Herlyn-Werner-Wunderlich syndrome is an unusual congenital anomaly defined by a triad of congenital defects of the female urogenital tract - homolateral renal agenesis, uterus duplex and obstructed hemi-hematometrocolpos whose etiology remains still unclear. Pelvic pain, dysmenorrhea and palpable mass due to the hematocolpos or hematometra are the most common clinical symptoms. Endometriosis is considered to be a prevalent finding in these young patients possibly explaining the pathophysiological mechanism of endometriosis as the result of retrograde menstruation. Early diagnosis and subsequent treatment are important to prevent the development of severe complications. In general, clinical and reproductive outcomes after drainage of the hematometrocolpos are reported to be satisfactory. A 13-year-old patient presented with pelvic pain and was diagnosed with OHVIRA syndrome treated with Balloon septostomy.
- Klíčová slova
- Herlyn-Werner-Wunderlich syndrome, Mullerian anomaly, Wolffian anomaly, hemi-hematocolpos, obstructive genital abnormality,
- MeSH
- endometrióza * MeSH
- lidé MeSH
- mladiství MeSH
- mnohočetné abnormality * diagnóza MeSH
- pánevní bolest MeSH
- urogenitální abnormality MeSH
- uterus diagnostické zobrazování chirurgie abnormality MeSH
- vagina abnormality MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Arterial branches to the uterus and ovaries that pass through the mesosalpinx contribute significantly to the maintenance of the ovarian reserve. Especially arterial supply of the uterine tube is provided by a number of anastomoses between both the uterine and ovarian vessels. Knowledge on the morphologic peculiarities will allow to identify main contributors especially blood flow ultrasound examination for the purpose of ovary preserving surgery. This study aimed at identifying landmarks especially for so-called low-flow tubal vessels. Arteries of 17 female Thiel-embalmed bodies were studied along three preselected paramedian segments and measurements taken. A section was made through the center of the ovary perpendicular to uterine tube, then the mesosalpinx tissue distance was divided into 3 equivalent zones: upper, middle and lower thirds. The surface area of the mesosalpinx averaged 1088 ± 62 mm2. 47.7 ± 7.1 % of the mesosalpinx zones included macroscopically visible vessels. The lower third segment of mesosalpinx was the thickest averaging 2.4 ± 1.5 mm. One to three tubal branches were identified in the middle third of the mesosalpinx. Arterial anastomoses were found in the upper segment of the mesosalpinx, but no presence of a marginal vessel supplying the fallopian tube could be found. Statistically significant moderate positive correlations were established between the diameters of the mesosalpingeal arteries between the three zones. The mesosalpinx, uterine tube and the ovary form areas of segmental blood supply. Variants of tubal vessels appear to be a sparse source of blood supply.
- MeSH
- arterie * diagnostické zobrazování MeSH
- lidé MeSH
- ovarium diagnostické zobrazování MeSH
- regionální krevní průtok MeSH
- uterus diagnostické zobrazování krevní zásobení MeSH
- vejcovody * diagnostické zobrazování krevní zásobení MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Anatomical variations and congenital anomalies of the uterine tubes (UTAVsCAs) are rare conditions, which are often undiagnosed, or accidentally diagnosed upon imaging, laparotomy, laparoscopy for unrelated condition, or during the Cesarean section. UTAVsCAs are often asymptomatic, but their clinical relevance lies in their possibly adverse impact on fertility. Since their rare occurrence, they are usually published as case reports. The most typically described are: agenesis of the uterine tubes (UTs), accessory UT (UT duplication), accessory UT ostium, and paratubal cysts (e.g. the hydatid cyst of Morgagni). UTAVsCAs are classified into an umbrella category of Müllerian duct anomalies (MDAs) which comprises anomalous development of all the organs developing from the paramesonephric (Müllerian) ducts, i.e., UTs, uterus and upper portion of the vagina. Interestingly, most of the classification systems of MDAs discuss solely the uterine and vaginal anomalies, while the UTs are often utterly ignored. This probably originates from the fact that UTs are no longer interesting for many clinicians as they think of UTs as superfluous organs whose function can be easily replaced in the in vitro fertilization (IVF) laboratory. Indeed, the modern reproductive medicine has been helping enormously with the conception of infertile couples. In many instances, the UTs are in fact successfully bypassed and a "test-tube" baby is born. Nevertheless, the UTs are still absolutely unique in providing suitable environment for fertilization and early embryo development - processes that hasn´t been still completely understood. This fact could partially explain why the success rate of IVF is "only" around 30-50 % depending on age. Therefore, the research of the UTAVsCAs is still clinically relevant in the context of reproductive medicine and should not be omitted from research endeavors.
INTRODUCTION: The aim of our study was to compare long-term morbidity after elective and emergency cesarean delivery (CD). METHODS: A prospective cohort study was conducted in 200 women delivered by CD. Ultrasound examinations were performed transvaginally at 6 weeks and 18 months after CD. Clinical data were collected at the time of CD and after 18 months. RESULTS: In the group of 200 women, 29% underwent emergency and 71% elective CD. Then, 6 weeks and 18 months after CD, a severe scar defect was present in 7% and 5%, respectively (P = .4). After 18 months of CD, 17% (34/200) of women had evidence of adhesions of the vesicouterine pouch. Severe CD scar defects were significant predictors for adhesion formation in vesicouterine pouch (OR 3.14, 95% CI, 1.54-4.74), pelvic pain (OR 1.68, 95% CI, 0.22-3.14), dysmenorrhea (OR 2.12, 95% CI, 0.74-3.50), and dyspareunia (OR 1.38, 95% CI, 0.09-2.67). Uterine scar defects detected at 6 weeks after elective CD were detectable at 18 months in only 40% of cases, whereas uterine scar defects after emergency CD were still detectable in 87% of cases. CONCLUSION: Uterine scar defects are more frequent at 18 weeks after emergency CD, than after elective CD (40% vs 87%). Women with severe scar defects have higher risk of adhesion formation, dysmenorrhea, dyspareunia, and chronic pelvic pain.
- Klíčová slova
- cesarean delivery, cesarean delivery scar, cesarean scar syndrome, scar defect, ultrasound,
- MeSH
- adheze tkání MeSH
- císařský řez škodlivé účinky metody MeSH
- dospělí MeSH
- dysmenorea etiologie MeSH
- jizva diagnostické zobrazování patologie MeSH
- lidé MeSH
- longitudinální studie MeSH
- pánevní bolest etiologie MeSH
- prospektivní studie MeSH
- těhotenství MeSH
- ultrasonografie MeSH
- uterus diagnostické zobrazování patologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: Presentation of rare complication following the assisted reproduction at a patient after cesarean section and bilateral salpingectomy. DESIGN: Case report. SETTINGS: Department of Obstetrics and Gynaecology, Regional Hospital Liberec, a. s.; Department of Obstetrics and Gynaecology, Palacky University Hospital, Olomouc. OBSERVATION: Pregnant woman, 26-years old, primiparous, with history of cesarean section and bilateral salpingectomy, was referred from the assisted reproduction centre to solve suspicion of molar intrauterine pregnancy. This diagnosis was settled on the basis of ultrasound scan of uterine cavity and high level of human choriogonadotropine. Instrumental revision of uterine cavity was performed, however there was not consequently demonstrated any histological prove of the pregnancy tissue in uterine cavity and decrease of human choriogonadotropine values. The verifying ultrasound examination was made and then the suspicion of ectopic pregnancy on the right side of the uterus was expressed. Laparoscopy diagnosed ectopic pregnancy localized in the right broad ligament. It was treated by exstirpation of the pregnancy tissue. CONCLUSION: The diagnosis of ectopic pregnancy should be based on personal history, human choriogonadotropine level assessment and pelvic ultrasound examination. Although it´s important to evaluate all the components globally, ultrasound examination is in a majority of cases the most important part for setting the right diagnosis.
- Klíčová slova
- abdominal ectopic pregnancy, cesarean section broad ligament., embryotransfer, salpingectomy,
- MeSH
- asistovaná reprodukce MeSH
- choriogonadotropin krev MeSH
- císařský řez MeSH
- dospělí MeSH
- laparoskopie * MeSH
- lidé MeSH
- mimoděložní těhotenství diagnostické zobrazování MeSH
- přenos embrya MeSH
- salpingektomie MeSH
- těhotenství abdominální * MeSH
- těhotenství MeSH
- uterus diagnostické zobrazování MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- choriogonadotropin MeSH
OBJECTIVE: The aim of the study was to compare the sonographic characteristics of the cesarean section (CS) scar 6 weeks and 6 months after operation. We tested the hypothesis that the dehiscence risk coefficient (DRC) measured 6 weeks and 6 month after CS does not change. MATERIALS AND METHODS: A prospective longitudinal study was conducted in 43 primiparous women delivered by CS. The thickness of the myometrium proximal and distal to the CS scar, and the thickness of the CS scar were measured transvaginally. The severity of the CS scar defect was evaluated using the DRC. RESULTS: The cut-off value (5th percentile) for the CS scar thickness and for DRC was 3.0 mm and 0.25, respectively. Statistical analysis revealed a significant correlation between DRC 6 weeks and 6 months after CS (correlation coefficient r = 0.97). CONCLUSION: DRC can describe the defect of the CS scar adequately by the end of the puerperium.
- Klíčová slova
- cesarean section, cesarean section scar, dehiscence risk coefficient, ultrasound, uterus,
- MeSH
- časové faktory MeSH
- císařský řez škodlivé účinky MeSH
- dospělí MeSH
- jizva diagnóza etiologie MeSH
- lidé MeSH
- mladý dospělý MeSH
- následné studie MeSH
- novorozenec MeSH
- pooperační komplikace diagnóza etiologie MeSH
- poporodní období * MeSH
- prospektivní studie MeSH
- těhotenství MeSH
- ultrasonografie prenatální metody MeSH
- uterus diagnostické zobrazování MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
AIMS: Caesarean section is the most common obstetric operation associated with short and long term risks, one of which is uterine scar dehiscence. In this case report we describe four cases of in vitro fertilization and embryo transfer (IVF+ET) treatment where the embryo was transferred into the uterus with known scar dehiscence in the lower uterine segment after a previous Caesarean section (SC). METHODS: All transfers of embryos were ultrasound guided directly into the middle of uterine cavity. All resulting pregnancies continued without problems related to the dehiscent scar and babies were delivered in the third trimester by elective/emergency SC. RESULTS: Our cases suggest that IVF+ET can be offered as an infertility treatment option despite a dehiscent scar in the lower uterine segment after previous SC.
- MeSH
- císařský řez škodlivé účinky MeSH
- dehiscence operační rány etiologie MeSH
- dospělí MeSH
- fertilizace in vitro škodlivé účinky MeSH
- infertilita terapie MeSH
- jizva komplikace MeSH
- lidé MeSH
- přenos embrya škodlivé účinky MeSH
- těhotenství MeSH
- ultrasonografie MeSH
- uterus diagnostické zobrazování patologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
OBJECTIVE: Clarifying the role of three-dimensional transvaginal sonography in diagnosis sterility and assisted reproduction treatment. DESIGN: Review. SETTING: Institute for the Care of Mother and Child, Department of IVF, Charles University, Prague. METHODS: Study of current literature. SUMMARY: With arrised frequency of ovarian, uterus and another pelvic patologies remains the three-dimensional transvaginal sonography in diagnosis of sterility women very actual in the fields of reproductive medicine. Actually the assessment of ovarian reserve belong to the essentials investigations in the diagnosis of primary and secondary sterility at this time. The advance in the three-dimensional transvaginal sonography allows to assess the endometrial volume, echogenity, endometrial vascularity and endometrial receptivity. There is a significant importance of 3D power Doppler angiography by measurement of folicular and ovarian vascularity with three indices (VI, FI, VFI) and provides the calculation of ovarian vascularity from the volume. New Sono-Automatic Volume Calculation (Sono-AVC) software that identifies and quantifies hypoechoic regions within a three-dimensional dataset and provides automatic estimation of their absolute dimensions, mean diameter and volume. An unlimited number of volumes can theoretically be quantified, which makes it an ideal tool for assessment of the ovarian volume and the antral follicle count (AFC) in women undergoing controlled ovarian stimulation.
AIM: To evaluate the effects of estrogen substitution on the uterine development in patients with Turner syndrome. METHOD: 57 women, aged 18.1-41.5 years, were treated with estrogen from puberty induction. RESULTS: In 21 women (37%), the uterus developed to >65 mm in length. The daily estrogen dose correlated with both uterine length (r = 0.29; p < 0.05) and Tanner breast stage (r = 0.44; p < 0.001). A negative correlation between age at artificial menarche and uterine length was found (r = -0.29; p < 0.05). The endometrium thickness was greater in women with an uterus length >65 mm (p < 0.05). In 50% of the women (18 were evaluated), an adult-shaped uterus developed. Previous growth hormone therapy (n = 32) had no impact on the uterus length. CONCLUSIONS: The uterine development was suboptimal in most patients. Further investigation is needed to optimize estrogen therapy for uterine development in patients with Turner syndrome.
- MeSH
- dospělí MeSH
- estrogenní substituční terapie MeSH
- estrogeny aplikace a dávkování MeSH
- lidé MeSH
- menarche * MeSH
- mladiství MeSH
- prsy účinky léků růst a vývoj MeSH
- průřezové studie MeSH
- těhotenství MeSH
- Turnerův syndrom diagnostické zobrazování farmakoterapie patofyziologie MeSH
- ultrasonografie MeSH
- uterus diagnostické zobrazování účinky léků růst a vývoj MeSH
- vedení porodu MeSH
- vztah mezi dávkou a účinkem léčiva MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Názvy látek
- estrogeny MeSH
OBJECTIVE: One of the most important factors contributing to developing of the breast cancer is a female organism exposure to estrogens. Thickness and structure of endometrium in postmenopausal women is a sign of the hormonal status. The goal of the study was to investigate whether there is a difference in the endometrial thickness and quality in postmenopausal women with breast cancer. DESIGN: Prospective cohort study. SETTING: Ultrasound Unit, 2nd Department of Obstetrics and Gynecology, Medical School and Medical Teaching Hospital of L. Pasteur, Kosice, Slovakia. MATERIAL AND METHODS: Endometrial thickness was measured by transvaginal ultrasonography in 21 patients with histologically verified breast cancer and was compared with a group of 26 well women. We assessed the thickness of endometrium, the size of uterus and the endometrium/myometrium index. RESULTS: Despite the fact there existed a difference between these two groups (the average thickness of 3.6 mm and 2.9 mm), the result was not statistically applicable to show a correlation with a benign or malignant breast tissue. CONCLUSION: The results may support the theory of breast cancerogenesis in correlation with estrogen influence or increased incidence of estrogen receptors, respectively. As definitive statistical result can not be stated due to a limited group of patients, more investigation might be necessary in the future. The study dealing with a similar problem was not found in available publications.
- MeSH
- endometrium diagnostické zobrazování patologie MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory prsu patologie MeSH
- postmenopauza * MeSH
- prospektivní studie MeSH
- ultrasonografie MeSH
- uterus diagnostické zobrazování MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
