The lateral support of the vaginal wall depends on the integrity of the paravaginal section of the visceral pelvic fascia, levator ani, and their connection. Various defects of the muscle and fascia can result in identical clinical findings-ie, the descent of the lateral vaginal sulcus. In this study, we created a realistic scheme for classifying paravaginal defects, based on the complex relationship of the pelvic fascia with the levator ani. Surgical observations, cadaver examinations, and a complex magnetic resonance imaging (MRI)-based 3-dimensional (3D) model were used to analyze the spatial relationships of normal and defective anatomy of the female pelvic floor. Descent of the lateral vaginal sulcus can result from a defect in the paravaginal visceral pelvic fascia, levator ani, or both. The fascial defect can be partial or complete, and the muscle defect can vary in location. A detailed illustrated classification is presented. We present a new model of the pathology that underlies a common clinical finding.
- MeSH
- Adult MeSH
- Fascia injuries MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Pelvic Floor injuries MeSH
- Wounds and Injuries classification MeSH
- Aged MeSH
- Muscles injuries MeSH
- Vagina anatomy & histology injuries pathology MeSH
- Imaging, Three-Dimensional MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
During the last several decades, screening methods in pregnancy have shown dramatic improvements in detection rates for fetal aneuploidies, with advances in technology allowing for more comprehensive examinations as early as the first trimester. The results of first trimester screening have demonstrated the potential of predicting other pregnancy complications, such as preeclampsia. Similarly to the evolution of screening methods for aneuploidies, screening methods for preeclampsia have evolved from using maternal characteristics to introducing measurable parameters, and bringing the focus to the first trimester of pregnancy.
- MeSH
- Biomarkers MeSH
- Pregnancy Complications * diagnosis MeSH
- Humans MeSH
- Mass Screening MeSH
- Prenatal Diagnosis * MeSH
- Prenatal Care * methods MeSH
- Pregnancy Trimester, First MeSH
- Pregnancy MeSH
- Ultrasonography, Doppler MeSH
- Check Tag
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Review MeSH
Cíl studie: Cílem práce bylo vytvořit doporučený postup k ultrazvukovému vyšetření zhoubného nádoru děložního hrdla, včetně jednotné ultrazvukové terminologie. Typ studie: Původní práce. Název a sídlo pracoviště: Onkogynekologické centrum, Gynekologicko-porodnická klinika LF MU a FN Brno a Onkogynekologické centrum, Gynekologicko-porodnická klinika 1. LF UK a VFN, Praha. Předmět a metoda studie: Standardní vyšetřovací algoritmus pro vyšetření zhoubného nádoru děložního hrdla v onkogynekologických centrech v České republice vychází z publikovaných prací, vlastních zkušeností pracoviště (Onkogynekologické centrum, Gynekologicko-porodnická klinika 1. LF UK a VFN) a zkušeností skupiny sonografistů, kteří se podílejí na řešení grantového projektu IGA MZ ČR NT13070 zaměřeného na implementaci onkogynekologického ultrazvuku do klinické praxe. Standardní ultrazvukové vyšetření zahrnuje real-time ultrazvukové vyšetření v dvourozměrném obraze (sagitální a transverzální). Transrektální nebo transvaginální ultrazvukové vyšetření je kombinované s transabdominálním ultrazvukem. Podmínkou je kvalitní ultrazvukový přístroj, vysokofrekvenční mikrokonvexní lineární sonda a abdominální konvexní a lineární sonda. Vyšetření je provedeno zkušeným sonografistou (stupeň 2 nebo 3 podle doporučení sekce ultrazvukové diagnostiky ČGPS a České ultrazvukové společnosti v porodnictví a gynekologii). Intravenózní podání kontrastní látky ani třídimenzionální ultrazvuk neovlivní přesnost vyšetření a není podmínkou vyšetření. Závěr: Na základě konsenzu zkušených sonografistů a přehledu literatury byl vytvořen doporučený postup pro ultrazvukový staging zhoubného nádoru děložního hrdla.
Objective: To develop guidelines for the ultrasound examination of cervical cancer, including a unified ultrasound terminology. Subject: Original paper. Setting: Gynecological Oncology Center, Department of Obstetrics and Gynecology, Masaryk University and General Faculty Hospital Brno, and Gynecological Oncology Center, Department of Obstetrics and Gynecology, Charles University in Prague – First Faculty of Medicine and General Faculty Hospital Prague. Subject and method: The standard diagnostic algo-rithm for examination of cervical cancer in oncogynecology centers in the Czech Republic is based on published studies, own experience (Oncogynecological Center, Department of Gynecology and Obstetrics,1st Medical Faculty, Charles University) and the experiences of a group of ultrasonographers involved in the grant project IGA MZ ČR NT13070 focused on the implementation of an oncogynecological ultrasound into clinical practice. Standard ultrasound examination includes two-dimensional real-time ultrasound examination (sagittal and transverse views). Transrectal or transvaginal ultrasound examination is combined with transabdominal ultrasound. Prerequisites are quality ultrasound equipment, a high frequency microconvex linear probe and abdominal convex and linear probe. The examination is performed by an experienced sonographer (level 2 or 3 according to the recommendations of the Ultrasound division of the Czech Society of Obstetrics and Gynecology and the Czech Society of Ultrasound in Obstetrics and Gynecology). Intravenous administration of contrast material or three-dimensional ultrasound examination do not influence accuracy of the examination and is not a prerequisite. Conclusion: Based on the consensus of experienced sonographers and a review of the literature, guidelines were created for ultrasound staging of cervical cancer.
- MeSH
- Abdomen pathology ultrasonography MeSH
- Cervix Uteri pathology ultrasonography MeSH
- Humans MeSH
- Uterine Cervical Neoplasms * diagnosis ultrasonography MeSH
- Practice Guidelines as Topic MeSH
- Neoplasm Staging * methods MeSH
- Ultrasonography * classification methods utilization MeSH
- Uterus pathology ultrasonography MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
V případě histologicky ověřené přítomnosti endomet-riálního karcinomu závisí další léčebný postup (rozsah stagingové operace) na tom, zda se jedná o nádor vysoce, nebo nízce rizikový z hlediska extrauterinního šíření a frekvence recidiv. Kromě histologického typu nádoru a jeho gradingu je významným prognostickým faktorem rozsah lokálního postižení dělohy. Hloubku myometriální invaze a přítomnost infiltrace cervikálního stromatu, tedy lokální staging, lze stanovit sonograficky s diagnostickou přesností srovnatelnou s magnetickou rezonancí (MR). Transvaginální sonografie umožní detailní zobrazení pánevní anatomie, a proto je vhodným nástrojem pro hodnocení lokálního rozsahu endometriálního karcinomu. Při ultrazvukovém vyšetření je doporučeno dodržovat standardizovanou terminologii popisu endometriálních nálezů tak, jak byla definovaná mezinárodní pracovní skupinou IETA (International Endometrial Tumor Analysis group). V rámci ultrazvukového předoperačního stagingu zhoubného nádoru endometria má význam standardizovat rovněž metodiku vyšetření podle preformovaných protokolů.
The extent of the staging surgery in cases of histologically proven endometrial cancer depends on whether the tumor is of high risk or low risk for extrauterine spread and recurrence. There are several significant prognostic factors – histological subtype and grade of dediferentiation from preoperative biopsy and local stage of uterine involvement based on imaging methods. The depth of myometrial invasion and presence of cervical stromal infiltration (local staging) can be assessed by ultrasound with the overall accuracy comparable to that of magnetic resonance. Transvaginal ultrasound enables to vizualize detailed pelvic anatomy and that is why it is considered to be a suitable tool for assessment of local stage of endometrial cancer. It is advisable to use the standardized terminology defined by International Endometrial Tumor Analysis group (IETA) to describe ultrasound findings. The standardized methodology of ultrasound preoperative staging examination based on prearranged protocols is recommended.
- MeSH
- Endometrium anatomy & histology pathology ultrasonography MeSH
- Risk Assessment MeSH
- Humans MeSH
- Neoplasm Metastasis diagnosis pathology ultrasonography MeSH
- Multicenter Studies as Topic MeSH
- Endometrial Neoplasms * diagnosis classification pathology ultrasonography MeSH
- Preoperative Care MeSH
- Prospective Studies MeSH
- Neoplasm Staging MeSH
- Ultrasonography utilization MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
- Keywords
- kongenitální diafragmatická hernie, prenatální diagnostika,
- MeSH
- Hernia, Diaphragmatic therapy ultrasonography MeSH
- Echocardiography, Three-Dimensional MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Infant, Newborn MeSH
- Prenatal Care MeSH
- Pregnancy MeSH
- Ultrasonography, Prenatal MeSH
- Hernias, Diaphragmatic, Congenital MeSH
- Check Tag
- Humans MeSH
- Infant, Newborn MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Review MeSH
OBJECTIVES: To compare the clinical results of three minimally invasive hysterectomy techniques: vaginal hysterectomy (VH), laparoscopically assisted vaginal hysterectomy (LAVH), and total laparoscopic hysterectomy (TLH). STUDY DESIGN: A prospective, randomized study was performed at a tertiary care center between March 2004 and October 2005. A total of 125 women indicated to undergo hysterectomy for benign uterine disease were randomly assigned to three different groups (40 VH, 44 LAVH, and 41 TLH). Outcome measures, including operating time, blood loss, rate of complications, inflammatory response, febrile morbidity, consumption of analgesics, and length of hospital stay, were assessed and compared between groups. RESULTS: Vaginal hysterectomy had the shortest operating time (66 min) and smallest drop in hemoglobin. However, there were technical problems with salpingo-oophorectomy from the vaginal approach (3/20 cases) and this group had a significantly higher rate of febrile complications (20%) compared to LAVH (2.3%) and TLH (7.3%). The increase in inflammatory markers was higher in vaginal hysterectomy patients. Laparoscopically assisted vaginal hysterectomy had an acceptable operating time (85 min), a low complication rate, lack of severe post-operative complications, and the lowest consumption of analgesics. However, it had the highest blood loss. Total laparoscopic hysterectomy had the longest operating time (111 min) and severe complications occurred only in this group. Conversions to another hysterectomy method occurred in all three groups, most of these conversions were to LAVH. CONCLUSIONS: Based on our results, in women with non-malignant disease of the uterus, LAVH and VH seem to be the preferred hysterectomy techniques for general gynecological surgeons. Vaginal hysterectomy had the shortest operating time and least drop in hemoglobin, making it a suitable method for women for whom the shortest duration of surgery and anesthesia is optimal. LAVH is a versatile procedure, combining the advantages of both the vaginal and laparoscopic approach, and is preferable in cases when oophorectomy is required. Total laparoscopic hysterectomy did not appear to offer any significant benefits over the other two methods and should be strictly indicated in women where neither VH nor LAVH are feasible and should only be performed by very experienced laparoscopists.
- MeSH
- Hysterectomy, Vaginal adverse effects statistics & numerical data MeSH
- Laparoscopy adverse effects statistics & numerical data MeSH
- Middle Aged MeSH
- Humans MeSH
- Uterine Diseases surgery MeSH
- Prospective Studies MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
- Comparative Study MeSH
Cíl: Práce prezentuje obtížnou prenatální diagnostiku a řešení těžkého intrakraniálního krvácení u plodu. Analýzou dostupných literárních dat, které souvisejí s touto problematikou, chceme upozornit na nutnost exaktního posouzení mozkových struktur plodu i při rutinním ultrazvukovém vyšetření v pozdním třetím trimestru. Typ studie: Kazuistika. Název a sídlo pracoviště: Gynekologicko-porodnická klinika Všeobecné fakultní nemocnice a 1. lékařské fakulty Univerzity Karlovy, Praha. Metodika a výsledky: Jsou prezentovány čtyři případy prenatálně vzniklého intrakraniálního krvácení. Všechny případy byly odhaleny při ultrazvukovém vyšetření ve třetím trimestru těhotenství a nález byl upřesněn pomocí nukleární magnetické rezonance. Etiologická příčina byla zjištěna pouze ve dvou případech. Poporodní sledování postižených dětí v rozsahu jednoho až dvou let věku ukazuje na velice závažnou prognózu popsaných krvácivých stavů. Závěr: Antenálně diagnostikované intrakraniální fetální krvácení je vzácnou, ale závažnou komplikací gravidity provázenou fetální a neonatální morbiditou i mortalitou. Popis a precizní obrazová dokumentace vyšetření mozkových struktur plodu má zásadní forenzní význam. Postnatální odhad stáří krvácení pomocí vyšetření mozkomíšního moku a ultrazvukových známek (echogenita léze) nemusí být vždy jednoznačné.
Aim: We present a case of difficult prenatal diagnosis and follow-up of severe fetal intracranial hemorrhage. With an analysis of the available literature that is related to this topic, we would like to bring attention to the necessity of accurate evaluation of fetal brain morphology even during routine ultrasound examination in the late third trimester. Type of study: Case report. Setting: Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague. Methods and results: Four cases of prenatal intracranial hemorrhage are presented. All cases were diagnosed during ultrasound examination during the third trimester of pregnancy and the findings were clarified using nuclear magnetic resonance imaging. The etiology of the hemorrhage was determined in only two cases. Postnatal follow-up of the affected children over a range of one to two years of age shows a very severe prognosis of the described hemorrhagic conditions. Conclusion: Prenatally diagnosed fetal intracranial hemorrhage is a rare but severe complication in pregnancy associated with fetal and neonatal morbidity and mortality. A detailed description and precise image documentation of the damaged fetal structures have a fundamental forensic significance. Postnatal estimation of the time of hemorrhage using analysis of the cerebrospinal fluid and ultrasound findings (echogenicity of the lesions) is not always unified.
- Keywords
- fetální intrakraniální krvácení, prenatální diagnostika,
- MeSH
- Cesarean Section MeSH
- Child MeSH
- Adult MeSH
- Intracranial Hemorrhages diagnosis MeSH
- Pregnancy Complications MeSH
- Humans MeSH
- Magnetic Resonance Spectroscopy MeSH
- Infant, Premature MeSH
- Infant, Newborn MeSH
- Fetus abnormalities MeSH
- Premature Birth MeSH
- Prenatal Diagnosis MeSH
- Prognosis MeSH
- Pregnancy MeSH
- Pregnancy Trimester, Third MeSH
- Ultrasonography, Prenatal MeSH
- Ultrasonography MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
OBJECTIVE: Severe fetomaternal transplacental hemorrhage increases the risk of fetal anemia. In the third trimester, the syncytiotrophoblast becomes thinner, especially in areas where it comes into intimate contact with villous capillaries, and forms a vasculosyncytial membrane. Our aim was to determine whether ABO compatibility puts the fetus at a greater risk of severe fetomaternal hemorrhage. DESIGN: Case study. SETTING: A tertiary care center. Sample and methods. Between 2003 and 2007, we evaluated eight cases of severe fetomaternal transfusion. The Kleihauer-Betke test was used for diagnosis of fetomaternal hemorrhage. We evaluated blood group compatibility between the mother and fetus and assessed the perinatal outcome. The Fischer's factorial test was used for testing a hypothesis. RESULTS: The incidence of adverse outcomes following transplacental hemorrhage was 75% (six of eight). There were two perinatal deaths and four infants were affected by post-hypoxic damage of varying severity. Fetomaternal ABO compatibility was present in seven of the eight cases. The risk of severe fetomaternal hemorrhage was significantly increased when there was ABO compatibility between the mother and fetus. This was associated with a very poor perinatal outcome. CONCLUSION: We recommend that resuscitation in utero by intrauterine transfusion should be considered before the 33rd week of gestation in cases of severe fetal anemia. In later gestation, urgent cesarean section is required with adequate resuscitation of the newborn.
- MeSH
- ABO Blood-Group System physiology MeSH
- Microscopy, Electron MeSH
- Fetomaternal Transfusion diagnosis etiology therapy MeSH
- Financing, Organized MeSH
- Blood Transfusion, Intrauterine MeSH
- Pregnancy Complications diagnosis etiology MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Placenta physiopathology ultrastructure MeSH
- Fetus MeSH
- Pregnancy MeSH
- Pregnancy Trimester, Third MeSH
- Check Tag
- Humans MeSH
- Infant, Newborn MeSH
- Pregnancy MeSH
- Female MeSH
