OBJECTIVES: To uncover gynecologic conditions with similar transvaginal sonographic findings of thick uterine endometrium with honeycomb appearance in pre-and postmenopausal women.METHODS: We retrospectively reviewed cases of patients with endometrial tissue biopsy from January 2010 to December 2016. We also collected office flexible hysteroscopic findings and surgical pathologic results. We analyzed data from 393 patients with confirmed endometrial pathology. Among these patients, 69 had transvaginal ultrasonographic images with thick uterine endometrium and honeycomb or “Swiss cheese” appearance.RESULTS: We found gynecologic conditions such as submucosal leiomyoma with degeneration, endometrial polyp, pseudocystic endometrial change associated with tamoxifen use, progesterone associated endometrial change, pyometra, retained placenta, and uterine synechiae manifested with similar thick endometrium with “Swiss cheese” appearance in transvaginal sonographic images. The most common diagnosis in postmenopausal women was atrophic endometritis, followed by endometrial cancer and endometrial polyps. The most common diagnosis in premenopausal women was abnormal uterine bleeding without pathologic conditions.CONCLUSIONS: Sonographic findings of thick uterine endometrium with “Swiss cheese” appearance need to be considered together with a thorough review of the patient's history and chief complaint before making a tentative diagnosis due to the various conditions sharing the feature.
Biopsy ; Diagnosis ; Endometrial Neoplasms ; Endometritis ; Endometrium ; Female ; Gynatresia ; Humans ; Hyperplasia ; Leiomyoma ; Menopause ; Pathology ; Placenta, Retained ; Polyps ; Progesterone ; Pyometra ; Retrospective Studies ; Tamoxifen ; Ultrasonography ; Uterine Hemorrhage

We determined the threshold proportion of polymorphonuclear leukocytes (PMNs) for a diagnosis of cytological endometritis (CEM), the risk factors for this condition, and its impact on reproductive performance in dairy cows. Uterine cytology was performed on 407 Holstein cows 4 weeks postpartum to determine the proportions of endometrial cells and PMNs. A receiver operator characteristics curve was used to determine the threshold above which the PMN proportion affected the likelihood of cows conceiving by 200 days postpartum. The optimal threshold was ≥ 14% PMN (sensitivity, 31.3%; specificity, 81.7%; p < 0.05). The farm identity, retained placenta (odds ratio [OR] = 1.87), and septicemic metritis (OR = 3.07) were risk factors for CEM (p < 0.05). Cows with CEM were less likely to resume cyclicity (OR = 0.58) and to conceive by 200 days postpartum (hazard ratio = 0.58). Cows with CEM tended (p < 0.1) to be less likely to become pregnant after their first insemination (OR = 0.65) and to require a greater number of inseminations per conception (2.3 vs. 2.2). In conclusion, a PMN threshold of 14% defined the presence of CEM at 4 weeks postpartum. The farm, retained placenta, and septicemic metritis were risk factors for CEM, which reduces subsequent reproductive performance.
Agriculture ; Diagnosis ; Endometritis ; Female ; Fertilization ; Insemination ; Neutrophils ; Periodicity ; Placenta, Retained ; Postpartum Period ; Risk Factors ; Sensitivity and Specificity

OBJECTIVE: To evaluate the safety and efficacy of prophylactic uterine artery embolization (UAE) before obstetrical procedures with high risk for massive bleeding. MATERIALS AND METHODS: A retrospective review of 29 female patients who underwent prophylactic UAE from June 2009 to February 2014 was performed. Indications for prophylactic UAE were as follows: dilatation and curettage (D&C) associated with ectopic pregnancy (cesarean scar pregnancy, n = 9; cervical pregnancy, n = 6), termination of pregnancy with abnormal placentation (placenta previa, n = 8), D&C for retained placenta with vascularity (n = 5), and D&C for suspected gestational trophoblastic disease (n = 1). Their medical records were reviewed to evaluate the safety and efficacy of UAE. RESULTS: All women received successful bilateral prophylactic UAE followed by D&C with preservation of the uterus. In all patients, UAE followed by obstetrical procedure prevented significant vaginal bleeding on gynecologic examination. There was no major complication related to UAE. Vaginal spotting continued for 3 months in three cases. Although oligomenorrhea continued for six months in one patient, normal menstruation resumed in all patients afterwards. During follow-up, four had subsequent successful natural pregnancies. Spontaneous abortion occurred in one of them during the first trimester. CONCLUSION: Prophylactic UAE before an obstetrical procedure in patients with high risk of bleeding or symptomatic bleeding may be a safe and effective way to manage or prevent serious bleeding, especially for women who wish to preserve their fertility.
Abortion, Spontaneous ; Cicatrix ; Dilatation and Curettage ; Female ; Fertility ; Follow-Up Studies ; Gestational Trophoblastic Disease ; Hemorrhage* ; Humans ; Medical Records ; Menstruation ; Metrorrhagia ; Oligomenorrhea ; Placenta, Retained ; Placentation ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy, Ectopic ; Retrospective Studies ; Uterine Artery Embolization* ; Uterine Artery* ; Uterine Hemorrhage ; Uterus

We present a case of retained placenta accreta treated by high-intensity focused ultrasound (HIFU) ablation followed by hysteroscopic resection. The patient was diagnosed as submucosal myoma based on ultrasonography in local clinic. Pathologic examination of several pieces of tumor mass from the hysteroscopic procedure revealed necrotic chorionic villi with calcification. HIFU was performed using an ultrasound-guided HIFU tumor therapeutic system. The ultrasound machine had been used for real-time monitoring of the HIFU procedure. After HIFU treatment, no additional vaginal bleeding or complications were observed. A hysteroscopic resection was performed to remove ablated placental tissue 7 days later. No abnormal vaginal bleeding or discharge was seen after the procedure. The patient was stable postoperatively. We proposed HIFU and applied additional hysteroscopic resection for a safe and effective method for treating retained placenta accreta to prevent complications from the remaining placental tissue and to improve fertility options.
Chorionic Villi ; Fertility ; High-Intensity Focused Ultrasound Ablation ; Humans ; Methods ; Myoma ; Placenta, Retained* ; Ultrasonography* ; Uterine Hemorrhage

We present a case of retained placenta accreta treated by high-intensity focused ultrasound (HIFU) ablation followed by hysteroscopic resection. The patient was diagnosed as submucosal myoma based on ultrasonography in local clinic. Pathologic examination of several pieces of tumor mass from the hysteroscopic procedure revealed necrotic chorionic villi with calcification. HIFU was performed using an ultrasound-guided HIFU tumor therapeutic system. The ultrasound machine had been used for real-time monitoring of the HIFU procedure. After HIFU treatment, no additional vaginal bleeding or complications were observed. A hysteroscopic resection was performed to remove ablated placental tissue 7 days later. No abnormal vaginal bleeding or discharge was seen after the procedure. The patient was stable postoperatively. We proposed HIFU and applied additional hysteroscopic resection for a safe and effective method for treating retained placenta accreta to prevent complications from the remaining placental tissue and to improve fertility options.
Chorionic Villi ; Fertility ; High-Intensity Focused Ultrasound Ablation ; Humans ; Methods ; Myoma ; Placenta, Retained* ; Ultrasonography* ; Uterine Hemorrhage

Placenta accreta during the first trimester of pregnancy is rare. Only a few cases of placenta accreta manifesting as a uterine mass have been published. Most patients with placenta accreta present with vaginal bleeding during or after pregnancy. This report describes a patient with placenta accreta that caused vaginal bleeding three years after a first trimester abortion. The patient had regular menstruation for three years after the abortion. Initially endometrial cancer or a uterine myoma with degeneration was suspected. This is the first report of a placenta accreta detected as a uterine mass long after a first trimester abortion with delayed vaginal bleeding.
Endometrial Neoplasms ; Female ; Humans ; Menstruation ; Myoma ; Placenta Accreta ; Placenta, Retained ; Pregnancy ; Pregnancy Trimester, First ; Uterine Hemorrhage ; Uterine Neoplasms

Calving records of Holstein dairy cows from 2005 to 2010 comprising Goyang and Paju cities herd with 2,362 calving events representing 240 twin births were used to evaluate the effect of abomasal displacement and retained placenta after single or twin births on fertility. In retained placenta cows, the period of twin pregnancy (mean 270.5 days) was shorter than that of single pregnancy (mean 274.8 days), however first artificial insemination period (twin: mean 107.4 days, single: mean 92.0 days), non-pregnant period (twin: 154.8 days, single: 132.2 days), and number of insemination (twin: mean 2.00 times, single: mean 1.87 times) of twin pregnancy were increased as compared with single pregnancy. In abomasal displacement cows, first artificial insemination period (twin: mean 122.9 days, single: mean 106.0 days), non-pregnant period (twin: 172.4 days, single: 152.0 days), and number of insemination (twin: mean 2.16 times, single: mean 1.89 times) of twin pregnancy were increased as compared with single pregnancy. The prevalence of complication such as retained placenta, abomasal displacement with single or twin births increased first artificial insemination period, non-pregnant period, and number of insemination period.
Displacement (Psychology) ; Fertility ; Humans ; Insemination ; Insemination, Artificial ; Korea ; Parturition ; Placenta, Retained ; Pregnancy ; Pregnancy, Twin ; Prevalence ; Twins

The objective of this study was to evaluate the duration of retained placenta (RP) on postpartum diseases and culling in dairy cows. Data were collected from 456 Holstein cows between 2008 and 2010. RP (> or = 24 h after parturition) and postpartum diseases were diagnosed by farm managers and a veterinarian according to standardized definitions. The overall incidence rate of RP was 14.0%, and the incidence rate of RP with fourth and higher parity was two times that of cows having offspring for the first time. The duration of RP was 2 to 15 days with a mean of 6.8 days, except for cases of fourth and higher parity which had a mean of 10.5 days. A total of 63% of cows with RP had postpartum diseases. Among the cows diagnosed with RP, 23.4% developed metritis, and of those, 35.3% developed endometritis or pyometra. A total of 25% (n = 16) cows with RP were culled within 60 days in milk (DIM) and of those culled, 75% (n = 12) had postpartum diseases. These results suggest that RP increases the risk of postpartum diseases such as metritis and mastitis and is a culling hazard up to 60 DIM.
Endometritis ; Female ; Humans ; Incidence ; Mastitis ; Milk ; Parity ; Placenta, Retained ; Postpartum Period ; Pyometra ; Veterinarians

Angular pregnancy refers to implantation of the embryo just medial to uterotubal junction in the lateral angle of the uterine cavity. This is differentiated from interstitial pregnancy in which the gestational sac is located within intramural portion of the tube. Angular pregnancy is categorized as intrauterine pregnancy and the outcome is known favorable. However, there have been few reports about adverse perinatal complications such as abortion, retained placenta, placenta accreta, placenta percreta and uterine rupture. We report a case of angular pregnancy complicated with preterm labor at 25 gestational weeks, placenta accreta and postpartum endometritis. This case suggests that angular pregnancy should be differentiated from normal intrauterine pregnancy because of its potential risk of adverse outcome.
Embryonic Structures ; Endometritis ; Female ; Gestational Sac ; Obstetric Labor, Premature ; Placenta Accreta ; Placenta, Retained ; Postpartum Period ; Pregnancy ; Uterine Rupture

Placenta accreta is a rare condition in which the placenta abnormally attaches to myometrium. It is associated with a high maternal morbidity and mortality rate due to massive hemorrhage, perforation, and infection. It is very rare to have placenta accreta in first trimester. Traditionally, hysterectomy has been the most performed management in abnormal placentation. Because it cannot preserve fertility, the conservative management such as methotrexate usage, and uterine artery embolization are pursued, recently. For monitoring the efficacy of the conservative management, serum human chorionic gonadotrophin (hCG) level has been used, however, low hCG does not always reflect the success of the treatment. 3D-ultrasonography is a new method to pursue the effect of conservative care, by measuring the volume of placenta accreta left in situ. We present a case of a 23-year-old patient with retained placenta accreta following dilatation and curettage, under a successful methotrexate treatment. The effect of methotrexate usage was evaluated by 3D-volume.
Animals ; Chorion ; Dilatation and Curettage ; Female ; Fertility ; Hemorrhage ; Humans ; Hysterectomy ; Methotrexate ; Mice ; Myometrium ; Placenta ; Placenta Accreta ; Placenta, Retained ; Placentation ; Pregnancy ; Pregnancy Trimester, First ; Uterine Artery Embolization ; Young Adult