Uterine artery Doppler in the management of early pregnancy loss: a prospective, longitudinal study

The pharmacological management of early pregnancy loss reduced substantially the need for dilation and curettage. However, prognostic markers of successful outcome were not established. Thus the major purpose of this study was to determine the sensitivity and specificity of the uterine artery pulsatility (PI) and resistance (RI) indices to detect early pregnancy loss patients requiring dilation and curettage after unsuccessful management.

Pregnancy after uterine artery embolization: a case report in a woman with leiomyomata

Background. Several pregnancies have been reported after embolization of uterine artery. This procedure is an accepted nonsurgical treatment for symptomatic uterine fibroids but its safety in women desiring future childbearing is not well established. Case Report. We present a 40-year-old woman with leiomyomata who became pregnant after previously undergone uterine artery embolization for three times. The placenta was previa and the fetus was in transverse position. She had a cesarean delivery of an appropriately grown fetus at 37 weeks, which was followed by uterine atony requiring hysterectomy. Conclusion. Although pregnancy-related outcomes remain understudied, the available reports evidence that pregnancies after uterine artery embolization may be at significantly increased risk for postpartum hemorrhage, cesarean delivery, abnormal placentation, and malpresentation. In patients who are undergoing this type of treatment and contemplating pregnancy, the possibility of adverse complications should be taken in consideration and women should be appropriately advised.

Uterine sarcomas: clinical presentation and MRI features

Uterine sarcomas are a rare heterogeneous group of tumors of mesenchymal origin, accounting for approximately 8% of uterine malignancies. They comprise leiomyosarcoma, endometrial stromal sarcoma, undifferentiated endometrial sarcoma, and adenosarcoma. Compared with the more common endometrial carcinomas, uterine sarcomas behave more aggressively and are associated with a poorer prognosis. Due to their distinct clinical and biological behavior, the International Federation of Gynecology and Obstetrics introduced a new staging system for uterine sarcomas in 2009, categorizing uterine carcinosarcoma as a variant of endometrial carcinoma, rather than a pure sarcoma. Magnetic resonance imaging (MRI) has a developing role in the assessment of these malignancies. Features such as tumor localization, irregular or nodular margins, necrosis, rapid growth, intense contrast enhancement, and restriction at diffusion-weighted imaging can suggest the diagnosis and help differentiate from more common leiomyomas and endometrial carcinoma. MRI is therefore extremely useful in preoperative detection and staging and, consequently, in determination of appropriate management. This pictorial review aims to discuss the clinical features of uterine sarcomas, as well as their most common appearances and distinct characteristics in MRI.

regulatorische Funktion von HO-1 auf uterine NK Zellen an der feto-maternalen Grenzfläche

Otto-von-Guericke-Universität Magdeburg, Fakultät für Naturwissenschaften, Dissertation, 2016

Miomatosis uterina, sintomatología urinaria y alteraciones sexuales en mujeres con indicación de tratamiento quirúrgico

Introducción Las pacientes con miomas uterinos pueden llegar a sufrir de síntomas urinarios y de disfunción sexual. Es para nosotros importante conocer la frecuencia de estas patologías en pacientes con miomas con indicación de cirugía atendidos en el Hospital Universitario Mayor Méderi y la relación entre estas tres entidades. Metodología Estudio cuasi experimental de antes-después. El estudio se encuentra dividido en dos fases, en esta primera fase a las pacientes se les aplicó los cuestionarios FSFI, IIQ-7 y UDI-6 antes de realizar el procedimiento quirúrgico. En una segunda fase se realizará un nuevo abordaje a los 6 y 12 meses donde se aplicarán los mismos instrumentos. Se utilizó coeficiente de Spearman y Kruskall-Wallis para evaluar la relación. Resultados En esta primera fase se incluyeron 81 participantes, con una mediana de años de 46 (RIQ=42-49) mínimo 33 y máximo 71 años. La mediana de miomas fue de 1 (RIQ1-2) máximo 5 miomas. El resultado total de la FSFI fue de 21(RIQ=18,5-25,5). La mediana de la escala UDI -6 fue de 50,4 (RIQ=0-31,2) y la mediana de IIQ-7 fue de 4,75 (RIQ=0-23,7). Se presentó una correlación negativa débil entre los puntajes de FSFI y los cuestionarios UDI-6 (-0.3604) e IIQ 7 (-0.3530), con una prevalencia de riesgo de disfunción sexual de 61%. Conclusiones En esta primera fase de la investigación se pudo observar una existencia de correlación entre la función sexual y la sintomatología urinaria. La prevalencia de disfunción sexual es mayor que en población de mujeres sin patología de miomas uterino.

Crescita volumetrica dei miomi uterini: analisi dei fattori di rischio

I miomi uterini sono la neoplasia uterina più comune e colpiscono fino al 30% delle donne in età fertile. Nonostante l’elevata prevalenza, pochi studi in Letteratura hanno analizzato i fattori di rischio per la crescita dei miomi uterini, mostrando spesso dei risultati contrastanti. Nel nostro studio osservazionale prospettico sono state arruolate pazienti che rispettassero i criteri di inclusione e di esclusione, con diagnosi di miomi uterini evidenziati mediante ecografia eseguita presso i nostri ambulatori, a partire da giugno 2017. A partire da gennaio 2019, sono state ricercate mensilmente le pazienti precedentemente arruolate che erano tornate presso i nostri ambulatori per esecuzione di ulteriore ecografia, a distanza di 24 ± 5 mesi, fino a raggiungere il campione designato, cioè 450 pazienti totali. È stato, quindi, valutato il tasso di crescita annuo del mioma di maggiori dimensioni ed è stato utilizzato l'approccio polinomiale frazionario multivariabile per selezionare i fattori di rischio anamnestici ed ecografici legati all’incremento volumetrico. Circa la metà dei miomi uterini analizzati ha mostrato stabilità dimensionale nel corso del follow-up (crescita ≤10%), mentre la restante metà ha mostrato una crescita > 10%. Il solo fattore di rischio associato alla crescita volumetrica dei miomi uterini è risultato essere il volume del mioma durante l’ecografia di arruolamento (P = 0.001), quindi miomi di piccole dimensioni presentano un tasso di crescita maggiore rispetto ai miomi di grandi dimensioni. Lo studio ha raccolto la più ampia casistica in Letteratura nella valutazione del naturale andamento di modifica dimensionale dei miomi uterini. Sebbene siano necessari ulteriori studi con campione più ampio, questi dati possono fornire un utile supporto per eseguire un adeguato counselling con le pazienti nella pratica clinica quotidiana.

Identificazione e classificazione delle lesioni endocavitarie uterine dalle immagini isteroscopiche con il deep learning

Anche se l'isteroscopia con la biopsia endometriale è il gold standard nella diagnosi della patologia intracavitaria uterina, l'esperienza dell’isteroscopista è fondamentale per una diagnosi corretta. Il Deep Learning (DL) come metodica di intelligenza artificiale potrebbe essere un aiuto per superare questo limite. Sono disponibili pochi studi con risultati preliminari e mancano ricerche che valutano le prestazioni dei modelli di DL nell'identificazione delle lesioni intrauterine e il possibile aiuto derivato dai fattori clinici. Obiettivo: Sviluppare un modello di DL per identificare e classificare le patologie endocavitarie uterine dalle immagini isteroscopiche. Metodi: È stato eseguito uno studio di coorte retrospettivo osservazionale monocentrico su una serie consecutiva di casi isteroscopici di pazienti con patologia intracavitaria uterina confermata all’esame istologico eseguiti al Policlinico S. Orsola. Le immagini isteroscopiche sono state usate per costruire un modello di DL per la classificazione e l'identificazione delle lesioni intracavitarie con e senza l'aiuto di fattori clinici (età, menopausa, AUB, terapia ormonale e tamoxifene). Come risultati dello studio abbiamo calcolato le metriche diagnostiche del modello di DL nella classificazione e identificazione delle lesioni uterine intracavitarie con e senza l'aiuto dei fattori clinici. Risultati: Abbiamo esaminato 1.500 immagini provenienti da 266 casi: 186 pazienti avevano lesioni focali benigne, 25 lesioni diffuse benigne e 55 lesioni preneoplastiche/neoplastiche. Sia per quanto riguarda la classificazione che l’identificazione, le migliori prestazioni sono state raggiunte con l'aiuto dei fattori clinici, complessivamente con precision dell'80,11%, recall dell'80,11%, specificità del 90,06%, F1 score dell’80,11% e accuratezza dell’86,74% per la classificazione. Per l’identificazione abbiamo ottenuto un rilevamento complessivo dell’85,82%, precision 93,12%, recall del 91,63% ed F1 score del 92,37%. Conclusioni: Il modello DL ha ottenuto una bassa performance nell’identificazione e classificazione delle lesioni intracavitarie uterine dalle immagini isteroscopiche. Anche se la migliore performance diagnostica è stata ottenuta con l’aiuto di fattori clinici specifici, questo miglioramento è stato scarso.

[preservation Of The Fertility And The Ovaries In Women With Benign Adnexal Tumors].

To evaluate the sparing of fertility and ovaries in women submitted to surgical treatment for benign adnexal tumors. Between February 2010 and January 2014, 206 patients were included in this observational study as they were submitted to surgical treatment for benign ovarian tumors at CAISM, a tertiary hospital. Fertility sparing surgery was defined as tumorectomy or unilateral salpingoophorectomy without hysterectomy in premenopausal women. Preservation of the ovary occurred when at least one ovary or part of it was mantained. Of the 206 women with benign tumors, 120 (58%) were premenopausal and 86 (42%) were postmenopausal. There were 36 (30%) ovarian germ cell tumors, 31 (26%) epithelial neoplasms and 11 (9%) sex-cord stromal tumors among premenopausal women. In the group of postmenopausal women, 35 (41%) epithelial neoplasms, 27 (31%) sex-cord stromal tumors and 8 (9%) ovarian germ cell tumors were identified. Among 36 women with non-neoplastic ovarian tumors, 21 (58%) had endometriomas and 8 (22%) functional cysts. Among 22 women with extra-ovarian tumors, uterine leiomyomatosis was the most frequent finding (50%). In the group of women who were ≤ 35 years old, 26 (57%) were treated by tumorectomy and 18 (39%) were submitted to unilateral salpingoophorectomy with sparing of the uterus and the contralateral ovary. Women who were ≤ 35 years old were more frequently operated by laparoscopy which was associated with a higher number of fertility sparing procedures when compared to laparotomy (p<0.01). Twenty-six (28%) women submitted to hysterectomy with bilateral salpingoophorectomy were premenopausal. Although there is a trend to perform only tumorectomy in women who are ≤ 35 years old, a significant number of young women is still treated by salpingoophorectomy. Among 36- to 45-year-old women, only 70% had their fertility spared, while 20% had both ovaries removed. However, whenever possible, we must try to preserve the ovaries, mainly in premenopausal women.

Usefulness Of Vaginal Cytology Tests In Women With Previous Hysterectomy For Benign Diseases: Assessment Of 53,891 Tests.

To assess the value of vaginal screening cytology after hysterectomy for benign disease. This cross-sectional study used cytology audit data from 2,512,039 screening tests in the metropolitan region of Campinas from 2000 to 2012; the object was to compare the prevalence of abnormal tests in women who had undergone a hysterectomy for benign diseases (n=53,891) to that of women who had had no hysterectomy. Prevalence ratios (95% confidence intervals, 95% CI) were determined, and chi-square analysis, modified by the Cochrane-Armitage test for trend, was used to investigate the effects of age. The prevalence of atypical squamous cells (ASC), low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion or squamous-cell carcinoma (HSIL/SCC) was 0.13%, 0.04% and 0.03%, respectively, in women who had undergone hysterectomy, and 0.93%, 0.51% and 0.26% in women who had not undergone hysterectomy. The prevalence ratios for ASC, LSIL and HSIL/SCC were 0.14 (0.11-0.17), 0.08 (0.06-0.13) and 0.13 (0.08-0.20), respectively, in women with a hysterectomy versus those without. For HSIL/SCC, the prevalence ratios were 0.09 and 0.29, respectively, for women <50 or ≥50years. The prevalence rates in women with a previous hysterectomy showed no significant variation with age. The prevalence rates of ASC, LSIL and HSIL/SCC were significantly lower in women with a previous hysterectomy for benign disease compared with those observed in women with an intact uterine cervix. This study reinforces the view that there is no evidence that cytological screening is beneficial for women who have had a hysterectomy for benign disease.

Contribution Of Antepartum And Intrapartum Hemorrhage To The Burden Of Maternal Near Miss And Death In A National Surveillance Study.

To evaluate the occurrence of severe obstetric complications associated with antepartum and intrapartum hemorrhage among women from the Brazilian Network for Surveillance of Severe Maternal Morbidity. Multicenter cross-sectional study. Twenty-seven obstetric referral units in Brazil between July 2009 and June 2010. A total of 9555 women categorized as having obstetric complications. The occurrence of potentially life-threatening conditions, maternal near miss and maternal deaths associated with antepartum and intrapartum hemorrhage was evaluated. Sociodemographic and obstetric characteristics and the use of criteria for management of severe bleeding were also assessed in these women. The prevalence ratios with their respective 95% confidence intervals adjusted for the cluster effect of the design, and multiple logistic regression analysis were performed to identify factors independently associated with the occurrence of severe maternal outcome. Antepartum and intrapartum hemorrhage occurred in only 8% (767) of women experiencing any type of obstetric complication. However, it was responsible for 18.2% (140) of maternal near miss and 10% (14) of maternal death cases. On multivariate analysis, maternal age and previous cesarean section were shown to be independently associated with an increased risk of severe maternal outcome (near miss or death). Severe maternal outcome due to antepartum and intrapartum hemorrhage was highly prevalent among Brazilian women. Certain risk factors, maternal age and previous cesarean delivery in particular, were associated with the occurrence of bleeding.

Severe Maternal Morbidity And Near Miss Due To Postpartum Hemorrhage In A National Multicenter Surveillance Study.

To assess the occurrence of severe maternal complications owing to postpartum hemorrhage (PPH) and its associated factors. A secondary analysis of data from a multicenter cross-sectional prospective surveillance study included 9555 cases of severe maternal morbidity at 27 centers in Brazil between July 2009 and June 2010. Complications of PPH, conditions of severity management, and sociodemographic and obstetric characteristics were assessed. Factors independently associated with severe maternal outcome (SMO) were identified using multiple regression analysis. Overall, 1192 (12.5%) of the 9555 women experienced complications owing to PPH (981 had potentially life-threatening conditions, 181 maternal near miss, and 30 had died). The SMO ratio was 2.6 per 1000 live births among women with PPH and 8.5 per 1000 live births among women with other complications. Women with PPH had a higher risk of blood transfusion and return to the operating theater than did those with complications from other causes. Maternal age, length of pregnancy, previous uterine scar, and cesarean delivery were the main factors associated with an increased risk of SMO secondary to PPH. PPH frequently leads to severe maternal morbidity. A surveillance system can identify the main causes of morbidity and could help to improve care, especially among women identified as being at high risk of PPH.

Estudo vídeo-polissonográfico em recém-nascidos de termo pequenos para a idade gestacional

Video-polygraphic-EEG studies were performed in the first 24 life-hours of 26 healthy full-term newborns without perinatal injuries. The neurological examination and cranial ultrasonography were normal. The newborns were divided into two groups: one, with full-term appropriate - birth weight 11 newborns (control group ) and the other with full-term low-birth weight 15 newborns. Thirteen newborns of the second group had video-polygraphic-EEG study abnormalities. The most frequent abnormalities were found in 11 cases, as far as sleep architecture is concerned. Also, when compared with the control group, 8 cases of an excessive amount of startles and 2 cases of low behavior activities were found. The results demonstrate the usefulness of video-polygraphic-EEG study in the full-term newborns with intra-uterine growth retard. This examination was sensitive to detect behavior, sleep architecture and EEG standard differences in the low birth-weight newborns as to the control group.

Detection of Brucella ovis in ovine from Paraíba State, in the Northeast region of Brazil

To determine the presence of Brucella ovis in ovine from Paraíba State, in the Northeast region of Brazil, 80 animals slaughtered in the public slaughterhouse of Patos city were used. Before slaughter, blood samples were collected by jugular venopuncture from each animal, and after slaughter, testicles, epidydimus and uterus were aseptically collected. For the serological diagnosis of B. ovis and B. abortus infections, the agar gel immunodiffusion (AGID) and Rose Bengal (RBT) tests were carried out, respectively. In addition, microbiological culture and polymerase chain reaction (PCR) were performed on testicle, epidydimus and uterus samples. Six animals (7.5%) tested positive for the presence of B. ovis antibodies and all animals tested negative for the presence of B. abortus antibodies. One AGID-positive animal tested positive at uterine swab culture. PCR was able to amplify DNA of Brucella spp. from the pool of testicle, epidydimus and uterus samples from AGID-positive animals. This is the first report of isolation and detection of B. ovis DNA by PCR in ovine from the Northeast region of Brazil.

Monitorização materno-fetal durante procedimento odontológico em portadora de cardiopatia valvar

FUNDAMENTO: Os efeitos da anestesia local em odontologia com lidocaína e epinefrina, sobre parâmetros cardiovasculares de gestantes portadoras de valvopatias e seus conceptos, não estão esclarecidos. OBJETIVO: Avaliar e analisar parâmetros da cardiotocografia, de pressão arterial e eletrocardiográficos da gestante portadora de doença valvar reumática, quando submetida à anestesia local com 1,8 ml de lidocaína 2% sem vasoconstritor e com epinefrina 1:100.000, durante procedimento odontológico restaurador. MÉTODOS: Realizamos monitorização ambulatorial da pressão arterial, eletrocardiografia ambulatorial materna e cardiotocografia de 31 portadoras de cardiopatia reumática, entre a 28ª e 37ª semana de gestação, divididas em dois grupos conforme presença ou não do vasoconstritor RESULTADOS: Demonstrou-se redução significativa dos valores de frequência cardíaca materna nos dois grupos, durante o procedimento, quando comparado aos demais períodos (p < 0,001). Houve ocorrência de arritmia cardíaca em 9 (29,0%) pacientes, das quais 7 (41,8%) pertencentes ao grupo de 17 gestantes que recebeu anestesia com adrenalina. A pressão arterial materna não apresentou diferença quando comparamos períodos ou grupos (p > 0,05). O mesmo ocorreu (p > 0,05) com número de contrações uterinas, nível e variabilidade da linha de base e número de acelerações da frequência cardíaca fetal. CONCLUSÃO: O uso de 1,8 ml de lidocaína 2% associado à adrenalina mostrou-se seguro e eficaz em procedimento odontológico restaurador durante a gestação de mulheres com cardiopatia valvar reumática.