing and treating intrauterine lesions, with a low rate of intraoperative complications. However, it is important to be cautious as fluid overload can still occur when performing any hysteroscopic surgical technique. CASE PRESENTATION In this case report, we present a unique instance where lung ultrasound was utilized to diagnose pulmonary edema in a patient following a hysteroscopic myomectomy procedure. The development of pulmonary edema was attributed to the excessive absorption of fluid during the surgical intervention. By employing lung ultrasound as a diagnostic tool, we were able to promptly identify and address the pulmonary edema. As a result, the patient received timely treatment with no complications. This case highlights the importance of utilizing advanced imaging techniques, such as lung ultrasound, in the perioperative management of patients undergoing hysteroscopic procedures. CONCLUSIONS This case report underscores the significance of early detection and intervention in preventing complications associated with fluid overload during hysteroscopic myomectomy procedures.
Collapse
Affiliation(s)
- Heng Dai
- Department of Anesthesiology, Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University), Chongqing, China
| | - Lin Gan
- Department of Anesthesiology, Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University), Chongqing, China
| | - Jing Li
- Department of Anesthesiology, Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University), Chongqing, China
| | - Jin Yu
- Department of Anesthesiology, Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University), Chongqing, China
| | - Xiaofeng Lei
- Department of Anesthesiology, Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University), Chongqing, China.
| |
Collapse
|
2
|
Xiong Q, Huang F, Xu Y, Wei K, Cheng B, Dan Liu MD, Wang Q, Deng Y. Association Between the Blood Glucose Value at PACU Discharge and Postoperative Hypoglycemia in Nondiabetic Patients With Hyperglycemia After Hysteroscopic Surgery: A Retrospective Cohort Study. J Perianesth Nurs 2024; 39:552-557.e1. [PMID: 38219082 DOI: 10.1016/j.jopan.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/16/2023] [Accepted: 10/13/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE The target glycemic control for nondiabetic patients in the postanesthesia care unit (PACU) after hysteroscopic surgery remains unclear. Our goal is to determine the optimal level of glycemic control by finding the relationship between blood glucose level (BGL) leaving the PACU and postoperative hypoglycemia in nondiabetic patients. DESIGN This retrospective cohort study was conducted at a comprehensive tertiary hospital in Chongqing, China between June 2018 and December 2020. METHODS The target independent and dependent variables were BGL leaving the PACU and postoperative hypoglycemia, respectively. The primary outcome was the incidence of hypoglycemia. Logistic regression was used to explore the association between discharge BGL and hypoglycemia. The optimal glycemic control range was determined by using the receiver operating characteristic (ROC) curve. FINDINGS Prior to insulin use, BGL in the insulin-using subgroup might be as high as 20 mmol/L. Hypoglycemia was related to the BGL while leaving the PACU (odds ratio (OR) 0.37 [95% confidence interval (CI) 0.22 to 0.65]). The best cut-off value (12.95 mmol/L) was determined by fitting the ROC curve. CONCLUSIONS If severe hyperglycemia develops during hysteroscopic surgery in individuals with 5% glucose as the mediator of uterine distention, the recommendation is to maintain blood glucose above 12.95 mmol/L when treated with insulin.
Collapse
Affiliation(s)
- Qiuju Xiong
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fusen Huang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Yi Xu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ke Wei
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Cheng
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - M D Dan Liu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qunying Wang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Youlin Deng
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
3
|
Wolfman W, Bougie O, Chen I, Tang Y, Goldstein S, Bouteaud J. Guideline No. 451: Asymptomatic Endometrial Thickening in Postmenopausal Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102591. [PMID: 38901794 DOI: 10.1016/j.jogc.2024.102591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
OBJECTIVE To formulate strategies for clinical assessments for endometrial thickening on ultrasound in a postmenopausal woman without bleeding. TARGET POPULATION Postmenopausal women of any age. OUTCOMES To reduce unnecessary invasive interventions and investigations in women with asymptomatic endometrial thickening while selectively investigating women at risk for endometrial cancer. BENEFITS, HARMS, AND COSTS It is anticipated that the adoption of these recommendations would save postmenopausal women unnecessary anxiety, pain, and risk of procedural complications. It is also expected to decrease the cost to the health care system by eliminating unnecessary interventions. EVIDENCE English language articles from Medline, Cochrane, and PubMed databases for relevant peer-reviewed articles dating from 1995 to 2022 (e.g., asymptomatic endometrial thickness, endometrial cancer, postmenopausal bleeding, transvaginal ultrasound, endometrial biopsy, cervical stenosis, hormone therapies and the endometrium, tamoxifen, tibolone, aromatase inhibitors). Results were restricted to systematic reviews and meta-analyses, randomized controlled trials/controlled clinical trials, and observational studies. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE Physicians, including gynaecologists, obstetricians, family physicians, radiologists, pathologists, and internists; nurse practitioners and nurses; medical trainees, including medical students, residents, and fellows; and other providers of health care of the postmenopausal population. SOCIAL MEDIA ABSTRACT Postmenopausal women often have a thickening of the lining of the uterus found during ultrasound. Without bleeding, an endometrium <11 mm is rarely a serious problem but should be evaluated by a health care provider. SUMMARY STATEMENTS RECOMMENDATIONS.
Collapse
|
4
|
Wolfman W, Bougie O, Chen I, Tang Y, Goldstein S, Bouteaud J. Directive clinique n o 451 : Épaississement asymptomatique de l'endomètre chez les femmes ménopausées. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102590. [PMID: 38901795 DOI: 10.1016/j.jogc.2024.102590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
|
5
|
Mohammadi B, Nazari Robati L, Tavakol Z, Movahhed M. Evaluation of the effect of Nigella sativa oil on the outcome of missed abortion in women: A randomized double-blind clinical trial. Health Sci Rep 2024; 7:e2029. [PMID: 38633734 PMCID: PMC11022303 DOI: 10.1002/hsr2.2029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/07/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Background and Aim Due to the concern about the side effects of chemical drugs and their ineffectiveness, the use of natural compounds as alternatives or complementary therapies has received increasing attention. The purpose of this study was to investigate the effect of Nigella sativa oil on the outcome of missed abortion. Methods In this double-blind clinical trial, 70 nulliparous pregnant women referred to Hajar Hospital and Imam Ali clinics of Shahrekord and had missed abortion before the 12-week gestational age were selected and randomly divided into two interventions and control groups. The intervention group received 5 g of Nigella sativa oil alone daily for up to 3 days and the control group received a placebo. In case of nonresponse, 3 days after the last dose of medication or placebo, 800 μg of misoprostol (vaginal) were used. Data were analyzed by SPSS software. The chi-square test, Fisher's exact test, independent t-test and paired t-test were used for analytical statistics. Results According to the results, 18 cases (51.4%) in the intervention group and seven cases (20%) in the control group showed complete evacuation of uterine contents which had a significant difference (p < 0.05). The frequency of vagina physical examination and type of hemorrhage did not show any significant difference between the two groups before and after the intervention. After the intervention, human chorionic gonadotropin (HCG) was significantly decreased in the intervention group but did not change in the control group (p < 0.05). The frequency of adverse events in the intervention group was three (8.6%) and in the control group was one (2.9%) which had no significant difference. Conclusion Nigella sativa improves the outcome of missed abortion by reducing HCG and facilitating cervix dilatation and delivery of uterine contents.
Collapse
Affiliation(s)
- Belgheis Mohammadi
- Clinical Research Development Unit, Hajar HospitalShahrekord University of Medical SciencesShahrekordIran
| | | | - Zeinab Tavakol
- Community‐Oriented Nursing Midwifery Research Center, Nursing and Midwifery SchoolShahrekord University of Medical SciencesShahrekordIran
| | - Mina Movahhed
- Department of Traditional Medicine, School of Traditional MedicineShahid Beheshti University of Medical SciencesTehranIran
| |
Collapse
|
6
|
Costumbrado J, Snyder L, Ghassemzadeh S, Ng D. Vaginal Bleeding Due to Iatrogenic Uterine Perforation - A Case Report. JOURNAL OF EDUCATION & TEACHING IN EMERGENCY MEDICINE 2024; 9:V6-V9. [PMID: 38707940 PMCID: PMC11068317 DOI: 10.21980/j83643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 03/16/2024] [Indexed: 05/07/2024]
Abstract
Uterine perforation is a rare but potentially life-threatening complication of gynecologic procedures. Serious complications include hemorrhage, infection, and injury to surrounding organ systems (eg, gastrointestinal, urological, vascular, etc.). Risk factors include advanced maternal age, prior gynecologic surgeries, and other anatomical features that impact the difficulty of accessing the uterine cavity. In this case report, we discuss a patient who presented to the emergency department (ED) with diffuse abdominal pain and vaginal bleeding that occurred after an elective dilation and curettage (D&C) for a termination of pregnancy. The diagnosis was suspected clinically and confirmed by imaging including ultrasound (US) and computed tomography (CT) of the abdomen and pelvis. The patient was managed operatively with a multidisciplinary approach including Gynecology, General Surgery, and Urology. The patient was stabilized and eventually discharged. Uterine perforation should be included in the differential for patients with a history of recent gynecologic instrumentation presenting with abdominal pain and vaginal bleeding. The stabilization of these patients requires aggressive volume resuscitation, controlling the source of bleeding, and emergent surgical consultation. Topics Gynecology, vaginal bleeding, ultrasound, computed tomography.
Collapse
Affiliation(s)
- John Costumbrado
- University of California, Riverside, School of Medicine, Riverside, CA
- Riverside Community Hospital, Department of Emergency Medicine, Riverside, CA
| | - Leah Snyder
- Riverside Community Hospital, Department of Emergency Medicine, Riverside, CA
| | - Sassan Ghassemzadeh
- University of California, Riverside, School of Medicine, Riverside, CA
- Riverside Community Hospital, Department of Emergency Medicine, Riverside, CA
| | - Daniel Ng
- University of California, Riverside, School of Medicine, Riverside, CA
- Riverside Community Hospital, Department of Emergency Medicine, Riverside, CA
| |
Collapse
|
7
|
Shao L, Yang Z, Yan H, Xu R. Uterine rupture in patients with a history of hysteroscopy procedures: Case series and review of literature. Medicine (Baltimore) 2024; 103:e37428. [PMID: 38457539 PMCID: PMC10919467 DOI: 10.1097/md.0000000000037428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 03/10/2024] Open
Abstract
RATIONALE Uterine rupture during pregnancy poses significant risks to both the fetus and the mother, resulting in high mortality and morbidity rates. While awareness of uterine rupture prevention after a cesarean section has increased, insufficient attention has been given to cases caused by pregnancy following hysteroscopy surgery. PATIENT CONCERNS We report 2 cases here, both of whom had a history of hysteroscopy surgery and presented with severe abdominal pain during pregnancy. DIAGNOSES Both patients had small uterine ruptures, with no significant abnormalities detected on ultrasonography. The diagnosis was confirmed by a CT scan, which showed hemoperitoneum. INTERVENTIONS We performed emergency surgeries for the 2 cases. OUTCOMES We repaired the uterus in 2 patients during the operation. Both patients recovered well. The children survived. No abnormalities were detected during their follow-up visits. LESSONS Attention should be paid to the cases of pregnancy after hysteroscopy.
Collapse
Affiliation(s)
- Liping Shao
- Department of Obstetrics and Gynecology, Changzhou Cancer Hospital Changzhou Fourth People’s Hospital, Changzhou, Jiangsu, China
| | - Zhilong Yang
- Department of General Surgery, Nanjing Lishui People’s Hospital, Nanjing, Jiangsu, China
| | - Huifang Yan
- Department of Obstetrics and Gynecology, Nanjing Lishui People’s Hospital, Nanjing, Jiangsu, China
| | - Rong Xu
- Department of Obstetrics and Gynecology, Nanjing Lishui People’s Hospital, Nanjing, Jiangsu, China
| |
Collapse
|
8
|
Vitale SG, De Angelis MC, Della Corte L, Saponara S, Carugno J, Laganà AS, Török P, Tinelli R, Pérez-Medina T, Ertas S, Urman B, Angioni S. Uterine cervical stenosis: from classification to advances in management. Overcoming the obstacles to access the uterine cavity. Arch Gynecol Obstet 2024; 309:755-764. [PMID: 37428263 PMCID: PMC10866788 DOI: 10.1007/s00404-023-07126-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/20/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND To date hysteroscopy is the gold standard technique for the evaluation and management of intrauterine pathologies. The cervical canal represents the access route to the uterine cavity. The presence of cervical stenosis often makes entry into the uterine cavity difficult and occasionally impossible. Cervical stenosis has a multifactorial etiology. It is the result of adhesion processes that can lead to the narrowing or total obliteration of the cervical canal. PURPOSE In this review, we summarize the scientific evidence about cervical stenosis, aiming to identify the best strategy to overcome this challenging condition. METHODS The literature review followed the scale for the quality assessment of narrative review articles (SANRA). All articles describing the hysteroscopic management of cervical stenosis were considered eligible. Only original papers that reported data on the topic were included. RESULTS Various strategies have been proposed to address cervical stenosis, including surgical and non-surgical methods. Medical treatments such as the preprocedural use of cervical-ripening agents or osmotic dilators have been explored. Surgical options include the use of cervical dilators and hysteroscopic treatments. CONCLUSIONS Cervical stenosis can present challenges in achieving successful intrauterine procedures. Operative hysteroscopy has been shown to have the highest success rate, particularly in cases of severe cervical stenosis, and is currently considered the gold standard for managing this condition. Despite the availability of miniaturized instruments that have made the management of cervical stenosis more feasible, it remains a complex task, even for experienced hysteroscopists.
Collapse
Affiliation(s)
- Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Maria Chiara De Angelis
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Stefania Saponara
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Jose Carugno
- Division of Minimally Invasive Gynecology, Department of Obstetrics, Gynecology and Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Péter Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Raffaele Tinelli
- Department of Obstetrics and Gynecology, "Valle d'Itria" Hospital, Martina Franca, Taranto, Italy
| | - Tirso Pérez-Medina
- Department of Obstetrics and Gynecology, University Hospital Puerta de Hierro Majadahonda, Autónoma University of Madrid, Madrid, Spain
| | - Sinem Ertas
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey
| | - Bulent Urman
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| |
Collapse
|
9
|
Siferih M, Gebre T, Hunduma F, Abebe A, Gebremichael A, Sewunet H, Shibabaw T. Review of Asherman syndrome and its hysteroscopic treatment outcomes: experience in a low-resource setting. BMC Womens Health 2024; 24:99. [PMID: 38326846 PMCID: PMC10848492 DOI: 10.1186/s12905-024-02944-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 02/01/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Asherman syndrome is one of the endometrial factors that influence a woman's reproductive capacity. However, in our context, it needs to be well-documented. This study aimed to evaluate the clinical characteristics and hysteroscopic treatment outcomes of Asherman syndrome. METHOD A retrospective follow-up study from January 1, 2019, to December 31, 2022, was conducted on cases of Asherman syndrome after hysteroscopic adhesiolysis at St.Paul's Hospital in Addis Ababa, Ethiopia. Clinical data were collected via telephone survey and checklist. Epidata-4.2 and SPSS-26 were employed for data entry and analysis, respectively. RESULT A total of 177 study participants were included in the final analysis. The mean patient age was 31 years (range: 21-39) at the initial presentation, and 32.3 years (range: 22-40) during the phone interview. The majority of the patients (97.7%) had infertility, followed by menstrual abnormalities (73.5%). Among them, nearly half (47.5%) had severe, 38.4% had moderate, and 14.1% had mild Asherman syndrome. The review identified no factor for 51.4% of the participants. Endometrial tuberculosis affected 42 patients (23.7%). It was also the most frequent factor in both moderate and severe cases of Asherman syndrome. Only 14.7% of patients reported menstrual correction. Overall, 11% of women conceived. Nine patients miscarried, three delivered viable babies, and six were still pregnant. The overall rate of adhesion reformation was 36.2%. Four individuals had complications (3 uterine perforations and one fluid overload) making a complication rate of 2.3%. CONCLUSION Our study revealed that severe forms of Asherman syndrome, which are marked by amenorrhea and infertility, were more common, leading to incredibly low rates of conception and the resumption of regular menstruation, as well as high recurrence rates. A high index of suspicion for Asherman syndrome, quick and sensitive diagnostic testing, and the development of a special algorithm to identify endometrial tuberculosis are therefore essential. Future multi-centered studies should focus on adhesion preventive techniques.
Collapse
Affiliation(s)
- Melkamu Siferih
- Department of Obstetrics and Gynecology, School of Medicine, Debremarkos University, Debremarkos, Ethiopia.
| | - Thomas Gebre
- Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Fufa Hunduma
- Field Epidemiology, Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abraham Abebe
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Akebom Gebremichael
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Habtamu Sewunet
- Department of Midwifery, Debremarkos Comprehensive Specialized Hospital, Debremarkos, Ethiopia
| | - Tewodros Shibabaw
- School of Medicine, College of Medicine and Health Sciences, Gondar University, Gondar, Ethiopia
| |
Collapse
|
10
|
Salmanov AG, Strakhovetska YV, Leshchova OD, Artyomenko V, Korniyenko SM, Rud VO, Nastradina NM, Kokhanov IV. Endometritis after hysteroscopic procedures in Ukraine: results a multicenter study. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:187-193. [PMID: 38592977 DOI: 10.36740/wlek202402101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Aim: To determine the current prevalence of endometritis after hysteroscopic procedures and antimicrobial resistance of responsible pathogens in Ukraine. PATIENTS AND METHODS Materials and Methods: Multicenter prospective cohort study was conducted from January 2020 to December 2022 in fifteen hospitals from twelve regions of Ukraine. Definitions of endometritis were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network. Antibiotic susceptibility was done by the disc diffusion test as recommended by EUCAST. RESULTS Results: Among 13,872 patients with hysteroscopic procedures, 1027 (7.4%) endometritis were observed. Of these cases, 0.4% were detected after diagnostic hysteroscopy, and 7.0% were detected after operative hysteroscopy. Of all endometritis cases, 64.2% were detected after hospital discharge. The most commonly reported bacterial species were Escherichia coli (24.3%), followed by Enterobacter spp. (12.7%), Enterococcus spp. (8.3%), Pseudomonas aeruginosa (8.1%), Serratia marcescens (6.8%), Staphylococcus aureus (5.9%), Proteus mirabilis (5.8%), Klebsiella oxytoca (5.1%), Stenotrophomonas maltophilia (4.5%), Klebsiella pneumoniae (4.1%). A significant proportion of patients were affected by endometritis caused by bacteria developed resistance to several antimicrobials, varying widely depending on the bacterial species, antimicrobial group, and geographical region of Ukraine. CONCLUSION Conclusions: Our data suggest a high prevalence of endometritis after hysteroscopic procedures. Risk for endometritis was higher after operative hysteroscopy compared with diagnostic hysteroscopy. Many most of patients were affected by endometritis caused by bacteria developed resistance to several antimicrobials. These data underscore the importance of tracking antimicrobial resistance of responsible pathogens of HAIs in hospitals.
Collapse
Affiliation(s)
- Aidyn G Salmanov
- 1SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE; INSTITUTE OF PEDIATRICS, OBSTETRICS AND GYNECOLOGY OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE, KYIV, UKRAINE
| | | | - Olha D Leshchova
- PRIVATE ESTABLISHMENT OF HIGHER EDUCATION "DNIPRO INSTITUTE OF MEDICINE AND PUBLIC HEALTH", DNIPRO, UKRAINE
| | | | | | - Victor O Rud
- NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
| | | | - Igor V Kokhanov
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE
| |
Collapse
|
11
|
Su D, She J, Xu Y, Li Y, Guo Y, Yang Y, Tan Q, Wang L, Diao R. Case report: septic shock after endometrial polypectomy with tissue removal system. BMC Womens Health 2023; 23:546. [PMID: 37872546 PMCID: PMC10594765 DOI: 10.1186/s12905-023-02690-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/05/2023] [Indexed: 10/25/2023] Open
Abstract
As an emerging surgical technology, tissue removal systems have been widely used in the treatment of endometrial polyps due to its characteristics of less endometrial damage, shorter learning curve and clearer vision of the operative field. There are few cases in the literature reporting serious complications after endometrial polypectomy using tissue removal systems. As known, septic shock is a rare complication following hysteroscopic polypectomy. Now, we present the case of a 23-year-old woman who developed septic shock after polypectomy with tissue removal system. The patient had a history of recurrent vaginitis for more than half a year. Due to endometrial polyps, she was admitted to our hospital and scheduled to undergo hysteroscopic endometrial polypectomy. Three hours after the endometrial polypectomy using the tissue removal system, the patient had shock symptoms such as increased body temperature, decreased blood pressure and increased heart rate. Then, the patient was successfully treated and discharged after anti-infection and anti-shock treatments. The purpose of this case report is to remind clinicians to consider the possibility of serious infection and comprehensively evaluate the risk of infection before choosing hysteroscopic devices for endometrial polyps, especially for patients who choose the mechanical hysteroscopic tissue removal systems. Furthermore, the mechanical hysteroscopic tissue removal systems should be used with caution in patients with previous recurrent vaginitis.
Collapse
Affiliation(s)
- Danna Su
- Reproductive Medicine Centre, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, China
| | - Jiajie She
- Reproductive Medicine Centre, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, China
| | - Yuting Xu
- Shantou University Medical College, Shantou, Guangdong, China
| | - Ying Li
- Reproductive Medicine Centre, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, China
| | - Yan Guo
- Reproductive Medicine Centre, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, China
| | - Yajie Yang
- Department of Pathology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Qiao Tan
- Reproductive Medicine Centre, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, China
| | - Liping Wang
- Reproductive Medicine Centre, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, China
| | - Ruiying Diao
- Reproductive Medicine Centre, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, China.
| |
Collapse
|
12
|
Chen Y, Zhao S, Tang W, Li Z, Xie J, Luo B. Acute water intoxication in hysteroscopic myomectomy: a rare case report. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00717-z. [PMID: 37736830 DOI: 10.1007/s12024-023-00717-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 09/23/2023]
Abstract
Water intoxication is rarely seen in forensic practice and is typically associated with excessive water consumption, amphetamine intake, and child abuse. Iatrogenic water intoxication is rare but usually related to medical disputes. Here, we report a 44-year-old female was admitted to the hospital due to a 3-month history of excessive menstrual bleeding. B-ultrasound revealed multiple substantial intrauterine masses, leading to a diagnosis of multiple uterine fibroids. After admission, she underwent submucous myomectomy, endometrial resection, and transcervical resection of endometrial polyps. During the procedure, the patient suffered dizziness and chest tightness, her blood pressure decreased to 89/52 mmHg, and moist rales were heard in her both lungs; she died despite medical efforts. A forensic autopsy was performed and revealed severe pulmonary edema. Considering the patient's clinical history, acute water intoxication was considered to be the cause of death. This highlights the need for forensic pathologists to be vigilant of postoperative water intoxication, a rare complication in obstetrics, to ensure accurate assessments.
Collapse
Affiliation(s)
- Yanchang Chen
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhognshan Erlu, Guangzhou, China
- Forensic Medicine Centre, Sun Yat-sen University, No. 74 Zhognshan Erlu, Guangzhou, China
| | - Shuquan Zhao
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhognshan Erlu, Guangzhou, China
- Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-sen University, No. 74 Zhognshan Erlu, Guangzhou, China
| | - Weilong Tang
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhognshan Erlu, Guangzhou, China
| | - Zhiyan Li
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhognshan Erlu, Guangzhou, China
- Forensic Medicine Centre, Sun Yat-sen University, No. 74 Zhognshan Erlu, Guangzhou, China
| | - Jianjie Xie
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhognshan Erlu, Guangzhou, China
- Forensic Medicine Centre, Sun Yat-sen University, No. 74 Zhognshan Erlu, Guangzhou, China
| | - Bin Luo
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhognshan Erlu, Guangzhou, China.
- Forensic Medicine Centre, Sun Yat-sen University, No. 74 Zhognshan Erlu, Guangzhou, China.
- Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-sen University, No. 74 Zhognshan Erlu, Guangzhou, China.
| |
Collapse
|
13
|
Linck JH, Torres WI, Dayal ST. Post-hysteroscopy Ruptured Tubo-Ovarian Abscess With Atypical Bacteremia: A Case Report. Cureus 2023; 15:e45618. [PMID: 37868482 PMCID: PMC10588765 DOI: 10.7759/cureus.45618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Hysteroscopies are commonly performed in the diagnosis and treatment of patients with abnormal uterine bleeding. Current research suggests a low rate of all types of complications following hysteroscopies. The rate of infectious complications has been reported as exceptionally low. We present a case of tubo-ovarian abscess with Escherichia coli bacteremia and eventual abscess rupture in a 51-year-old gravida 3, para 2012 (G3P2) woman who underwent a hysteroscopy with concurrent polypectomy. The patient had no risk factors that have historically been attributed to the development of post-hysteroscopy infection, such as a history of pelvic inflammatory disease or endometriosis. The patient also had no known intra-operational complications that might predispose her to infection. Further, the patient's clinical presentation was significantly atypical. Despite having E. coli bacteremia on admission, severe abdominal pain, lack of an adequate response to several days of intravenous broad-spectrum antibiotics, and eventually evidence of abscess rupture, the patient never met clinical criteria for sepsis, including a lack of leukocytosis. This case demonstrates a rare presentation of a rare complication and emphasizes the necessity of clinical vigilance in diagnosing and promptly treating gynecological infectious complications.
Collapse
Affiliation(s)
- Jillian H Linck
- Obstetrics and Gynecology, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Wanda I Torres
- Obstetrics and Gynecology, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
- Obstetrics and Gynecology, Suncoast Women's Care, Trinity, USA
| | - Shailja T Dayal
- Obstetrics and Gynecology, Suncoast Women's Care, Trinity, USA
| |
Collapse
|
14
|
Sharon A, Zidane M, Aiob A, Apel-Sarid L, Bornstein J. Nonelectric shaving of endometrial polyp by hysteroscopy - A new technique to eliminate thermal damage. Eur J Obstet Gynecol Reprod Biol 2023; 285:170-174. [PMID: 37146506 DOI: 10.1016/j.ejogrb.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 04/17/2023] [Accepted: 04/22/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To present a new technique for complete endometrial polypectomy, using the bipolar loop hysteroscope, but without the activation of electrical energy, and follow its efficiency and safety for the patient. STUDY DESIGN This is a prospective descriptive study conducted at a university hospital. Forty four patients were recruited to the study according to an intra uterine polyp diagnosed by transvaginal ultrasound (TVS). Out of them 25 really had an endometrial polyp which was inspected by hysteroscopy. Eighteen were at menopause age and seven in their reproductive age. The hysteroscopic removal of the endometrial polyp was performed using the operative loop resectoscope without using electricity, meaning by cold loop. We called this unique technique SHEPH: Shaving of Endometrial Polyp by Hysteroscopy. RESULTS The range age was 21-77 years old. All patients with apparently endometrial polyp, underwent a complete removal of the polyp which could be directly seen through hysteroscopy. No bleeding was seen in all cases. The other nineteen patients had normal uterine cavity, so a biopsy was taken according to the indication. The specimen from all cases were sent to histological evaluation. An endometrial polyp was histologically confirmed in all cases who underwent the SHEPH technique, while fragments of an endometrial polyp was revealed by histology in six cases from the group that had normal uterine cavity. No complications were noted for the short and long periods. CONCLUSIONS Nonelectric Shaving of Endometrial Polyp by Hysteroscopy (SHEPH technique) is a safe and effective procedure which allows the surgeon to achieve a complete endometrial polypectomy but without using electrical energy within the body of the patient. The technique which is easy to learn, is new and unique by eliminate thermal damage in a very common gynecologic indication.
Collapse
Affiliation(s)
- Avishalom Sharon
- Department of Obstetrics and Gynecology, Galilee Medical Center, PO Box 21, Nahariya 2210001, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, Safed 1311502, Israel.
| | - Muhammad Zidane
- Department of Obstetrics and Gynecology, Galilee Medical Center, PO Box 21, Nahariya 2210001, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, Safed 1311502, Israel
| | - Ala Aiob
- Department of Obstetrics and Gynecology, Galilee Medical Center, PO Box 21, Nahariya 2210001, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, Safed 1311502, Israel
| | - Liat Apel-Sarid
- Department of Pathology, Galilee Medical Center, PO Box 21, Nahariya 2210001, Israel
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, PO Box 21, Nahariya 2210001, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, Safed 1311502, Israel
| |
Collapse
|
15
|
Su D, She J, Li Y, Guo Y, Yang Y, Tan Q, Wang L, Diao R. Case report:Septic shock after endometrial polypectomy with tissue removal system.. [DOI: 10.21203/rs.3.rs-2665154/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Abstract
As an emerging surgical technology, tissue removal systems have been widely used in the treatment of endometrial polyps due to its characteristics of less endometrial damage, shorter learning curve and clearer vision of the operative field. There are few cases in the literature reporting serious complications after endometrial polypectomy using tissue removal systems. As known, septic shock is a rare complication following hysteroscopic polypectomy. Now, we present the case of a 23-year-old woman who developed septic shock after polypectomy with tissue removal system. The patient had a history of recurrent vaginitis for more than half a year. Due to EPs, she was admitted to our hospital and scheduled to undergo hysteroscopic endometrial polypectomy. Three hours after the endometrial polypectomy using the tissue removal system, the patient had shock symptoms such as increased body temperature, decreased blood pressure and increased heart rate. Then, the patient was successfully treated and discharged after anti-infection and anti-shock treatments. The purpose of this case report is to remind clinicians to consider the possibility of serious infection and comprehensively evaluate the risk of infection before choosing hysteroscopic devices for EPs, especially for patients who choose the mechanical hysteroscopic tissue removal systems. Furthermore, the mechanical hysteroscopic tissue removal systems should be used with caution in patients with previous recurrent vaginitis.
Collapse
Affiliation(s)
- Danna Su
- The First Affiliated Hospital of Shenzhen University
| | - Jiajie She
- The First Affiliated Hospital of Shenzhen University
| | - Ying Li
- The First Affiliated Hospital of Shenzhen University
| | - Yan Guo
- The First Affiliated Hospital of Shenzhen University
| | - Yajie Yang
- The First Affiliated Hospital of Shenzhen University
| | - Qiao Tan
- Shantou University Medical College
| | - Liping Wang
- The First Affiliated Hospital of Shenzhen University
| | - Ruiying Diao
- The First Affiliated Hospital of Shenzhen University
| |
Collapse
|
16
|
Pharmacologic Interventions to Minimize Fluid Absorption at the Time of Hysteroscopy: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 141:285-298. [PMID: 36649319 DOI: 10.1097/aog.0000000000005051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/20/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess which interventions are effective in reducing fluid absorption at the time of hysteroscopy. DATA SOURCE Ovid MEDLINE, Ovid EMBASE, PubMed (non-MEDLINE records only), EBM Reviews-Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov , and Web of Science were searched from inception to February 2022 without restriction on language or geographic origin. METHODS OF STUDY SELECTION Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, all English-language, full-text articles reporting fluid balance, with an intervention and comparator arm, were included. Title and abstract screening and full-text review were completed independently by two authors. Conflicts were resolved through discussion and consensus. Studies' risk of bias was assessed using the Cochrane Risk of Bias Tool for RCTs and the Newcastle-Ottawa Scale for observational studies. TABULATION, INTEGRATION, AND RESULTS The search identified 906 studies, 28 of which were eligible for inclusion, examining the following interventions: gonadotropin-releasing hormone (GnRH) agonist; ulipristal acetate; vasopressin; danazol; oxytocin; and local, general, and regional anesthesia. A significant reduction in mean fluid absorption was seen in patients preoperatively treated with danazol (-175.7 mL, 95% CI -325.4 to -26.0) and a GnRH agonist (-139.68 mL, 95% CI -203.2, -76.2) compared with patients in a control group. Ulipristal acetate and type of anesthesia showed no difference. Data on type of anesthesia and vasopressin use were not amenable to meta-analysis; however, four studies favored vasopressin over control regarding fluid absorption. Mean operative time was reduced after preoperative treatment with ulipristal acetate (-7.1 min, 95% CI -11.31 to -2.9), danazol (-7.5 min, 95% CI -8.7 to -6.3), and a GnRH agonist (-3.3 min, 95% CI -5.6 to -0.98). CONCLUSION Preoperative treatment with a GnRH agonist and danazol were both found to be effective in reducing fluid absorption and operative time across a range of hysteroscopic procedures. High-quality research aimed at evaluating other interventions, such as combined hormonal contraception, progestin therapy, and vasopressin, are still lacking in the literature. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021233804.
Collapse
|
17
|
Bridwell R, Long B, Montrief T, Gottlieb M. Post-abortion Complications: A Narrative Review for Emergency Clinicians. West J Emerg Med 2022; 23:919-925. [DOI: 10.5811/westjem.2022.8.57929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/23/2022] [Indexed: 11/15/2022] Open
Abstract
An abortion is a procedure defined by termination of pregnancy, most commonly performed in the first or second trimester. There are several means of classification, but the most important includes whether the abortion was maternally “safe” (performed in a safe, clean environment with experienced providers and no legal restrictions) or “unsafe” (performed with hazardous materials and techniques, by person without the needed skills, or in an environment where minimal medical standards are not met). Complication rates depend on the procedure type, gestational age, patient comorbidities, clinician experience, and most importantly, whether the abortion is safe or unsafe. Safe abortions have significantly lower complication rates compared to unsafe abortions. Complications include bleeding, retained products of conception, retained cervical dilator, uterine perforation, amniotic fluid embolism, misoprostol toxicity, and endometritis. Mortality rates for safe abortions are less than 0.2%, compared to unsafe abortion rates that range between 4.7-13.2%. History and physical examination are integral components in recognizing complications of safe and unsafe abortions, with management dependent upon the diagnosis. This narrative review provides a focused overview of post-abortion complications for emergency clinicians.
Collapse
Affiliation(s)
- Rachel Bridwell
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
| | - Brit Long
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| | - Tim Montrief
- Jackson Memorial Health System, Department of Emergency Medicine, Miami, Florida
| | - Michael Gottlieb
- Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois
| |
Collapse
|
18
|
Implementation of Office Hysteroscopy for the Evaluation and Treatment of Intrauterine Pathology. Obstet Gynecol 2022; 140:499-513. [PMID: 35926213 DOI: 10.1097/aog.0000000000004898] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/19/2022] [Indexed: 01/05/2023]
Abstract
Hysteroscopy provides a minimally invasive strategy to evaluate intrauterine pathology and manage conditions such as abnormal uterine bleeding, infertility, intrauterine adhesions, müllerian anomalies, and intrauterine foreign bodies. Increasing access to hysteroscopy procedures in the office has the potential to improve patient care by minimizing financial and logistical barriers, aiding in streamlined diagnosis and treatment planning, and potentially averting unnecessary operative procedures and anesthesia. Office hysteroscopy refers to procedures performed in outpatient settings where pain management involves no medications, oral nonsedating medications, local anesthetic agents, or oral or inhaled conscious sedation. We present best practices for the implementation of hysteroscopy in an office setting. These include appropriate patient selection, optimal procedural timing, cervical preparation for patients at highest risk of cervical stenosis or pain with dilation, individualized pain-management strategies, use of distension media, and video monitoring to engage patients in the procedure. We describe miniaturized equipment for use in the office setting and "no-touch" vaginoscopic approaches to limit patient discomfort. With appropriate training and experience, office hysteroscopy presents a simple and cost-effective modality for optimizing gynecologic care for our patients.
Collapse
|
19
|
Schwarzman P, Baumfeld Y, Mastrolia SA, Yaniv-Salem S, Leron E, Silberstein T. Obstetric Outcomes after Perforation of Uterine Cavity. J Clin Med 2022; 11:jcm11154439. [PMID: 35956056 PMCID: PMC9369682 DOI: 10.3390/jcm11154439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 12/10/2022] Open
Abstract
We aimed to evaluate the pregnancy characteristics and obstetric outcomes in patients after perforation of the uterus. Study design: A retrospective cohort study was conducted and included all patients who were diagnosed with uterine perforation and treated in a tertiary referral medical center between the years 1996 and 2018. Up to two deliveries after perforations were investigated. Results: During the study period, 51 women were diagnosed with uterine perforation during gynecological procedures, including intrauterine device (IUD) insertion. The mean age of patients at the time of diagnosis was 27.9 (±4.7) years. The majority, 76.5% (n = 39), experienced perforation during IUD insertion, and 23.5% (n = 12) of the patients experienced perforation during surgical procedures. Most of the patients were multiparous or grand multiparous, 45.8. % (n = 22) and 39.6% (n = 19) respectively. Anteflexed uterus was found in 86.4% of the patients (n = 38). Five patients (9.8%) had pelvic abscesses after the IUD insertion. A total of 50 patients had 71 deliveries subsequent to uterine perforation. One patient experienced intrauterine fetal death due to fetal malformations. One patient experienced uterine rupture. No other major obstetric complications were noted. Conclusions: Uterine perforation may be associated with adverse obstetric outcomes. The possibility of uterine rupture must be considered while managing the deliveries of patients after uterine perforation. Moreover, a larger cohort and further studies are needed to establish an association between uterine perforation and adverse outcomes of the subsequent deliveries.
Collapse
Affiliation(s)
- Polina Schwarzman
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (P.S.); (Y.B.); (S.Y.-S.); (E.L.); (T.S.)
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (P.S.); (Y.B.); (S.Y.-S.); (E.L.); (T.S.)
- Clinical Research Center, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel
| | - Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (P.S.); (Y.B.); (S.Y.-S.); (E.L.); (T.S.)
- Department of Obstetrics and Gynecology, Ospedale Civile Umberto I, Via Ruvo, 108, 70033 Corato, Italy
- Correspondence:
| | - Shimrit Yaniv-Salem
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (P.S.); (Y.B.); (S.Y.-S.); (E.L.); (T.S.)
| | - Elad Leron
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (P.S.); (Y.B.); (S.Y.-S.); (E.L.); (T.S.)
| | - Tali Silberstein
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (P.S.); (Y.B.); (S.Y.-S.); (E.L.); (T.S.)
| |
Collapse
|
20
|
Hofmann L, Readman E, Kapurubandara S. Uptake of outpatient hysteroscopy in Australia using Medical Benefits Scheme data: Have we fallen behind? Aust N Z J Obstet Gynaecol 2022; 62:875-880. [PMID: 35906723 DOI: 10.1111/ajo.13597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hysteroscopy is a safe procedure which allows both diagnosis and management of cervical and endometrial pathology. Improving Australian women's access to outpatient hysteroscopy would improve cost efficiency and allow women a quicker recovery, negating the need for a general anaesthetic. Increasing the Medicare renumeration for outpatient hysteroscopy could incentivise provision of outpatient hysteroscopy. AIM We sought to review the trend and current uptake of outpatient diagnostic hysteroscopy in Medicare Benefits Scheme (MBS)-funded clinics within Australia. MATERIALS AND METHODS A retrospective review of Australian MBS data from 1 January 1993 to 31 December 2020. RESULTS Over the past 27 years, 1 319 909 hysteroscopies have been claimed from Medicare in Australia, with 39 958 (3.1%) claimed as an outpatient diagnostic procedure. Australian outpatient diagnostic hysteroscopy MBS item number use peaked in 1994 (5871 cases) representing 18.2% of all hysteroscopies claimed through the MBS that year. Uptake of the outpatient hysteroscopy item number rapidly declined after 1994 and in 2010, it represented 0.8% of all hysteroscopies claimed (426 of 49 618) and has remained below <0.5% from 2010 to 2020. CONCLUSIONS The lower Medicare rebate and lack of recognition of the importance of outpatient hysteroscopy has likely been a driving factor in continuing inpatient hysteroscopy. Incentivised government funding has been successfully utilised in the UK to improve outpatient hysteroscopy access. This MBS data suggests that Australia has not progressed in outpatient hysteroscopy access and support a change in the current funding model to assist in supporting the uptake of outpatient access.
Collapse
Affiliation(s)
- Lauren Hofmann
- Women's and Children's Department, Westmead Hospital, Sydney, Australia
| | - Emma Readman
- Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia
| | - Supuni Kapurubandara
- Women's and Children's Department, Westmead Hospital, Sydney, Australia.,University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
21
|
Kovalak EE. Does “no-touch” technique hysteroscopy increase the risk of infection? Turk J Obstet Gynecol 2022; 19:145-151. [PMID: 35770455 PMCID: PMC9249365 DOI: 10.4274/tjod.galenos.2022.04272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Today, thanks to its many advantages, hysteroscopy with a vaginoscopic approach (no-touch) is increasingly being used more in outpatient diagnoses and treatments. However, there are concerns that the “no-touch” technique increases ascending genital tract infections since a speculum is not inserted, and disinfection of the cervix cannot achieve. Materials and Methods: Between 2011 and 2017, 302 patients who underwent office hysteroscopy with the vaginoscopic approach (group 1) and 254 patients who underwent hysteroscopy with the standard method under anesthesia in the operating room (group 2) were compared in terms of early complications (within two weeks postoperatively). The primary outcome was early postoperative infection, and the secondary outcome was other early complications, such as bleeding and rupture. Results: In this study, the success rate of hysteroscopy with the vaginoscopic approach was 96.4%. According to the visual analog scale scoring system, 88.7% of the patients described mild-to-moderate pain. When group 1 and 2 were compared in terms of postoperative infection (3% and 2.4%, respectively) and other early complication rates (0% and 0.8%, respectively), no statistically significant difference was found (p>0.05). Conclusion: Hysteroscopy with a vaginoscopic approach continues to be the gold standard method that is safe and well-tolerated by patients.
Collapse
|
22
|
Valero I, García-Jiménez R, Florez N, Weber-Fernandez AM, Oña López MR, Lara MD. Mini-resectoscope vs morcellator for in-office hysteroscopic myomectomy: Evaluation of results and patient satisfaction. Eur J Obstet Gynecol Reprod Biol 2022; 270:95-99. [PMID: 35033932 DOI: 10.1016/j.ejogrb.2021.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/26/2021] [Accepted: 12/30/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The development of hysteroscopic techniques has led to an advance in submucous myoma treatment, offering a safe and effective minimally invasive alternative. Our objective was to compare the results of hysteroscopic myomectomy when using whether the mini-resectoscope or the MyoSure morcellator, as well as patient satisfaction after the procedure. MATERIAL AND METHODS A prospective, cross-sectional, observational study including 80 patients distributed into two groups: Mini-Resectoscope group (MRG) or MyoSure group (MSG), depending on the instrument used for the in-office hysteroscopic myomectomy. Resection time, pain during entry, pain during resection, number of resections required, complete resection, and total satisfaction were recorded. RESULTS MSG had statistically significant shorter time of entrance. There were no other statistically significant differences between groups. CONCLUSIONS In-office hysteroscopic myomectomy is associated with high levels of patient satisfaction, without differences between the mini-resectoscope or the MyoSure, allowing high rates of complete resection using both instruments. Thus, it is a feasible technique which could be performed with both instruments, depending on the operator's expertise.
Collapse
Affiliation(s)
- Irene Valero
- Obstetrics and Gynecology Department, Juan Ramon Jimenez Hospital, Huelva, Spain
| | - Rocio García-Jiménez
- Obstetrics and Gynecology Department, Valme University Hospital, Seville, Spain.
| | - Natalia Florez
- Obstetrics and Gynecology Department, Valme University Hospital, Seville, Spain
| | | | | | - Maria Dolores Lara
- Obstetrics and Gynecology Department, Valme University Hospital, Seville, Spain
| |
Collapse
|
23
|
Vilà Famada A, Cos Plans R, Costa Canals L, Rojas Torrijos M, Rodríguez Vicente A, Bainac Albadalejo A. Outcomes of surgical hysteroscopy: 25 years of observational study. J OBSTET GYNAECOL 2021; 42:1365-1369. [PMID: 34913810 DOI: 10.1080/01443615.2021.1971176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this prospective study was to analyse the complications of operative hysteroscopy over the last 25 years and determine whether such complications were related to patient characteristics, surgery type, surgical time or distension-medium balance. Three thousand and sixty-three operative hysteroscopies were performed; 52.7% were polypectomies and 31.5% were myomectomies. Myectomies had the highest incidence of complications, at 14%, followed by septolysis, at 6.9%. The most common complications were mechanical (52%). Myomectomies had seven times higher risk than polypectomies of distension-medium complications (RR 7.5, p<.001) but three times lower risk of mechanical complications (RR 0.32, p<.001). The highest incidence of complications occurred in type I myomas and those larger than 3 cm. If we define fluid-balance complications as only those patients who absorbed more than 1.5 L and developed related symptoms, our overall complication rate, including all mechanical complications, was 5.6%.Impact StatementWhat is already known on this subject? In recent years, the importance of properly preventing and managing hysteroscopic complications has risen in line with the number of diagnostic and operative hysteroscopies performed. Complications in operative hysteroscopy differ between surgery types, patient characteristics and the distending media used.What do the results of this study add? This study provides data from a high number of patients compared to previously published studies on the complications of operative hysteroscopies, and includes a study of the relationship between type of surgery and type of complication.What are the implications of these findings for clinical practice and/or further research? Our study shows the importance of a good preoperative assessment, since the complications of hysteroscopy differ greatly depending on the indication. Thus, within myomectomies, knowing the exact type, size and location of the myoma will allow the surgeon to carefully plan the procedure to avoid complications.
Collapse
Affiliation(s)
- Anna Vilà Famada
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
| | - Ramon Cos Plans
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
| | - Laura Costa Canals
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
| | - Mireia Rojas Torrijos
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
| | - Agueda Rodríguez Vicente
- Department of Obstetrics and Gynaecology, Parc Taulí University Hospital, Research and Innovation Institute Parc Taulí I3PT, Autonomous University of Barcelona, Barcelona, Spain
| | | |
Collapse
|
24
|
A Fluid-Management Drape for Hysteroscopy: Innovation for Improved Patient Safety and Surgical Care. Obstet Gynecol 2021; 138:905-910. [PMID: 34735388 DOI: 10.1097/aog.0000000000004604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/26/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hysteroscopy requires accurate collection of unabsorbed distension media to measure patient fluid absorption. We assessed the effectiveness and usability of a novel total capture drape compared with a standard drape during hysteroscopy. METHOD Simulation trials were followed by an early-phase study to compare fluid-capture efficiency and measures of drape usability during hysteroscopy randomizing the total capture drape compared with a standard drape. EXPERIENCE Simulation trials indicated complete collection of unabsorbed fluid with the total capture drape and progressive loss of unabsorbed fluid with the standard drape. An early-phase study with 68 women found no statistical difference between groups for the hysteroscopic fluid deficit, but saw fewer cases with lost fluid in the total capture drape compared with the standard drape. Direct observation and focus group data indicated a trend for better capture of unabsorbed fluid with the total capture drape, along with increased usability once surgeons became familiar with correct placement. CONCLUSION Simulation and early-phase study results are favorable for the total capture drape, demonstrating comparable fluid collection with the standard drape. With repeated use and in-service training, surgeons expressed greater confidence in the accuracy of the hysteroscopic fluid deficit with the total capture drape compared with the standard drape. Design modifications should improve overall usability and fluid-capture efficiency.
Collapse
|
25
|
Pomeranz M, Klein Z, Mulla D, Ovadia M, Sharvit M, Schonman R, Daykan Y, Arbib N. "What you see is what you get" abnormal endometrial sonographic findings are sufficient for direct surgical hysteroscopy: Retrospective cohort study. Int J Gynaecol Obstet 2021; 158:295-300. [PMID: 34606087 DOI: 10.1002/ijgo.13964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/25/2021] [Accepted: 09/30/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the possibility of referring women with uterine polyps larger than 1.5 cm directly to surgical hysteroscopy. METHODS This retrospective cohort study included all women referred to a university-affiliated tertiary medical center for hysteroscopy, with the diagnosis of endometrial polyp, from 01/2013 to 05/2016. Women were referred for surgical hysteroscopy based on TVUS findings. PPV of TVUS for detecting intrauterine polyps was evaluated relating to pathology as gold standard, with sub-group analysis relating to polyp size and other parameters. RESULTS We selected 1.5 cm as a cutoff size for subgroup analysis of endometrial polyps. PPV of TVUS for the entire cohort of 295 cases eligible for analysis, was 79.3%. TVUS describing polyps ≥1.5 cm had PPV of 92.1%, higher than the PPV for smaller polyps. Among post-menopausal women in this group, PPV was as high as 96.2%. Use of doppler or saline was found to improve PPV in the entire cohort. Indication for performing TVUS did not affect the PPV. CONCLUSION TVUS describing polyps ≥1.5 cm may suffice for direct referral of women to surgical hysteroscopy. A personalized approach based on the initial diagnosis may avoid unnecessary invasive procedures for patients.
Collapse
Affiliation(s)
- Meir Pomeranz
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Klein
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Mulla
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Ovadia
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Merav Sharvit
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Schonman
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Daykan
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nissim Arbib
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
26
|
Acute Severe Hyponatremia following Hysteroscopic Procedure in a Young Patient: A Case Report and Review of the Literature. Case Rep Nephrol 2021; 2021:7195660. [PMID: 34594582 PMCID: PMC8478601 DOI: 10.1155/2021/7195660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background Hysteroscopic surgery is a minimally invasive procedure used to diagnose and treat intrauterine pathologies. It requires distension of the uterine cavity for the adequate visualization of the operative field. Glycine (1.5%) is one of the most commonly used solutions because it is nonconductive and also has good optical properties. However, acute hyponatremia is a critical complication that can develop after the absorption of a sufficient amount of the irrigation medium. Case Presentation. We report a case of a 43-year-old female patient who developed acute symptomatic hyponatremia (104 mEq/L) and pulmonary edema secondary to hysteroscopic resection of leiomyoma and hastily approached with rapid sodium correction measures. Conclusion Multiple strategies can be taken to reduce the risk of fluid absorption and subsequent hyponatremia. Moreover, attention should be paid to the treatment approach for patients with acute hyponatremia following hysteroscopic procedures; rapid correction of acute hyponatremia for such patients might be safe, although there is no consensus in the literature, and further trials are needed.
Collapse
|
27
|
Raz N, Feinmesser L, Moore O, Haimovich S. Endometrial polyps: diagnosis and treatment options - a review of literature. MINIM INVASIV THER 2021; 30:278-287. [PMID: 34355659 DOI: 10.1080/13645706.2021.1948867] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND AIM Endometrial polyps (EPs) are a common gynecologic condition, associated with abnormal uterine bleeding (AUB), infertility, and premalignant and malignant conditions. Technologies for diagnosis and treatment of EPs are constantly evolving. We aim to provide an updated review on diagnosis and management options for patients with EPs. MATERIAL AND METHODS We conducted an electronic search in databases including MEDLINE, PubMed, Cochrane Central Register and others. We included 68 publications regarding EPs, their clinical burden, diagnostic modalities, treatment options and new technologies. RESULTS Transvaginal ultrasound (TVS) is the common modality for EP detection and color doppler increases its diagnostic accuracy. Dilation and curettage (D&C) should be avoided for diagnosis and treatment of EPs. Hysteroscopy shows high diagnostic value in EPs and allows for both histological diagnosis and effective treatment. Office hysteroscopy and see and treat hysteroscopy without anesthesia is feasible and safe for EP diagnosis and treatment, gaining more trained surgeons globally. Effective and safe technological tools for EP resection include Laser, resectoscopes, morcellators, MyoSure, Truclear and scissors\graspers. CONCLUSIONS EPs are safely and effectively diagnosed and treated with the hysteroscopic tools reviewed in this article. More research is needed to define the best treatment modality.
Collapse
Affiliation(s)
- Nili Raz
- Gynecology Ambulatory Surgery Unit, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.,Technion Israel Institute of Technology, Haifa, Israel
| | - Larissa Feinmesser
- Gynecology Ambulatory Surgery Unit, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.,Technion Israel Institute of Technology, Haifa, Israel
| | - Omer Moore
- Gynecology Ambulatory Surgery Unit, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.,Technion Israel Institute of Technology, Haifa, Israel
| | - Sergio Haimovich
- Gynecology Ambulatory Surgery Unit, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel.,Technion Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
28
|
Ludwin A, Lindheim SR, Booth R, Ludwin I. Removal of uterine polyps: clinical management and surgical approach. Climacteric 2021; 23:388-396. [PMID: 32648824 DOI: 10.1080/13697137.2020.1784870] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Endometrial polyps have a reported prevalence from 7.8% up to 30% and are one of the most cost-consuming gynecological conditions for our specialty. There are strong practitioner beliefs that surgical removal of endometrial polyps is highly beneficial, particularly for those with abnormal uterine bleeding and infertility. Additionally, polypectomy is indicated to reduce the risk of malignancy. Transvaginal ultrasound is the first-line diagnostic option for detection of endometrial polyps, while sonohysterography has similar accuracy as hysteroscopy in the diagnostic confirmation. Blind dilatation and curettage is not recommended for polyp removal; rather, hysteroscopy in the operating room and office setting using small-diameter hysteroscopic equipment is the standard approach. This can be performed without anesthesia in most women. While hysteroscopy is an effective method for polypectomy with a low complication rate, it is unknown whether this is truly beneficial for reproductive-age women with infertility and prior assisted reproduction therapy. The risk of malignancy in women with postmenopausal bleeding justifies the necessity of polypectomy with histologic tissue examination. In asymptomatic women, the risk of malignancy is low, and there are no known benefits of polyp removal in the prevention of malignant transformation. Cost-effective studies remain to be done to provide us with the optimal approach to endometrial polyps including the management of asymptomatic and/or infertile women, ideal location including office-based or the operating room setting, complication prevention including intrauterine adhesions, and recurrence issues.
Collapse
Affiliation(s)
- A Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland.,Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland.,Centermed - Private Hospital and Clinic, Krakow, Poland
| | - S R Lindheim
- Department of Obstetrics and Gynecology, Wright State University, Boonshoft School of Medicine, Dayton, Ohio, USA
| | - R Booth
- Department of Obstetrics and Gynecology, Wright State University, Boonshoft School of Medicine, Dayton, Ohio, USA
| | - I Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland.,Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland.,Centermed - Private Hospital and Clinic, Krakow, Poland
| |
Collapse
|
29
|
Donan PC, Pace KA, Ruiz CW, Gracia MM. Distending Media Used During Hysteroscopy: Perioperative Nursing Implications. AORN J 2021; 112:634-648. [PMID: 33252805 DOI: 10.1002/aorn.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Hysteroscopy is a gynecological procedure that may be indicated for abnormal uterine bleeding, diagnosis and management of infertility, contraception, or sterilization. Surgeons use distending media during hysteroscopy to view the uterine cavity. Media options include carbon dioxide gas and both electrolytic and nonelectrolytic fluids. All distending media is absorbed by the patient's body, but the manner in which each media is absorbed is unique to its chemical composition. Understanding the properties of each distending medium and the risks involved with its use is critical to safe perioperative nursing care for patients undergoing hysteroscopy. This article provides perioperative nurses with a review of uterine anatomy and evidence-based information on the types of distending media used during hysteroscopy and the corresponding perioperative nursing implications.
Collapse
|
30
|
Yang L, Wang L, Chen Y, Guo X, Miao C, Zhao Y, Li L, Zhang Q. Cold scissors versus electrosurgery for hysteroscopic adhesiolysis: A meta-analysis. Medicine (Baltimore) 2021; 100:e25676. [PMID: 33907137 PMCID: PMC8084071 DOI: 10.1097/md.0000000000025676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 04/07/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Intrauterine adhesion seriously affects reproductive health in women. Hysteroscopic adhesiolysis using cold scissors or electrosurgery is the main treatment, although there is no consensus on the preferable method. This review aimed to compare the efficacy and safety of these methods for treating moderate to severe intrauterine adhesion. METHODS PubMed, EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Web of Science, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure were searched on April 30, 2020. Randomized controlled trials and observational studies that were published in all languages (must contain English abstracts) and compared hysteroscopic cold scissors with electrosurgery for the treatment of intrauterine adhesion were included. Mean differences, odds ratios, and 95% confidence intervals (CIs) were reported. Bias was evaluated using the Cochrane Risk of Bias assessment tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. Data were analyzed using RevMan software (Review Manager version 5.3, The Cochrane Collaboration, 2014). Two researchers independently extracted data and assessed the quality of the included studies. If a consensus was not reached, a third researcher was consulted. RESULTS Nine studies (n = 761; 6 randomized controlled trials and 3 retrospective studies) were included. The intrauterine adhesion recurrence rate with second look hysteroscopy was significantly lower (odds ratio = 0.30, 95% CI = 0.16-0.56; P = .0002) with hysteroscopic cold scissors than with electrosurgery. The total operation time was significantly shorter (mean difference = -7.78, 95% confidence interval = -8.50 to -7.07; P < .00001), intraoperative blood loss was significantly lower (mean difference = -9.88, 95% CI = -11.25 to -8.51; P < .00001), and the menstrual flow rate was significantly higher (odds ratio = 4.36, 95% confidence interval = 2.56-7.43; P < .00001) with hysteroscopic cold scissors than with electrosurgery. There were no significant differences in the pregnancy rate. One complication (1 perforation case, hysteroscopic cold scissors group) was reported. CONCLUSIONS Hysteroscopic cold scissors is more efficient in preventing intrauterine adhesion recurrence, increasing the menstrual flow, reducing intraoperative blood loss, and shortening the operation time.
Collapse
Affiliation(s)
- Liuqing Yang
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
| | - Ling Wang
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
- The First Clinical College of Zhejiang Chinese Medical University
| | - Yun Chen
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
| | - Xiaoshi Guo
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
| | - Chenyun Miao
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
| | - Ying Zhao
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
| | - Lu Li
- College of Pharmaceutical Sciences, Zhejiang University, Xihu District, Hangzhou, Zhejiang, PR China
| | - Qin Zhang
- Department of TCM Gynecology, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University
| |
Collapse
|
31
|
Chen T, Yao L, Tong F, Zhu C. Successful treatment of cardiac arrest following hysteroscopic surgery using extracorporeal membrane oxygenation: A case report. Medicine (Baltimore) 2021; 100:e25519. [PMID: 33847671 PMCID: PMC8052025 DOI: 10.1097/md.0000000000025519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/14/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Cardiac arrest caused by water intoxication syndrome following hysteroscopic surgery is a rare but life-threatening occurrence. Extracorporeal membrane oxygenation (ECMO) is rarely used to treat water intoxication syndrome in hysteroscopic surgery. Here, we successfully treated a patient with water intoxication syndrome following hysteroscopic surgery with ECMO. PATIENT CONCERNS We report a rare case of cardiac arrest during hysteroscopic surgery treated with veno-venous (VV) ECMO. DIAGNOSIS Water poisoning syndrome was diagnosed by electrolyte examination, the lowest value of serum sodium was 110.7 mmol/L. INTERVENTIONS VV-ECMO was prescribed as a measure after traditional cardiopulmonary resuscitation. RESULTS ECMO was successfully evacuated on day 5 and the patient was discharged on day 45. CONCLUSION Mastering the hysteroscopic operative techniques and using a bipolar hysteroscopic generator, isotonic fluid, perfusion pressures less than 100 mm Hg, and local anesthesia may reduce the risk of hysteroscopic water intoxication syndrome. During hysteroscopic surgery, patients may experience cardiac arrest and fatal water intoxication syndrome. Even when traditional cardiopulmonary resuscitation is successful, VV ECMO may contribute to the recovery of brain function if oxygenation is not maintained.
Collapse
Affiliation(s)
- Ting Chen
- Intensive Care Unit, The Second People's Hospital of Hefei
| | - Li Yao
- Intensive Care Unit, The Second People's Hospital of Hefei
| | - Fei Tong
- Intensive Care Unit, The First Affiliated Hospital of USTC, University of Science and Technology of China, Anhui, China
| | - Chunyan Zhu
- Intensive Care Unit, The First Affiliated Hospital of USTC, University of Science and Technology of China, Anhui, China
| |
Collapse
|
32
|
Okazaki H, Miura N, Kashima Y, Miyashita R, Oe K, Kawakami K, Ishikawa T, Masui K. Severe hyponatremia with seizures and confirmed mild brain edema by hysteroscopic myomectomy: a case report. JA Clin Rep 2020; 6:74. [PMID: 33001333 PMCID: PMC7530158 DOI: 10.1186/s40981-020-00381-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hyponatremia can be developed during hysteroscopic surgery with electrolyte-free irrigation fluid. We experienced severe hyponatremia with postoperative seizures and confirmed mild brain edema. CASE PRESENTATION A quadragenarian female patient underwent a 2-h hysteroscopic myomectomy with electrolyte-free fluid for uterine distension under general anesthesia. Plasma sodium level of 84.1 mmol/L 100 min after the start of surgery indicated excessive absorption of the irrigation fluid. Acute severe hyponatremia was diagnosed with significant edema in the conjunctiva, lip, and extremities. She was treated with a continuous infusion of hypertonic saline. However, seizures and cerebral edema developed 7 h later. The patient recovered without neurological deficits at postoperative day 2. CONCLUSION The electrolyte-free irrigation fluid can be absorbed rapidly during hysteroscopic surgery. Its interruption with hyponatremia should be considered against prolonged surgery. Especially under general anesthesia, caution should be exercised because the typical symptoms of hyponatremia such as nausea and confusion are blinded.
Collapse
Affiliation(s)
- Haruko Okazaki
- Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan
| | - Norikazu Miura
- Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan
| | - Yuki Kashima
- Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan
| | - Ryoichi Miyashita
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo, 142-8666, Japan
| | - Katsunori Oe
- Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan
| | - Keiko Kawakami
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, 142-8666, Japan
| | - Tetsuya Ishikawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, 142-8666, Japan
| | - Kenichi Masui
- Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan.
| |
Collapse
|
33
|
Lima MPJDS, Costa-Paiva L, Brito LGO, Baccaro LF. Factors Associated with the Complications of Hysteroscopic Myomectomy. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:476-485. [PMID: 32898912 PMCID: PMC10309217 DOI: 10.1055/s-0040-1713915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To evaluate the factors associated with complete myomectomy in a single surgical procedure and the aspects related to the early complications. METHODS A cross-sectional study with women with submucous myomas. The dependent variables were the complete myomectomy performed in a single hysteroscopic procedure, and the presence of early complications related to the procedure. RESULTS We identified 338 women who underwent hysteroscopic myomectomy. In 89.05% of the cases, there was a single fibroid to be treated. According to the classification of the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO, in French), most fibroids were of grade 0 (66.96%), followed by grade 1 (20.54%), and grade 2 (12.50%). The myomectomies were complete in 63.31% of the cases, and the factors independently associated with complete myomectomy were the diameter of the largest fibroid (prevalence ratio [PR]: 0.97; 95% confidence interval [95%CI]: 0.96-0.98) and the classification 0 of the fibroid according to the FIGO (PR: 2.04; 95%CI: 1.18-3.52). We observed early complications in 13.01% of the hysteroscopic procedures (4.44% presented excessive bleeding during the procedure, 4.14%, uterine perforation, 2.66%, false route, 1.78%, fluid overload, 0.59%, exploratory laparotomy, and 0.3%, postoperative infection). The only independent factor associated with the occurrence of early complications was incomplete myomectomy (PR: 2.77; 95%CI: 1.43-5.38). CONCLUSIONS Our results show that hysteroscopic myomectomy may result in up to 13% of complications, and the chance of complete resection is greater in small and completely intracavitary fibroids; women with larger fibroids and with a high degree of myometrial penetration have a greater chance of developing complications from hysteroscopic myomectomy.
Collapse
Affiliation(s)
| | - Lúcia Costa-Paiva
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Luiz Francisco Baccaro
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| |
Collapse
|
34
|
Wang MT, Chang CC, Hsieh MH, Chang CW, Fan Chiang YH, Tsai HC. Operative hysteroscopy intravascular absorption syndrome is more than just the gynecological transurethral resection of the prostate syndrome: A case series and literature review. Taiwan J Obstet Gynecol 2020; 59:748-753. [DOI: 10.1016/j.tjog.2020.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2020] [Indexed: 11/26/2022] Open
|
35
|
The Use of Hysteroscopy for the Diagnosis and Treatment of Intrauterine Pathology: ACOG Committee Opinion, Number 800. Obstet Gynecol 2020; 135:e138-e148. [PMID: 32080054 DOI: 10.1097/aog.0000000000003712] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This Committee Opinion provides guidance on the current uses of hysteroscopy in the office and the operating room for the diagnosis and treatment of intrauterine pathology and the potential associated complications. General considerations for the use of diagnostic and operative hysteroscopy include managing distending media, timing for optimal visualization, and cervical preparations. In premenopausal women with regular menstrual cycles, the optimal timing for diagnostic hysteroscopy is during the follicular phase of the menstrual cycle after menstruation. Pregnancy should be reasonably excluded before performing hysteroscopy. There is insufficient evidence to recommend routine cervical ripening before diagnostic or operative hysteroscopy, but it may be considered for those patients at higher risk of cervical stenosis or increased pain with the surgical procedure. In randomized trials, patients reported a preference for office-based hysteroscopy, and office-based procedures are associated with higher patient satisfaction and faster recovery when compared with hospital-based operative hysteroscopy. Other potential benefits of office hysteroscopy include patient and physician convenience, avoidance of general anesthesia, less patient anxiety related to familiarity with the office setting, cost effectiveness, and more efficient use of the operating room for more complex hysteroscopic cases. Appropriate patient selection for office-based hysteroscopic procedures for women with known uterine pathology relies on thorough knowledge and understanding of the target pathology, size of the lesion, depth of penetration of the lesion, patient willingness to undergo an office-based procedure, physician skills and expertise, assessment of patient comorbidities, and availability of proper equipment and patient support. Both the American College of Obstetricians and Gynecologists (ACOG) and the American Association of Gynecologic Laparoscopists (AAGL) agree that vaginoscopy may be considered when performing office hysteroscopy because studies have shown that it can significantly reduce procedural pain with similar efficacy. The office hysteroscopy analgesia regimens commonly described in the literature include a single agent or a combination of multiple agents, including a topical anesthetic, a nonsteroidal antiinflammatory drug, acetaminophen, a benzodiazepine, an opiate, and an intracervical or paracervical block, or both. Based on the currently available evidence, there is no clinically significant difference in safety or effectiveness of these regimens for pain management when compared to each other or placebo. Patient safety and comfort must be prioritized when performing office hysteroscopic procedures. Patients have the right to expect the same level of patient safety as is present in the hospital or ambulatory surgery setting.
Collapse
|
36
|
Stoll F, Lecointre L, Meyer N, Faller E, Host A, Hummel M, Boisrame T, Akladios C, Garbin O. Randomized Study Comparing a Reusable Morcellator with a Resectoscope in the Hysteroscopic Treatment of Uterine Polyps: The RESMO Study. J Minim Invasive Gynecol 2020; 28:801-810. [PMID: 32681995 DOI: 10.1016/j.jmig.2020.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To compare a reusable hysteroscopic morcellator and standard resectoscopes in the hysteroscopic management of uterine polyps. DESIGN Single-center randomized prospective single-blind trial (resectoscope-morcellator study). SETTING Centre Médico-chirurgical Obstétrique teaching hospital, Strasbourg University Hospitals, France. PATIENTS All patients presenting with a single endometrial polyp of size 1 cm or larger. INTERVENTIONS After consent, the patients were randomized into 2 groups: hysteroscopic morcellation (HM) group or standard resection (SR) group. Office-based review hysteroscopy was performed 6 weeks to 8 weeks after surgery. Primary end point: time of morcellation or resection. SECONDARY OUTCOMES total operating time (minutes), volume of fluid used (mL), fluid deficit (mL), number of morcellator or resectoscope insertions, operator comfort (visual analog scale: 0 to 10) and quality of vision (0 to 5), perioperative complications, completeness of resection, need to convert to another technique, pain assessment (visual analog scale), and length of hospitalization. At review hysteroscopy, we noted whether the resection or morcellation had been effective and if synechiae were present or absent. Statistical analyses followed Bayesian methods. MEASUREMENTS AND MAIN RESULTS Ninety patients were randomized: 45 in the HM group and 45 in the SR group. The average size of polyps at hysteroscopy was 13.3 mm. Morcellation time was lower than resection time (6.1 minutes vs 9 minutes; p [HM < SR] = .996). This also applied to total operating time (12.7 minutes vs 15.6 minutes; p [HM < SR] = .985), number of device insertions (1.50 vs 6; p [HM < SR] > .999), volume of fluid used (766.9 mL vs 1118.9 mL; p [HM < SR] = .994), and fluid deficit (60.2 mL vs 169.8 mL; p [HM < SR] = .989). Operator comfort was better in the HM group (8.4 vs 7.4; p [HM > SR] = .999) as was visualization (4 vs 3.7; p [HM > SR] = .911, highly probable). Operative complications were higher in the SR group (5 vs 0; p [HM < SR] = .989]. One patient in the SR group died after surgery owing to an anesthetic complication (anaphylactic shock complicated by pulmonary embolism). No differences were noted between the groups for pain assessment, length of hospitalization, and outcome on review hysteroscopy. CONCLUSION The reusable morcellator is quicker, uses less fluid with less deficit and fewer introductory maneuvers, and offers better comfort and visualization than the resectoscope while being as effective for the hysteroscopic treatment of uterine polyps.
Collapse
Affiliation(s)
- François Stoll
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
| | - Lise Lecointre
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nicolas Meyer
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Emilie Faller
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Aline Host
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Michel Hummel
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thomas Boisrame
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Cherif Akladios
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Olivier Garbin
- Department of Obstetrics and Gynecology (Drs. Stoll, Lecointre, Faller, Host, Hummel, Boisrame, Akladios, and Garbin); Medical Information Department (Dr. Meyer), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| |
Collapse
|
37
|
Abstract
Hysteroscopy and anesthesia have come a long way in the last 150 years. While traditionally performed in the operating theater under general anesthesia, the alternative approach - so-called 'office' hysteroscopy - has gained popularity in recent years. Supporters of this modality cite the 'see and treat' capabilities, avoidance of anesthesia, more rapid turn-around time, and favorable economics as advantages. On the other hand, some question the success rate, capabilities, and patient comfort levels as potential drawbacks. In this article, we review the evidence behind all of these points as well as the requirements for setting up an office hysteroscopy service.
Collapse
Affiliation(s)
- J N Mak
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital School, Saint Leonards, NSW, Australia
| | - A Imran
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital School, Saint Leonards, NSW, Australia
| | - S Burnet
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital School, Saint Leonards, NSW, Australia
| |
Collapse
|
38
|
Liao CY, Lo CH, Yu MX, Chan WH, Wei KY, Tseng MF, Wu CC. Life-threatening acute water intoxication in a woman undergoing hysteroscopic myomectomy: a case report and review of the literature. BMC WOMENS HEALTH 2020; 20:52. [PMID: 32164632 PMCID: PMC7069039 DOI: 10.1186/s12905-020-0895-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/29/2020] [Indexed: 11/17/2022]
Abstract
Background Acute water intoxication after hysteroscopy is a rare, life-threatening condition, often accompanied with delayed diagnosis owing to masked symptoms because of general anesthesia. Case presentation Herein we presented a 39-year-old female who presented with cardiac arrest after hysteroscopic myomectomy because of acute water intoxication and survived after extracorporeal membrane oxygenation, continuous venous–venous hemofiltration, and aggressive high sodium fluid resuscitation. Conclusion Failure to recognize and treat this condition appropriately may lead to potentially lethal cardiopulmonary complications.
Collapse
Affiliation(s)
- Chen-Yi Liao
- Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Chang-Han Lo
- Division of Nephrology, Department of Medicine, Tri Service General Hospital, Pen-Hu Branch, Peng-Hu, Taiwan
| | - Mu-Xian Yu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu, 114, Taipei, Taiwan
| | - Wei-Hung Chan
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kuang-Yu Wei
- Division of Nephrology, Department of Medicine, Tri Service General Hospital, Pen-Hu Branch, Peng-Hu, Taiwan
| | - Min-Feng Tseng
- Division of Nephrology, Department of Medicine, Tri Service General Hospital, Pen-Hu Branch, Peng-Hu, Taiwan
| | - Chia-Chao Wu
- Division of Nephrology, Department of Medicine, Tri Service General Hospital, Pen-Hu Branch, Peng-Hu, Taiwan.
| |
Collapse
|
39
|
Lee EB, Park J, Lim HK, Kim YI, Jin Y, Lee KH. Complications of fluid overload during hysteroscopic surgery: cardiomyopathy and epistaxis - A case report. Anesth Pain Med (Seoul) 2020; 15:61-65. [PMID: 33329791 PMCID: PMC7713864 DOI: 10.17085/apm.2020.15.1.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/07/2019] [Accepted: 09/10/2019] [Indexed: 11/17/2022] Open
Abstract
Background Hysteroscopic surgery has been used in various gynecological fields. However, massive fluid overload can occur as a complication due to persistent infusion of media for uterine cavity distension. We present the case of a woman who developed cardiomyopathy with pulmonary edema and epistaxis during hysteroscopic surgery. Case A 76-year-old female underwent hysteroscopic septectomy. She manifested abrupt, active nasal bleeding and regurgitation in the intravenous line. Heart rate, SpO2, and PETCO2 decreased from 55 beats/min to 29 beats/min, from 100% to 56%, and from 31 mmHg to 9 mmHg, respectively. After the operation, brain CT showed bilateral prominent superior ophthalmic vein dilation. Echocardiography showed left ventricle apical ballooning and global hypokinesia. The patient recovered after two days of conservative management, with no sequelae. Conclusions Although hysteroscopic surgery is a simple procedure, careful monitoring is necessary to prevent complications from absorption of fluid distending media during the procedure.
Collapse
Affiliation(s)
- Eun Bi Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jihyoung Park
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyun Kyo Lim
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yong Il Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yeonghyeon Jin
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kwang Ho Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| |
Collapse
|
40
|
Oxley SG, Mallick R, Odejinmi F. Laparoscopic Myomectomy: An Alternative Approach to Tackling Submucous Myomas? J Minim Invasive Gynecol 2019; 27:155-159. [PMID: 30926366 DOI: 10.1016/j.jmig.2019.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/14/2019] [Accepted: 03/21/2019] [Indexed: 02/08/2023]
Abstract
STUDY OBJECTIVE To evaluate the differences in perioperative outcomes and immediate complication rates between laparoscopic myomectomy for submucous myomas and laparoscopic myomectomy for myomas in other locations. DESIGN Retrospective cohort study. SETTING University-affiliated hospital in London. PATIENTS A total of 350 patients with symptomatic uterine myomas underwent laparoscopic myomectomy. Thirty-three of these were performed for submucous myomas (group 1), and 317 were for myomas in other uterine locations (group 2). INTERVENTIONS Analysis of prospectively collected data on patient demographics, myoma characteristics, perioperative outcomes, and immediate complications. MEASUREMENTS AND MAIN RESULTS Patient demographics, including age, body mass index, and parity, were similar in the 2 groups. No significant differences in myoma characteristics were seen between groups 1 and 2, including the mean dimension of largest myoma (7.1 vs 7.8 cm, respectively; p = .35), mean number of myomas removed (3.8 vs 4.1; p = .665), and mean mass of myomas removed (142.0 g vs 227.3 g; p = .186). There were also no significant between-group differences in any perioperative outcomes, including mean blood loss (226.8 mL vs 266.4 mL; p = .373), duration of surgery (103 minutes vs 113 minutes; p = .264), and duration of hospital stay (1.4 days vs 1.7 days; p = .057). No complications arose from laparoscopic resection of submucous myomas. CONCLUSION Laparoscopic myomectomy for submucous myomas has similar perioperative outcomes and immediate complications as laparoscopic myomectomy for other myomas and can be considered for large or type 2 submucous myomas.
Collapse
Affiliation(s)
- Samuel George Oxley
- Department of Women's Health, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (Drs. Oxley and Odejinmi).
| | - Rebecca Mallick
- Department of Women's Health, Brighton and Sussex University Hospitals NHS Trust, Princess Royal Hospital, Haywards Heath, United Kingdom (Dr. Mallick)
| | - Funlayo Odejinmi
- Department of Women's Health, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (Drs. Oxley and Odejinmi)
| |
Collapse
|
41
|
Overcoming the Challenging Cervix: Identification and Techniques to Access the Uterine Cavity. Obstet Gynecol Surv 2019; 73:641-649. [PMID: 30468239 DOI: 10.1097/ogx.0000000000000614] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Cervical stenosis is a challenging clinical entity that requires prompt identification and management in order to avoid iatrogenic injury at the time of endocervical canal cannulation. Objective The aim of this study was to identify cervical stenosis and discuss associated etiologies, risk factors, and review medical and surgical approaches for overcoming cervical stenosis. Evidence Acquisition Computerized searches of MEDLINE and PubMed were conducted using the key words "cervix", "cervical stenosis," "embryo transfer," "hysteroscopy complications," "misoprostol," and "ultrasound." References from identified sources were manually searched to allow for a thorough review. Data from relevant sources were compiled to create this review. Results Transcervical access to the uterine cavity is frequently required for procedures such as hysteroscopy, dilation and curettage, endometrial biopsy, sonohysterogram, hysterosalpingogram, intrauterine insemination, embryo transfer in those undergoing in vitro fertilization, and insertion of intrauterine devices. These procedures can become complicated when difficult cannulation of the endocervical canal is encountered. Management strategies include preprocedural use of cervical-ripening agents or osmotic dilators, ultrasound guidance, no-touch vaginoscopy, manual dilatation, and hysteroscopic resection of the obstructed endocervical canal. Conclusions and Relevance Cervical stenosis is associated with iatrogenic complications that can result in significant patient morbidity. In patients undergoing in vitro fertilization, difficult embryo transfer is associated with lower pregnancy rates. The clinician should carefully consider the patient's menopausal status, risk factors, and symptoms in order to anticipate difficult navigation of the endocervical canal. Various medical and surgical management strategies, including hysteroscopic resection, can be used to overcome the stenotic cervix.
Collapse
|
42
|
Sapienza LG, Jhingran A, Kollmeier MA, Lin LL, Calsavara VF, Gomes MJL, Baiocchi G. Decrease in uterine perforations with ultrasound image-guided applicator insertion in intracavitary brachytherapy for cervical cancer: A systematic review and meta-analysis. Gynecol Oncol 2018; 151:573-578. [PMID: 30333082 DOI: 10.1016/j.ygyno.2018.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To estimate uterine perforations rates during intracavitary brachytherapy for cervical cancer with and without ultrasound (US) image guidance. MATERIALS AND METHODS A systematic search of databases (PubMed and EMBASE) was performed. The pooled summary uterine perforation rate (detected by postinsertion CT or MRI) for the un-guided insertion group and the guided insertion group was calculated by using the random-effects model weighted by the inverse variance. RESULTS A total of 690 articles were initially found, resulting in 12 studies that met the inclusion criteria. A total of 1757 insertions and 766 patients were included in the meta-analysis. The overall uterine perforation rate per insertion was 4.56% (95%CI: 2.35-8.67) and per patient was 7.39% (95%CI: 3.92-13.50). The pooled perforation rate per insertion without image guidance was 10.54% (95%CI: 6.12-17.57) versus 1.06% (95%CI: 0.41-2.67) with image guidance (p < 0.01). The pooled perforation rate per patient without guidance was 16.67% (95%CI: 10.01-26.45) versus 2.54% (95%CI: 1.21-5.24) with image guidance (p < 0.01). The ratio of perforations in the un-guided/guided groups was 9.94 and 6.56, per insertion and per patient, respectively. The most common sites of perforation were the posterior wall (>47 events) and the uterine fundus (24 events). None of the studies reported significant acute clinical consequences. Prophylactic antibiotic after perforation was used in 3 of the 4 studies that described the management. CONCLUSION Using postinsertion CT or MRI to detect the perforation, the rate of uterine perforation per insertion in patients who received US-guided intracavitary brachytherapy insertion is 90% lower than with un-guided insertion.
Collapse
Affiliation(s)
- Lucas Gomes Sapienza
- Department of Radiation Oncology, AC Camargo Cancer Center, São Paulo, SP, Brazil; Department of Radiation Oncology, Hospital Central do Exército do Rio de Janeiro (HCE-RJ), Rio de Janeiro, RJ, Brazil.
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marisa A Kollmeier
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lillie L Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Maria José Leite Gomes
- Department of Radiation Oncology, Hospital Federal dos Servidores do Estado (HFSE-RJ), Rio de Janeiro, RJ, Brazil
| | - Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, SP, Brazil
| |
Collapse
|
43
|
Taniguchi F, Wada-Hiraike O, Hirata T, Tajima H, Masuda H, Kitade M, Kumakiri J, Uchiide I, Saito J, Kurose K, Takeshita T, Harada T. A nationwide survey on gynecologic endoscopic surgery in Japan, 2014-2016. J Obstet Gynaecol Res 2018; 44:2067-2076. [PMID: 30125428 DOI: 10.1111/jog.13774] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/08/2018] [Indexed: 11/28/2022]
Abstract
AIM Since 2014, Japan Society of Gynecologic and Obstetric Endoscopy and minimally invasive therapy (JSGOE) conducted a nationwide survey on gynecologic endoscopic surgery. We aimed to evaluate the current status and complications associated with endoscopic surgery by Japan gynecologic and obstetric endoscopy-database registry system (JOE-D). METHODS Electrical medical records concerning the endoscopic surgery were generated from the daily use of reporting system. The subjects were all patients who underwent gynecologic endoscopic surgery. In addition to assessment of actual numbers, diagnosis, and operative methods, adverse events were registered. RESULTS Total 203 970 patients performed laparoscopic, hysteroscopic and falloposcopic surgery for 3 years, 2014-2016. The numbers of endoscopic surgeries conducted in 2016 were increased more than 67 000, 13 000 or 450 cases, respectively. Incidence rates of complications involving these three types of surgeries in each year were approximately 3.1%. Incidences of intraoperative complications were relatively high in malignant diseases, laparoscopic-assisted vaginal hysterectomy (LAVH) and myomectomy (LAM). In total laparoscopic hysterectomy/laparoscopic hysterectomy (TLH/LH) performed from 2014 to 2016, ureteral injury as intra and postoperative complication occurred in 0.35%. In the past 3 years, the rates of vascular injury, urinary tract, and bowel injury as intraoperative complications caused by laparoscopic surgery were approximately 0.1%. In the hysteroscopic surgery, the rates of total intra- and postoperative complications were 0.78%. CONCLUSION We exhibited the current status by the nationwide survey of gynecologic endoscopic surgery all over Japan. Severe intra or postoperative complications were identified over the 3 years at a rate of 0.04%.
Collapse
Affiliation(s)
| | - Osamu Wada-Hiraike
- Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuya Hirata
- Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | | | | | | | | | | | - Juichiro Saito
- Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | | | | | - Tasuku Harada
- Tottori University Faculty of Medicine, Yonago, Japan
| | | |
Collapse
|
44
|
Li HM, Sung FC, Li SC, Huang YK, Chang Y, Chang CC, Huang SJ, Lin CL, Kao CH. The effect of antibiotic prophylaxis for acute pelvic inflammatory disease after hysterosalpingography: a retrospective cohort study. Curr Med Res Opin 2018; 34:1271-1276. [PMID: 29239678 DOI: 10.1080/03007995.2017.1417243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS Concerns about acute pelvic inflammatory disease (PID) after hysterosalpingography (HSG) have been raised since 1980. However, the effectiveness of prophylactic antibiotics remains unclear. This study investigated the effect of antibiotic prophylaxis in women undergoing HSG. METHODS Women undergoing HSG between 2000 and 2012 were screened from the Taiwan National Health Insurance Research Database for eligibility. The prophylactic cohort included patients using any antibiotics of 1st-generation cephalosporins, doxycycline, clindamycin, and metronidazole, within 7 days before HSG (n = 3257). Patients not using any antibiotics were registered as the non-prophylactic cohort (n = 4662). An unconditional logistic regression model was applied to calculate the odds ratio (OR) and 95% confidence interval (CI) of acute PID after HSG associated with prophylactic antibiotics. RESULTS The cumulative incidences of acute PID after HSG were 0.46% and 1.42% in the prophylactic and non-prophylactic cohorts, respectively. Prophylactic patients had a significantly reduced estimated relative risk of acute PID compared with non-prophylactic patients (adjusted OR = 0.33, 95% CI = 0.19-0.58; p = .001). Doxycycline users had the lowest adjusted OR of 0.20 (95% CI = 0.04-0.81; p = .02), followed by users of 1st-generation cephalosporins (adjusted OR = 0.35, 95% CI = 0.18-0.68; p = .002). Multivariate sub-group analysis verified this protective effect for almost all sub-groups of prophylactic patients. CONCLUSIONS Antibiotic prophylaxis is associated with a decreased estimated relative risk of acute PID in HSG patients. Doxycycline and 1st-generation cephalosporins may be effective prophylactic regimens for HSG.
Collapse
Affiliation(s)
- Hao-Ming Li
- a Department of Radiology , E-Da Hospital , Kaohsiung , Taiwan
| | - Fung-Chang Sung
- b Management Office for Health Data, China Medical University Hospital , Taichung , Taiwan
| | - Shang-Chieh Li
- a Department of Radiology , E-Da Hospital , Kaohsiung , Taiwan
| | - Ying-Kai Huang
- c Department of Radiology , Kaohsiung Municipal Min-Sheng Hospital , Kaohsiung , Taiwan
| | - Yu Chang
- d Department of Obstetrics and Gynecology , E-Da Hospital , Kaohsiung , Taiwan
| | - Chi-Chang Chang
- d Department of Obstetrics and Gynecology , E-Da Hospital , Kaohsiung , Taiwan
- e School of Medicine , I-Shou University , Kaohsiung , Taiwan
| | - S Joseph Huang
- d Department of Obstetrics and Gynecology , E-Da Hospital , Kaohsiung , Taiwan
- e School of Medicine , I-Shou University , Kaohsiung , Taiwan
- f Department of Obstetrics and Gynecology, College of Medicine , University of South Florida , Tampa , FL , USA
| | - Cheng-Li Lin
- b Management Office for Health Data, China Medical University Hospital , Taichung , Taiwan
- g College of Medicine , China Medical University , Taichung , Taiwan
| | - Chia-Hung Kao
- h Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine , China Medical University , Taichung , Taiwan
- i Department of Nuclear Medicine and PET Center , China Medical University Hospital , Taichung , Taiwan
- j Department of Bioinformatics and Medical Engineering , Asia University , Taichung , Taiwan
| |
Collapse
|
45
|
Dealberti D, Riboni F, Vitale SG, Vitagliano A, Santangelo F, Zizolfi B. A Polypectomy Nearly Becoming a Tragedy: A Case of Multiorgan Perforation. J Minim Invasive Gynecol 2018; 25:763-764. [DOI: 10.1016/j.jmig.2018.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 01/08/2018] [Indexed: 11/15/2022]
|
46
|
Rodríguez-Mías NRL, Cubo-Abert M, Fernandez-Oliva A, Poza-Barrasus JL, Gil Moreno A. Abdominal Ultrasound Assessment During Operative Hysteroscopy: A Case Series. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Montserrat Cubo-Abert
- Department of Gynecology, Hospital Vall d'Hebrón, Autonomous University of Barcelona, Barcelona, Spain
| | - Antonio Fernandez-Oliva
- Department of Gynecology, Hospital Vall d'Hebrón, Autonomous University of Barcelona, Barcelona, Spain
| | - Jose Luis Poza-Barrasus
- Department of Gynecology, Hospital Vall d'Hebrón, Autonomous University of Barcelona, Barcelona, Spain
| | - Antonio Gil Moreno
- Department of Gynecology, Hospital Vall d'Hebrón, Autonomous University of Barcelona, Barcelona, Spain
| |
Collapse
|
47
|
Zeteroğlu Ş, Aslan M, Akar B, Ada Bender R, Başbuğ A, Çalışkan E. Uterine rupture in pregnancy subsequent to hysteroscopic surgery: A case series. Turk J Obstet Gynecol 2017; 14:252-255. [PMID: 29379670 PMCID: PMC5780571 DOI: 10.4274/tjod.77642] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/12/2017] [Indexed: 12/01/2022] Open
Abstract
Uterine rupture during pregnancy is associated with high mortality and morbidity rates in both the fetus and the mother. Hysteroscopic surgeries such as myomectomy and septum resection are known risk factors for uterine rupture in pregnancy following the operation. We present four infertile patients who were admitted to Kocaeli Medical Park Hospital between February 2014 and November 2016. Three of the patients underwent hysteroscopic septum resection without complication and one had hysteroscopic myomectomy and a 7-8 mm sized rupture was detected. All of the patients became pregnant in less than a year after the operations. The first three patients had uterine rupture at 22nd, 38th, and 10th week, which is the earliest rupture in the literature. The last patient had an uneventful pregnancy and the rupture was observed during cesarean section. A short interval between hysteroscopy and pregnancy may increase the risk of rupture. It may be possible to become pregnant despite rupture and not have any problems during the entire pregnancy.
Collapse
Affiliation(s)
- Şahin Zeteroğlu
- Bursa Acıbadem Hospital, Clinic of Obstetrics and Gynecology, Bursa, Turkey.,Acıbadem University, Vocaitonal High School, İstanbul, Turkey
| | - Melisa Aslan
- Bahçeşehir University Faculty of Medicine, İstanbul, Turkey
| | - Bertan Akar
- İstinye University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Rukiye Ada Bender
- İstinye University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Alper Başbuğ
- Düzce University Faculty of Medicine, Department of Obstetrics and Gynecology, Düzce, Turkey
| | - Eray Çalışkan
- Bahçeşehir University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| |
Collapse
|
48
|
Aas-Eng MK, Langebrekke A, Hudelist G. Complications in operative hysteroscopy - is prevention possible? Acta Obstet Gynecol Scand 2017; 96:1399-1403. [DOI: 10.1111/aogs.13209] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/05/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Anton Langebrekke
- Department of Obstetrics and Gynecology; Oslo University Hospital; Oslo Norway
| | - Gernot Hudelist
- Department of Gynecology; Hospital St. John of God; Vienna Austria
| |
Collapse
|
49
|
Umranikar S, Clark TJ, Saridogan E, Miligkos D, Arambage K, Torbe E, Campo R, Sardo ADS, Tanos V, Grimbizis G. BSGE/ESGE guideline on management of fluid distension media in operative hysteroscopy. ACTA ACUST UNITED AC 2016; 13:289-303. [PMID: 28003797 PMCID: PMC5133285 DOI: 10.1007/s10397-016-0983-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Vasilios Tanos
- St’ Georges Med School, Nicosia University and Aretaeio Hospital, Nicosia, Cyprus
| | | | | |
Collapse
|
50
|
Ziegler N, Korell M, Herrmann A, de Wilde MS, Torres-de la Roche LA, Larbig A, De Wilde RL. Uterine perforation following a fractional curettage successfully treated with the modified polysaccharide 4DryField® PH: a case report. J Med Case Rep 2016; 10:243. [PMID: 27599567 PMCID: PMC5011909 DOI: 10.1186/s13256-016-1029-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/09/2016] [Indexed: 01/01/2023] Open
Abstract
Background Uterine perforation is the most common complication of curettage and may result in bleeding. Therefore, urgent control of bleeding from the uterine wall perforation is necessary to avoid an emergency hysterectomy or blood transfusion, to prevent peritoneal adhesion formation, possible chronic pelvic pain, and infertility. In the present case, an active bleeding secondary to a perforation of the uterus during curettage, for diagnosis of endometrial carcinoma, was instantaneously and successfully treated with only the application of a novel modified polysaccharide powder. This is, to the best of our knowledge, the first time that the agent 4DryField® has been used for this purpose. Case presentation A 71-year-old German woman with serometra and endometrial hyperplasia suffered a perforation of the anterior wall of the uterus during the hysteroscopic resection of submucosal polyps and a fractional curettage. Subsequently, an immediate laparoscopy showed an active bleeding from the wound, which was promptly stopped with only the application of the hemostatic and anti-adhesion polysaccharide powder, 4DryField®. There were no postoperative complications. Nine weeks later, a laparoscopic hysterectomy with bilateral salpingoophorectomy for endometrial carcinoma (histology: stage IA, pT1a, cN0, L0 V0 M0/G2) was performed. The former injured area looked slightly prominent, was completely healed, and showed a shiny serosa. All her pelvic organs were free of adhesions, and there was one 0.5-mm calcified granuloma in the Douglas pouch. Conclusions The efficient hemostasis combined with the adhesion prevention effect of 4DryField®, allowed a fast control of the uterine wall bleeding, saved operation time, avoided the risks of other procedures for bleeding control and contributed to the normal healing of the uterine wall without any adhesion formation.
Collapse
Affiliation(s)
- Nicole Ziegler
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius Hospital-Medical Campus University, Oldenburg, Germany
| | - Matthias Korell
- Department of Obstetrics and Gynecology, Johanna-Etienne-Hospital, Neuss, Germany
| | - Anja Herrmann
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius Hospital-Medical Campus University, Oldenburg, Germany
| | - Maya Sophie de Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius Hospital-Medical Campus University, Oldenburg, Germany
| | - Luz Angela Torres-de la Roche
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius Hospital-Medical Campus University, Oldenburg, Germany
| | - Angelika Larbig
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius Hospital-Medical Campus University, Oldenburg, Germany
| | - Rudy Leon De Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius Hospital-Medical Campus University, Oldenburg, Germany.
| |
Collapse
|