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Results for “Uterine Retroversion”

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PubMed1994

A comparison of pregnancy loss between transcervical and transabdominal chorionic villus sampling.

OBJECTIVE: To evaluate the comparative safety of transcervical and transabdominal chorionic villus sampling (CVS). METHODS: From May 1988 to January 1992, CVS was performed by two operators at 9-12 weeks' gestation in 1048 singleton pregnancies. The sampling method for each patient, transabdominal or transcervical, was chosen primarily based upon placental location; the transabdominal route was used for anterior or fundal location and the transcervical route for posterior placentation. Perinatal outcome was assessed by post-procedure patient telephone contact, mid-gestation ultrasound evaluation, postpartum questionnaire completed by the referring obstetrician, and telephone interview with each patient after delivery. RESULTS: Complete follow-up was available in 1012 cases (97%). Excluding 39 elective abortions, 35 of 973 euploid pregnancies aborted spontaneously. The difference in fetal loss rate between transcervical and transabdominal CVS approached statistical significance (5.2 versus 2.9%; P = .058). Bleeding before CVS (P = .006) and multiple placental aspirations (P = .022) were associated with fetal loss for the entire study group. An interaction between uterine position and sampling method was also indicated; an increased loss rate was associated with transcervical CVS in the presence of uterine retroversion (P = .0017). CONCLUSION: Despite choosing the preferred CVS method for each patient, an increased loss rate may be associated with transcervical sampling in the presence of uterine retroversion.

Abdomen↗

PubMed2002

Laparoscopic uterine suspension by round ligament plication.

OBJECTIVE: To describe a method for laparoscopic uterine suspension by round ligament plication using standard suturing instruments. STUDY DESIGN: Forty-six women underwent uterine suspension for treatment of chronic pelvic pain due to uterine retroversion over a period of five years. All operations were performed by the principal author. RESULTS: Forty-six patients treated with this technique were selected from 388 who underwent clinical evaluation and diagnostic laparoscopy for chronic pelvic pain, defined as lasting more than six months. There were no intraoperative complications in this series. Mean follow-up was 23.6 months (range, 6-42). At each follow-up, patients were asked to rate their pain relative to preoperatively as unchanged, minor, moderate, significant or resolved. At six months, 44 of 46 patients (96%) reported at least some improvement, with 17 (37%) reporting significant improvement, and 18 (39%) reporting resolution of pain. Sixteen of 27 patients (59%) at 24 months' follow-up and 15 of 23 patients (65%) with 36 months' follow-up reported significant improvement in or resolution of their pain. CONCLUSION: For patients experiencing chronic pelvic pain associated with uterine retroversion, round ligament plication is an effective method of repositioning the uterus and reducing or eliminating the patient's symptoms.

Adult↗

PubMed2000

Laparoscopic uterine suspension using three-stitch technique.

We conducted a prospective, longitudinal study to assess the efficacy of a new laparoscopic hysteropexy technique in alleviating pelvic pain. Subjects were 50 women of reproductive age with chronic pelvic pain or dyspareunia in whom the only clinical finding was uterine retroversion who underwent laparoscopic uterine suspension using three-stitch technique. There were no intraoperative complications. The only postoperative complication was abdominal pain in one woman. The technique was effective in relieving symptoms in these patients. Of the 22 women who had associated infertility for longer than 3 years, 10 became pregnant within 1 year after surgery. This benefit, however, is likely due to couples' improved sex life rather than change in surgical axis of the uterus.

Adult↗

PubMed2006

Cesarean delivery by posterior hysterotomy due to torsion of the pregnant uterus.

BACKGROUND: We describe a case of cesarean delivery by posterior hysterotomy in a woman with uterine torsion secondary to a blocked retroverted uterus. CASE: At 28 weeks of gestation this patient's fetus was found to have club feet, initially suspected to be secondary to sacculation of the posterior uterine segment. At cesarean delivery, intraoperative inspection revealed the uterus to be twisted 180 degrees without evidence of posterior sacculation. The uterine incision was performed on the posterior aspect of the lower uterine segment. CONCLUSION: Fixed uterine retroversion with torsion is associated with fetal abnormalities and may require a posterior uterine incision.

Adult↗

PubMed1992

Laparoscopic uterine suspension.

Laparoscopic uterine suspension is an effective method of correcting symptomatic uterine retroversion. Eighty patients with deep dyspareunia reproduced by palpation of their retroverted uterus underwent a modified Gilliam uterine suspension under laparoscopic visualization. There were no intraoperative or postoperative complications requiring laparotomy, and symptoms were relieved in 74 patients.

Adolescent↗

PubMed1997

The role of laparoscopy in the management of pelvic pain in women of reproductive age.

OBJECTIVE: To review the diagnostic and therapeutic roles of laparoscopy in women of reproductive age with acute and chronic pelvic pain. DATA IDENTIFICATION: Studies relating to the use of laparoscopy in women with acute and chronic pelvic pain were identified through the literature and MEDLINE searches. CONCLUSION(S): Laparoscopy has an important place in the management of conditions that cause acute pelvic pain in women of reproductive age, including ectopic pregnancy, pelvic inflammatory disease, tubo-ovarian abscess, and adnexal torsion. The procedure frequently facilitates the diagnosis and provides the necessary access for surgical treatment. Prompt diagnosis and effective management prevent complications and help preserve fertility. The role of laparoscopy in women with chronic pelvic pain is more controversial and limited, but abnormal laparoscopic findings are detected in approximately 60% of those who have undergone a multidisciplinary investigation and received a tentative clinical diagnosis. The access provided by laparoscopy permits the effective surgical treatment of many of the conditions encountered, including endometriosis, pelvic adhesions, ovarian lesions, and symptomatic uterine retroversion.

Adnexal Diseases↗

PubMed1995

A series of 1000 consecutive out-patient diagnostic hysteroscopies.

OBJECTIVE: To review the success of out-patient diagnostic hysteroscopy. METHOD: Retrospective review of 1000 consecutive out-patient hysteroscopies. RESULTS: Hysteroscopy was successfully performed in 96%. Cervical dilatation was required in 15.0% and local anaesthesia was administered in 31.4%; 77.3% of those requiring cervical dilatation received local anaesthesia. Intrauterine pathology was noted in 49.3%. The procedure failed in 40 (4%) patients for the following reasons: pain or anxiety in 23, cervical stenosis in 11, equipment failure in 4, and extreme uterine retroversion and inadvertent false cavity formation in one case each. CONCLUSION: Out-patient diagnostic hysteroscopy is a safe, well tolerated and successful investigation procedure in the majority of patients and should be the procedure of choice for suspected intrauterine pathology.

Adult↗

PubMed1992

Factors associated with multiple-pass procedures during chorionic villus sampling: a video analysis.

Multiple placental passes during chorionic villus sampling (CVS) increase the risk of fetal loss; however, specific factors that predispose to repeat aspiration have not been delineated. To identify anatomic and technical variables associated with multiple-pass procedures, a detailed review of 205 videotaped CVS procedures (single pass = 163; multiple pass = 42) was performed, blinded to pregnancy outcome. The route of sampling did not influence the need for multiple aspiration attempts (transabdominal--30/135; transcervical--12/70), nor was placental location alone discriminatory. However, the combination of a posterior placenta and uterine retroversion was observed more frequently in the multiple-pass cohort (8/42 vs. 9/163; p less than 0.05). In transabdominal cases, suboptimal needle placement (e.g., perpendicular to the placental long axis) was more common in the initial aspiration of a multiple-pass procedure (21/30 vs. 38/105; p less than 0.01), while limited penetration of the catheter tip (e.g., just inside the placental edge) characterized a majority of multiple-pass cases in the transcervical subset (7/12 vs. 3/58; p less than 0.0001). A case-control cohort was constructed to evaluate the impact of these technical variables on sampling efficacy, independent of the influence of uterine position and placental site. In that analysis, suboptimal location and/or orientation of the sampling device remained characteristic of multiple-pass cases. We conclude that further reduction in the frequency of multiple-pass procedures might be achieved by consistent placement of the device tip in the central placental mass. Unlike amniocentesis, where any point of amnion entry will suffice, this technical nuance should be emphasized with CVS to maximize the single-pass success rate.

Case-Control Studies↗

PubMedDate not supplied

Operative laparoscopy for uterine pathology.

In the first years of its use, operative laparoscopy for uterine pathology was employed in the surgical treatment of myomas and in the correction of uterine retroversion (hysteropexy). More recently the technique has been employed for the laparoscopically assisted hysterectomy or for subtotal laparoscopical hysterectomy using the Semm Kit. Also radical hysterectomy has been performed in advanced centers by laparoscopy. In this paper, the Authors discuss the indications, the counterindications, the risks and complications of the operative laparoscopy in the different forms of ovarian pathology.

Female↗

PubMedDate not supplied

[Post-partum urogenital and perineal prolapse].

BACKGROUND: It is well known that vaginal birth, even under apparently normal circumstances, involves a significant mechanical straining of the various muscular connective structures which make up the pelvic floor and that an unusual strain of the perineal plates can cause morphologic-functional alterations which are not entirely reversible. The integrity of structures which make up the "pelvic floor" and the "endopelvic fascia" is the fundamental element to maintaining a normal anatomic position of the pelvic organs in the various functional conditions. Consequently prolapse of female pelvic organs can be linked back to the functional limitations of perineal plates (muscular support fascia system) and/or of the ligaments of the sub-peritoneal endopelvic connective tissue (ligament suspension system). METHODS: After birth 537 mothers underwent a urological and gynecological examinations as follows: collection of clinical data regarding pregnancy development and birth; medical history regarding the number of day- and night-time urinations, urinary volume, possible encouraging factors and pre-urinary sensations; objective urological and gynecological examination (pubo-coccygeal test, highlighting of possible agonistic and antagonistic muscular synergies, stress test, evaluation and staging of vaginal prolapse according to Baden and Walker; instrumental evaluation in cases of post-partum urinary incontinence. Simple regression analyses were carried out where prolapse of various vaginal segments were proportionately related to the various risk factors. RESULTS: Maternal age at birth, parity, weight before pregnancy and at term, weight increase, duration of second stage of labour, development and characteristics of the birth, perineal condition and neonatal weight were all variables considered risk factors while prolapse in each vaginal segment, PC-test, involuntary reflex execution of opposite command and uterine retroversion were all "response variables" whose dependence on various risk factors was studied. Analysis of the associations between the various pairs of variables showed a correlation, both positive and negative, whether the population considered was that of all mothers or that of primiparae. CONCLUSIONS: In the light of the results of this study, it can be said that there are two important pathogenetic factors: the tissue factors and the iatrogenic factor. Elevated maternal age and multiparity underline the role of the tissue factor in the pathogenesis of obstetric perineal damage. With regard to the iatrogenic factor it is interesting to note a higher concentration of symptomatic women cases where labour had been induced or birth had been achieved through instrumental delivery.

Analysis of Variance↗

PubMed1996

Are there any clinical signs and symptoms that are related to endometriosis in infertile women?

OBJECTIVE: Our purpose was to assess the physical signs and clinical symptoms associated with endometriosis in infertile women. STUDY DESIGN: This case-control study was carried out in an academic tertiary hospital. There were 174 infertile women with endometriosis and 174 infertile women without endometriosis, all of them studied by laparoscopy. Before laparoscopy a standard interview and a standard physical examination were performed. RESULTS: Cul-de-sac nodularity was more frequent in infertile women with endometriosis than in infertile women without endometriosis (6.3% vs 0%). Although uterosacral tenderness was also more frequent in infertile women with endometriosis (7.5% vs 1.7%), uterosacral tenderness without nodularity was similar in both populations. Uterine retroversion and cul-de-sac obstruction frequencies were somewhat higher in the endometriosis group (p<0.10). The remaining signs and symptoms analyzed, including pelvic pain and dysmenorrhea, were similarly frequent in both populations. Symptoms were similarly frequent in all American Fertility Society stages, although adnexal mass was higher in stage IV. CONCLUSION: Uterosacral nodularity was pathognomonic of endometriosis in infertile women. Uterosacral nodularity and uterosacral tenderness (associated with uterosacral nodularity) were the only symptoms or signs of value to indicate endometriosis in infertile patients. The remaining clinical signs, as well as clinical symptoms, were of no value in diagnosing endometriosis in infertile women.

Biopsy↗

PubMed1982

Etiological factors in tubal infertility.

An analysis was made of the history of 820 patients who underwent diagnostic laparoscopy for infertility reasons. Events in the patient's history related to abdominal surgery, infection of the genital tract, and endometriosis were compared with the incidence of tubal disease at laparoscopy. Salpingitis, puerperal endometritis, gynecologic operations such as ovarian cystectomy, wedge resection, and operative correction of uterine retroversion and appendicitis complicated by perforation of the appendix, inflammatory mass or appendiceal abscess, were all associated with a significantly higher incidence of tubal disease. In patients that had undergone an uncomplicated appendectomy, the occurrence of tubal abnormalities was not increased (42%), when they were compared with the group with a completely negative history (37%). Implications of these findings with relation to the prevention of tubal disease are discussed.

Adult↗

PubMed2000

Laparoscopic plication and suspension of the round ligament for chronic pelvic pain and dyspareunia.

STUDY OBJECTIVE: To describe a technique of uterine suspension using round ligaments to relieve pain in selected patients with various degrees of uterine retroversion. DESIGN: Prospective clinical study (Canadian Task Force classification II-2). SETTING: University-based center for reproductive medicine. PATIENTS: Thirty women who underwent laparoscopy for investigation of chronic pelvic pain (CPP) and dyspareunia. INTERVENTION: Round ligaments were plicated using a modification of intracorporeal knot tying during laparoscopy. MEASUREMENTS AND MAIN RESULTS: The extent of plication was planned to elevate the uterus and bring it minimally forward. Mean +/- SD operating time was 14+/-4 minutes. Pain scores before and after surgery were 4.5+/-1.0 and 1.6+/-0.6, respectively (p<0.001). There were no complications during or after surgery. Only three women had minimal dyspareunia postoperatively, although they had anteverted uteri. One patient had severe dyspareunia that developed 7 months after surgery and continued through the second year of follow-up. Nineteen women with anteverted uteri were free of dyspareunia after 2 years. CONCLUSION: Round ligament plication is safe and effective in patients with retroverted uteri and dyspareunia or CPP.

Adult↗

PubMed1991

Minimal incision Pereyra needle uterine suspension.

Ten patients underwent uterine suspension in conjunction with extensive operative laparoscopy or as primary treatment for deep thrust dyspareunia due to fixed uterine retroversion. Of the 10 patients, 9 had satisfactory relief of symptoms. The Pereyra needle allows the use of very small suprapubic incisions with little increase in operative morbidity or discomfort.

Adult↗

PubMed1985

Unexplained infertility: a review.

When investigations fail to reveal a cause for infertility, treatment must then be based on possible, but unproven, causes, and since there is a high spontaneous pregnancy rate in unexplained infertility the effect of any treatment is difficult to assess. Such treatment has included correction of anatomical variants such as uterine retroversion and the use of hormonal manipulation during the follicular and luteal phases of the menstrual cycle. Ovum entrapment, occult spontaneous abortion and faults in sperm fertilizing capacity have all been implicated, and it is likely that immunological factors play a substantial role in unexplained infertility. Evidence does not support the use of bromocriptine in the absence of hyperprolactinaemia. Successful treatment by intrauterine insemination is unlikely if there are circulating anti-sperm antibodies in the partner. Improving cervical mucus by treatment with oestrogens and clearing infections with antibiotics may have a modest place but it is very difficult to show that these treatments have more than a placebo effect. Endometriosis is often missed and the possibility of it having developed after initial investigation warrants repeat laparoscopy after 2 years. Three approaches are currently acceptable in the management of the couple with unexplained infertility: await spontaneous pregnancy, the empirical use of clomiphene and in-vitro fertilization.

Adult↗

PubMed1999

[Clinical presentation and natural history of endometriosis].

Natural history of endometriosis is unpredictable. Some recent data show that endometriosis is a progressive disease. Minimal lesions are transient and peritoneal implants are reorganized continuously. So, minimal endometriosis could be considered like a transient statement close to physiology. In favourable statement such as the decreased activation of NK cells, the variable secretions of cytokines, pelvic macrophages and growth factors, the peritoneal implants evoluted like a progressive disease until severe endometriosis. Endometriosis is a frequent cause of pelvic pain with dysmenorrhea, dyspareunia, chronic pelvic pain and infertility. The diagnosis can be suspected by a clinical examination preferentially during menstruation with fixed uterine retroversion peritoneal infiltration, retraction of the rectum and retrovaginal endometriosis, and adnexal cyst.

Adnexal Diseases↗

PubMed1975

[The comparative value of ultrasound examinations and quantitative determinations of chorionic gonadotropin in the differential diagnosis of the disturbed early pregnancy (author's transl)].

The diagnostic value of ultrasound examinations is compared to the diagnostic value of determinations of the chorionic gonadotropin (HCG) excretion in normal and abnormal early pregnancy. 330 pregnancies between 5 and 16 weeks gestation were examined. there were 78 cases of normal early pregnancy, 131 cases of threatened abortion, 29 cases of missed abortion and 92 cases of incomplete abortion. the diagnostic accuracy of ultrasound examination was 95,5% in 582 determinations, the HCG excretions showed a diagnostic accuracy of 87,1%. The combined accuracy of both methods reduced the diagnostic error to 0,58%. The results in the different groups of patients were compared. Errors in ultrasound diagnosis decrease with increasing gestational age. Diagnostic errors were especially observed in cases of uterine retroversion, obesity or unknown menstrual history. The diagnostic accuracy of the HCG excretion is improved by serial determinations.

Abortion, Incomplete↗

PubMed1991

Percutaneous transvesical chorionic villus sampling: an alternative approach to the retroverted uterus.

In 458 consecutive chorionic villus sampling (CVS) procedures, we observed a significant influence of uterine position upon sampling efficacy. Compared with anteverted (N = 243) or axial (N = 149) locations, the retroverted uterus (N = 66) was associated with a lower mean sample weight per aspiration (22, 18, and 15 mg, respectively; P less than .01) and a greater frequency of multiple-pass procedures (23, 31, and 52%, respectively; P less than .0001). To improve sampling efficiency in selected cases of uterine retroversion, we adopted a transvesical approach. When compared with transabdominal or transcervical techniques, transvesical CVS had the highest single-pass success rate (33, 33, and 60%, respectively). Only one in 30 transvesical cases required three placental passes, compared with nine of 36 retroverted uteri sampled by either transabdominal or transcervical techniques (P less than .05). The mean transvesical sample weight was 18.7 mg; at least 10 mg was retrieved in all cases. Post-procedure bleeding occurred in four instances and an additional patient suffered a spontaneous loss at 16 weeks' gestation. Aneuploidy was found in four of 30 biopsy specimens, and the remaining pregnancies either have delivered at term (N = 18) or are continuing (N = 7). Our preliminary experience suggests that selected use of this CVS method may improve sampling efficiency without increasing the incidence of complications.

Analysis of Variance↗