Cases reported "Uterine Hemorrhage"

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1/80. Cervical pregnancy: assessment with three-dimensional power Doppler imaging and successful management with selective uterine artery embolization.

    Cervical pregnancy is frequently associated with extensive hemorrhage which, in severe cases, may be stopped only by hysterectomy. We report a case of an anembryonic cervical pregnancy diagnosed at 10 weeks, and associated with a large arteriovenous malformation. The patient was conservatively managed with simple selective uterine artery embolization. After embolization, her vaginal bleeding ceased and the level of serum beta-human chorionic gonadotropin decreased rapidly. No additional treatment was given. The patient's postoperative course was uneventful and the cervical mass had disappeared at the follow-up 4 months later. To the best of our knowledge, this is the first report of conservative management of cervical pregnancy simply by uterine artery embolization. The role of three-dimensional power Doppler ultrasonography in the assessment of cervical pregnancy and in monitoring the therapeutic response is discussed.
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ranking = 1
keywords = operative
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2/80. Transient myocardial ischemia may occur following subendometrial vasopressin infiltration.

    A case of transient myocardial ischemia following subendometrial vasopressin infiltration in intractable intra-operative postpartum bleeding due to placenta accreta is described. In our experience, the rate of this side effect is one in 14 patients (rate of 7.1%). We believe that the benefits of the treatment outweigh the risks, since the uterus was saved in all 14 patients. Nevertheless, this case emphasises that extreme precaution is needed with subendometrial vasopressin infiltration. It should be emphasised that the needle must not be within a blood vessel because intravascular injection of vasopressin solution can precipitate acute arterial hypertension, bradycardia and even death. We suggest that local vasopressin infiltration into the placental site is indicated in cases of intractable bleeding at cesarean section after other conventional obstetric and pharmacological maneuvers have failed.
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ranking = 1
keywords = operative
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3/80. Primary carcinoma of the fallopian tube: study of 11 cases.

    OBJECTIVE: Primary fallopian tube carcinoma is a rare tumor that histologically and clinically resembles primary ovarian carcinoma. The purpose of this study was to present the experience of the Soroka Medical Center (SMC), beer-Sheva, israel of handling this tumor. STUDY DESIGN: Data from the files of 11 patients with primary fallopian tube carcinoma who were managed at the SMC between January 1978 and December 1998 were evaluated. RESULTS: The mean age of the patients was 59.4 years. Presenting symptoms and signs included abdominal pain, postmenopausal bleeding, watery vaginal discharge and adnexal mass. In all patients, the diagnosis of primary fallopian tube carcinoma was not made preoperatively. In ten patients in whom the adnexal mass was discovered preoperatively it was thought to be an ovarian tumor and in one patient the adnexal mass was first noticed during vaginal hysterectomy. Postoperatively, multi-drug chemotherapy was given to seven patients, multi-drug chemotherapy followed by pelvic radiotherapy to one patient, pelvic radiotherapy followed by single-agent chemotherapy to two patients, and one patient received no further treatment. The actuarial 5-year survival rate was 50%. CONCLUSIONS: Fallopian tube carcinoma is rarely suspected preoperatively. The symptom complex of 'hydrops tubae profluence', said to be pathognomonic for this tumor, is rarely encountered. The treatment approach is similar to that used for ovarian carcinoma and includes primary surgery comprised of total abdominal hysterectomy, bilateral salpingo-oophorectomy and staging followed by chemotherapy. The prognosis of patients with primary fallopian tube carcinoma is similar to that of patients with primary ovarian carcinoma.
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ranking = 4
keywords = operative
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4/80. Modified cesarean hysterectomy for placenta previa percreta with bladder invasion: retrovesical lower uterine segment bypass.

    BACKGROUND: Present conservative and radical surgical management of placenta previa percreta with bladder invasion is associated with significant hemorrhage and the need for blood salvage, transfusion, and component therapy. Conventional cesarean hysterectomy strategies have high surgical morbidity, despite adequate personnel and resources. CASE: A 37-year-old, gravida 3, para 2-0-0-2, with a radiographic diagnosis of placenta previa percreta with bladder invasion, and confirmed fetal lung maturity, had a modified cesarean hysterectomy at 34 weeks' gestation. The bladder was partially mobilized beneath the percreta invasion site via the paravesical spaces. Estimated blood loss was 900 mL. Superficial placental bladder invasion was confirmed by pathology. The postoperative course was uneventful. CONCLUSION: Modified cesarean hysterectomy prevented hemorrhage and need for blood salvage, transfusion, or component therapy in managing a case of placenta previa percreta with bladder invasion.
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keywords = operative
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5/80. Intracavitary radiotherapy for refractory dysfunctional uterine bleeding. A case report.

    BACKGROUND: Pelvic irradiation was once a common treatment for dysfunctional uterine bleeding (DUB). Today the majority of women with DUB are successfully treated with hormonal therapy; patients unresponsive to hormonal therapy may require endometrial ablation or hysterectomy. We present a patient with severe, intractable DUB and contraindications to surgery who was treated with intracavitary radiotherapy. CASE: A 39-year-old, 150-cm-tall, 310-kg woman was referred for management of severe DUB refractory to medical management. The bleeding was successfully treated with intracavitary cesium. hysterectomy was not recommended due to the operative risks posed by the patient's massive obesity. Because of technical difficulties during a previous dilation and curettage and the expense of long-term GnRH agonist therapy, the patient elected to undergo intracavitary radiotherapy. CONCLUSION: In selected patients, intracavitary radiotherapy can be used to treat DUB when conventional therapy fails or is contraindicated.
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ranking = 1
keywords = operative
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6/80. Alternative conservative management of placenta accreta. A case report.

    BACKGROUND: placenta accreta is a rare event in pregnancy and may cause life-threatening hemorrhage. This obstetric complication is a diagnostic and management challenge. When the condition is diagnosed, medical management is usually employed first for hemostasis. If the bleeding cannot be controlled, conservative surgical management is attempted, but hysterectomy is often required for definitive care. CASE: The diagnosis of placenta accreta was made intraoperatively at cesarean section undertaken for breech presentation. The placenta was densely adherent to the anterior lower uterus. Severe hemorrhage, which resulted from attempts to manually remove it, was treated with oxytocin, carboprost tromethamine and methylergonovine without success. The uterus was everted to provide access to the placental site, which was excised; the myometrial defect was sutured closed. Three Foley balloons were used to provide uterine tamponade. methotrexate was administered prophylactically. These measures effectively controlled the hemorrhage. CONCLUSION: Because placenta accreta might not be diagnosed antepartum or during labor, especially when no risk factors are present, adequate preparations cannot be made. If it is diagnosed at the time of cesarean section, a combined conservative approach may prove helpful in controlling bleeding and avoid hysterectomy and hypovolemia.
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ranking = 1
keywords = operative
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7/80. Surgical treatment for acute type A aortic dissection in pregnancy: a case of aortic root replacement just after cesarean section.

    A 25-year-old woman with marfan syndrome in the 37th week of pregnancy was referred for acute chest pain and dyspnea. An emergency cesarean section was performed because of fetal distress. Intraoperative echocardiography at the end of the cesarean section showed dilatation of the aortic root and dissection of the ascending aorta. The patient underwent replacement of the aortic root and the ascending aorta on the following day because of uterine bleeding. The postoperative course was uneventful for the mother and her baby.
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ranking = 2
keywords = operative
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8/80. Placenta percreta with bladder invasion as a cause of life threatening hemorrhage.

    PURPOSE: Abnormal placental penetration through the myometrium with bladder invasion is a rare obstetric complication with potential for massive blood loss. Urologists are usually consulted after a life threatening emergency has already arisen. Their familiarity with this condition is crucial for effective management. We describe 2 cases of placenta percreta with bladder invasion to highlight the catastrophic nature of this clinical entity, and review the literature on current diagnostic and management strategies. MATERIALS AND methods: Between 1986 and 1998, 250 cases of adherent placenta (0.9%) were identified in 25,254 births at our institution, including 2 (0.008%) of placenta percreta with bladder invasion. We treated these 2 multiparous women who were 33 and 30 years old, respectively. Each had undergone 2 previous cesarean sections. RESULTS: Presenting symptoms were severe hematuria in 1 patient and prepartum hemorrhage with shock in the other. Ultrasound showed complete placenta previa in each with evidence of bladder invasion in 1 patient. hysterectomy, bladder wall resection and repair, and bilateral internal iliac artery ligation were required to control massive intraoperative hemorrhage. The patients received 22 and 15 units of packed red blood cells, respectively. fetal death occurred in each case. convalescence was complicated by disseminated intravascular coagulation in patient 1 but subsequent recovery was uneventful. CONCLUSIONS: A high index of suspicion for placenta percreta with bladder invasion is required when evaluating pregnant women with a history of cesarean delivery and placenta previa who present with hematuria and lower urinary tract symptoms. ultrasonography and magnetic resonance imaging may assist in establishing the diagnosis preoperatively. With proper planning and a multidisciplinary approach fetal and maternal morbidity and mortality may be decreased.
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ranking = 2
keywords = operative
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9/80. adenocarcinoma diagnosed at endometrial ablation.

    BACKGROUND: Endometrial ablation is a surgical alternative to hysterectomy. Cases exist in the literature of endometrial adenocarcinoma found at endometrial ablation. If endometrial cancer is occult it might not be detected during ablation, especially if destructive techniques are used. CASE: A 41-year-old woman had a history of menorrhagia. A previous D&C showed benign proliferative endometrium. Investigations for menorrhagia found no abnormalities. The diagnosis was dysfunctional uterine bleeding. Endometrial ablation was done and the pathologic examination of the resected endometrium found focal, well-differentiated adenocarcinoma of the endometrium. CONCLUSION: This case shows the importance of patient selection, evaluation, and surveillance after endometrial ablation. Resection of the endometrium is superior to destructive techniques because it provides tissue for pathologic evaluation. We recommend close postoperative surveillance in such cases.
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ranking = 1
keywords = operative
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10/80. Uterine artery aneurysm mimicking pelvic sarcoma. A case report and review of literature. [email protected]

    We report a case of true uterine artery aneurysm in a 77-year-old diabetic woman, which was suspected radiologically as a pelvic sarcoma. The aneurysm was communicating with the atherosclerotic left uterine artery. Pelvic aneurysms carry the potential risk of massive intra-operative hemorrhage if the diagnosis was not established prior to operation.
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keywords = operative
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