A 31-year-old woman, with a history of previous cesarean section and right oophorectomy, was admitted for a repeat cesarean section. After the commencement of surgery uterine torsion was diagnosed because of the anterior position of the remaining left ovary and tube, the absence of normal uterovesical peritoneum, and extremely engorged vessels in the lower uterine surface. Posterior classical hysterotomy was performed and a healthy female baby was delivered. Following delivery of the baby and suturing the incision site of the uterus, the contracted uterus was detorted and put back in the pelvic cavity. Extreme uterine torsion of 180 degrees at term is a rare obstetric event. This paper presents a case of uterine torsion at full term pregnancy in which the delivery and repositioning of the uterus was successful.
Adult ; Case Report ; Cesarean Section ; Female ; Human ; Infant, Newborn ; Pregnancy ; Pregnancy Complications* ; Torsion ; Uterine Diseases/surgery ; Uterine Diseases/physiopathology* ; Uterine Diseases/etiology*

Cervical stenosis is a challenging condition that often recurs despite intervention. Multiple therapeutic options have been described, but a clearly effective and reliable treatment method has yet to be identified. Patients with recurrent stenosis are at risk of developing severe complications such as chronic pelvic pain and infertility. We describe a case of congenital cervical stenosis with secondary haematometra in which repeated cervical dilatation, hysteroscopic canalisation and administration of medications to retard endometrial development were unsuccessful in relieving the obstruction and preventing re-accumulation of menstrual blood. Total hysterectomy was eventually mandated by spontaneous rupture of the haematometra.
Adult ; Constriction, Pathologic ; complications ; diagnosis ; Endometrium ; pathology ; Female ; Hematometra ; complications ; diagnostic imaging ; surgery ; Humans ; Infertility ; Pelvic Pain ; Recurrence ; Risk ; Rupture, Spontaneous ; complications ; Tomography, X-Ray Computed ; Uterine Cervical Diseases ; complications ; diagnosis ; Uterine Diseases ; complications ; diagnosis ; Uterine Hemorrhage ; complications ; diagnosis ; Uterine Rupture ; diagnostic imaging ; etiology ; surgery

Spontaneous rupture of the rectosigmoid colon and herniation of the small intestine through the rupture site and eventual evisceration through the anus is a very rare event. In the literature, only 42 cases have been reported. The majority of them occurred in patients with rectal prolapse and one case was reported in association with a third-degree uterine prolapse. We experienced an 81-year-old female patient with rectal prolapse and second-degree uterine prolapse complicated by spontaneous perforation of the rectosigmoid colon and anal evisceration of the small intestine. Segmental resection of the nonviable small intestine, primary repair of the ruptured rectosigmoid colon, and sigmoid loop colostomy were performed, and the patient recovered well. In our patient, both rectal and uterine prolapses cooperatively damaged the anterior wall of the rectosigmoid colon and resulted in perforation. So, rectal and uterine prolapses should be treated before the complication develops. In this patient, uterine prolapse should be treated because of the recurrence of this rare episode.
Aged ; Aged, 80 and over ; Case Report ; Colonic Diseases/etiology* ; Female ; Human ; Rectal Prolapse/complications* ; Rupture, Spontaneous ; Uterine Prolapse/complications*

OBJECTIVES: The most often perfomed major operation in gynecology is hysterectomy.Our purpose was to compare the indications, charateristics and outcomes of patients undergoing total abdominal hysterectomy and total vaginal hysterectomy and to help to establish guidelines to determine the route of hysterectomy. METHOD: The hospital charts of 400 women who underwent elective inpatient hysterectomy at Kyung-Hee University hospital from January 1994 to January 1999, were abstracted retrospectively. Data were collected regarding patients, age, parity, preoperative indications, the route of hysterectomy, uterine weight, operative and postoperative complications and the length of stay. The operative indications were benign uterine disease except from uterine prolapse. Bisection or combined morcellation were used in most cases to obtain reduction in uterine size. RESULT: Patients in whom the vaginal route was successful included 18% of those with uterine weights exceeding 280gm. There was statistically significant difference for uterine weight, operative time, bleeding amount, the length of stay in two camparative group. 4% of vaginal hysterectomy and 7% of total abdominal hysterectomy has documented operative complications. CONCLUSIONS: Vaginal hysterectomy is safe operation with few intraoperative and postoperative complications without notable blood loss. Vaginal hysterectomy allow one to shorten the operating time and allows early postoperative discharge of some patients from hospital. Skilled performance of vaginal hysterectomy is worth greater attention and should be used more often in gynecological study.
Female ; Gynecology ; Hemorrhage ; Humans ; Hysterectomy* ; Hysterectomy, Vaginal ; Inpatients ; Length of Stay ; Operative Time ; Parity ; Postoperative Complications ; Retrospective Studies ; Statistics as Topic* ; Uterine Diseases ; Uterine Prolapse ; Weights and Measures

This study aimed to investigate the relationship between bladder trabeculation, urinary function, and the stage of pelvic organ prolapse (POP). The medical records of 104 patients with POP who underwent cystoscopies and urodynamic studies were reviewed retrospectively. Age, incidence of detrusor instability, stage and site of POP, and the parameters of urodynamic studies of patients with and without bladder trabeculation were compared. The difference in the incidence of bladder trabeculation was estimated between patients with and without a suspected bladder outlet obstruction. There were significant differences in the patients' age, stage of POP, and maximal voiding velocity. Patients with a suspected bladder outlet obstruction had a significantly higher incidence of bladder trabeculation. In addition, patients with advanced stages of POP were also found to have a higher incidence of bladder trabeculation.
Uterine Prolapse/complications ; Urodynamics/*physiology ; Urinary Bladder Neck Obstruction/complications ; Urinary Bladder Diseases/*physiopathology ; Retrospective Studies ; Rectal Prolapse/complications ; Prolapse ; Pelvic Floor/physiopathology ; Middle Aged ; Humans ; Female ; Aged

OBJECTIVETo investigate the effects of hysteroscopic treatment of women with previous cesarean scar defect (PCSD).

METHODSFrom May 2006 to October 2008, 12 patients with PCSD were diagnosed and treated hysteroscopically in our hospital, all of them were successful followed-up for one year postoperatively, and their clinical data were analyzed.

RESULTSAll 12 hysteroscopic procedures were completed successfully, and there were no surgical complications. Nine patients with longer periods and 1 patient with intermenstrual spotting preoperatively remained asymptomatic after hysteroscopic surgery, and 1 patient with longer periods and infertility experienced normal periods, while remained infertility, and the remaining 1 patient complaining postcoital bleeding preoperatively had recurrence of the bleeding.

CONCLUSIONHysteroscopic surgery of women with PCSD was minimally invasive and effective.

Adult ; Cesarean Section ; adverse effects ; Cicatrix ; etiology ; surgery ; Female ; Follow-Up Studies ; Humans ; Hysteroscopy ; Postoperative Complications ; surgery ; Uterine Diseases ; surgery

Hysteroscopic surgery is a minimally invasive procedure for the treatment of intrauterine pathologies. However, it can result in fatal complications. We herein report a case of symptomatic hyponatremia and hyperglycemia during hysteroscopic resection of severe intrauterine adhesion with 5% dextrose in water as the distension medium. Because of the difficulty of the incision, the infusion pressure was 100 to 150 mmHg, and surgery was continued for 70 minutes. A total of 19 L of 5% dextrose in water was used as an irrigating fluid. Large-scale absorption of irrigating fluid (3 L) induced dilutional hyponatremia (120 mmol/L) and hyperglycemia (30 mmol/L). Initial signs were abnormal flatulence and postoperative coma. Hypertonic saline, diuretics, insulin, and liquid restriction were the prevailing treatment strategies for hyponatremia and hyperglycemia. Ionized calcium and potassium levels decreased during treatment. We emphasize the importance of prevention, recognition, and a meticulous perioperative treatment standard. Surgical teams must be vigilant in fluid deficit monitoring and serum electrolyte analysis.
Adult ; Female ; Humans ; Hyperglycemia ; etiology ; Hyponatremia ; etiology ; Hysteroscopy ; adverse effects ; Intraoperative Complications ; etiology ; Tissue Adhesions ; Uterine Diseases ; surgery

OBJECTIVE: To depict the cell landscape and molecular biological characteristics of human intrauterine adhesion (IUA) so as to better understand its immune microenvironment and provide new inspirations for clinical treatment. METHODS: Four patients with IUA who underwent hysteroscopic treatment at Dongguan Maternal and Child Health Care Hospital from February 2022 to April 2022 were selected as the study subjects. Hysteroscopy was used to collect the tissues of IUA, which were graded based on the patient's medical history, menstrual history and status of IUA. Library construction, sequencing, single cell data comparison and gene expression matrix construction were carried out in strict accordance with the single cell RNA sequencing process. Thereafter, the UMAP dimension reduction analysis of cell population and genetic analysis were carried out based on the cell types. RESULTS: A total of 27 511 cell transcripts were obtained from four moderately graded IUA tissue samples and assigned to six cell lineages including T cells, mononuclear phagocytes, epithelial cells, fibroblasts, endothelial cells and erythrocytes. Compared with normal uterine tissue cells, the four samples showed different cell distribution, and the proportions of mononuclear phagocytes and T cells in sample IUA0202204 were significantly increased, suggesting a strong cellular immune response. CONCLUSION The cell diversity and heterogeneity of moderate IUA tissues have been described. Each cell subgroup has unique molecular characteristics, which may provide new clues for further study of the pathogenesis of IUA and heterogeneity among the patients.
Pregnancy ; Female ; Child ; Humans ; Endothelial Cells ; Uterine Diseases/complications* ; Hysteroscopy/methods* ; Tissue Adhesions/etiology* ; Sequence Analysis, RNA

OBJECTIVE: We have performed Classic Intrafascial Supracervical Hysterectomy (CISH) since April 1993, so we are to report the clinical results of CISH for 10 years, and introduce the technical aspects of new CISH. METHODS: A retrospective analysis on 470 cases of CISH (conventioal and new method) was carried out including age, parity, operating time, blood loss, uterine weight, pathologic results, complications and postoperative recovery. RESULTS: The mean age was 44.8 years (range 25-68), parity 2.23 (0-9), operating time 131 minutes (70-310), mean blood loss 148 mL (20-1000) and mean uterine weight was 306 gram (90-880). The most common uterine pathology was uterine leiomyoma (49.3%) and there were adenomyosis (15.5%), leiomyoma with adenomyosis (12.5%), chronic cervicitis (5%) and so on. Intraoperative complications included one case of bladder injury due to thick adhesion and 6 cases of bleeding requiring transfusion. Postoperative complications included 5 cases of cervical coring site bleeding, 2 cases of febrile complications, 2 cases of trocar site bleeding, 1 case of transient nerve injury of lower extremity, and 1 case of urinary tract infection. The mean hospital stay was 5.3 days (3-10). two hundreds and seventy eight patients of 470 had been followed for cervical pathology, and no pathologic findings except 3 cases of mild dysplasia were shown. CONCLUSION: Classic intrafascial supracervical hysterectomy, a minimally invasive organ-preserving procedure indicated for benign uterine disease, is associated with few operative complications and low morbidity, and the disadvantages of conventional Semm's CISH technique can be overcome by new CISH technique using triple ligation method.
Adenomyosis ; Female ; Hemorrhage ; Humans ; Hysterectomy* ; Intraoperative Complications ; Leiomyoma ; Length of Stay ; Ligation ; Lower Extremity ; Parity ; Pathology ; Postoperative Complications ; Retrospective Studies ; Surgical Instruments ; Urinary Bladder ; Urinary Tract Infections ; Uterine Cervicitis ; Uterine Diseases

BACKGROUNDCongenital uterine anomalies are associated with the highest incidence of reproductive failure and obstetric complications. This study aimed to summarize the clinical characteristics and prenatal outcome of pregnancy in women with congenital uterine malformations.

METHODSThis retrospective study evaluated the fertility and obstetric outcome of 116 inpatients with uterine malformations with pregnancy in Peking University Third Hospital from June 1998 to June 2009. A total of 270 randomly selected pregnant women with a previously confirmed normally shaped uterus as a control group. Student's t test and analysis of variance (ANOVA) were used to compare means for normally distributed variables. The analysis was carried out using the SPSS.

RESULTSAmong 21 961 deliveries in Peking University Third Hospital, 116 (0.45%) were in women with uterine anomalies. A septate uterus was present in 43 (37.1%) and the uterus didelphys in 28 (24.2%) of the 116 women identified. Bicornuate uterus, arcuate and unicomate uterus were observed in 12 (10.3%), 18 (15.5%) and 15 (12.9%) patients, respectively. Patients with uterine anomalies had significantly higher rates of malpresentation (38.8%), preterm delivery (19.8%), and cesarean section (78.5%) compared with the group of women with a normal uterus. Patients with uterine anomalies had significantly lower mean birth-weight neonates and a significantly higher incidence of small for gestationalage (SGA) neonates; women with uterus didelphys more frequently required infertility treatment than patients with other uterine anomalies (P < 0.001). The rate of malpresentation was significantly higher in patients with septated uterus in comparison with patients with uterus unicorns (P < 0.05).

CONCLUSIONSWomen with congenital uterinemal formation usually have higher incidence of complications during pregnancy and delivery. A septate uterus appears to be associated with poorer obstetric outcomes.

Adult ; Birth Weight ; Cesarean Section ; China ; Female ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Infertility, Female ; Obstetric Labor Complications ; physiopathology ; Pregnancy ; Pregnancy Complications ; physiopathology ; Pregnancy Outcome ; Premature Birth ; Retrospective Studies ; Uterine Diseases ; complications ; physiopathology ; Young Adult