Cases reported "Uterine Diseases"

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1/5. Torsion of the pregnant uterus.

    A 31-year-old woman, with a history of previous cesarean section and right oophorectomy, was admitted for a repeat cesarean section. After the commencement of surgery uterine torsion was diagnosed because of the anterior position of the remaining left ovary and tube, the absence of normal uterovesical peritoneum, and extremely engorged vessels in the lower uterine surface. Posterior classical hysterotomy was performed and a healthy female baby was delivered. Following delivery of the baby and suturing the incision site of the uterus, the contracted uterus was detorted and put back in the pelvic cavity. Extreme uterine torsion of 180 degrees at term is a rare obstetric event. This paper presents a case of uterine torsion at full term pregnancy in which the delivery and repositioning of the uterus was successful.
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ranking = 1
keywords = hysterotomy
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2/5. Uterine compression suture without hysterotomy--why a non-absorbable suture should be avoided.

    We describe 2 cases of uterine compression suture without hysterotomy, only described once in the literature previously (Hayman et al. 2002). We consider in detail the suture material used for this technique and show photos of the compression suture at laparoscopy 4 weeks after insertion to demonstrate why it is inappropriate to use a non-absorbable suture. Modified compression sutures are being used increasingly and a wide variety of suture materials are being chosen, including vicryl, PDS and nylon (verbal communications). We feel it important to report our findings so that others can avoid the use of non or slowly absorbable sutures.
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ranking = 5
keywords = hysterotomy
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3/5. Cesarean delivery by posterior hysterotomy due to torsion of the pregnant uterus.

    BACKGROUND: We describe a case of cesarean delivery by posterior hysterotomy in a woman with uterine torsion secondary to a blocked retroverted uterus. CASE: At 28 weeks of gestation this patient's fetus was found to have club feet, initially suspected to be secondary to sacculation of the posterior uterine segment. At cesarean delivery, intraoperative inspection revealed the uterus to be twisted 180 degrees without evidence of posterior sacculation. The uterine incision was performed on the posterior aspect of the lower uterine segment. CONCLUSION: Fixed uterine retroversion with torsion is associated with fetal abnormalities and may require a posterior uterine incision.
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ranking = 5
keywords = hysterotomy
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4/5. Management problems associated with carcinoma of the cervix diagnosed in the second trimester of pregnancy.

    A 29-year-old women presented in the second trimester of pregnancy with a stage IIB squamous carcinoma of the cervix. Fundal hysterotomy was performed with a view to radical radiotherapy the following week. The patient developed a pyometra in the postoperative period due to the position and nature of the tumor. Management strategies for dealing with similar cases are outlined.
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ranking = 1
keywords = hysterotomy
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5/5. Managing extreme uterine torsion at term. A case report.

    BACKGROUND: Extreme uterine torsion at term is a rare obstetric event and raises several critical management considerations. CASE: At the time of repeat cesarean section at term for fetal malpresentation, 180 degrees torsion of the uterine corpus was diagnosed. At laparotomy, the gravid uterus would not yield to anatomic repositioning, necessitating delivery through a deliberate posterior transverse hysterotomy. No maternal abdominopelvic pathology or fetal abnormalities were demonstrated. Prophylactic bilateral shortening of the round ligaments was performed at delivery to prevent recurrent torsion in the immediate puerperium. The patient recovered uneventfully. CONCLUSION: Deliberate posterior cesarean hysterotomy is an option for fetal delivery with irreducible torsion, and round ligament plication may prevent recurrent torsion in the immediate puerperium.
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ranking = 2
keywords = hysterotomy
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