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Kabiri D, Amsalem H, Watad H, Lipschuetz M, Haj-Yahya R, Alter R, Ezra Y. Assessing the Clinical Significance of Third-Trimester Post-Coital Bleeding. Fetal Diagn Ther 2023; 51:168-174. [PMID: 38071960 PMCID: PMC10994628 DOI: 10.1159/000535707] [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: 03/07/2023] [Accepted: 12/04/2023] [Indexed: 04/04/2024]
Abstract
INTRODUCTION This study aimed to evaluate the impact of third-trimester post-coital bleeding (PCB) on pregnancy outcomes. METHODS A retrospective cohort study was conducted at two tertiary medical centers, including all pregnant women between 24 and 34 weeks of gestation referred due to vaginal bleeding over an 11-year period. The study population includes all singleton deliveries; within this population, women were further classified into three groups: those admitted due to vaginal bleeding related to PCB, those admitted due to vaginal bleeding not related to PCB, and those who did not report vaginal bleeding. The primary outcome measure was delivery prior to 37 weeks of gestation, while secondary outcome measures included maternal and neonatal complications. Baseline characteristics of the two groups were compared. RESULTS During the study period, there were a total of 51,698 deliveries. Among these, 230 cases involved bleeding between 24 and 34 weeks of gestation, 34 (14.8%) were identified as PCB, and 196 as bleeding unrelated to intercourse. In addition, 51,468 pregnancies without bleeding were analyzed as the general population for comparison. The incidence of preterm labor before 37 weeks of gestation was notably higher in both women with PCB (14.7%) and those with bleeding unrelated to coitus (20.9%) compared to the general population (5.6%); however, there was no statistically significant difference between the two bleeding groups (p = 0.403) while both were significantly different from the general population (p < 0.001). The odds ratio for preterm birth before 37 weeks of gestation after PCB was 3.29 (95% CI: 1.26-8.56, p = 0.0149). There were no significant differences between the PCB and bleeding unrelated to intercourse groups in terms of maternal and neonatal complications. CONCLUSION This study found that third-trimester PCB is a risk factor for preterm delivery, with rates similar to other causes of third-trimester bleeding but significantly higher than the general population without bleeding. These findings challenge the assumption that PCB is benign.
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Affiliation(s)
- Doron Kabiri
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Amsalem
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hadel Watad
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rani Haj-Yahya
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roie Alter
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yossef Ezra
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Roy A, Sen B, Vm M. Management of threatened abortion through Ayurvedic intervention: A case report. J Ayurveda Integr Med 2023; 14:100783. [PMID: 37751635 PMCID: PMC10539652 DOI: 10.1016/j.jaim.2023.100783] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/05/2022] [Accepted: 07/08/2023] [Indexed: 09/28/2023] Open
Abstract
Untreated vaginal bleeding during pregnancy can potentially give rise to various complications, with the incidence ranging from 12% to 40% of all cases. In Ayurveda, this condition is referred to as garbhashrava, which encompasses the manifestation of abortion, with raktadarshana (vaginal bleeding) serving as a key diagnostic symptom. In this present case study, 28 years old second gravida woman with amenorrhea of 3 months 08 days presented with vaginal bleeding (1 pad/day) for 15 days on and off. The case was diagnosed as first-trimester vaginal bleeding due to low-lying posterior placenta (placental cause). Pregnancy outcome depends on the severity of bleeding thus early diagnosis and proper management are the priority. Traditionally, the conventional approach involves the use of hemostatic agents and injectable hormonal support, which is an invasive method. In this present study, a local non-invasive method i.e application of gairika choorna 5 g with shatadhauta ghrita 15-20 g in the form of lepa (anointment) below the umbilicus was advised thrice a day for 1 week. This treatment resulted in complete relief from vaginal bleeding within a one-week period while maintaining the pregnancy.
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Affiliation(s)
- Anuradha Roy
- Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, UP, India.
| | - Binay Sen
- Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, UP, India
| | - Monisha Vm
- Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, UP, India
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Benlghazi A, Belouad M, Hallak M, Benali S, Aitbouhou R, Kouach J. Vaginal bleeding as a rare presentation of metastatic renal cell carcinoma: Case report and literature review. Int J Surg Case Rep 2023; 110:108657. [PMID: 37579631 PMCID: PMC10429265 DOI: 10.1016/j.ijscr.2023.108657] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Renal cell carcinoma (RCC) is a relatively uncommon malignancy, comprising only 3 % of adult cancers, but it is responsible for 85 % of primary renal tumors. When RCC metastasizes, the most common sites are the lungs, liver, bones, and brain. Although it is rare, RCC can also metastasize to the vagina. About 18-33 % of RCC cases are diagnosed with metastasis at the time of initial diagnosis. CASE PRESENTATION A 48-year-old woman presented with postcoital bleeding and dyspareunia. At the physical examination, a polypoid mass was discovered on the right lateral wall of the upper third of her vagina and CT scan showed a right renal. Biopsies revealed clear cell renal carcinoma with metastasis to the vagina. The patient was diagnosed with stage IV (T3cN2 M1) renal cancer and underwent systemic therapy with Everolimus. However, subsequent imaging showed tumor progression, and the patient opted to halt treatment and was subsequently lost to follow-up. CLINICAL DISCUSSION In the past decade, there have been fewer than ten reported cases of RCC metastasizing to the vagina. Diagnosing vaginal clear cell carcinoma is challenging due to overlapping morphology with clear cell renal cell carcinoma, requiring immunohistochemistry. Treatment of vaginal cancers is challenging due to their rarity, and there is a lack of consensus on the optimal approach due to limited prospective studies. CONCLUSIONS Although the occurrence of RCC metastasis to the vagina is very uncommon, it is important to consider the possibility of metastatic RCC in cases of vaginal bleeding or lesions.
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Affiliation(s)
- Abdelhamid Benlghazi
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Rabat, Morocco.
| | - Moad Belouad
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Mohammed Hallak
- Department of Nephrology, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Saad Benali
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Rachid Aitbouhou
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Jaouad Kouach
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Rabat, Morocco
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Saedi N, Ghaemi M, Moghadam M, Haddadi M, Hashemi Z, Hantoushzadeh S. Emergency postpartum hysterectomy as a consequence of cervical varix during pregnancy; a case report and literature review. Int J Surg Case Rep 2023; 108:108425. [PMID: 37379718 PMCID: PMC10382762 DOI: 10.1016/j.ijscr.2023.108425] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Vaginal bleeding might accrue during pregnancy and it has different causes due to the pregnancy trimester and the diagnosis and management would be crucial to prevent maternal-fetal life-threatening situations. In uncommon cases, varicose veins can emerge in the neck of the uterus, leading to a severe maternal hemorrhage. CASE PRESENTATION We presented a pregnant woman with vaginal bleeding and spotting during pregnancy with the diagnosis of cervical varix at 22 weeks of gestation. Close monitoring and proper patient education led to a term delivery at 37 weeks of gestation. Otherwise, an emergency postpartum hysterectomy after a cesarean section was performed due to uncontrolled bleeding from cervical varix. CLINICAL DISCUSSION Although rare, cervical varix should be included in the differential diagnosis in a pregnant patient who appears with extensive vaginal bleeding to reduce maternal and/or neonatal morbidity or fatality. The approved diagnosis for that is not clear. CONCLUSION This case report showed that Doppler and transvaginal sonography could be suitable diagnostic tools. The best management for cervical varix needs further research.
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Affiliation(s)
- Nafisseh Saedi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghaemi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Moghadam
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Haddadi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Hashemi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Hantoushzadeh
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Youssef J, Afolayan V, Mack M, Sze A. Cervical varicosities, an uncommon cause of third-trimester bleeding in pregnancy: A case report. Case Rep Womens Health 2023; 38:e00507. [PMID: 37151576 PMCID: PMC10154955 DOI: 10.1016/j.crwh.2023.e00507] [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: 04/14/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/09/2023] Open
Abstract
Cervical varicosities are dilated cervical veins and are uncommon causes of third-trimester vaginal bleeding. Early identification of patients with cervical varices is critical to prevent postpartum hemorrhage, which increases the risk of maternal morbidity and mortality. This is a case report of a 30-year-old woman, gravida 2 para 1, who presented to the labor and delivery unit at 35 weeks 6 days of gestation with a singleton pregnancy with vaginal bleeding. She underwent a pelvic exam under anesthesia and was found to have a 5x5 cm mass of varicosities protruding from the external cervical os, extending over the anterior vaginal lip to the anterior vaginal fornix. A decision was made to deliver via cesarean section. Intraoperative findings were significant for 800 cc of blood loss and a 5-6 cm right ovarian teratoma, which was excised. The patient received two units of packed red blood cells for acute blood-loss anemia postoperatively. This case is unique as the patient had none of the established risk factors for the development of cervical varices. Due to the risks of hemorrhage, morbidity and mortality, physicians and healthcare providers should include cervical varices in their differential diagnoses of patients who present with vaginal bleeding.
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Affiliation(s)
- Julia Youssef
- Department of Obstetrics and Gynecology, Metropolitan Hospital, 1901 1st Ave., New York, NY 10029, USA
- Department of Obstetrics and Gynecology, Westchester Medical Center, 100 Woods Road, Valhalla, NY, 10595, USA
- Corresponding author at: 100 Woods Road, Valhalla, NY 10595, USA.
| | - Victoria Afolayan
- Department of Obstetrics and Gynecology, Metropolitan Hospital, 1901 1st Ave., New York, NY 10029, USA
- New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, USA
| | - Maat Mack
- Department of Obstetrics and Gynecology, Metropolitan Hospital, 1901 1st Ave., New York, NY 10029, USA
- New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, USA
| | - Angelica Sze
- Department of Obstetrics and Gynecology, Metropolitan Hospital, 1901 1st Ave., New York, NY 10029, USA
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Alsharif A, Ghabisha S, Ahmed F, Badheeb M. Congenital uterine arteriovenous malformation presenting as vaginal bleeding following vaginal delivery in a 23-year-old woman: A case report. Case Rep Womens Health 2023; 37:e00493. [PMID: 36915294 PMCID: PMC10006706 DOI: 10.1016/j.crwh.2023.e00493] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023] Open
Abstract
Congenital uterine arteriovenous malformations (AVMs) are an uncommon cause of vaginal bleeding in women of reproductive age. In the medical literature, there are few reports of congenital uterine AVMs. This report describes a 23-year-old woman who presented with intermittent vaginal bleeding following a vaginal delivery two years prior. Initially, a molar pregnancy was suspected, but further assessment with magnetic resonance imaging revealed a diagnosis of right uterine AVM. The patient underwent uterine artery embolization, which was repeated three months later. At two-year follow-up, the patient remained free of symptoms. This case highlights the importance of considering congenital uterine AVM as a potential cause of vaginal bleeding and emphasizes the need for clinical examination and radiologic investigations to establish an accurate diagnosis. Treatment depends on disease severity, comorbidities, patient age, and fertility desires.
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Affiliation(s)
- Afaf Alsharif
- Department of Gynecology, School of Medicine, Jeblah University for Medical and Health Sciences, Ibb, Yemen
| | - Saif Ghabisha
- Department of General Surgery, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen
| | - Faisal Ahmed
- Department of Urology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen
| | - Mohamed Badheeb
- Department of Internal Medicine, College of Medicine, Hadhramaut University, Mukalla, Yemen
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Cipres DT, Shim JY, Grimstad FW. Postoperative Vaginal Bleeding Concerns after Gender-Affirming Hysterectomy in Transgender Adolescents and Young Adults on Testosterone. J Pediatr Adolesc Gynecol 2023; 36:33-38. [PMID: 36089115 DOI: 10.1016/j.jpag.2022.09.002] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/05/2022] [Accepted: 09/02/2022] [Indexed: 01/18/2023]
Abstract
STUDY OBJECTIVE This study aimed to characterize the incidence and management of postoperative vaginal bleeding concerns experienced by transgender adolescents and young adults (AYA) on testosterone hormone therapy after gender-affirming hysterectomy (GAH). METHODS This was a retrospective cohort of transgender AYA, 18 years and older, using testosterone therapy who underwent a GAH between July 2020 and September 2021 at a tertiary care children's hospital. The incidence of patient-reported postoperative vaginal bleeding concerns and management of bleeding are described. RESULTS Patient ages ranged between 18 and 33 years. Among 25 patients who met the inclusion criteria, 13 (52.0%) reported vaginal bleeding concerns. No modifiable patient or operative characteristics reached statistical significance in association with postoperative bleeding concerns. Among patients with bleeding concerns, 10 (76.9%) experienced such concerns during the first 2 weeks after surgery, and 6 (46.2%) had resolution of bleeding without intervention. Among 11 patients who underwent an exam for evaluation of bleeding, findings included granulation tissue (n = 5, 45.5%), vaginal atrophy (n = 4, 36.4%), bleeding vessel (n = 1, 9.1%), mucosal separation (n = 1, 9.1%), or no cause of bleeding identified (n = 4, 36.4%). CONCLUSIONS Over half of transgender AYA on testosterone therapy in this cohort reported postoperative vaginal bleeding concerns that were most often secondary to atrophy and granulation tissue, suggesting possible susceptibility to vaginal tissue trauma at the time of GAH and granulation-susceptible healing in patients on testosterone. As vaginal bleeding could worsen gender dysphoria, these findings support the need for patient counseling on postoperative bleeding expectations and identification of interventions to reduce vaginal bleeding after GAH.
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Affiliation(s)
- Danielle T Cipres
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
| | - Jessica Y Shim
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Frances W Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
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Golub SA, Pham DQ, Oelschlager AA. The Use of "Natural" Substances for Menstrual Hygiene: A Case Report of an Embedded Vaginal Sea Sponge. J Pediatr Adolesc Gynecol 2023; 36:83-5. [PMID: 36162721 DOI: 10.1016/j.jpag.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/30/2022] [Accepted: 09/19/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND In early adolescence, irregular menstrual bleeding patterns are common and are frequently due to anovulatory cycles or bleeding disorders. As such, the diagnosis of a vaginal foreign body might initially be missed. CASE We describe a 14-year-old adolescent female presenting with ongoing irregular menstrual spotting despite reassuring laboratory workup and ultrasonography. She was found to have an embedded vaginal sea sponge eroding through the vaginal wall. On further discussion, she reported using a natural sea sponge for menstrual blood absorption. SUMMARY AND CONCLUSION In cases of persistent vaginal spotting, vaginal foreign body should be considered in the differential diagnosis. Use of nontraditional menstrual hygiene products could lead to medical complications and negative health outcomes in adolescents.
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Wang YN, Dong Y, Wang L, Chen YH, Hu HY, Guo J, Sun L. Special epithelioid trophoblastic tumor: A case report. World J Clin Cases 2022; 10:9354-9360. [PMID: 36159420 PMCID: PMC9477662 DOI: 10.12998/wjcc.v10.i26.9354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/29/2022] [Accepted: 08/05/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Epithelioid trophoblastic tumor (ETT) is a special type of gestational trophoblastic tumor. However, its pathogenesis has been incompletely elucidated. ETT rarely occurs in the ovaries and fallopian tubes, unlike placental site trophoblastic tumor, requiring a histopathological biopsy and immunohistochemistry for further diagnosis.
CASE SUMMARY A 29-year-old woman with irregular vaginal bleeding and elevated serum chorionic gonadotropin (β-hCG) levels presented similar symptoms to ectopic pregnancy. Transvaginal ultrasound revealed abnormal echoes of the left adnexa. Postoperatively, the pathology of the left ovary and fallopian tube was reported as ETT. The patient was followed up with regular hCG measurements and ultrasounds. The blood hCG values showed an upward trend 3 mo after the operation and then chemotherapy was prescribed. The current health status is normal.
CONCLUSION For women of childbearing age with elevated serum β-hCG levels, practitioners should consider ETT and be alert to the poor prognosis of the disease. After surgery, the patient's condition should be closely observed to prevent recurrence and metastasis. Postoperative chemotherapy is only helpful for treating the disease to a certain extent.
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Affiliation(s)
- Ya-Nan Wang
- Departments of Clinical, Jining Medical University, Jining 272000, Shandong Province, China
| | - Yan Dong
- Departments of Clinical, Jining Medical University, Jining 272000, Shandong Province, China
| | - Lin Wang
- Departments of Clinical, Jining Medical University, Jining 272000, Shandong Province, China
| | - Ya-Hui Chen
- Departments of Clinical, Jining Medical University, Jining 272000, Shandong Province, China
| | - Hai-Yang Hu
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
| | - Jing Guo
- Department of Pathology, Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
| | - Lin Sun
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
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Hutchcraft ML, Miller RW. Bleeding from Gynecologic Malignancies. Obstet Gynecol Clin North Am 2022; 49:607-622. [PMID: 36122988 DOI: 10.1016/j.ogc.2022.02.022] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Initial assessment of vaginal bleeding in gynecologic malignancies includes a thorough history and physical examination, identification of site and extent of disease, and patient goals of care. Patients who are initially hemodynamically unstable may require critical care services. Choice of treatment is disease site specific. Cervical cancer frequently is treated with chemoradiation. Uterine cancer may be treated surgically, with radiation, or pharmacologically. Gestational trophoblastic disease is treated surgically. Alternative treatment modalities include vascular embolization and topical hemostatic agents. Patients with bleeding gynecologic malignancies should be managed as inpatients in facilities with gynecologic oncology, radiation oncology, and critical care services.
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Affiliation(s)
- Megan L Hutchcraft
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Markey Cancer Center, 800 Rose Street, Lexington, KY 40536, USA.
| | - Rachel W Miller
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Markey Cancer Center, 800 Rose Street, Lexington, KY 40536, USA
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González-García SM, Pastrana-Arroyo MJ, Medina-Parrilla E, González A, Martín J. A Rare Case of Non-IUD-Related Chronic Endometritis caused by Actinomyces Bacteria in a Postmenopausal Woman: A Case Report. P R Health Sci J 2022; 41:165-167. [PMID: 36018747] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Pelvic actinomycosis is a rare condition, usually associated with intrauterine device (IUD) use. Its clinical presentation may vary from being asymptomatic to the mimicking of pelvic malignancy; it has been described as one of the most misdiagnosed diseases. A 78-year-old woman without a history of IUD use, arrived at our clinic complaining of chronic and intermittent postmenopausal bleeding associated with lower pelvic pain. An endometrial curettage was performed, and endometritis (caused by Actinomyces) identified. Treatment with intravenous piperacillin and tazobactam for 7 days, followed by 6 weeks of oral ampicillin, daily, decreased the bleeding and the pain. Although rare, it is important to consider Actinomyces-related endometritis as a differential diagnosis in cases of elderly woman with postmenopausal bleeding and without a history of IUD use.
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Affiliation(s)
| | | | - Eduardo Medina-Parrilla
- Department of Pathology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Anarda González
- Department of Pathology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - José Martín
- Department of Obstetrics & Gynecology, San Juan City Hospital, San Juan, Puerto Rico
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Zhong C, Xiong G, Lin L, Li Q, Chen X, Zhang X, Zhang Y, Xu S, Wang X, Gao D, Wu M, Yang S, Han W, Sun G, Yang X, Hao L, Jin Z, Yang N. The association of maternal vaginal bleeding and progesterone supplementation in early pregnancy with offspring outcomes: a prospective cohort study. BMC Pregnancy Childbirth 2022; 22:390. [PMID: 35513779 PMCID: PMC9074309 DOI: 10.1186/s12884-022-04711-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022] Open
Abstract
Background Progesterone is widely used to improve the adverse pregnancy outcomes related to vaginal bleeding during early pregnancy. However, the evidence of its effectiveness is equivocal. Methods Six thousand six hundred fifteen mother-infant pairs from Tongji Maternal and Child Health Cohort (TMCHC) were involved in the study. Information on vaginal bleeding, progesterone administration in early pregnancy were obtained at enrolment. Birth outcomes were obtained from the hospital notes. Body weight of the infants at 12 months of age was collected by telephone interview. Multivariable logistic regression was conducted to estimate the effect of vaginal bleeding and progesterone administration in early pregnancy on birth outcomes and weight status of infants at 12 months of age. Results 21.4% (1418/6615) participants experienced bleeding in early pregnancy, and 47.5% (674/1418) of them were treated with progesterone. There were no significant associations between progesterone supplementation in early pregnancy and offspring outcomes. Compared to women without bleeding or any therapy, women with bleeding and progesterone therapy experienced increased risk of preterm (OR 1.74, 95% CI 1.21–2.52), and delivering a small-for-gestational-age (SGA) (OR 1.46, 95% CI 1.07–1.98) or low birth weight (LBW) (OR 2.10, 95% CI 1.25–3.51) neonate, and offspring of them had an increased risk of weight for age z-score (WAZ) < -1 at 12 months of age (OR 1.79, 95%CI 1.01–3.19). Conclusions Offspring of mothers with bleeding and progesterone therapy were more likely to be a premature, SGA or LBW neonate, and had lower weight at 12 months of age. Progesterone supplementation may have no beneficial effect on improving adverse offspring outcomes related to early vaginal bleeding. Trial registration TMCHC was registered at clinicaltrials.gov as NCT03099837 on 4 April 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04711-1.
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Affiliation(s)
- Chunrong Zhong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Guoping Xiong
- Department of Obstetrics and Gynecology, The Central Hospital of Wuhan, Wuhan, China
| | - Lixia Lin
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Qian Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Xi Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Xu Zhang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Yu Zhang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Shangzhi Xu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Xiaoyi Wang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Duan Gao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Meng Wu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Sen Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Weizhen Han
- Department of Obstetrics and Gynecology, The Central Hospital of Wuhan, Wuhan, China
| | - Guoqiang Sun
- Department of Obstetrics, Maternal, Child Health Hospital of Hubei Province, Wuhan, China
| | - Xuefeng Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Liping Hao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Zhichun Jin
- Department of Integrated Traditional & Western Medicine, Maternal, Child Health Hospital of Hubei Province, Wuhan, China
| | - Nianhong Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China.
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13
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Kusumo F, Adegoke OA, Guelfguat M. Reprint of: Twin live gestation in a cesarean section scar ectopic pregnancy. Dis Mon 2022; 68:101380. [PMID: 35483976 DOI: 10.1016/j.disamonth.2022.101380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/08/2020] [Indexed: 10/18/2022]
Affiliation(s)
- Faiz Kusumo
- Jacobi Medical Center, Department of Radiology, Albert Einstein College of Medicine, USA
| | - Oluwakemi A Adegoke
- Jacobi Medical Center, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, USA
| | - Mark Guelfguat
- Jacobi Medical Center, Department of Radiology, Albert Einstein College of Medicine, 1400 South Pelham Parkway, Building 1, Room 4N15, Bronx, NY, 10461, USA.
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Kale AR, Kale AA, Yelikar K. A Comparative, Randomized Control Trial in Patients of Per Vaginal Bleeding Comparing Efficacy of Oral Dydrogesterone Versus Vaginal Progesterone in Successful Pregnancy Outcome for Patients with Recurrent Pregnancy Loss. J Obstet Gynaecol India 2021; 71:591-595. [PMID: 34898896 DOI: 10.1007/s13224-021-01473-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 02/24/2021] [Indexed: 11/28/2022] Open
Abstract
Background Progesterone is essential for the maintenance of a healthy pregnancy. Any defect in the secretion of human chorionic gonadotropin or progesterone is associated with a significantly increased risk of first-trimester abortion. Progesterone is frequently prescribed to patients presenting with per vaginal (PV) bleeding in early pregnancy and a history of recurrent pregnancy loss. Methods Pregnant women up to 12 weeks of gestation with a history of more than two early pregnancy losses and presenting with vaginal bleeding were included in this study. All subjects were randomized to receive either vaginal progesterone 600 mg/day or oral dydrogesterone 30 mg/day. A detailed history-including menstrual history, previous pregnancies, previous miscarriages, and other risk factors-was obtained. The mean time required for the cessation of PV bleeding and continuation of pregnancy up to 24 weeks and till term was compared. Results A total of 200 patients were randomized to vaginal progesterone 600 mg/day (n = 100) or oral dydrogesterone 30 mg/day (n = 100). While 74 patients had two miscarriages in the progesterone group, 68 patients had two miscarriages in the dydrogesterone group. The time required for complete cessation of bleeding was significantly lesser among patients who received oral dydrogesterone compared to those who received intravaginal progesterone (53.90 ± 9.09 vs. 94.60 ± 7.29 h, p < 0.0001). Numerically higher number of patients receiving oral dydrogesterone had a successful continuation of pregnancy up to 24 weeks of gestation, as well as till full term compared to progesterone group (70 vs. 75). Conclusion Oral dydrogesterone is preferred over vaginal progesterone in patients presenting with vaginal bleeding during early pregnancy and a history of recurrent early pregnancy loss.
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Affiliation(s)
- Ashish Ramchandra Kale
- Ashakiran Hospitals and Asha IVF Centre, 555, Narsinha Chintamani Kelkar Road, Narayan Peth, Pune, Maharashtra 411030 India
| | - Ashwini Ashish Kale
- Ashakiran Hospitals and Asha IVF Centre, 555, Narsinha Chintamani Kelkar Road, Narayan Peth, Pune, Maharashtra 411030 India
| | - Kanan Yelikar
- Ashwini Hospital, Govt Medical College & Hospital, Aurangabad, MS India
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15
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Green S, Sheeder J, Richards M. The Etonogestrel Implant in Adolescents: Factors Associated With Removal for Bothersome Bleeding in the First Year After Insertion. J Pediatr Adolesc Gynecol 2021; 34:825-831. [PMID: 34089858 DOI: 10.1016/j.jpag.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE Temporizing measures such as hormonal pills can temporarily improve the side effect of breakthrough bleeding in individuals using the etonogestrel implant. The aims of this study were to determine demographic factors that are associated with bothersome bleeding and to evaluate the impact of prescribing temporizing measures on implant continuation. DESIGN Retrospective chart review. SETTING The research was conducted in an adolescent medicine primary and specialty care clinic, an adolescent family planning clinic, and a clinic that cares for parenting adolescents. PARTICIPANTS A chart review was conducted on 1200 patients aged 12-24 years who received the implant in 2016. INTERVENTIONS AND MAIN OUTCOME MEASURES The primary outcome measure was removal of the implant within the first year of use. We followed each patient for 1 year to determine rates of removal, reasons for removal, and temporizing measures prescribed for bleeding. RESULTS Younger age and lower body mass index were associated with reporting bothersome vaginal bleeding. Patients who were nulliparous or had bothersome bleeding were more likely to have the implant removed in the first year. Patients who received a temporizing measure for bleeding were more likely to retain the implant for 1 year than were those who did not receive one (67.1% vs 40%, P < .001). CONCLUSIONS Some patients are more likely to report concerns with bleeding or to have the implant removed in the first year after insertion. Prescribing temporizing measures to control bothersome vaginal bleeding may decrease rates of removal in the first year.
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Affiliation(s)
- Sarah Green
- Department of Pediatrics, Section of Adolescent Medicine, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado.
| | | | - Molly Richards
- Department of Pediatrics, Section of Adolescent Medicine, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
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16
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Lozano AFQ, Moura MS, Tavares BM, Kempinas WDG. Exposure of pregnant rats to stress and/or sertraline: Side effects on maternal health and neurobehavioral development of male offspring. Life Sci 2021; 285:119960. [PMID: 34536495 DOI: 10.1016/j.lfs.2021.119960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/01/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022]
Abstract
AIMS Sertraline (SE) is one of the most prescribed medications for treating gestational depression, anxiety and stress. However, little is known about its effects on nervous-system development in offspring. Therefore, this study investigated the somatic, reflex and neurobehavioral development of rats exposed to SE during pregnancy, associated or not with stress. MAIN METHODS Pregnant Wistar rats were assigned to the following groups (n = 10-8 rats/group): CO - control animals administered filtered water by gavage; SE - animals administered 20 mg/kg SE by gavage; ST - animals subjected to restraining stress and administered filtered water; ST/SE - animals subjected to restraining stress and administered 20 mg/kg SE. The treatment was administered between gestational days (GD) 13 to 20. Somatic and reflex developments were investigated in the male offspring from postnatal day (PND) 1 to 21. The elevated plus maze was performed on PND 25 and 80. The open field and light/dark box test were performed on PND 90 and 100, respectively. KEY FINDINGS Body weight reduction and vaginal bleeding were observed in pregnant rats exposed to SE. The male offspring of the SE group showed delay in incisor eruption, fur development and negative geotaxis. In addition, the SE group was less exploratory (anxious personality) compared to the CO and ST groups. SIGNIFICANCE The results obtained in the present study demonstrate that sertraline not only impairs maternal health, but also, associated or not with stress, can compromise the somatic, reflex and neurobehavioral development of male rats.
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Affiliation(s)
- Ana Flávia Quiarato Lozano
- Graduate Program in General and Applied Biology, São Paulo State University (UNESP), Institute of Biosciences, Botucatu, SP, Brazil; Laboratory of Reproductive and Developmental Biology and Toxicology, Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, SP, Brazil.
| | - Mayara Silva Moura
- Graduate Program in General and Applied Biology, São Paulo State University (UNESP), Institute of Biosciences, Botucatu, SP, Brazil; Laboratory of Reproductive and Developmental Biology and Toxicology, Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Bruna Marques Tavares
- Laboratory of Reproductive and Developmental Biology and Toxicology, Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Wilma De Grava Kempinas
- Laboratory of Reproductive and Developmental Biology and Toxicology, Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, SP, Brazil
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17
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Grimstad F, Kremen J, Shim J, Charlton BM, Boskey ER. Breakthrough Bleeding in Transgender and Gender Diverse Adolescents and Young Adults on Long-Term Testosterone. J Pediatr Adolesc Gynecol 2021; 34:706-16. [PMID: 33910088 DOI: 10.1016/j.jpag.2021.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/16/2021] [Accepted: 04/09/2021] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE Amenorrhea is a goal of many transgender and gender diverse adolescent and young adult (TGD AYA) patients on testosterone gender-affirming hormone therapy (T-GAHT). Breakthrough bleeding can contribute to worsening gender dysphoria. Our objective was to evaluate breakthrough bleeding in TGD AYA on T-GAHT. DESIGN Institutional review board-approved retrospective cohort. SETTING Tertiary-care children's hospital. PARTICIPANTS TGD AYA on T-GAHT >1 year. INTERVENTIONS None; observational. MAIN OUTCOME MEASURES Presence of, and risk factors for, breakthrough bleeding. RESULTS Of the 232 patients who met inclusion criteria, one-fourth (n = 58) had 1 or more episodes of breakthrough bleeding, defined as bleeding after more than 1 year on T-GAHT. In comparing patients with breakthrough bleeding to those without, there were no significant differences between age of initiation, body mass index (BMI), race/ethnicity, testosterone type used, use of additional menstrual suppression, serum testosterone, or estradiol levels. Patients with breakthrough bleeding patients were on T-GAHT longer (37.3 ± 17.0 vs 28.5 ± 14.6 months, P < .001) and were more likely to have endometriosis (P = .049). Breakthrough bleeding began at a mean of 24.3 ± 17.2 months after T-GAHT initiation. Of those with breakthrough bleeding, 46 (79.3%) had no known cause, 10 (17.2%) bled only with missed T-GAHT doses, and 2 (3.4%) bled only when withdrawing from concomitant menstrual suppression. No breakthrough bleeding management method was found to be superior. CONCLUSION Breakthrough bleeding is relatively common (25%) on T-GAHT despite early amenorrhea. Most cases do not have an identifiable cause. Our data did not show superiority of any 1 method for managing breakthrough bleeding on T-GAHT.
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18
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Alenzi KA, Alharbi FH, Tawhari FM, Fradees GS. Alteration of Coagulation Test Results and Vaginal Bleeding Associated With the Use of Feverfew ( Tanacetum parthenium). J Med Cases 2021; 12:9-12. [PMID: 34434419 PMCID: PMC8383641 DOI: 10.14740/jmc3601] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/17/2020] [Indexed: 11/20/2022] Open
Abstract
Tanacetum parthenium (feverfew) is a member of the daisy family; it is used to prevent and treat migraine and rheumatoid arthritis. It has a long history of use as a traditional and folk medicine in Chinese, Greek, Indian and Arabic medicine, having been used for hundreds of years. The term feverfew comes from the Latin word febrifugia and means fever reducer. However, Short term use of feverfew (up to 4 months) is considered safe in adults. According to a few clinical trials, Tanacetum parthenium was not associated with serious adverse events but rather with mild and reversible events. Adverse events leading to withdrawals were mainly of a gastrointestinal nature. There is no major safety issue. Nevertheless, we report one case of a 36-year-old woman with known migraine who visited the obstetrics and gynecology clinic upon developing vaginal bleeding, prolonged duration of the menstrual cycle, and reddish skin without bruising. The patient suffered from these symptoms over a period of 3 months prior to the clinic visit. Based on history, the patient began taking 800 mg capsules of feverfew three times per day 9 months ago. We applied the Naranjo scale in our case, and it indicated that a probable relationship exists between feverfew and vaginal bleeding. Feverfew should be used cautiously by patients planning elective surgery, having coagulant disorders or taking antithrombotic drugs.
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Affiliation(s)
- Khalidah A Alenzi
- Ministry of Health, Regional Drug Information and Pharmacovigilance Center, Tabuk, Saudi Arabia
| | - Fasil H Alharbi
- Ministry of Health, Regional Drug Information and Pharmacovigilance Center, Tabuk, Saudi Arabia
| | - Fasil M Tawhari
- Ministry of Health, Regional Drug Information and Pharmacovigilance Center, Tabuk, Saudi Arabia
| | - Ghada S Fradees
- Ministry of Health, Prince Sultan Cardiac Center, Al-Qassim, Saudi Arabia
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19
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Saidman JM, Bertoni V, Demeco CM, Padilla ML, Ormaechea MN, Chacon CRB, Kreindel TG. Importance of Doppler ultrasound in vaginal foreign body: case report and review of the literature. J Ultrasound 2021; 25:409-412. [PMID: 34145533 DOI: 10.1007/s40477-021-00596-6] [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: 03/01/2021] [Accepted: 05/19/2021] [Indexed: 11/30/2022] Open
Abstract
The aim of this paper is to describe the distinctive ultrasound findings of a case of vaginal bleeding caused by the presence of a foreign body. We present the case of an infant who consulted for vaginal bleeding and foul-smelling discharge. The ultrasound revealed signs of vaginal distension due to heterogeneous-hematic contents and parietal thickening. At Doppler examination, a striking finding of increased vascularization limited to the upper two-thirds of the vaginal wall was found, which was initially interpreted as a sign of local inflammation suggesting the presence of an underlying foreign body. At direct vaginoscopic examination remains of toilet paper in the vaginal fundus were found. The presence of a foreign body in the vagina is an uncommon cause of discharge and vaginal bleeding in pediatrics, therefore, this etiology should be kept in mind when the adequate clinical context arises. Doppler ultrasound represents a first-line complementary method when this entity is suspected.
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Affiliation(s)
- Julia Mariel Saidman
- Radiology Service, Radiology Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, CABA, C1181ACH, Autonomous City of Buenos Aires, Argentina.
| | - Victoria Bertoni
- Radiology Service, Radiology Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, CABA, C1181ACH, Autonomous City of Buenos Aires, Argentina
| | - Cristian Miguel Demeco
- Radiology Service, Radiology Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, CABA, C1181ACH, Autonomous City of Buenos Aires, Argentina
| | - Maria Laura Padilla
- Radiology Service, Radiology Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, CABA, C1181ACH, Autonomous City of Buenos Aires, Argentina
| | - Maria Nieves Ormaechea
- Pediatric Surgery Department, Hospital Italiano de Buenos Aires, Autonomous City of Buenos Aires, Argentina
| | - Carolina Rosa Beatriz Chacon
- Radiology Service, Radiology Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, CABA, C1181ACH, Autonomous City of Buenos Aires, Argentina
| | - Tamara Glenda Kreindel
- Radiology Service, Radiology Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, CABA, C1181ACH, Autonomous City of Buenos Aires, Argentina
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20
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Abstract
Examinations of young children for suspicions of sexual abuse are challenging for the involved medical specialists because the consequences of the interpretation of the findings can be severe and dramatic. A broad knowledge of differential diagnoses including rare pathologies like urethral prolapse and failure of the midline fusion of the perineum, known as perineal groove, is essential in order to avoid unnecessary diagnostics and treatment, prejudgment, and to reduce patient family’s anxiety. We report two independent cases of girls aged 7 months and 5 years suffering from these rare pathologies, one presenting with painless lower genital tract bleeding, the other showing a lesion of the perineum as random finding during a neuropediatrician’s consultation. In both cases, the pathologies were initially misdiagnosed as injuries due to sexual assault, and judicial investigation procedures were initiated. In this paper, the characteristic symptoms and morphology of urethral prolapse and perineal groove are presented to enhance the awareness of these pathologies among forensic experts and help to establish the correct diagnosis.
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Affiliation(s)
- Martine Schaul
- Service Medico-Judiciaire, Département Médecine Légale, Laboratoire National de Santé, 1, Rue Louis Rech 3555, Dudelange, Luxembourg.
| | - Thorsten Schwark
- Service Medico-Judiciaire, Département Médecine Légale, Laboratoire National de Santé, 1, Rue Louis Rech 3555, Dudelange, Luxembourg
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21
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Son SY, Wu E, Gariwala V, O'Neill C. Mesenteric ectopic pregnancy with tubo-ovarian abscess. Radiol Case Rep 2021; 16:1165-1168. [PMID: 33777281 PMCID: PMC7985701 DOI: 10.1016/j.radcr.2021.02.043] [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: 02/06/2021] [Revised: 02/17/2021] [Accepted: 02/20/2021] [Indexed: 12/03/2022] Open
Abstract
An ectopic pregnancy is the implantation of a fertilized ovum in a location other than the main cavity of the uterus. Ectopic pregnancies are reported in approximately 1%-2% of pregnancies, and while 95% of ectopic pregnancies are in fallopian tubes, only 3% are in ovarian, cervical, or abdominal sites. We present a case of a 38-year-old female with acute onset of severe lower abdominal pain, sepsis, chills, and diarrhea who was evaluated with a CT of the abdomen and pelvis with IV contrast only. The imaging revealed a likely second trimester age fetal skeleton with a partially collapsed calvarium within the peritoneal cavity and an abnormal complex cystic lesion in the right adnexal area. In this case, the patient successfully underwent exploratory laparotomy with removal of both the abdominal ectopic pregnancy and the tubo-ovarian mass.
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Affiliation(s)
- Sam Y Son
- EVMS Radiology, Eastern Virginia Medical School, 825 Fairfax Ave, Norfolk, VA 23507, USA
| | - Eunice Wu
- EVMS Radiology, Eastern Virginia Medical School, 825 Fairfax Ave, Norfolk, VA 23507, USA
| | - Veer Gariwala
- EVMS Radiology, Eastern Virginia Medical School, 825 Fairfax Ave, Norfolk, VA 23507, USA
| | - Christopher O'Neill
- EVMS Radiology, Eastern Virginia Medical School, 825 Fairfax Ave, Norfolk, VA 23507, USA
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22
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Abstract
Objectives: This study was planned with an aim to find out the effectiveness of oral versus vaginal micronized progesterone for the treatment of threatened miscarriage. Methods: This randomized controlled trial was conducted at The Department of Obstetrics and Gynaecology, Nishtar Hospital Multan, from August 2019 to January 2020. A total of 136 pregnant women, aged 18 to 45 years having vaginal bleeding were included and divided into two groups (68 women in each group). Participants in the Group-A were given oral micronized progesterone as 200mg twice a day while Group-B participants were given vaginal progesterone suppository 400mg once a day. All women were followed up until 20th week of their pregnancy. Outcome was labeled as prevention of miscarriage if woman had no bleeding per vagina and pregnancy went beyond 20th weeks of gestation. Results: In a total of 136 women enrolled, mean age was noted to be 30.85+3.34 years. Overall, mean gestational age was noted to be 9.3+2.7 weeks. A total of 98 women (49 in each group) completed the follow up and were included in the final analysis regarding outcome. Among Groups-A, 45 (91.8) had prevention of miscarriage while 4 (9.2%) had miscarriage in comparison to 36 (73.5%) in Group-B had prevention of miscarriage whereas 13 (26.5%) had miscarriage and this difference was statistically significant in between the both study groups as women in Group-A had significantly better outcome in terms of prevention of miscarriage. (P value = 0.0164). Conclusion: The use of oral micronized progesterone was found to be significantly more effective than vaginal progesterone in women with threatened miscarriage.
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Affiliation(s)
- Rashida Parveen
- Rashida Parveen, FCPS (OBG). Department of Obstetrics and Gyne, Unit-II, Nishtar Medical University Hospital, Multan, Pakistan
| | - Mehnaz Khakwani
- Mehnaz Khakwani, FCPS (OBG). Department of Obstetrics and Gyne, Unit-II, Nishtar Medical University Hospital, Multan, Pakistan
| | - Sobia Tabassum
- Sobia Tabassum, FCPS (OBG). Department of Obstetrics and Gyne, Civil Hospital, Bahawalpur, Pakistan
| | - Sajjad Masood
- Sajjad Masood, FCPS (OBG). Department of Obstetrics and Gyne, Unit-II, Nishtar Medical University Hospital, Multan, Pakistan
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23
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Huynh C, Ha TN, Hoang VT, Huynh PH. Acquired life-threatening uterine arteriovenous malformation treated by endovascular embolization. Radiol Case Rep 2021; 16:241-245. [PMID: 33304434 PMCID: PMC7708760 DOI: 10.1016/j.radcr.2020.11.013] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 11/22/2022] Open
Abstract
Uterine arteriovenous malformation (AVM) is a rare condition that may lead to a life-threatening state. The urgency of diagnosis and treatment for uterine AVM should be emphasized. This case report describes a 42-year-old woman with a vaginal hemorrhage. In the previous month, the patient also had a hemorrhage after induced abortion that required a bilateral artery suture hemostasis of the uterus. On ultrasound, there was a lesion suspected by acquired AVM. Magnetic Resonance Angiography and Digital Subtraction Angiography was indicated to confirm the diagnosis. The patient was successfully treated by uterine artery embolization. After 6 months, the re-examined result showed no lesion of AVM.
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Affiliation(s)
- Chinh Huynh
- Department of Radiology, Tu Du Hospital, Ho Chi Minh, Viet Nam
| | - To-Nguyen Ha
- Department of Radiology, Tu Du Hospital, Ho Chi Minh, Viet Nam
| | - Van-Trung Hoang
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Viet Nam
| | - Phuong-Hai Huynh
- Department of Radiology, University Medical Center, Ho Chi Minh, Viet Nam
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24
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Mayhew AC, Rytting H, Olson TA, Smith E, Childress KJ. Vaginal Yolk Sac Tumor: A Case Series and Review of the Literature. J Pediatr Adolesc Gynecol 2021; 34:54-60.e4. [PMID: 32628992 DOI: 10.1016/j.jpag.2020.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/31/2020] [Accepted: 06/25/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To report diagnosis, treatment, and outcomes of vaginal yolk sac tumor (YST) cases at a single institution and review literature on vaginal YST to outline advancements in diagnosis, treatment, and survival. DESIGN Retrospective chart review of female patients less than 21 years of age with pathologic diagnosis of vaginal YST treated at a large children's hospital, and summary of a 100-year review of the literature on vaginal yolk sac tumor. SETTING Children's Healthcare of Atlanta, a tertiary center in Atlanta, GA. PARTICIPANTS Female patients less than 21 years of age diagnosed with vaginal YST. RESULTS Two cases of vaginal YST at our institution are outlined. Both patients presented within the first 2 years of life with vaginal bleeding and were treated successfully with chemotherapy alone. After review of the literature, 137 cases of vaginal YST were found. The mean age at diagnosis was 11 months, and all patients presented with vaginal bleeding. Before 2000, more radical treatments were pursued, and 40% resulted in death. Since the year 2000, treatment has shifted toward chemotherapy and more conservative surgical management, with 51% of vaginal YST cases treated with chemotherapy alone with 92% of patients alive at time of publication. CONCLUSION Our cases contribute to the limited literature demonstrating the efficacy of conservative management of rare cases of vaginal YST with chemotherapy alone. This case series and review of the literature provide mounting evidence that vaginal YST should be in the differential diagnosis in young girls with vaginal tumors, and conservative management of vaginal YST has excellent outcomes.
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Affiliation(s)
- Allison C Mayhew
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA; Division of Pediatric and Adolescent Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
| | - Heather Rytting
- Department of Pathology, Emory University School of Medicine, Atlanta, GA
| | - Thomas A Olson
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Edwin Smith
- Division of Urology, Children's Healthcare of Atlanta, Atlanta, GA; Divisions of Pediatric Surgery and Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA
| | - Krista J Childress
- Divisions of Pediatric Surgery and Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA; Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
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Shipp TD, Poder L, Feldstein VA, Oliver ER, Promes SB, Strachowski LM, Sussman BL, Wang EY, Weber TM, Winter T, Glanc P. ACR Appropriateness Criteria® Second and Third Trimester Vaginal Bleeding. J Am Coll Radiol 2020; 17:S497-S504. [PMID: 33153560 DOI: 10.1016/j.jacr.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
Vaginal bleeding can occur throughout pregnancy with varied etiologies. Although history and physical examination can identify many etiologies, imaging, in particular ultrasound (US), is the backbone of current medical practice. US pregnant uterus transabdominal, US pregnant uterus transvaginal, and US duplex Doppler velocimetry are usually appropriate for the evaluation of women with painless vaginal bleeding, those with painful vaginal bleeding, and also for those with second or third trimester vaginal bleeding with suspicion of or known placenta previa, low-lying placenta, or vasa previa. US cervix transperineal may be appropriate for those with painless or painful vaginal bleeding but is usually not appropriate for second or third trimester vaginal bleeding with suspicion of or known placenta previa, low-lying placenta, or vasa previa. Because the outcome of pregnancies is unequivocally related to the specific etiology of the vaginal bleeding, knowledge of imaging results directly informs patient management to optimize the outcome for mother and fetus. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Thomas D Shipp
- Brigham & Women's Hospital, Boston, Massachusetts; American College of Obstetricians and Gynecologists.
| | - Liina Poder
- Panel Chair, University of California San Francisco, San Francisco, California
| | | | - Edward R Oliver
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan B Promes
- Penn State Health, Hershey, Pennsylvania; American College of Emergency Physicians
| | | | - Betsy L Sussman
- The University of Vermont Medical Center, Burlington, Vermont
| | - Eileen Y Wang
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; American College of Obstetricians and Gynecologists
| | | | - Tom Winter
- University of Utah, Salt Lake City, Utah
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Elbaz M, Qadiry RE, Fouraiji K, Jalal H, Elhoudzi J. Yolk sac tumor of vagina: a rare cause of vaginal bleeding in adolescents - a case report. Pan Afr Med J 2020; 37:169. [PMID: 33425202 PMCID: PMC7757295 DOI: 10.11604/pamj.2020.37.169.20949] [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: 11/11/2019] [Accepted: 07/24/2020] [Indexed: 11/11/2022] Open
Abstract
Yolk sac tumor (YST) is one of the malignant germ-cell tumors (MGCT) that usually occurs in the ovaries and testes of young patients. Its occurrence in the vagina is extremely rare. We present a rare case of extragonadal YST occurring in the vaginal region. A 12-year-old girl, presented with vaginal bleeding and pain in the perineal region. Physical exam identified a limited pelvic mass, 5 x 4cm in size. Abdominal ultrasound and magnetic resonance imaging (MRI) showed a heterogeneous mass in cervico-vaginal region. The patient was taken to the surgery, where an excisional biopsy was obtained. The diagnosis of YST is confirmed by histopathology and immunohistochemistry studies. However, the tumor marker (alpha fetoprotein and BHCG) was normal. The patient was treated according to the French TGM-95 protocol. Surgery was done after chemotherapy, hysterectomy in front of the cervical invasion, with a good decline at 2 years of end of treatment.
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Affiliation(s)
- Meriem Elbaz
- Pediatric Hematology and Oncology Department, Mohamed VI University Hospital, Marrakech, Morocco
| | - Rabiy El Qadiry
- Pediatric Hematology and Oncology Department, Mohamed VI University Hospital, Marrakech, Morocco
| | - Karima Fouraiji
- Pediatric Surgery Department, Mohamed VI University Hospital, Marrakech, Morocco
| | - Hicham Jalal
- Pediatric Radiology Department, Mohamed VI University Hospital, Marrakech, Morocco
| | - Jamila Elhoudzi
- Pediatric Hematology and Oncology Department, Mohamed VI University Hospital, Marrakech, Morocco
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Devall AJ, Coomarasamy A. Sporadic pregnancy loss and recurrent miscarriage. Best Pract Res Clin Obstet Gynaecol 2020; 69:30-39. [PMID: 32978069 DOI: 10.1016/j.bpobgyn.2020.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/16/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
Progesterone is essential for the maintenance of pregnancy, and progesterone deficiency is associated with miscarriage. The subject of whether progesterone supplementation in early pregnancy can prevent miscarriage has been a long-standing research question and has been investigated and debated in the medical literature for over 70 years. During this time, several different progestogens have been synthesised and tested for the prevention of miscarriage. In this chapter, we describe the prior evidence alongside the latest research using micronized natural progesterone as well as synthetic progestogens, which were used to treat both recurrent and threatened miscarriage. The totality of evidence indicates that women with a past history of miscarriage who present with bleeding in early pregnancy may benefit from the use of vaginal micronized progesterone. The clinical implications of the findings are discussed.
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Affiliation(s)
- Adam J Devall
- Tommy's National Centre for Miscarriage Research, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Arri Coomarasamy
- Tommy's National Centre for Miscarriage Research, College of Medical and Dental Sciences, University of Birmingham, UK.
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Horvath S, Tsao P, Huang ZY, Zhao L, Du Y, Sammel MD, Prak ETL, Schreiber CA. The concentration of fetal red blood cells in first-trimester pregnant women undergoing uterine aspiration is below the calculated threshold for Rh sensitization. Contraception 2020; 102:1-6. [PMID: 32135125 PMCID: PMC7272297 DOI: 10.1016/j.contraception.2020.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To calculate the minimum fetal red blood cell concentration required to cause maternal Rh sensitization; validate the use of a flow cytometry protocol below that concentration; preliminarily assess the concentrations of fetal red blood cells in pregnant women before and after uterine aspiration. STUDY DESIGN Using pre-existing literature, we calculated the lowest concentration of fetal red blood cells found to cause sensitization within adult female circulation. We validated a two-color flow cytometry protocol using fluorescently labeled antibodies to Hemoglobin F (expressed by fetal red blood cells and adult F cells) and Carbonic Anhydrase (expressed in red blood cells during the third trimester and postnatally) by titrating second trimester cord blood into non-pregnant adult blood. We applied this flow cytometry protocol in a prospective cohort study of 42 pregnant women at 5-12 weeks gestational age undergoing uterine aspiration for induced or spontaneous abortion. RESULTS The calculated threshold for causing Rh sensitization was 250 fetal red blood cells per 10 million total red blood cells. We showed a linear relationship between observed and expected fetal red blood cell fractions in titrated samples. Fetal red blood cell counts were more reliable when samples acquired by flow cytometry contained at least 1 million red blood cells. All 37 subjects with evaluable paired samples demonstrated fetal red blood cell concentrations below the calculated threshold for Rh sensitization both pre- and post-procedure. The fetal RBC concentrations increased from a mean of 4.5 (median 0, range 0-57) fetal RBCS pre- to a mean of 8.6 (median 2, range 0-32) fetal RBCs post- per 10 million total RBCs (p < 0.001). CONCLUSIONS Flow cytometry was capable of separately quantifying fetal red blood cells and maternal F cells to very dilute concentrations. Fetal red blood cell exposure in the first trimester was well below the calculated threshold for maternal Rh sensitization in our cohort. Larger studies are warranted to confirm our pilot study findings, fill this evidence gap and inform universal guidelines for administering Rh immunoglobulin after first trimester uterine aspiration. IMPLICATIONS Fetal red blood cell exposure following first trimester uterine aspiration is well below the calculated threshold for maternal Rh sensitization in our cohort.
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Affiliation(s)
- Sarah Horvath
- Division of Family Planning, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States.
| | - Patricia Tsao
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States.
| | - Zhen-Yu Huang
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States.
| | - Ling Zhao
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States.
| | - Yangzhu Du
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States.
| | - Mary D Sammel
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States.
| | - Eline T Luning Prak
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States.
| | - Courtney A Schreiber
- Division of Family Planning, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States.
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Zhang J, Zhang B, Su Y, Guo S, Liu C, Bai J, Xie X. Prepubertal Vaginal Bleeding: An Inpatient Series from a Single Center in Fujian China. J Pediatr Adolesc Gynecol 2020; 33:120-124. [PMID: 31765797 DOI: 10.1016/j.jpag.2019.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/03/2019] [Accepted: 11/14/2019] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE This study characterizes the etiology, clinical features and outcomes of prepubescent vaginal bleeding and summarizes our experience. DESIGN The data of patients who were hospitalized with vaginal discharge or bleeding treated from January 2012 to December 2018 were retrospectively reviewed. SETTING A provincial Grade III Level A Maternity and Children's Hospital. PARTICIPANTS Prepubertal patients with vaginal discharge or bleeding. MAIN OUTCOME MEASURES Patient age, bleeding duration, etiology, treatment and prognosis were recorded. Physical examinations and color Doppler ultrasonography were also performed. RESULTS There were 158 patients aged from 1 month to 10 years (mean age 5.2 years). Bleeding duration ranged from 1 to 98 days, with an average of 13.3 days. Sixty patients were diagnosed with vaginal foreign bodies, 34 with vulvovaginitis, 34 with vulvar trauma, 13 with ovarian granulosa cell tumors, 8 with urethral mucosa prolapse, 5 with vaginal yolk sac tumors and 1 each with pituitary tumor, hypothyroidism, McCune-Albright syndrome, and short-term intake of a large number of strawberries. All the children were treated according to their different disease etiologies. CONCLUSION Prepubertal vaginal bleeding is caused by a variety of different conditions. In our study, the most common causes were vaginal foreign bodies, vulvovaginitis, trauma, vaginal malignant tumors and urethral mucosa prolapse. Careful medical histories and targeted examinations are needed. Vaginoscopy could be considered. Considering the different causes, different treatments should be administered to achieve a good prognosis.
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Affiliation(s)
- Jinna Zhang
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Fuzhou, China
| | - Bing Zhang
- Department of Pediatric Surgery, Fujian Provincial Maternity and Children's Hospital, Fuzhou, China
| | - Yanzhao Su
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Fuzhou, China
| | - Sang Guo
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Fuzhou, China
| | - Chaobin Liu
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Fuzhou, China
| | - Jianxi Bai
- Department of Pediatric Surgery, Fujian Provincial Maternity and Children's Hospital, Fuzhou, China
| | - Xi Xie
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Fuzhou, China.
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Chambers C, Adeyemi-Fowode O. Prepubertal Bleeding as a Presenting Symptom of Von Willebrand Disease: A Case Report. J Pediatr Adolesc Gynecol 2020; 33:167-169. [PMID: 31883461 DOI: 10.1016/j.jpag.2019.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/16/2019] [Accepted: 12/19/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Von Willebrand disease (VWD) affects approximately 1% of the population and is often diagnosed after the presentation of mucocutaneous bleeding. CASE A 7-year-old girl with eczema and constipation presented to clinic reporting vaginal bleeding. External genital examination findings were normal, and results of a workup for precocious puberty were negative. Vaginoscopy revealed an atypical appearance with increased vascularity and friability. Oral mucosal bleeding at the time of extubation prompted additional workup and hematology referral, which led to diagnosis of type I VWD. SUMMARY AND CONCLUSION It is important to keep bleeding disorders on the differential, for unexplained prepubertal vaginal bleeding, to aid in prompt diagnosis.
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Affiliation(s)
- Charis Chambers
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| | - Oluyemisi Adeyemi-Fowode
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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Gupta J, Lin-Su K. Van Wyk-Grumbach syndrome in a female pediatric patient with trisomy 21: a case report. Int J Pediatr Endocrinol 2020; 2020:2. [PMID: 32002020 PMCID: PMC6986150 DOI: 10.1186/s13633-020-0072-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/14/2020] [Indexed: 11/20/2022]
Abstract
Background Children with hypothyroidism typically present with delayed growth and development, but on rare occasions can present with signs of precocious puberty. This presentation is called Van Wyk-Grumbach syndrome. Van Wyk-Grumbach syndrome has seldom been described in patients with trisomy 21. Case presentation We present the case of a 4-year-old girl with trisomy 21, who recently moved to the United States from Guyana, and presented to the emergency room with recurrent vaginal bleeding. She was eventually diagnosed with hypothyroidism and Van Wyk-Grumbach syndrome. She was noted to have Tanner I breasts and pubic hair. A pelvic ultrasound was performed, which showed a simple cyst in the right adnexa. Subsequent laboratory evaluation revealed a thyroid stimulating hormone (TSH) of > 150 mIU/ml along with low free thyroxine of 0.3 ng/dl, suggesting longstanding untreated hypothyroidism. Estradiol and alpha-fetoprotein (AFP) levels were elevated. Bone age was delayed. The patient was diagnosed with Van Wyk-Grumbach syndrome and was started on levothyroxine therapy with subsequent resolution of vaginal bleeding. Estradiol and AFP both normalized after initiating levothyroxine therapy. Conclusion This case emphasizes the importance of recognizing the presence of precocious puberty, delayed bone age and ovarian cyst as a manifestation of primary hypothyroidism. In addition, it highlights the need for thyroid function screening in patients with Trisomy 21. Tumor markers may be elevated in Van Wyk-Grumbach syndrome with subsequent normalization after treatment.
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Affiliation(s)
- Jyotsna Gupta
- Division of Pediatric Endocrinology, Department of Pediatrics, Weill Cornell Medicine, New York Presbyterian Hospital, 505 East 70th Street, New York, NY NY-10021 USA
| | - Karen Lin-Su
- Division of Pediatric Endocrinology, Department of Pediatrics, Weill Cornell Medicine, New York Presbyterian Hospital, 505 East 70th Street, New York, NY NY-10021 USA
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Moradi A, Shakiba B, Maghsoudi R, Dehghaniathar R. Vaginal bleeding as primary presentation of renal cell carcinoma. CEN Case Rep 2020; 9:138-140. [PMID: 31916227 DOI: 10.1007/s13730-019-00442-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022] Open
Abstract
Vaginal metastases from renal cell carcinoma has been recorded as extremely rare. We present a patient with vaginal bleeding as primary manifestation of renal cell carcinoma. A 40-year-old woman presented to a local private clinic with intermittent vaginal bleeding for approximately one month. Gynecological examination revealed a mass on the vaginal wall at approximately 8 o'clock. She underwent dilation and curettage (D&C) and mass excision. Microscopic histopathology and immunohistochemical stains showed vaginal metastases of clear cell RCC. The patient was referred to our urology clinic. Magnetic Resonance Imaging (MRI) of abdomen and pelvic showed a well-defined solid mass lesion measuring 16 × 12 × 11 cm in left kidney. Patient underwent left side radical nephrectomy through a left subcostal intraperitoneal incision. Histopathological results and metastasis workup confirmed the diagnosis of RCC with solitary metastatic vaginal lesion. After radical nephrectomy, she was treated with Sunitinib. No local relapse or distant metastasis was recognized 5 months after radical nephrectomy. In conclusion, the incidence of RCC metastasis to the vagina is extremely rare; but, in cases of vaginal bleeding or lesions we have to keep in mind the possibility of metastatic RCC.
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Affiliation(s)
- Asaad Moradi
- Department of Urology, Firoozgar Hospital, Iran University of Medical Sciences, Valadi St., Valiasr Ave., 1593748711, Tehran, Iran
| | - Behnam Shakiba
- Department of Urology, Firoozgar Hospital, Iran University of Medical Sciences, Valadi St., Valiasr Ave., 1593748711, Tehran, Iran.
| | - Robab Maghsoudi
- Department of Urology, Firoozgar Hospital, Iran University of Medical Sciences, Valadi St., Valiasr Ave., 1593748711, Tehran, Iran
| | - Reza Dehghaniathar
- Department of Urology, Firoozgar Hospital, Iran University of Medical Sciences, Valadi St., Valiasr Ave., 1593748711, Tehran, Iran
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Fornari A, Gressler M, Murari JCL. Urethral Prolapse: A Case Series and Literature Review. J Obstet Gynaecol India 2019; 70:158-162. [PMID: 32255955 DOI: 10.1007/s13224-019-01288-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022] Open
Abstract
Introduction and Hypothesis Urethral mucosal prolapse is most frequently seen in children and postmenopausal women, and extremely rare in young adult patients. In this context, we aim to describe our experience with this condition and compare our findings with the literature. Methods We reviewed the medical records of our outpatient micturition disorders clinic (between August 2014 and April 2017) for patients with a diagnosis of urethral mucosal prolapse, seeking to evaluate their demographic characteristics, presenting complaints, treatment, and outcomes. Results We found 12 cases of urethral mucosal prolapse, including a mother and daughter and a reproductive-aged patient. Presenting symptoms included bleeding, urinary retention, partially thrombosed mucosa, and pain. Misdiagnosis was common and caused treatment delay, even in some very symptomatic patients. Conclusion Urethral mucosal prolapse is a readily diagnosed condition and often associated with complications in our series. Proper diagnosis is key to successful, timely treatment. Descriptive studies such as this are important to raise awareness of this diagnosis and improve patient care.
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Affiliation(s)
- Alexandre Fornari
- Outpatient Micturition Disorders Clinic, Urology Department, Santa Casa de Misericórdia de Porto Alegre, Rua General Vitorino, 330/1101, Porto Alegre, RS 90020-170 Brazil
| | - Marina Gressler
- Outpatient Micturition Disorders Clinic, Urology Department, Santa Casa de Misericórdia de Porto Alegre, Rua General Vitorino, 330/1101, Porto Alegre, RS 90020-170 Brazil
| | - Jean Carlos Levay Murari
- Outpatient Micturition Disorders Clinic, Urology Department, Santa Casa de Misericórdia de Porto Alegre, Rua General Vitorino, 330/1101, Porto Alegre, RS 90020-170 Brazil
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Abstract
The emergency medicine provider sees a broad range of pathology involving the female genitourinary system on a daily basis. Must-not-miss diagnoses include pelvic inflammatory disease and ovarian torsion, because these diagnoses can have severe complications and affect future fertility. Although most patients with abnormal uterine bleeding are hemodynamically stable, it can present as a life-threatening emergency and providers should be adept managing severe hemorrhage. Bartholin gland cysts are common complaints that often require procedural intervention. This article discusses these diagnoses and appropriate evaluation and management in the emergency department.
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Affiliation(s)
- Sarah Mahonski
- Heritage Valley Health System, 1000 Dutch Ridge Road, Beaver, PA 15009, USA
| | - Kami M Hu
- Emergency/Internal/Critical Care Medicine, University of Maryland, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
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Park YH, Byun JM, Cho HJ, Jeong DH, Kim YN, Park HR, Lee KB, Sung MS. The first case of vaginal angiomatoid Spitz nevus causing vaginal bleeding. Obstet Gynecol Sci 2019; 62:290-3. [PMID: 31338348 DOI: 10.5468/ogs.2019.62.4.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/12/2018] [Accepted: 08/22/2018] [Indexed: 12/01/2022] Open
Abstract
Angiomatoid Spitz nevus is a variant of melanocytic nevus with prominent vasculature. Due to its pathologic features, angiomatoid Spitz nevus in the vaginal wall is extremely rare. A 42-year-old woman presented to the hospital with abnormal vaginal bleeding. Vaginal examination revealed a 2×2-cm well-demarcated tumor on the posterior wall of the vagina. The mass was successfully removed by complete excision and was diagnosed as angiomatoid Spitz nevus on pathologic examination. We present the first reported case of vaginal angiomatoid Spitz nevus, which caused vaginal bleeding. Although angiomatoid Spitz nevus has many histopathological similarities with malignant melanoma, precise histopathological diagnosis is important for preventing overtreatment.
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Dean J, Kramer KJ, Akbary F, Wade S, Hüttemann M, Berman JM, Recanati MA. Norethindrone is superior to combined oral contraceptive pills in short-term delay of menses and onset of breakthrough bleeding: a randomized trial. BMC Womens Health 2019; 19:70. [PMID: 31138184 PMCID: PMC6537409 DOI: 10.1186/s12905-019-0766-6] [Citation(s) in RCA: 5] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/13/2019] [Indexed: 12/03/2022]
Abstract
Background To determine whether oral norethindrone acetate is superior to combined oral contraceptives (OCP) in delaying menstruation and preventing breakthrough bleeding when started late in the cycle. Methods This article comprises of a case control study followed by a pilot randomized controlled study. In the first study, four women who presented late in their cycle and desired avoiding vaginal bleeding within 10 days before a wedding were started on norethindrone 5 mg three times daily and compared to age matched controls started on OCPs. Subsequently, a randomized controlled pilot study (n = 50) comparing OCPs to norethindrone for the retiming of menses was conducted. Percentage of women reporting spotting were compared with level of statistical significance set at p < 0.05. Results Of the norethindrone treated group, only 2 women (8%) reported spotting compared with 10 women (43%) in the control group (p < 0.01). Norethindrone recipients experienced significant weight gain, which resolved after cessation of therapy and had heavier withdrawal bleed (p < 0.04) when compared to controls. Patient satisfaction was significantly higher in the norethindrone group, with 80% willing to choose this method again. Time to conceive was significantly shorter in the norethindrone group (p < 0.03). Conclusions Norethindrone, begun on or before cycle day 12, is superior for women who desire to avoid breakthrough bleeding and maintain fertility when compared to OCPs. It is an ideal approach in patients presenting late in their cycle and who desire delaying menses as well as in circumstances when even minute amounts of breakthrough bleeding cannot be tolerated. Trial registration Clinicaltrials.gov NCT03594604, July 2018. Retrospectively registered.
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Affiliation(s)
- Joshua Dean
- School of Medicine, Wayne State University, Detroit, MI, 48201, USA
| | - Katherine J Kramer
- Department of Obstetrics and Gynecology, St. Vincent's Catholic Medical Centers, New York, NY, 10011, USA
| | - Fauzia Akbary
- Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Shaunte Wade
- School of Medicine, Wayne State University, Detroit, MI, 48201, USA
| | - Maik Hüttemann
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Jay M Berman
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, 48201, USA
| | - Maurice-Andre Recanati
- NIH-Women's Reproductive Health Research (WRHR) Scholar, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, 48201, USA.
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Dyne PL, Miller TA. The Patient with Non-Pregnancy-Associated Vaginal Bleeding. Emerg Med Clin North Am 2019; 37:153-164. [PMID: 30940364 DOI: 10.1016/j.emc.2019.01.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abnormal uterine bleeding (AUB) unrelated to pregnancy affects 20% to 30% of women at some point in life and is a common emergency department (ED) and urgent care (UC) presentation. AUB is a complex condition with extensive terminology, broad differential diagnosis, and numerous treatment options, yet few published evidence-based guidelines. In the ED or UC setting most affected patients are often more frustrated than acutely ill. These factors can make for a challenging patient encounter in the EC/UC setting. This article reviews acute and chronic AUB in the nonpregnant patient and suggests a simplified approach for its evaluation and management.
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Affiliation(s)
- Pamela L Dyne
- UCLA-OV Emergency Medicine, Olive View-UCLA Department of Emergency Medicine, 14445 Olive View Drive, North Annex, Sylmar, CA 91342, USA.
| | - Teri Anne Miller
- UCLA-OV Emergency Medicine, UCLA Department of Emergency Medicine, 924 Westwood Boulevard, Suite 300, Los Angeles, CA 90024, USA
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Shim DJ, Choi SJ, Jung JM, Choi JH. Uterine arteriovenous malformation with repeated vaginal bleeding after dilatation and curettage. Obstet Gynecol Sci 2019; 62:142-145. [PMID: 30918884 PMCID: PMC6422849 DOI: 10.5468/ogs.2019.62.2.142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 10/12/2018] [Revised: 12/13/2018] [Accepted: 12/26/2018] [Indexed: 12/30/2022] Open
Abstract
Uterine arteriovenous vascular malformation (UAVM) is a disease that causes excessive bleeding. The symptoms do not subside without proper treatment and this can lead to life-threatening situations. The correct diagnosis of UAVM can be complicated if the patient's uterus did not completely discharge everything during abortion (in broader terms, retaining remnants of the products of conception). In this case, Doppler ultrasonography and computed tomography angiography with 3-dimensional rendering were used to analyze the cause of bleeding and provide proper treatment of this patient. Then, uterine artery embolization, dilatation, and curettage were performed safely and successfully. The patient no longer had symptoms of vaginal spotting during the planned follow up care. UAVM is uncommon; however, if reproductive-age women show repeated abnormal vaginal bleeding after dilatation and curettage, a diagnosis of UAVM must be considered based on the medical history and examination.
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Affiliation(s)
- Da Joung Shim
- Department of Obstetrics and Gynecology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Sang Joon Choi
- Department of Obstetrics and Gynecology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Ji Min Jung
- Department of Obstetrics and Gynecology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Ji Hyun Choi
- Department of Obstetrics and Gynecology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
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Wilkie GL, Taggart AA, Prensner JR, Billett AL, Laufer MR. Burkitt Lymphoma Presenting as Menorrhagia and a Vaginal Mass in an Adolescent. J Pediatr Adolesc Gynecol 2019; 32:90-92. [PMID: 30278229 DOI: 10.1016/j.jpag.2018.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/02/2018] [Accepted: 09/24/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Menorrhagia is a common gynecologic complaint among adolescents, which rarely is secondary to malignancy. Burkitt lymphoma can mimic gynecologic malignancy, however it is rarely seen in adolescents. Burkitt lymphoma of the gynecologic tract requires early diagnosis and intervention for optimal outcomes. CASE We report a case of a 15-year-old adolescent who had multiple admissions for menorrhagia that was thought to be secondary to anovulatory bleeding until pelvic ultrasound revealed a large 8-cm vaginal/cervical mass. Histologic examination of the biopsy specimen revealed Burkitt lymphoma, which was treated with chemotherapy leading to resolution of her menorrhagia. SUMMARY AND CONCLUSION Burkitt lymphoma presenting as a vaginal/cervical mass is exceedingly rare, especially in the adolescent patient. Burkitt lymphoma is generally highly responsive to chemotherapy, and symptoms rapidly improve after initiation of treatment.
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Affiliation(s)
- Gianna L Wilkie
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Ashley A Taggart
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - John R Prensner
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Amy L Billett
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Marc R Laufer
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts.
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Park JE, Kim MJ, Kim MK, Kim HM. Cervical varix with thrombosis diagnosed in the first trimester of pregnancy. Obstet Gynecol Sci 2019; 62:65-8. [PMID: 30671395 DOI: 10.5468/ogs.2019.62.1.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 11/25/2022] Open
Abstract
Cervical varix is rare and can develop due to various conditions in pregnancy. Most cases of cervical varix during pregnancy are diagnosed in the second or third trimester and are usually associated with abnormal placental location, such as placenta previa or low-lying placenta. A 23-year-old woman with cervical varix bleeding visited our institution at 8 weeks of gestation. This case report describes cervical varix bleeding that developed into a venous thrombus in the first trimester. Ultrasonography with color Doppler and magnetic resonance imaging could be helpful in diagnosis.
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Zhao F, Xu Y, Zhang H, Ren Y. Ultrasonographic Findings of Uterine Carcinosarcoma. Gynecol Obstet Invest 2018; 84:277-282. [PMID: 30504724 DOI: 10.1159/000481885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/28/2017] [Indexed: 11/19/2022]
Abstract
AIMS The aim of this study was to investigate the clinical features and ultrasonographic findings of uterine carcinosarcoma (UCS). METHODS Seventy-five patients (mean age, 58.6 years) with pathologically proven UCS who were treated at our hospital from January 2003 to December 2015 were retrospectively recruited. The clinical features and preoperative findings on transvaginal sonography (TVS) were investigated. RESULTS Eighty percent of the patients were postmenopausal. The primary symptoms were postmenopausal abnormal uterine bleeding (57.3%), irregular menstruation (18.7%), vaginal discharge (10.7%) and the presence of a uterine mass or others (13.3%). The tumor marker CA125 was evaluated in 43 women and was found to be elevated in 15 (34.9%); in 60% of those women (9/15), the CA125 level was lower than 200U/ml. According to the frequency of the different types of lesions observed by ultrasonic imaging, we decided to categorize the lesions into 3 different groups as follows: Group I, intrauterine tumors (73.33%); group II, intra-myometrial tumors (13.33%); and group III, intra-endometrial tumors (13.33 %). CONCLUSION Combined with the clinical features, the characteristics demonstrated by TVS provide evidence for an indication of the presence of UCS and could contribute to clinical decision-making.
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Affiliation(s)
- Fangui Zhao
- Department of Ultrasonic Diagnosis, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Yang Xu
- Department of Ultrasonic Diagnosis, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Hao Zhang
- Department of Pathology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Yunyun Ren
- Department of Ultrasonic Diagnosis, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China,
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Li Z, Li L. The incidence and predictors of gynecologic malignancies among postmenopausal patients with endometrial fluid collection. Arch Gynecol Obstet 2019; 299:1071-6. [PMID: 30519752 DOI: 10.1007/s00404-018-4997-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate the incidence and predictors of gynecologic malignancies among postmenopausal patients with endometrial fluid collection (EFC). METHODS All patients with EFC diagnosed by transvaginal sonography (TVS) were retrospectively reviewed if they had undergone biopsy of the endometrium from January 2008 to January 2016 in a tertiary teaching hospital. Follow-up ended in June 2017. The incidence of gynecologic malignancies was described, and predictive factors were determined by comparing the epidemiological and clinico-pathological characteristics of the patients. RESULTS During the study period, 273 women with EFC (3.4%) were enrolled. Biopsy pathology and the following hysterectomy revealed 29 (10.6%) cases of gynecological cancer. In the multivariable analysis, patient-reported genital symptoms [odds ratio (OR) 16.2, 95% confidence interval (CI) 1.9-139.3], abnormal serum CA125 (OR 14.5, 95% CI 4.5-46.5), lesions in the uterine cavity (OR 18.8, 95% CI 6.0-59.1) and endometrial thickness (OR 1.1, 95% CI 1.0-1.2) determined by TVS were independent factors associated with malignancy. Only 1.1% (1/90) of the asymptomatic patients had gynecologic cancer. During the follow-up, gynecologic cancer was diagnosed in nine patients, six of whom had vaginal bleeding at the time of initial enrollment. The prognosis of patients with cancer was worse than that of patients with benign results. CONCLUSION The risk of gynecologic malignancies in postmenopausal patients with EFC is related to genital symptoms, TVS findings and CA 125 levels. Asymptomatic EFC is associated with an extremely low risk of malignancy.
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Jo HC, Baek JC, Park JE, Park JK, Cho IA, Choi WJ, Sung JH. Clinicopathologic Characteristics and Causes of Postmenopausal Bleeding in Older Patients. Ann Geriatr Med Res 2018; 22:189-193. [PMID: 32743272 PMCID: PMC7387628 DOI: 10.4235/agmr.18.0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/25/2018] [Revised: 11/21/2018] [Accepted: 11/23/2018] [Indexed: 11/15/2022] Open
Abstract
Background This study aimed to reveal the clinicopathologic features and causes of bleeding in older patients with postmenopausal bleeding (PMB) and to investigate the correlation between the ultrasonographic findings and etiology of PMB. Methods We retrospectively analyzed the causes and clinical characteristics of PMB in 498 patients who were diagnosed between January 2007 and December 2017. The population with PMB was divided into 2 groups according to age: Group A (n=204) included individuals more than 65 years of age and group B (n=294) included those less than 65 years of age. Clinical characteristics such as age, parity, underlying conditions, previous surgical history, and previous menopausal hormone therapy were compared between the groups. Cervical cytology testing and transvaginal ultrasonography were performed in all patients with PMB. Endometrial biopsy was performed in all cases of endometrial thickness ≥5 mm. Results We examined 498 patients with PMB. In group A, atrophic endometrium (n=125, 61.27%) was the most common cause of PMB. Twenty-three patients had gynecological malignancy (cervical cancer: n=12, 5.88%; endometrial cancer: n=8, 3.42%; ovarian cancer: n=3, 1.46%), and 30 patients had benign gynecological disease (endometrial polyp: n=10, 4.90%; submucosal myoma: n=6, 2.94%; uterine prolapse: n=7, 3.42%; cervical dysplasia; n=5, 2.45%; cervical polyp: n=2, 0.98%). Forty patients had endometrial thickness ≥5 mm. Eight patients were diagnosed with endometrial cancer. All cases of endometrial cancer were diagnosed with endometrial thickness >10 mm. Conclusion Atrophic endometrium was the most common cause of PMB in both groups, and approximately 12% of cases were associated with gynecological malignancy in older patients.
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Affiliation(s)
- Hyen Chul Jo
- Department of Obstetrics and Gynecology, Gyeongsang National University Changwon Hospital, Gyeongsang National University, Changwon, Korea
| | - Jong Chul Baek
- Department of Obstetrics and Gynecology, Gyeongsang National University Changwon Hospital, Gyeongsang National University, Changwon, Korea
| | - Ji Eun Park
- Department of Obstetrics and Gynecology, Gyeongsang National University Changwon Hospital, Gyeongsang National University, Changwon, Korea
| | - Ji Kwon Park
- Department of Obstetrics and Gynecology, Gyeongsang National University Changwon Hospital, Gyeongsang National University, Changwon, Korea
| | - In Ae Cho
- Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Gyeongsang National University, Jinju, Korea
| | - Won Jun Choi
- Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Gyeongsang National University, Jinju, Korea
| | - Joo Hyun Sung
- Department of Occupational and Environmental Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University, Changwon, Korea
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Moon LM, Childress KJ, Isaac R, Adeyemi-Fowode O. Medical Child Abuse: A Case Presenting as Anogenital Bleeding of Unknown Origin in an Older Child. J Pediatr Adolesc Gynecol 2018; 31:637-639. [PMID: 29990550 DOI: 10.1016/j.jpag.2018.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Medical child abuse is a challenging diagnosis to make, particularly in older children with unusual presenting symptoms. CASE A 7-year-old child with complex medical history presented with anogenital bleeding of unknown origin. Extensive laboratory testing, imaging studies, and diagnostic procedures were negative for any etiology. Forensic testing confirmed the blood in her underwear was a genetic match to the patient. Trial separation from the mother was diagnostic and therapeutic in this case. SUMMARY AND CONCLUSION Older children who are victims of medical child abuse might present in a variety of ways, and might even collaborate with the perpetrator in falsifying symptoms. It is important to keep medical child abuse on the differential when the patient's symptoms and work-up do not match.
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Affiliation(s)
- Lisa M Moon
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| | - Krista J Childress
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Reena Isaac
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Oluyemisi Adeyemi-Fowode
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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Kagan R, Abreu P, Andrews E. Vaginal bleeding/spotting with conjugated estrogens/bazedoxifene, conjugated estrogens/medroxyprogesterone acetate, and placebo. Postgrad Med 2018; 130:687-693. [PMID: 30280946 DOI: 10.1080/00325481.2018.1520046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In the 1-year phase 3 Selective estrogens, Menopause, And Response to Therapy-5 trial, cumulative amenorrhea rates with conjugated estrogens/bazedoxifene (CE/BZA) were similar to placebo and higher than with conjugated estrogens/medroxyprogesterone acetate (CE/MPA). This post hoc analysis reports bleeding/spotting rates in 4-week intervals (cycles) and 3-month intervals (quarters) with these therapies and the percentage of cases attributable to spotting only. METHODS Generally healthy postmenopausal women with menopausal symptoms recorded vaginal bleeding/spotting in daily diaries while receiving CE 0.45 mg/BZA 20 mg, CE 0.625 mg/BZA 20 mg, CE 0.45 mg/MPA 1.5 mg, or placebo. RESULTS A total of 1596 women in the modified intent-to-treat population contributed data. Incidence of bleeding/spotting was significantly (p < 0.001) lower with CE 0.45 mg/BZA 20 mg (0.54‒4.44%), CE 0.625 mg/BZA 20 mg (1.26‒5.02%), and placebo (1.55‒4.82%) compared with CE 0.45 mg/MPA 1.5 mg (8.81‒25.63%) in all 4-week cycles. Each quarter, <10% of women taking CE/BZA doses or placebo had bleeding/spotting, significantly (p < 0.001) less than the 21-36% with CE 0.45 mg/MPA 1.5 mg. Odds ratio for bleeding/spotting with CE 0.45 mg/BZA 20 mg vs CE 0.45 mg/MPA 1.5 mg was 0.1 in each quarter (95% CI, Q1-Q3: 0.1-0.2; Q4: 0.1-0.3). Across all treatments, most (88-100%) bleeding/spotting cases were spotting only. Mean days of bleeding/spotting were <1 per quarter with CE/BZA doses and placebo, which was significantly (p < 0.01) less than the 3-5 days per quarter with CE/MPA. CONCLUSIONS Bleeding/spotting with CE/BZA treatment was similar to placebo and significantly less frequent than with CE/MPA treatment. Most cases were spotting only across all treatments.
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Affiliation(s)
- Risa Kagan
- a Department of Obstetrics, Gynecology, and Reproductive Sciences , University of California , San Francisco , CA , USA.,b Sutter East Bay Medical Foundation , Berkeley , CA , USA
| | - Paula Abreu
- c Department of Clinical Affairs , Pfizer Inc , New York , NY , USA
| | - Emma Andrews
- d US/Global Medical Affairs , Pfizer Inc , New York , NY , USA
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Jacobson AE, Vesely SK, Haamid F, Christian-Rancy M, O'Brien SH. Mobile Application vs Paper Pictorial Blood Assessment Chart to Track Menses in Young Women: A Randomized Cross-over Design. J Pediatr Adolesc Gynecol 2018; 31:84-8. [PMID: 29030160 DOI: 10.1016/j.jpag.2017.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 09/01/2017] [Accepted: 09/27/2017] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE Heavy menstrual bleeding is a common symptom reported by approximately 30% of women. The Pictorial Blood Assessment Chart (PBAC) score is often used to quantify severity of menstrual bleeding. However, the traditional PBAC paper diary might be subject to recall bias and compliance issues, especially in adolescents. We developed a mobile application (app) version of the PBAC score and evaluated patient satisfaction and compliance with app reporting vs paper reporting. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: This study was a randomized cross-over study of 25 postmenarchal female adolescents and young women ages 13-21 years. Participants agreed to track bleeding in 2 consecutive menstrual cycles and were randomized to use the PBAC paper diary or mobile app format first. At the end of each cycle, a satisfaction survey and system usability scale (app only) was used to assess the acceptability of the format used. RESULTS Twenty-five participants had a median age of 15 years. Cross-over analysis showed that satisfaction level was significantly higher for the app (P < .001). Twenty of 25 (80%) participants preferred the app over the paper diary. For the app, 20 of 25 participants (80%) had high compliance for reporting bleeding, with a mean of 2 app entries per day. Participants' PBAC scores did not vary significantly between the paper diary (median, 95) and mobile app (median, 114). All paper diaries met definition for high compliance. There was no significant period or carryover effect. CONCLUSION This study showed that a PBAC app compared with the paper diary was the preferred method of recording menstrual bleeding in adolescents and showed feasibility as a research data collection tool.
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Lopez HN, Focseneanu MA, Merritt DF. Genital injuries acute evaluation and management. Best Pract Res Clin Obstet Gynaecol 2017; 48:28-39. [PMID: 29117923 DOI: 10.1016/j.bpobgyn.2017.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/04/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Abstract
Genital trauma may result in external injuries to the labia, vulva or vagina, urethra and anus and internal injuries to the bony pelvis, bladder, bowels and reproductive organs. Worldwide, the most common cause of genital trauma in reproductive age women is injury sustained during childbirth, but in this chapter we will focus on accidental genital injuries as well as those arising from sexual violence, and female genital mutilation. While genital injuries alone rarely result in death; if not properly managed, chronic discomfort, dyspareunia, infertility, or fistula formation may result. Clinicians need to be able to recognize these injuries and provide initial management, and assure that the patient's mental, emotional and physical needs are addressed.
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Affiliation(s)
- Heather N Lopez
- Department of Obstetrics and Gynecology, Washington University School of Medicine in Saint Louis, 660 South Euclid, Saint Louis, MO, 63110, Barnes Jewish Hospital, USA.
| | - Mariel A Focseneanu
- Children's Hospital of the King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA.
| | - Diane F Merritt
- Washington University School of Medicine in Saint Louis, 660 South Euclid, Barnes Jewish Hospital, St. Louis Children's Hospital, Missouri Baptist Medical Center, Saint Louis, MO, 63110, USA.
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Tomà P, Magistrelli A, Lucchetti MC. Urethral prolapse in a paediatric patient with urogenital bleeding: diagnosis by imaging. Int Urogynecol J 2017; 28:1755-1756. [PMID: 28752232 DOI: 10.1007/s00192-017-3427-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/08/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Paolo Tomà
- Department of Imaging, Bambino Gesù Children Hospital, IRCCS, Rome, Italy.
| | - Andrea Magistrelli
- Department of Imaging, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
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Yun BJ, Raja AS, Dorner SC, Glover M, Eckardt MJ, White BA, Sonis JD, Prabhakar AM. Transvaginal ultrasounds in nonpregnant emergency department patients with abnormal uterine bleeding. Am J Emerg Med 2017; 35:1763-1765. [PMID: 28473277 DOI: 10.1016/j.ajem.2017.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Brian J Yun
- Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States; Center for Research in Emergency Department Operations (CREDO), Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States.
| | - Ali S Raja
- Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States; Center for Research in Emergency Department Operations (CREDO), Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States
| | - Stephen C Dorner
- Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States; Center for Research in Emergency Department Operations (CREDO), Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States; Harvard Affiliated Emergency Medicine Residency Program, 5 Emerson Place, Suite 101, Boston, MA 02114, United States
| | - McKinley Glover
- Center for Research in Emergency Department Operations (CREDO), Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States; Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States; Massachusetts General Physicians Organization, 55 Fruit St., Boston, MA 02114, United States
| | - Melody J Eckardt
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St., Suite 910, Boston, MA 02114, United States
| | - Benjamin A White
- Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States; Center for Research in Emergency Department Operations (CREDO), Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States
| | - Jonathan D Sonis
- Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States; Center for Research in Emergency Department Operations (CREDO), Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States; Harvard Affiliated Emergency Medicine Residency Program, 5 Emerson Place, Suite 101, Boston, MA 02114, United States
| | - Anand M Prabhakar
- Center for Research in Emergency Department Operations (CREDO), Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States; Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States; Division of Emergency Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States
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Kwon JH, Kim GM, Han K, Kim MD, Won JY, Lee DY. Safety and Efficacy of Uterine Artery Embolization in Ectopic Pregnancies Refractory to Systemic Methotrexate Treatment: A Single-Center Study. Cardiovasc Intervent Radiol 2017; 40:1351-7. [PMID: 28462440 DOI: 10.1007/s00270-017-1664-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND To investigate the use of uterine artery embolization (UAE) to manage ectopic pregnancies that are refractory to systemic methotrexate (MTX) therapy and plagued by persistently high serum β-human chorionic gonadotrophin (hCG) levels and vaginal bleeding. The safety and efficacy of UAE were addressed. MATERIALS AND METHODS A retrospective review was conducted for thirteen patients (mean age 35.2 years; range 28-41 years), who were treated between December 2006 and June 2016. Each was subjected to UAE due to persistently high serum β-hCG levels and vaginal bleeding after systemic MTX therapy for ectopic pregnancy. Embolic agents used were non-spherical polyvinyl alcohol or gelatin sponge particles. Post-treatment follow-up was performed by monitoring for clinical signs of vaginal bleeding, serum β-hCG testing, and transvaginal US. Outcomes were technical success, clinical success, and complications. RESULTS Median follow-up period was 172.5 days (range 30-600 days). Technical success was achieved in all 13 patients (100%). In 10 patients, vaginal bleeding resolved after one UAE attempt (clinical success 76.0%). Rebleeding in other three (23.1%) was controlled through repeat UAE. Seven patients (53.8%) had additional dilatation and curettage to remove gestational sac remnants. All ectopic pregnancies were successfully treated by UAE, with normalization of serum β-hCG levels during follow-up monitoring (P = 0.01). Uterine preservation was achieved in all 13 patients, without major procedural complications. CONCLUSION UAE appears safe and effective as treatment of ectopic pregnancies marked by persistently high serum β-hCG levels and vaginal bleeding after systemic MTX treatment.
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