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Damiani GR, Di Gennaro D, Vimercati A, Cicinelli E, Perrone AM, De Iaco P, Malvasi A, Gaetani M, Cascardi E, Cazzato G, Dellino M, Pellegrino A, Vitagliano A. Office intrauterine morcellation for retained products of conception. MINIM INVASIV THER 2023; 32:323-328. [PMID: 37493491 DOI: 10.1080/13645706.2023.2227694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 06/02/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE Proposing hysteroscopic morcellation (HM) as a surgical-therapeutic approach in the treatment of retained products of conception (RPOC) to prevent intrauterine adhesions (IUAs). DESIGN Prospective analysis. SETTING A teaching and university hospital. PATIENTS Women with RPOC. INTERVENTIONS Office -HM with 'Truclear 5 C'. MATERIAL AND METHODS Twenty-two consecutive patients presenting with trophoblastic residue retention after miscarriage and interruption of pregnancy or placenta remnants after cesarean section or delivery were enrolled. These women underwent office-HM with 'Truclear 5 C'. Primary outcomes were median time and rate of hospitalization. The quality of the specimen was also analyzed. A hysteroscopic second look for IUAs was performed. RESULTS Mean procedure time was six minutes (SD ± 5). Tissue samples had a mean collection size 2.5 cm3+0.9. 38% of the samples had spotting or abnormal vaginal discharge. Dilatation of the cervical canal was not performed in any case. Second-look hysteroscopy did not show any de novo IUAs in any of the enrolled patients. CONCLUSIONS In the hysteroscopic treatment of RPOC, HM is a valid choice in an office setting without the use of cervical dilatation. Removal of RPOC was uneventful in all cases, simple and carried out faster without any adverse outcomes.
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Affiliation(s)
| | - Daniele Di Gennaro
- Department of Obstetrics and Gynecology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Antonella Vimercati
- Department of Obstetrics and Gynecology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Ettore Cicinelli
- Department of Obstetrics and Gynecology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Anna Myriam Perrone
- Department of Obstetrics and Gynecology, Unit of Oncologic Gynecology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Pierandrea De Iaco
- Department of Obstetrics and Gynecology, Unit of Oncologic Gynecology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonio Malvasi
- Department of Obstetrics and Gynecology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Maria Gaetani
- Department of Obstetrics and Gynecology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Eliano Cascardi
- Department of Obstetrics and Gynecology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Gerardo Cazzato
- Department of Obstetrics and Gynecology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Miriam Dellino
- Department of Obstetrics and Gynecology, Policlinico of Bari, University of Bari, Bari, Italy
| | | | - Amerigo Vitagliano
- Department of Obstetrics and Gynecology, Policlinico of Bari, University of Bari, Bari, Italy
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Damiani GR, Gennaro DD, Malvasi A, Vimercati A, Loizzi V, Gaetani M, Fonzo TD, Dellino M, Cazzato G, Cicinelli E, Trojano G. Endometrial Osseous Metaplasia: An Hysteroscopic Incidental Finding - An Overview. Gynecol Minim Invasive Ther 2023; 12:243-245. [PMID: 38034103 PMCID: PMC10683954 DOI: 10.4103/gmit.gmit_89_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 12/22/2022] [Accepted: 01/06/2023] [Indexed: 12/02/2023] Open
Abstract
Endometrial osseous metaplasia (EOM) is an uncommon clinical entity with the presence of bone in the endometrium which requires clinical and therapeutic framework. It is also described by various other names such as endometrial ossification, ectopic intrauterine bone, and heterotopic intrauterine bone. Ossification could have various locations as the cervix the ovary, and the vagina. This overview highlights the attention on the actual pivotal points of EOM.
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Affiliation(s)
- Gianluca Raffaello Damiani
- Division of Gynecology and Obstetrics, Department of Biomedical Sciences and Human Oncology, University of Bari ‘Aldo Moro,’ Bari, Italy
| | - Daniele Di Gennaro
- Division of Gynecology and Obstetrics, Department of Biomedical Sciences and Human Oncology, University of Bari ‘Aldo Moro,’ Bari, Italy
| | - Antonio Malvasi
- Division of Gynecology and Obstetrics, Department of Biomedical Sciences and Human Oncology, University of Bari ‘Aldo Moro,’ Bari, Italy
| | - Antonella Vimercati
- Division of Gynecology and Obstetrics, Department of Biomedical Sciences and Human Oncology, University of Bari ‘Aldo Moro,’ Bari, Italy
| | - Vera Loizzi
- Division of Gynecology and Obstetrics, Department of Biomedical Sciences and Human Oncology, University of Bari ‘Aldo Moro,’ Bari, Italy
| | - Maria Gaetani
- Division of Gynecology and Obstetrics, Department of Biomedical Sciences and Human Oncology, University of Bari ‘Aldo Moro,’ Bari, Italy
| | - Tommaso Di Fonzo
- Division of Gynecology and Obstetrics, Department of Biomedical Sciences and Human Oncology, University of Bari ‘Aldo Moro,’ Bari, Italy
| | - Miriam Dellino
- Division of Gynecology and Obstetrics, Department of Biomedical Sciences and Human Oncology, University of Bari ‘Aldo Moro,’ Bari, Italy
| | - Gerardo Cazzato
- Division of Gynecology and Obstetrics, Department of Biomedical Sciences and Human Oncology, University of Bari ‘Aldo Moro,’ Bari, Italy
| | - Ettore Cicinelli
- Division of Gynecology and Obstetrics, Department of Biomedical Sciences and Human Oncology, University of Bari ‘Aldo Moro,’ Bari, Italy
| | - Giuseppe Trojano
- Division of Gynecology and Obstetrics, Department of Biomedical Sciences and Human Oncology, University of Bari ‘Aldo Moro,’ Bari, Italy
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Damiani GR, Dellino M, Cascardi E, Xuamin H, Di Gennaro D, Vimercati A, Vitagliano A, Malvasi A, loizzi V, Paniga C, Lanteri L, Alfonso R, Cicinelli E, Pellegrino A. Uterine venous malformations in the puerperium: 2 Atypical cases and literature review. Eur J Obstet Gynecol Reprod Biol X 2023; 19:100220. [PMID: 37636521 PMCID: PMC10450833 DOI: 10.1016/j.eurox.2023.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/29/2023] [Indexed: 08/29/2023] Open
Abstract
Uterine arteriovenous malformations (AVMs) is a rare but high-risk cause of uterine bleeding. The clinical management of this condition is challenging, as the ultrasound picture can sometimes be unambiguously interpreted. Moreover, in the puerperium in which acquired AVMs are most frequently formed, it is necessary to discuss the correct management in a multidisciplinary and personalized manner. We present two cases of AVMs developing in the puerperium, both with a vaginal delivery and spontaneous and complete secondment. The symptom of onset was an episode of bright red blood loss in the puerperium, on the 14th and 21st postpartum days, respectively. Transvaginal ultrasound showed a hypervascularized lesion in the myometrium with turbulent vascular flow, confirmed by transabdominal ultrasound and angiography. To date, there are no guidelines on the management of MAVs. In our cases we opted for a conservative approach, in order to preserve the fertility of the patient. These experiences reported have the purpose of enriching a literature still sparse on the subject and in the future to be able to represent a fulcrum for official recommendations.
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Affiliation(s)
- Gianluca Raffaello Damiani
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Miriam Dellino
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Eliano Cascardi
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
- Pathology Unit, FPO-IRCCS Candiolo Cancer Institute, 10060 Candiolo, Italy
| | - He Xuamin
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
- San Raffaele Hospital, Milan,Italy
| | - Daniele Di Gennaro
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Antonella Vimercati
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Amerigo Vitagliano
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Antonio Malvasi
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Vera loizzi
- Department of Interdisciplinary Medicine (DIM), University of Bari "Aldo Moro", 70124 Bari, Italy
- Oncology Unit IRCSS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy
| | - Cristiana Paniga
- University of Milan-Biccocca,Department of Medicine and Surgery, Milan, Italy
| | - Laura Lanteri
- University of Milan-Biccocca,Department of Medicine and Surgery, Milan, Italy
| | - Raffaello Alfonso
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Ettore Cicinelli
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Antonio Pellegrino
- Department of Obstetrics and Gynecology, ASTT LECCO, Alessandro Manzoni Hospital, Dell'Eremo Street 11, Lecco, Italy
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Gaetani M, Di Gennaro D, Vimercati A, Vitagliano A, Dellino M, Malvasi A, Loizzi V, Pinto V, Cicinelli E, Di Naro E, Lacalandra A, Damiani GR. Cornual Pregnancy. Gynecol Minim Invasive Ther 2023; 12:130-134. [PMID: 37807987 PMCID: PMC10553601 DOI: 10.4103/gmit.gmit_10_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 10/10/2023] Open
Abstract
Cornual pregnancy (CP) is a subtype of ectopic pregnancy that is implanted in the interstitial segment of the fallopian tube which is defined as the tubal section crossing uterine muscular tissue. Widely recognized risk factors for CP are endometriosis, uterine leiomyomata, or pelvic inflammatory disease; all these diseases can cause tubal anatomic changes and consequently alter embryo physiological implant process. Many treatment options are available for this condition each one must be tailored according to patient and operating scenario. The incidence of uterine ruptures in the scarred uterus appears to be low, but the fear of it remains and therefore medical treatment might be favored over cornual wedge resection. The actual risk of uterine rupture after medical treatment is unknown. Multiple testing strategies exist to diagnose CP, but caution needs to be used to avoid a false diagnosis.
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Affiliation(s)
- Maria Gaetani
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Daniele Di Gennaro
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Antonella Vimercati
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Amerigo Vitagliano
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Miriam Dellino
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Antonio Malvasi
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Vera Loizzi
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Vincenzo Pinto
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Ettore Cicinelli
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Edoardo Di Naro
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Angelo Lacalandra
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Gianluca Raffaello Damiani
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
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Di Gennaro D, Damiani GR, Muzzupapa G, Stomati M, Cicinelli R, Gaetani M, Schonauer LM, Di Naro E, Trojano G, Cicinelli E. Ectopic Pregnancy: An Overview. CLIN EXP OBSTET GYN 2022. [DOI: 10.31083/j.ceog4912262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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