Modern approaches to endoscopic hysterectomy

The new method of radical uterine surgery combining endoscopic approachand minilaparotomy is represented. 105 operative invasions on the uterus were performed using this method. Characteristic features of the surgical method, which was elaborated, are minimum blood loss and tissue injury, simple technique, low requirement of analgetics, fast rehabilitation of patients activity and capacity for work, using common equipments and materials.

Endoscopy in the preservation and restoration of reproductive function

The new method of radical uterine surgery combining endoscopic approachand minilaparotomy is represented. 105 operative invasions on the uterus were performed using this method. Characteristic features of the surgical method, which was elaborated, are minimum blood loss and tissue injury, simple technique, low requirement of analgetics, fast rehabilitation of patients activity and capacity for work, using common equipments and materials.

A Case Report of an Abdominal Wall Endometrioma

Abdominal wall endometrioma (AWE) is one of the rarest forms of the endometriosis, and usually found in the young patients, average age is 35years. The most common triad of the symptoms is, abdominal mass at or near the scar, cyclical pain and history of previous caesarean or any other gynecological surgery. Exact pathogenesis is unknown as average time of its presentation in the patients is highly variable from 3 months till 2 decades. It can be suspected on ultrasonography and CT scan and MRI are the modalities used to assess and stage the lesion prior to the surgery. Histopathological diagnosis is confirmatory. We are reporting 30 years old, Para 2, with history of first caesarean section 6 years ago followed by the normal delivery. She presented with the history of cyclical abdominal pain with the feeling of abdominal lump from last 3 months. On examination a slightly tender 5*4 cm extra abdominal mass was palpable above the right half of the previous transverse scar of the caesarean. After evaluation endometriosis was suspected and the patient opted for the surgical resection of the mass. The mass was removed in collaboration with the surgeons and the histopathology confirmed the diagnosis of the AWE. Conclusion: AWE is a dynamic yet incompletely known entity as a result of increasing number of the caesarean and gynecological procedures. It should be kept in the differential diagnosis of the patients coming with the cyclical abdominal pain and abdominal lump with the history of previous uterine surgery. Ultrasound and MRI are the main aiding modalities but the confirmation of the diagnosis is made only after histopathology. The surgical removal of the mass with negative margins represents the current best treatment. Key words: Abdominal wall, endometriosis, magnetic resonance imaging, ultrasonography.

Recurrent uterine rupture in third trimester of pregnancy

We report a case of recurrent upper segment uterine rupture in a 31-year-old woman at 32+5/40 weeks of gestation. She had fundal uterine rupture 3 years ago in her first pregnancy at 40 weeks of gestation. There was no history of uterine malformation or prior uterine surgery. However, we noted that she had had three laparoscopic procedures for endometriosis treatment. She was scheduled to have an elective repeat caesarean section at 34+6/40 weeks of gestation in the index pregnancy. Unfortunately, she presented at 32+5/40 weeks with features of acute abdomen and signs of fetal distress. She had a category 1 caesarean section and was found to have fundal uterine rupture at the same site. She had a smooth uneventful recovery following a timely intervention and discharged home on day 5 postoperatively in a good condition with her baby girl.

Uterine Rupture - Risk Factors and Pregnancy Outcome in Bundelkhand Region

BACKGROUND Uterine rupture is defined as the tearing of the muscular wall of the uterus during pregnancy or labour.1 Often it occurs from the tearing of previous caesarean scar during labour.2 The other known risk factors for uterine rupture include, maternal age, height, body mass index (BMI), education, birth weight, gestational age, induction of labour, instrumental vaginal delivery, interpregnancy interval, congenital uterine anomaly, grand multiparity, previous uterine surgery, fetal macrosomia, fetal malposition, obstructed labour, uterine instrumentation, attempted forceps delivery, external version, and uterine trauma. 2-6This study was done to find out the prevailing risk factors associated with this grave condition in Bundelkhand region, so that mortality and morbidity associated with it could be prevented. METHODS We have studied 37 cases of uterine rupture, operated in our institution from Jan. 2018 to Oct. 2019. During this period a total of 2986 Caesarean sections (CS) were performed. Of these 37 cases, 5 were Nullipara (13.51 %), 16 primipara (31.25 %) and 16 were grand multipara (31.25 %). 24 cases (64.86 %) had previous uterine scar while 13 (35.13 %) had no scar. RESULTS In our study major risk factors for uterine rupture were found to be previous scars (64.68 %). Obstructive labour (23.07 %), malpresentation (7.69 %), grand multiparity (38.46 %) and prolong labour (30.76 %), were responsible for rupture in unscarred uterus. In all cases we first tried to repair the tear and only 9 (24.32 %) needed hysterectomy. In our study 28 patients (75.67 %) required only repair whereas 24.32 % cases needed hysterectomy. Maternal death was just 1 case (2.7 %) and (51.35 %) babies survived. CONCLUSIONS Majority of uterine rupture cases were found in women who had previous CS. So, first CS should be performed after very careful understanding of its indications. 2.7 % maternal mortality and 51.35 % delivery of live birth babies in our study proves that early detection and proper managing of the case can reduce maternal and fetal mortality in uterine rupture cases. KEY WORDS Uterine Rupture, Previous Scar, Inter-Pregnancy Interval

HUBUNGAN USIA MENARCHE DENGAN KEJADIAN ENDOMETRIOSIS

AbstrakLatar belakang : Endometriosis adalah penyakit ginekologi yang bersifat menahun dan progresif dengan angka kejadiannya mengalami peningkatan dari tahun ke tahun namun penyebabnya sebagian besar masih belum diketahui. Usia menarche adalah salah satu faktor resiko yang berhubungan dengan kejadian endometriosis. Tujuan penulisan ini adalah untuk mengetahui hubungan antara usia menarche dengan kejadian endometriosis di Rumkital Dr. Ramelan Surabaya. Metode : Penelitian ini merupakan penelitian analitik retrospective dengan pendekatan case control. Kelompok kasus adalah wanita yang telah menjalani operasi kandungan dengan hasil Patologi Anatomi menunjukkan endometriosis dan kelompok kontrol adalah pasien wanita yang telah menjalani operasi laparaskopi MOW (Metode Opetratif Wanita). Sampel yang diambil sebanyak 70 responden (35 kasus, 35 kontrol) selama periode tahun 2017-2018 dengan teknik purposive sampling berdasarkan kriteria inklusi.. Analisa data menggunakan uji chi square pada tingkat kemaknaan α 0,05. Hasil : Responden dengan endometriosis sebagian besar mengalami menarche pada usia 12-13 tahun (62,9%). Usia menarche tidak memiliki hubungan yang signifikan dengan kejadian endometriosis (p=0,484). Kesimpulan: Tidak ada hubungan antara usia menarche dengan kejadian endometriosis di Rumkital Dr. Ramelan Surabaya. AbstractBackground: Endometriosis is a chronic and progressive gynecological disease with an increased incidence every year but the cause is largely unknown. Age of menarche is one of the risk factors associated with the incidence of endometriosis. The purpose of this study was to determine the association between age of menarche the incidence of endometriosis in Dr. Ramelan Hospital Surabaya. Method: This was a retrospective analytic study with a case control approach. The case group was women who had undergone uterine surgery with Anatomical Pathology results showing endometriosis and the control group were women who had undergone laparoscopic tuba ligation. 70 respondents (35 cases, 35 controls) taken during the period of 2017-2018 with a purposive sampling technique based on inclusion criteria. Analyzed data used chu square test at significant level of α 0,05. Results: Most respondent who got endometriosis had menarche at 12-13 years old (62.9%). The age of menarche had no significant association with the incidence of endometriosis (p = 0.484). Conclusion: We found no association between age of menarche and the incidence of endometriosis with the incidence of endometriosis in the Dr. Ramelan Hospital Surabaya.

Gitelman Syndrome in Pregnancy: A Clinical Challenge

Purpose Disease progress may be affected by pregnancy-related changes, and underlying conditions may also affekt pregnancy outcomes in women with Gitelman syndrome (GS). Case presentation A 35-year-old woman with GS (gravida 2 para 1) was referred to our hospital to start routine antenatal care follow-up at 6 weeks of gestation. At the age of 31, she had been diagnosed with GS after her first uneventful pregnancy. Upon early admission, her serum Mg+level was 0.51 mmol/L and her serum K+level 2.7 mmol/L with normal kidney function tests. She was already taking oral combined potassium citrate and potassium bicarbonate supplementation once a day before pregnancy. At the eighth gestational week, the medication was changed to an oral potassium color sachet of 1.5 gram per day until labor because of the insufficient dosage to maintain optimum potassium levels. She was also taking 365 milligrams of oral magnesium oxide twice a day before and during pregnancy. In the third trimester of the pregnancy, her serum Mg+level was 0.48 mmol/L and serum K+level 2.8 mmol/L. Because of the previous uterine surgery history, she underwent an elective cesarean operation at 39 weeks’ gestation under spinal anesthesia and delivered a healthy 3090-gram female infant. Conclusion Increased need for potassium and magnesium supplementation should be the critical considerations when managing pregnant patients with GS.