Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
  1. Home
  2. Search

Refine search

Refine search

Access:
Content type:
Publication date:
Apply   From and To filters
Subject: Show more
Journals Show more
Publishers: Show more
Societies Show more
Series: Show more
Collections: Show more

Actions for selected content:

Select all | Deselect all
  • View selected items
  • Export citations
  • Download PDF (zip)
  • Save to Kindle
  • Save to Dropbox
  • Save to Google Drive

Save Search

You can save your searches here and later view and run them again in "My saved searches".

Please provide a title, maximum of 40 characters.
Cancel
×

9 results

  • Case 23 - A 35-Year-Old G3P3 Woman with a 12-Week Uterus and a Prior Cesarean Section Who Desires Vaginal Hysterectomy

  • Edited by Todd R. Jenkins, University of Alabama, Birmingham, Lisa Keder, Abimola Famuyide, Kimberly S. Gecsi, David Chelmow
  • Book:
    Surgical Gynecology
    Published online:
    19 November 2021
    Print publication:
    02 December 2021, pp 64-66

  • Summary

    A 35-year-old gravida 3, para 3 presents with complaints of heavy menstrual bleeding. Patient reports her menses have been getting progressively heavier over the last year. She has been on oral contraceptive pills for the last six months, and feels they are not helping. She is experiencing heavy flow requiring her to wear a pad and a tampon together for the first two days of her seven-day cycle. She had a cesarean section for her second child followed by a vaginal birth after cesarean (VBAC) of an 8 lb infant. She has no other surgical history and no medical history and has no known drug allergies. She denies any history of sexually transmitted infections (STIs). Her last cervical cytology six months ago was normal. She is currently taking desogestrol 0.15 mg, 0.03 mg ethinyl estradiol contraceptive pills but she has completed her family and desires definitive therapy. After discussing her treatment options, patient requests a hysterectomy.

  • 6 - Uterine factors in infertility

  • Edited by Siladitya Bhattacharya, University of Aberdeen, Mark Hamilton
  • Book:
    Management of Infertility for the MRCOG and Beyond
    Published online:
    05 June 2014
    Print publication:
    30 January 2014, pp 67-76

  • Summary

    Septate uteri are the most prevalent congenital uterine anomaly in infertile women. Women with septate uteri have reduced conception rates and increased risks of first-trimester miscarriage, preterm birth and malpresentation at delivery. The prevalence of arcuate uteri in infertile women is almost identical to that of the general/fertile population. Acquired uterine abnormalities described in the chapter include endometrial polyps, intrauterine adhesions, and uterine fibroids. Hysteroscopic myomectomy is now considered the gold standard treatment for submucosal fibroids. Abdominal myomectomy remains the routine approach for most surgeons faced with multiple or large intramural fibroids. For appropriately trained surgeons, a laparoscopic approach may be adopted. Hysteroscopic resection of submucosal fibroids before IVF treatment is recommended. Although subfertile women who have otherwise asymptomatic fibroids may benefit from a myomectomy procedure, this approach should be individualised given the absence of any good randomised controlled trials (RCT) in this area.

  • Chapter 7 - Ethics of ultrasonography

  • from Section 1: - Imaging techniques
  • Edited by Botros R. M. B. Rizk, University of South Alabama
  • Book:
    Ultrasonography in Reproductive Medicine and Infertility
    Published online:
    07 September 2011
    Print publication:
    25 March 2010, pp 64-66

  • Summary

    This chapter reviews the basic principles of radiologic tests, and describes the basic female anatomy. It provides information for appropriate imaging modalities for each part of the female genital tract. Currently ultrasound plays a role in monitoring the uterus during ovarian stimulation and early pregnancy. Assessment of uterine leiomyoma is historically achieved with ultrasonography, although computed tomography (CT) and magnetic resonance imaging (MRI) also offer detection of uterine fibroids. In reproductive medicine, imaging of the tubes is typically limited to evaluation of patency and distortion of normal anatomy, as in hydrosalpinges and salpingitis isthmica nodosum. Pituitary imaging is mostly performed in reproductive medicine for the infertile patient with persistently elevated prolactin levels or with levels over 100 ng/ml. Imaging is rarely performed in reproductive medicine specifically to evaluate for peritoneal disease. Laparoscopy is considered the gold standard for diagnosis of peritoneal processes such as endometriosis.

  • 7 - Ultrasound assessment of women with pelvic pain

  • Edited by Davor Jurkovic, Lil Valentin, Sanjay Vyas
  • Book:
    Gynaecological Ultrasound in Clinical Practice
    Published online:
    05 February 2014
    Print publication:
    01 June 2009, pp 67-76

  • Summary

    Haemorrhagic corpus luteum cysts are common causes of acute pelvic pain in women of fertile age. At ultrasound examination, corpus luteum cysts are characterised by spiderweb-like contents but they may also contain bizarre-looking blood clots. This explains why corpus luteum cysts may sometimes be confused with malignancy. Endometriomas may cause pelvic pain but they are also quite common incidental ultrasound findings. A serious condition that may be more or less painful is torsion of the adnexa. Torsion occurs in adnexa containing a lesion, such as ovarian cyst or hydrosalpinx, but it may also occur in normal adnexa, especially in prepubertal girls. Uterine fibroids and adenomyosis may sometimes cause pelvic pain. Gynaecologists should be able to recognise the ultrasound image of non-gynaecological conditions that may cause pelvic pain. Ultrasound images of these conditions may be encountered when an ultrasound examination is performed because of suspicion of gynaecological disease.

  • 3 - The uterus

  • Edited by Davor Jurkovic, Lil Valentin, Sanjay Vyas
  • Book:
    Gynaecological Ultrasound in Clinical Practice
    Published online:
    05 February 2014
    Print publication:
    01 June 2009, pp 17-28

  • Summary

    The uterus is divided into four anatomical parts. The fundus is the uppermost part and extends into the interstitial portion of the fallopian tubes laterally. The corpus is the main body of the uterus, and the isthmus is the lowermost portion, which extends into the cervix. The lower uterine segment in the pregnant uterus forms at the isthmus, which is at the level of the reflection of the urinary bladder in the non-pregnant uterus. Uterine fibroids are the most common uterine abnormality encountered in women of reproductive age. Ultrasound has the advantages of being a widely available outpatient imaging modality, with the ability to measure and assess the depth of fibroid involvement into the myometrium more accurately than any other imaging technique. Uterine sarcoma is a rare tumour of the uterine myometrium that is usually diagnosed after hysterectomy. The clinical presentation is enlarging uterus in a post-menopausal woman.

  • Cost-effectiveness of magnetic resonance guided focused ultrasound for the treatment of uterine fibroids

  • Amy K. O'Sullivan, David Thompson, Paula Chu, David W. Lee, Elizabeth A. Stewart, Milton C. Weinstein
  • Journal:
    International Journal of Technology Assessment in Health Care / Volume 25 / Issue 1 / January 2009
    Published online by Cambridge University Press:
    06 January 2009, pp. 14-25
    • Article
      • You have access
    • PDF
    • HTML
    • Export citation

  • Objectives: The aim of this study is to evaluate the cost-effectiveness of Magnetic Resonance Guided Focused Ultrasound (MRgFUS) compared with alternative treatments for uterine fibroids in the United States.

    Methods: We used techniques of decision analysis and data from secondary sources to develop and estimate an economic model of the management of uterine fibroids among premenopausal women. Patients in the model receive treatment with MRgFUS, uterine artery embolization (UAE), abdominal myomectomy, hysterectomy, or pharmacotherapy. The model predicts total costs (including subsequent procedures) and quality-adjusted life-years (QALYs) for each treatment strategy over a lifetime horizon, discounted at 3 percent, from a societal perspective. Data on treatment efficacy and safety were obtained from published and unpublished studies. Costs (2005 US$) were obtained from an analysis of a large administrative database and other secondary sources. Lost productivity costs were included in the base-case analysis, but excluded in a sensitivity analysis.

    Results: UAE was associated with the most QALYs (17.39), followed by MRgFUS (17.36), myomectomy (17.31), hysterectomy (17.18), and pharmacotherapy (16.70). Pharmacotherapy was the least costly strategy ($9,200 per patient), followed by hysterectomy ($19,800), MRgFUS ($27,300), UAE ($28,900), and myomectomy ($35,100). Incremental cost-effectiveness ratios (cost per QALY gained) were $21,800 for hysterectomy, $41,400 for MRgFUS, and $54,200 for UAE; myomectomy was more costly and less effective than both MRgFUS and UAE. Results were sensitive to MRgFUS recurrence rates, MRgFUS procedure costs, and assumptions about quality of life following hysterectomy.

    Conclusions: Our findings suggest that MRgFUS is in the range of currently accepted criteria for cost-effectiveness, along with hysterectomy and UAE.

  • Association of intakes of fat, dietary fibre, soya isoflavones and alcohol with uterine fibroids in Japanese women

  • Chisato Nagata, Kozue Nakamura, Shino Oba, Makoto Hayashi, Noriyuki Takeda, Keigo Yasuda
  • Journal:
    British Journal of Nutrition / Volume 101 / Issue 10 / 28 May 2009
    Published online by Cambridge University Press:
    03 October 2008, pp. 1427-1431
    Print publication:
    28 May 2009
    • Article
      • You have access
    • PDF
    • HTML
    • Export citation

  • Certain dietary components which could affect oestrogen may have implications in the aetiology of uterine fibroids. We previously found that soya intake was inversely associated with a subsequent risk of hysterectomy, suggesting a potentially protective effect of soya against uterine fibroids, the major clinical indication for hysterectomy. We cross-sectionally assessed the associations of intakes of fat, soya foods, dietary fibre and alcohol with uterine fibroids. Study subjects were 285 premenopausal Japanese women participating in a health-check up programme, including gynaecological examinations, provided by a general hospital between October 2003 and March 2006. The presence of fibroids was confirmed by transvaginal sonogram. If women had undergone hysterectomy, self-report of fibroids was accepted. Each subject's usual diet, including alcohol, was determined with the use of a validated FFQ. Fifty-four women were identified as prevalent cases of fibroids or having had hysterectomy due to fibroids. The mean alcohol intake was statistically significantly higher among women with fibroids than among those without fibroids after controlling for known or suspected risk factors. For the highest compared with the lowest tertile of alcohol intake, the OR of uterine fibroids was 2·78 (95 % CI 1·25, 6·20). There was no significant association of intake of fats, soya isoflavones or dietary fibre with uterine fibroids. The data suggest that higher alcohol intake is associated with a higher prevalence of uterine fibroids. Further studies on diet, especially phyto-oestrogens, and uterine fibroids are needed given the limited data currently available.

  • 39 - Surgical Preparation of the Patient for In Vitro Fertilization

  • from PART III - ASSISTED REPRODUCTION
  • Edited by Botros R. M. B. Rizk, University of South Alabama, Juan A. Garcia-Velasco, Hassan N. Sallam, Antonis Makrigiannakis, University of Crete
  • Book:
    Infertility and Assisted Reproduction
    Published online:
    04 August 2010
    Print publication:
    15 September 2008, pp 361-370

  • Summary

    This chapter reviews the evidence surrounding the effect of reproductive surgery for tubal abnormalities, endometriosis, and uterine fibroids on in vitro fertilization (IVF) cycle outcome. Salpingectomy and proximal tubal occlusion are two surgical options in the treatment of distal tubal disease. Proximal tubal occlusion represents a significantly less invasive approach, which requires less surgical dissection and operating time while still eliminating retrograde flow of hydrosalpingeal fluid into the endometrial cavity. Consideration should be given to resection of submucosal fibroids and intramural lesions that distort directly impinge upon the endometrial cavity prior to IVF. Pregnancy rates achieved with assisted reproductive technology (ART) have increased progressively in recent years, and in endometriosis, patients achieve levels of success that are significantly higher than those obtained with alternative therapies. The prolonged use of a GnRH agonist, in at least a subset of endometriosis patients, appears to improve IVF cycle outcome.