Cesarean section scar increta following first trimester surgical abortion: A rare phenomenon requiring hysterectomy
A 30-year-old gravida 4, para 2 with two prior cesarean sections presented with persistent abnormal uterine bleeding one month following a surgical abortion at 7-weeks-gestation. 3D ultrasonography demonstrated a 6 cm vascular heterogenous mass at the prior uterine incision with lateral extension beyond the cesarean section scar concerning for placental increta (Fig 1). An ultrasound-guided dilation and curettage was performed by the family planning division to rule out a new pregnancy or placental tumor in light of abnormal beta-HCG levels (56-114 mIU/mL), but pathological examination only yielded necrotic placental tissue.
ConclusionPBM in obstetrics is based on three main pillars: diagnostic and/or therapeutic interventions during pregnancy, during delivery and in the postpartum phase. These three main pillars should be kept in mind by all professionals taking care of pregnant women, including obstetricians, general practitioners, midwifes, and anaesthesiologists, to improve pregnancy outcome and optimize resources.
AbstractIntroductionMidwife ‐led models of care have been subject of debate for many years. We conducted a study to compare intrapartum and neonatal mortality rates in midwife‐led (primary) versus obstetrician‐led (secondary) care at the onset of labour in low risk term women.Material and methodsWe performed an unmatched and a propensity score matched cohort study using data from the national perinatal audit registry (PAN) and from the national perinatal registry (PERINED) of the Netherlands. We included women with singleton pregnancies (without congenital anomalies or antepartum fetal death) who gave birth at term b...
ConclusionWe report a case of CSP that, following an initial apparently “successful” treatment with methotrexate, required surgical management due to heavy bleeding.
The aim of this study was to evaluate the efficacy and safety of prophylactic intraoperative bilateral uterine or internal iliac artery embolization in planned cesarean for pernicious placenta previa in the third trimester of pregnancy. The patients with pernicious placenta previa were retrospectively included from January 2011 to May 2018, being divided into embolization group and control group. Intraoperative uterine artery embolization (UAE) or internal iliac artery embolization (IIAE) was undertaken to stop intrapartum and postpartum hemorrhage in embolization group. There were no significant differences on age, preg...
There is no universally agreed upon and adopted management protocol supported by professional societies in the United States or around the world for the treatment of cesarean scar pregnancy. There is a wide range of management options in the literature, and many of them can to lead to severe bleeding complications, which can result in loss of fertility or even maternal death. If inadequately managed, it can lead to untoward complications throughout all 3 trimesters of the pregnancy. Early detection of CSP has a paramount clinical importance.
ConclusionUltrasound-guided local injection of MTX is an effective and minimally invasive treatment for CSP. However, it is not feasible for patients with long-term amenorrhea (>8 weeks) and markedly increased blood βHCG level.
DiscussionIndication ‐only IV cannulation for women experiencing an uncomplicated labor and birth is a reasonable practice in settings where IV access can be established urgently if needed.
Publication date: November–December 2019Source: Journal of Minimally Invasive Gynecology, Volume 26, Issue 7, SupplementAuthor(s): X Zhao, B Gao, X Guan, D XuStudy ObjectiveTo investigate the efficacy, feasibility, and safety of cold scissor ploughing technique in hysteroscopic adhesiolysis for intrauterine adhesions.DesignRetrospective cohort study.SettingUniversity-affiliated hospital.Patients or ParticipantsA total of 179 intrauterine adhesion (IUA) patients who had undergone hysteroscopic adhesiolysis (HA) at the Third Xiangya Hospital of Central South University were enrolled in this study from January 2016 to O...
ConclusionLaparoscopy with temporary internal iliac artery occlusion technique offers effective surgical management of cesarean scar pregnancy, and hysteroscopy is necessary to deal with intrauterine lesions.
ConclusionThe robotic-assisted laparoscopy view, with the 3-D dimension, and the forceps joint make the suture easily to be performed by the gynecologic surgeon.