OBJECTIVE: Some vaginal procedures may be safer, easier and more successful if they could be done under direct sonographic vision of the object. METHODS: All the procedures were done under the guidance of transrectal sonography. Suction curettage, after using curved plastic Karman's cannula, additional curettage was done only when there was probable remaining conceptal tissue seen on sonography. If additional curettage was needed curved metal cannula made in the same form as plastic Karman's cannula is used first and then usual metal curette if the former did not work. A high frequency cautery unit was used for myolysis. Insertion of the flexible curved cautery tip into the myoma mass was done through the uterine cavity and coagulation of the myoma tissue was performed. Myoma biopsies were done with thin loop high frequency cautery tip through laparoscopy and the vagina. RESULTS: Suction curettage in 156 cases of early pregnancy and 2 cases of previous cesarean incision site pregnancy, D&C in 11 cases, chorionic villus sampling in 13 cases, polypectomy in 1 case, myolysis in 1 case and myoma biopsy in 2 cases were done. CONCLUSION: Performing some vaginal procedures under the guidance of transrectal sonography may be better.
Biopsy ; Catheters ; Cautery ; Chorionic Villi Sampling ; Curettage ; Dilatation and Curettage ; Female ; Laparoscopy ; Myoma ; Plastics ; Pregnancy ; Ultrasonography* ; Vacuum Curettage ; Vagina

Cervical pregnancy is a rare life-threatening form of ectopic pregnancy. The exact etiology of cervical pregnancy is not known, but several contributing factors have been considered. Probably a combination of factors leads to cervical pregnancy. The first case was required hysterectomy. The second case was successfully treated with a unique combination of precurettage cerclage, suction curettage and postcurettage balloon tamponade. Conservative treatment has evolved in recent years, with a considerable reduction in the number of hysterectomies. We present two cases of cervical pregnancy associated with multiple risk factors in elderly gravida, with brief reviews.
Aged* ; Balloon Occlusion ; Female ; Humans ; Hysterectomy ; Pregnancy* ; Pregnancy, Ectopic ; Risk Factors* ; Vacuum Curettage

Suction curettage is a relatively safe procedure to induce abortion of first trimester pregnancy with a very low complication rate. But, in order to do that, cervix should be dilated enough to pass operating devices. We experienced a case of first trimester pregnancy terminated successfully using transvaginal misoprostol when suction curettage was failed due to severely cervical stenosis after LEEP conization.
Cervix Uteri ; Conization ; Constriction, Pathologic ; Female ; Humans ; Misoprostol* ; Pregnancy ; Pregnancy Trimester, First ; Vacuum Curettage

Cervical pregnancy is an uncommon life threatening form of ectopic pregnancy. It is associated with the unexpected occurrence of uncontrollable hemorrhage from the cervix. This condition is usually treated with hysterectomy. And thus the patient loses her fertility potential. To avoid hysterectomy and to maintain fertility, several conservative methods of termination have been used. We report a case of cervical pregnancy treated conservatively without hysterectomy. Hemorrhage from the implantation site was controlled with an inflated Foley catheter balloon positioned within the cervical canal. Foley catheter ballooning after endocervical suction curettage seems to be a simple and effective treatment of cervical pregnancy as conservative treatment to maintain fertility.
Catheters ; Cervix Uteri ; Female ; Fertility ; Hemorrhage ; Humans ; Hysterectomy ; Pregnancy* ; Pregnancy, Ectopic ; Vacuum Curettage

Acute Disease ; Child ; Child, Preschool ; Empyema, Pleural ; therapy ; Female ; Humans ; Infant ; Male ; Therapeutic Irrigation ; Vacuum Curettage

High gravidity hydatidiform mole (HM) without normal pregnancy is very rare. The challenge of managing such cases will dwell on the concern of having normal conception versus having another molar gestation and its neoplastic sequelae.

Presented in this paper is a case of a 32-year-old, gravida 5 para 0 (0040) who was admitted for the management of her fifth molar pregnancy. She underwent suction curettage and administration of methotrexate chemoprophylaxis. Genetic testing was done, which revealed a homozygous mutation in NLRP7, the gene implicated in recurrent molar gestations. This paper discusses the proper approach to determine the cause of recurrent molar pregnancies, as well as the management and prognosis of such cases.

Human ; Female ; Adult ; Gravidity ; Methotrexate ; Vacuum Curettage ; Hydatidiform Mole ; Homozygote ; Genetic Testing ; Mutation ; Prognosis ; Chemoprevention ; Molar

High gravidity hydatidiform mole (HM) without normal pregnancy is very rare. The challenge of managing such cases will dwell on the concern of having normal conception versus having another molar gestation and its neoplastic sequelae.

Presented in this paper is a case of a 32-year-old, gravida 5 para 0 (0040) who was admitted for the management of her fifth molar pregnancy. She underwent suction curettage and administration of methotrexate chemoprophylaxis. Genetic testing was done, which revealed a homozygous mutation in NLRP7, the gene implicated in recurrent molar gestations. This paper discusses the proper approach to determine the cause of recurrent molar pregnancies, as well as the management and prognosis of such cases.

Human ; Female ; Adult ; Gravidity ; Methotrexate ; Vacuum Curettage ; Hydatidiform Mole ; Homozygote ; Genetic Testing ; Mutation ; Prognosis ; Chemoprevention ; Molar

OBJECTIVE: To evaluate of safety and effectiveness of conservative treatment of previous cesarean section scar pregnancy. METHODS: Ten patients with previous cesarean section scar pregnancy were treated systemic methotrexate or intra-amnionic methotrexate injection. After treatment, patients were measured for the levels of serum beta-hCG and underwent ultrasound. According to the results, additional dose of methotrexate or curettage were done. Serum beta-hCG and ultrasound were checked several times until the level of serum beta-hCG and the finding of ultrasound had been normalized. RESULTS: Two patients showed normal serum beta-hCG levels and ultrasound findings after intra-amnionic methotrexate injection only. Two patients showed normal serum beta-hCG levels and ultrasound findings after systemic methotrexate/folinic acid therapy followed by dilatation and curettage. Six patients showed normal serum beta-hCG levels and ultrasound findings after intra-amnionic methotrexate injection followed dilatation and curettage. Two patients were transfused due to massive bleeding and other patients were not experienced severe complications. CONCLUSION: These results suggest that systemic or intra-amnionic methotrexate therapy with or without dilatation and curettage is safe and effective as a primary therapy for intramural pregnancy implanting in the cesarean section scar.
Cesarean Section* ; Cicatrix* ; Curettage ; Dilatation and Curettage ; Female ; Hemorrhage ; Humans ; Methotrexate ; Pregnancy* ; Pregnancy, Ectopic ; Ultrasonography

Idiopathic hypertrophic subaortic stenosis (IHSS) is characterized by asymmetric septal hypertrophy, wherein the upper portion of interventricular septum, and dynamic left ventricular outflow tract obstruction due to narrowing the subaortic area usually resulting from the middiastolic apposition of the mitral anterior leaflet against the hypertrophied septum. The goals of anesthetic management for IHSS are to prevent the development of dynamic obstruction to left ventricular ejection and to optimize ventricular filling by maintaining the heart in normal sinus rhythm. Spinal and epidural anesthesia decrease in the preload and afterload secondary to peripheral venous pooling and sympathetic blockade could act to increase the left ventricular outlet obstruction. We experienced the case of the epidural anesthesia for the dilatation and curettage of the uterus with IHSS, and there is no adverse effects of epidural anesthesia.
Anesthesia, Epidural* ; Cardiomyopathy, Hypertrophic* ; Dilatation and Curettage ; Female ; Heart ; Humans ; Uterus

Implantation of a blastocyst within the endocervical canal is termed a"cervical pregn-ancy", which is one of the most dangerous forms of ectopic pregnancy. It is even less common, but the incidence appear to be increasing, in part due to newer forms of assisted reproduction. Proper management is indicated as soon as the diagnosis is suspected. Hemorrhage may be massive and sometimes fatal. In the past, hysterectomy was often the only choice available because of profuse hemorrhage that accompanied attempts at removal of the cerv- ical pregnancy. We report two cases of cervical pregnancy treated conservatively without hysterect- omy. Hemorrhage from the implantation site was controlled by intracervical placement of a Foley catheter balloon without hemostatic cervical sutures at 3 and 9 o clock. Immediate insertion of a Foley catheter into the cervical canal and inflation of the catheter bulb after endocervical suction curettage appears to be a simple and effective technique of managing cervical pregnancy in a patient who wishes to maintain childbearing capacity.
Blastocyst ; Catheters ; Diagnosis ; Female ; Fertility ; Hemorrhage ; Humans ; Hysterectomy ; Incidence ; Inflation, Economic ; Pregnancy* ; Pregnancy, Ectopic ; Reproduction ; Sutures ; Vacuum Curettage