Objective: To detail the experience and evaluate the effectiveness of hysteroscopy in the Philippine General Hospital. Setting: Tertiary care center Study population: All available records of patients admitted for hysteroscopy from July 1996 to December 2000. Results: There were 240 records available for review with a mean patient age of 39.4 +/- 14.2 years (range 15-75). There was an increasing number of hysteroscopy cases, especially operative cases performed through the years. Bleeding was the most common complaint. Indications for hysteroscopy were: endometrial mass (49 percent), abnormal uterine bleeding (16 percent), infertility (10 percent), and thickened endometrium (7 percent). There were 6 cases of lost IUD. A total of 58.7 percent intracavitary abnormalities were noted during hysteroscopy and were observed in the following subgroups: 65.7 percent in those with premenopausal bleeding, 46.7 percent in those with postmenopausal bleeding, 28.9 percent in infertility, and 74.5 percent with the diagnosis of an intracavitary mass. Conclusion: A summary of hysteroscopy cases done at a tertiary care center in the Philippines was presented. This review demonstrates the utility of hysteroscopy in the diagnosis of intracavitary abnormalities and in the removal of IUDs.
HYSTEROSCOPY ; UTERINE HEMORRHAGE ; MENORRHAGIA

OBJECTIVE: The purpose of this study was to study the clinical efficacy of Levonorgestrel-releasing intrauterine system (Mirena(R)) for patients who have abnormal uterine bleeding before menopause or sustaining vaginal spotting during postmenopaual hormone replacement therapy. METHODS: Between June, 2001 and June, 2003, forty six premenopausal women with abnormal uterine bleeding such as menorrhagia and intermenstrual bleeding who did not prefer surgical treatment (Group 1) and twenty four postmenopausal patients with vaginal spotting (Group 2) were included in this study. The various parameters such as uterine bleeding, dysmenorrhea, volume changes of myoma or adenomyosis, and endometrial thickness were evaluated by transvaginal ultrasound examination before and after Levonorgestrel- releasing intrauterine system usage. RESULTS: A significant reduction in abnormal bleeding (26.3 vs 11.0) (p<0.0001) and dysmenorrhea (11.6 vs 6.1) (p<0.0001) were noticed. However, there was no significant change in volume of uterine myoma (40.0 vs 11.3) (p=0.282) and adenomyosis (103.0 vs 95.83) (p=0.266) before and after Mirena(R) insertion in Group 1. Vaginal spotting during hormone replacement therapy disappeared completely in 18/24. Also there was a significant reduction in endometrial thickness (6.3 vs 4.9) (p<0.0001) after Mirena(R) insertion in both group 1 and group 2. CONCLUSION: Levonorgestrel-releasing intrauterine system insertion was acceptable and convenient therapeutic modality for abnormal uterine bleeding of premenopausal abnormal uterine bleeding and vaginal spotting during the postmenopausal hormone replacement therapy.
Adenomyosis ; Dysmenorrhea ; Estrogen Replacement Therapy ; Female ; Hemorrhage ; Hormone Replacement Therapy ; Humans ; Leiomyoma ; Menopause ; Menorrhagia ; Metrorrhagia ; Myoma ; Ultrasonography ; Uterine Hemorrhage*

The average length of menstrual cycle is 28 days, and duration of flow is 4 days, and an average blood loss is 35cc. Abnormal uterine bleeding is defined as bleeding at abnormal or unexpected times or by an excessive flow at the time of expected menses. Any bleeding should be considered abnormal in premenarchal girls and in postmenopausal women. The etiology of abnormal uterine bleeding encompasses a wide range of disorders that can be secondary to pregnancy-related disorders, anatomic changes of the female genital tract, infection, endocrinologic disorders, malignancies, and systemic illnesses. Dysfunctional uterine bleeding (anovulatory or ovulatory) is diagnosed by exclusion of these causes. An appropriate workup is guided by age-related differential diagnoses for abnormal bleeding. Modern diagnostic tools can readily reveal the underlying pathology and allow timely intervention. Most abnormal genital tract bleeding occurs in the form of uterine bleeding, which is one of the most common gynecologic problems that health care providers encounter with, accounting for approximately 19% of office visits and 25% of gynecologic operations. The author will review the categories of abnormal uterine bleeding and the diagnostic tools needed to establish the correct diagnosis and treatment strategy.
Anovulation ; Diagnosis ; Diagnosis, Differential ; Female ; Health Personnel ; Hemorrhage ; Humans ; Menorrhagia ; Menstrual Cycle ; Metrorrhagia ; Office Visits ; Pathology ; Uterine Hemorrhage*

Uterine arteriovenous malformations are considered very rare conditions, potentially life-threatening lesions combined with various degrees of menorrhagia, postpartum bleeding, postmenopausal bleeding, an asymptomatic mass, and congestive heart failure. Clinical suspicion is essential for a prompt diagnosis and treatment. They may be diagnosed by gray-scale ultrasonography and Color Doppler imaging. Additionally, they can be detected using contrast material-enhanced computed tomography (CT), conventional angiography, hysteroscopy and hysterosalpingogram. More recently, diagnosis of uterine AVM with magnetic resonance imaging (MRI) has been reported. In the past, laparotomy with uterine artery ligation or hysterectomy was the only treatment available. However, successful conservative management with embolization of the affected vessels or methylergonovine maleate has been reported recently. A 37-year-old woman, gravida 3, para 1, presented with massive uterine bleeding that started abruptly four weeks after D and C. We promptly performed non-invasive diagnositic evaluations including color Doppler, MRI and MRA, with a clinical impression of uterine AVM. In this case, we describe the appropriate diagnosis and management of uterine AVMs with literatures.
Adult ; Angiography ; Arteriovenous Malformations* ; Diagnosis ; Female ; Heart Failure ; Hemorrhage ; Humans ; Hysterectomy ; Hysteroscopy ; Laparotomy ; Ligation ; Magnetic Resonance Imaging ; Menorrhagia ; Methylergonovine ; Postpartum Period ; Pregnancy* ; Ultrasonography ; Uterine Artery ; Uterine Hemorrhage*

Hemorrhage;Postpartum Period; Uterine Inertia; prevention & control; 777 postpartum women were studied at Tu Du Obstetric and Gynecology Hospital, HCM city. Rectal misoprostol of 400mg was well tolerated and effective to reduce hemorrhage amount and to shorten the 3rd phase of labor just after the delivery. The procedure is simple with low cost, easy to use in remote areas of the country contributing in lowering obstetric accidents and mortality.
Hemorrhage ; Postpartum Period ; Uterine Inertia ; prevention & control

Selective uterine arterial embolization is widely used in the management of obstetric hemorrhage. Owing to the physiological changes associated with pregnancy and selection of uterine arteries, ischemic injury after uterine arterial embolization in postpartum bleeding is rare. In previous reports, the known causes of ischemic injury after embolization are using the too small particle and complete occlusion of fine branch of uterine artery with absence of collateral ovarian artery. We experienced uterine necrosis despite partial obstruction of uterine arteries following the selective embolization. We report this case with brief review of literature
Arteries ; Hemorrhage ; Necrosis ; Postpartum Hemorrhage ; Postpartum Period ; Pregnancy ; Uterine Artery ; Uterine Artery Embolization

Uterine arterial pseudoaneurysm is a very rare condition usually associated with postpartum hemorrhage. It almost never occurs after cervical conization; however, since ruptured pseudoaneurysm could be life threatening, we should consider the possibility of vascular injury such as pseudoaneurysm when we find a patient with vaginal bleeding after the process of surgical operation. Emergency arterial embolization is a well established therapeutic option to control the ruptured pseudoaneurysm. This is a case report of uterine arterial pseudoaneurysm causing intra-abdominal bleeding followed by cervical conization, which was successfully treated by uterine artery embolization.
Aneurysm, False* ; Conization* ; Emergencies ; Hemorrhage ; Humans ; Postpartum Hemorrhage ; Uterine Artery Embolization ; Uterine Artery* ; Uterine Hemorrhage* ; Vascular System Injuries

Hormone therapy for peri- and postmenopausal women is widely used for relieving vasomotor symptoms or preventing osteoporosis. Even though exogenous hormone is the most common cause of vaginal bleeding in postmenopausal women under hormone therapy, in clinical practice, physicians must never exclude the possibility of endometrial disorders, such as endometrial hyperplasia or cancer. Taking thorough medical history and performing physical and pelvic examinations are essential for the evaluation of abnormal uterine bleeding in menopausal hormone therapy. Transvaginal ultrasonography, endometrial aspiration biopsy, dilatation and curettage, and hysteroscopy are the options which physicians may use. This case is about a woman with continuous combined hormone therapy for 5 years who had experienced rather sudden onset of vaginal spotting lasting for several months and was finally diagnosed as having malignant mixed Mullerian tumor. Our purpose is to inquire into the proper approaching steps for vaginal bleeding in menopausal hormone therapy.
Biopsy, Needle ; Dilatation and Curettage ; Endometrial Hyperplasia ; Female ; Gynecological Examination ; Humans ; Hysteroscopy ; Metrorrhagia ; Osteoporosis ; Uterine Hemorrhage

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.
Angiography ; Arteriovenous Malformations ; Curettage ; Diagnosis ; Dilatation and Curettage ; Dilatation ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Metrorrhagia ; Ultrasonography ; Ultrasonography, Doppler ; Uterine Artery ; Uterine Artery Embolization ; Uterine Hemorrhage ; Uterus ; Vascular Malformations

Embolization of the uterine arteries is a valuable method for controlling postpartum hemorrhage. There have been recent attempts to apply this tool as a means of controlling bleeding during Cesarean section, especially in patients with placenta previa. However, the benefits are controversial due to lack of randomized controlled studies, no evidence of significant improved outcomes, and potential harm including radiation exposure. This paper includes two case reports of intraoperative uterine artery embolization without fetal radiation exposure in patients with placenta previa totalis.
Cesarean Section ; Female ; Hemorrhage ; Humans ; Placenta ; Placenta Previa ; Postpartum Hemorrhage ; Pregnancy ; Uterine Artery ; Uterine Artery Embolization