DOCSLIB.ORG

A Delayed Therapy of Dysmenorrhea Due to Noncommunicating Rudimentary Horn and Unicornuate Uterus: Case Report and Review of the Literature

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Delayed Therapy of Dysmenorrhea Due to Noncommunicating Rudimentary Horn and Unicornuate Uterus: Case Report and Review of the Literature J Cases Obstet Gynecol, 2016;3(3):80-82 J o u r n a l o f C a s e s i n Obs tetrics & G ynecology Case Report A delayed therapy of dysmenorrhea due to noncommunicating rudimentary horn and unicornuate uterus: Case report and review of the literature Ali Sami Gurbuz1,*, Necati Ozcimen2, Emel Ebru Ozcimen3, Ahmet Salvarcı4, Serdar Altunay5 1Novafertil IVF Center, Obstetrics and Gynecology Department 2Medicana IVF Center, Obstetrics and Gynecology Department 3Baskent University Hospital, Perinatology Department 4Novafertil IVF Center, Urology Department 5Selcuk University, Pathology Department Abstract Although asymptomatic cases naturally occur, congenital mullerian abnormalities can present with infertility, menstrual irregulari- ty and recurrent pregnancy loss. Women with normal reproductive outcomes and recurrent pregnancy loss exhibit approximately 2-4% and 5-10% incidence of various congenital mullerian abnormalities. Following septate uterus, bicornuate uterus and arcuate uterus, unicor- nuat uterus is the fourth most frequent congenital uterine abnormality seen in a combined population of infertile and fertile women. Uni- cornuate uterus with a non-communicating functional rudimentary horn is a type of mullerian anomaly and is a rare cause of dysmen- orrhea. Here, we presented a case of this kind of abnormality and discussed the management strategies in the light of the literature. Key Words: Dysmenorrhea, mullerian anomaly, unicornuate uterus, rudimentary horn Introduction mal fusion of the mullerian ducts results from anatomical changes in the female genital system. Unicornuate uterus with a rudimentary horn is a rare type of mullerian duct mal- ysmenorrhea is defined as difficult menstrual flow or D formation. The frequency of uterine congenital anomalies painful menstruation. Dysmenorrhea is a common com- is 1/200 to 1/600 and 1/100000 for rudimentary horn [4]. plaint of women especially adolescent girls are affected. A non-communicating rudimentary horn usually has inac- The prevelance of dysmenorrhea is about 25% which its tive endometrium but can be associated with complications possible cause is the spasmic contraction of uterus [1]. It from menarche to menopause such as endometriosis, pri- can be divided in to 2 broad categories; primary (occuring mary infertility, hematometra, anomalies of the urinary sys- in the absence of pelvic pathology) and secondary (resulting tem and obstetrical problems such as malpresentation, ha- from organic diseases). Pharmacotherapy especially non- bitual abortus, ectopic pregnancies and premature birth [5]. steroidal anti inflammatory drugs (NSAID) are the most A middle aged women who has severe and intractible dys- effective treatment choices in primary dysmenorrhea [2]. menorrhea with noncommunicating rudimentary horn is There are some organic causes of secondary dysmenorrhea. reported here and discussed in the light of the literature. One of them is the congenital mullerian malformation of the uterus as bicornuate uterus or subseptate uterus [3]. Abnor- Case Presentation Article History: Received: 08/02/2016 Accepted: 09/05/2016 A 37-year-old woman with gravida:2 who had 2 vag- inal deliveries attended to gynecology department of our *Correspondence: Ali Sami Gurbuz Address: Novafertil IVF Center, Konya Turkey hospital with complaints of dysmenorrhea, severe cy- E-mail: [email protected] clic pelvic pain from menarche. The pelvic pain was Phone: +90 533 5530442 80 Journal of Cases in Obstetrics & Gynecology J o u r n a l o f C a s e s i n Obs tetrics & G ynecology typically felt over the right lower abdomen and used to start before the menstrual cycle and lasted during men- Figure 2. strual cycle. She used various analgesics for long years. On examination, no abnormality was detected on system- ic examination. Transvaginal ultrasonography showed us unicornuate uterus with non-communicating rudimentary horn. In the cavity of rudimentary horn, active endometri- um echogenicity was observed. To confirm the diagnosis, magnetic resonance imaging (MRI) was performed. Intra- venous pyelography also confirmed right renal agenesis. Figure 1. Hysterosalpingography of the patient which demonstrates unicornuat uterus Discussion Unicornuate uteus with non-communicating rudimentary horn is rare form of mullerian abnormalities which is also an important cause of dysmenorrhea. It causes cyclic pain due to intracavitary retentation of menstrual effluent and retro- grade menstrual flow. If there was no relationship between ru- Transvaginal ultrasonographic view of the rudi- dimentary horn and main functional endometrial cavity, he- mentary horn containing endometrial stripe matometra and maybe hematosalpinx would be observed [6]. Other mechanism of dysmenorrhea in unicornuate uter- Laparoscopy was planned but because of the adhesions us with rudimentary horn is the endometriosis. These pa- between intestines and rudimentary horn, laparotomy was tients usually attend to gynecology or emergency depart- performed for not to cause intestinal injury. No endome- ments with severe pain or pelvic mass [7]. Agarwal et al. triosis was observed in the abdomen. On laparotomy, the reported a 18-year-old woman who developed endome- right –sided rudimentary horn was excised. Cystoscopy triosis and had severe pelvic pain. Generally it is consid- was performed by urology doctor which revealed non-vi- ered to become the adolescent girl’s pathology but here sualization of the right ureteric orifice with normal left ure- we presented a 37-year-old woman with this abnormality teric orifice and bladder mucosa. The postoperative period with two vaginal deliveries. Borah et al. presented again was uneventful and the patient was discharged on the 2nd an adolescent girl with primary dysmenorrhea with similar day of operation. Histopathologic evaluation of the spec- mullerian abnormality [8]. The management of these two imen revealed a rudimentary horn with active endometri- cases were excision of the rudimentary horn. The wom- al and myometrial tissue (Figure 3). The dysmenorrhea en with primary dysmenorrhea are not evaluated in detail complaint was not observed during the follow-up period. during routine examination [2,8]. But a good transvaginal ultrasonography is enough for diagnosis but pelvic mag- netic resonance imaging (MRI) is good for confirmation of the diagnosis. This mullerian abnormality may be related 81 www.jcasesobstetgynecol.com July 2016 Gurbuz et al. with infertility, recurrent pregnancy loss, preterm deliv- ery and ectopic pregnancy. There may be coexisting uri- Figure 3. nary tract abnormalities like unilateral renal agenesis [8,9]. In this case drug resistant primary dysmenorrhea and uni- lateral renal agenesis were observed. Two term uneventful pregnancies were delivered vaginally. In the literature the laparoscopic excision of the rudimentary horn is offered for possible severe complications [3,10]. But as in our case se- vere adeshions can make laparoscopy difficult. If a woman complains about primary dysmenorrhea from menarche and presents with unilateral pelvic mass a mullerian anomaly should be remembered and shoud be evaluated carefully. Acknowledgement None Declaration of Interest None Histopathological evaluation of the rudimentary horn specimen References 1. Durain D.Primary dysmenorrhea: As- adenomyosis treated with laparoscopic hemihyster- ropean Journal of Obstetrics and Gynecology and sesssment and management update.J Mid- ectomy.Case Reports in Obstet.and Gynecol.Vol .2013 Reproductive Biology, vol.47, pp. 135–139, 1992 wifery Womens Health 2004;49:520-8. 5. Kuscu NK, Lacin S, Kartal O. Rupture of ru- 8. Agarwal M,Das A.,Singh AS.:Dysmenorrhea 2. Borah T,Ananya D,Panda S,Singh S. .A dimentary horn pregnancy at the 15th due to a rare mullerian anomaly.Nigerian Jour- case of unilateral dysmenorrhea.J Hum Re- week of gestation: a case report. Eur J Ob- nal of Clinical Practice Jul-Sep 2011 vol.14 377-79. prod Sciences.Volume 3 Issue 3 Sep-Dec 2010. stet Gynecol Reprod Biol. 2002;102:209 –210. 9. Heinonen PK. Unicornuate uterus and ru- 3. A.N.Fenton and B.P.Singh,’’Pregnancy associat- 6. Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker dimentary horn. Fertil Steril 1997;68:224-30. ed with congenital abnormalities of the female re- S, De Angelis C, Gergolet M, Li TC, Tanos V, Brölmann 10. Fedele,S. Bianchi,G.Zanconato,N.Berlan- productive tract.’’The American Journal of Obstet- H, Gianaroli L, Campo R. The ESHRE/ ESGE consen- da,and Bergamini,’’Laparoscopic removel of rics and Gynecology, vol.63,no.4,pp.744-755,1952. sus on the classification of female genital tract con- the cavited noncommunicating rudimentary 4. Morelli M, Venturella R,Mocciaro R,Lico D,Zu- genital anomalies. Hum Reprod. 2013;28:2032-44. uterine horn:surgical aspects in 10 cases,’’Fer- llo Fulvio: An unusual extremely distant non- 7. P. F. Donderwinkel, J. P. D¨orr, and W. N. Willemsen, tility and Sterility,vol.83,no.2,pp.432-436,2005. communicating uterine horn with myoma and “The unicornuate uterus: clinical implications,” Eu- 82 Journal of Cases in Obstetrics & Gynecology.
Load more

Recommended publications
  • Dysmenorrhea Due to a Rare Müllerian Anomaly
    CASE REPORT Dysmenorrhea due to a rare müllerian anomaly M Agarwal, A Das, AS Singh Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences Shillong, India Abstract Müllerian duct anomalies may produce reproductive failure like abortion and preterm birth, or obstetric problems like malpresentation, retained placenta, etc., or they may be asymptomatic. Unicornuate uterus with a noncommunicating functional rudimentary horn is a type of müllerian anomaly that results in obstruction to menstrual blood flow, leading to endometriosis and dysmenorrhea. Though the majority of cases of dysmenorrhea in adolescents are primary in nature and require only reassurance and symptomatic management, it is important to be aware of rare causes such as müllerian anomalies so that these cases can be properly managed. Hence, we present this case report, with interesting illustrations, so as to increase awareness regarding these anomalies. Key words: Dysmenorrhea, müllerian anomaly, unicornuate uterus Date of Acceptance: 13-Feb-2011 Introduction department with complaints of severe pain in the lower abdomen during her menses for the last 6 months. Apart Unicornuate uterus with a rudimentary horn is a rare type from severe dysmenorrhea there was no other menstrual of müllerian duct malformation and is the result of defective abnormality. Her vitals and per abdominal examination fusion of the malformed duct with the contralateral duct.[1] findings were normal. Ultrasonography of the abdomen The incidence of unicornuate uterus, although not precisely suggested the possibility of unicornuate uterus with right- known, is estimated at 1/1000 women.[2] A noncommunicating sided hematosalpinx and hematometra; also, the right rudimentary horn with a functional endometrial cavity is rare kidney was not visualized.
    [Show full text]
  • N35.12 Postinfective Urethral Stricture, NEC, Female N35.811 Other
    N35.12 Postinfective urethral stricture, NEC, female N35.811 Other urethral stricture, male, meatal N35.812 Other urethral bulbous stricture, male N35.813 Other membranous urethral stricture, male N35.814 Other anterior urethral stricture, male, anterior N35.816 Other urethral stricture, male, overlapping sites N35.819 Other urethral stricture, male, unspecified site N35.82 Other urethral stricture, female N35.911 Unspecified urethral stricture, male, meatal N35.912 Unspecified bulbous urethral stricture, male N35.913 Unspecified membranous urethral stricture, male N35.914 Unspecified anterior urethral stricture, male N35.916 Unspecified urethral stricture, male, overlapping sites N35.919 Unspecified urethral stricture, male, unspecified site N35.92 Unspecified urethral stricture, female N36.0 Urethral fistula N36.1 Urethral diverticulum N36.2 Urethral caruncle N36.41 Hypermobility of urethra N36.42 Intrinsic sphincter deficiency (ISD) N36.43 Combined hypermobility of urethra and intrns sphincter defic N36.44 Muscular disorders of urethra N36.5 Urethral false passage N36.8 Other specified disorders of urethra N36.9 Urethral disorder, unspecified N37 Urethral disorders in diseases classified elsewhere N39.0 Urinary tract infection, site not specified N39.3 Stress incontinence (female) (male) N39.41 Urge incontinence N39.42 Incontinence without sensory awareness N39.43 Post-void dribbling N39.44 Nocturnal enuresis N39.45 Continuous leakage N39.46 Mixed incontinence N39.490 Overflow incontinence N39.491 Coital incontinence N39.492 Postural
    [Show full text]
  • Left Twisted Hydrosalpinx Presenting As Acute Abdomen
    The Journal of Obstetrics and Gynecology of India January/February 2011 pg 81 - 82 Case Report Left Twisted Hydrosalpinx Presenting as Acute Abdomen Pawar Uddhav1, Ghanekar Mahendra2 Department of Obstetrics and Gynaecology, Goa Medical College, Goa . A 30-year-old para 3 not sterilized was admitted on hemorrhage within i.e. in other words a left twisted 18.01.2006 with a history of acute pain in the abdomen hematosalpinx (Fig. 1 & 2 – the red arrow showing the of one day duration. She was in the 10th day post hematosalpinx and the gloved hand holding the uterus). menstrual cycle.. There was no history of dysmenorrhea. From the rest of her history all other The left ovary was normal and rest of the pelvic non gynecological causes of acute abdomen were ruled structures did not reveal any pathology. Left out. salpingectomy was done and as the patient desired ligation, right sided tubal ligation was also carried out. On examination her vitals were stable barring a mild The patient was discharged on 24.01.2006. The tachycardia; pulse rate=94/min. Per abdomen postoperative period was uneventful. The patient was examination there was tenderness in the left iliac fossa, given IV ofloxacin and IV-metronidazole for 24 hrs and no guarding or rigidity and bowel sounds were present. then switched over to oral ofloxacin for 10 days. She Bimanual pelvic examination revealed normal sized was asked to follow up with the histopathology reports uterus with tender cystic mass in left adnexa after 15 days. She followed up on 11.02.2006. The report approximately 4X4 cm and cervical motion tenderness was: gross - tube dilated and tortuous appearing bluish was positive.
    [Show full text]
  • Unusual Traumatic Uterine Injury: First Reported Cervicouterine Transection
    178 Case report Unusual traumatic uterine injury: first reported cervicouterine transection Ettedal A. Aljahdali Cervical agenesis is one of the Müllerian developmental management. Ann Pediatr Surg 14:178–181 © 2018 Annals anomalies that can occur and is usually associated with of Pediatric Surgery. vaginal atresia rarely isolated. Here we are reporting a case Annals of Pediatric Surgery 2018, 14:178–181 that has been referred as cervical agenesis and found to be a cervicouterine transection, so far not reported in literature. Keywords: cervical agenesis, cervicouterine transection, hematometra, primary amenorrhea, uterine injury We report a case of traumatic cervicouterine transection in 08/07/2018 on BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3l7ttZ9b/VuKxIwH3Dy/2pqEl0VxTbhh37J87j9nSKYU= by https://journals.lww.com/aps from Downloaded teenager patient who presented with amenorrhea and Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia hematometra. She was primarily investigated and found Downloaded to have intact full length cervical canal, normal uterus, Correspondence to Ettedal A. Aljahdali, MBBCh, SBOG, CBG OBGYN AFSA, Department of Obstetrics and Gynecology, King Abdulaziz University Hospital, and urinary system. Operative management confirmed PO Box 80215, Jeddah 21589, Saudi Arabia from our diagnosis of transection rather than agenesis with Tel: + 966 504 637 282; e-mail: [email protected] https://journals.lww.com/aps her history of trauma at
    [Show full text]
  • Isolated Twisted Hematosalphinx Misleading with Ovarian Cyst Torsion
    International Journal of Reproduction, Contraception, Obstetrics and Gynecology Khairnar V et al. Int J Reprod Contracept Obstet Gynecol. 2019 Mar;8(3):1219-1222 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20190911 Case Report Isolated twisted hematosalphinx misleading with ovarian cyst torsion Vaibhav Khairnar*, Shalini Mahana Valecha, Pandeeswari Department of Obstetrics and Gynecology, ESI-PGIMSR, Mumbai, Maharashtra, India Received: 05 December 2018 Accepted: 05 February 2019 *Correspondence: Dr. Vaibhav Khairnar, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Normal or chronically inflamed fallopian tube can undergo torsion and present as acute abdomen, simulating clinically as ectopic gestation. Torsion of the fallopian tube is less frequent but significant cause of lower abdominal pain in reproductive age women that is difficult to recognize preoperatively. Authors present a rare case of hematosalpinx with torsion at its pedicle with hemoperitonium who presented as 28 years old female with acute abdomen that was successfully treated. In cases presenting with hemoperitoneum diagnosis of ruptured ectopic pregnancy should be made unless proved otherwise during reproductive age. Rarely ruptured ovarian cyst may also be a cause. Unfortunately, hematosalpinx sometimes can undergo torsion due to circulatory imbalance and can present as hemoperitoneum and circulatory collapse due to rupture. There have been no specific symptoms, clinical findings, imaging or laboratory characteristics identified for this condition.
    [Show full text]
  • A Choice for Treatment of Heavy Menstrual Bleeding
    D 1205 OULU 2013 D 1205 UNIVERSITY OF OULU P.O.B. 7500 FI-90014 UNIVERSITY OF OULU FINLAND ACTA UNIVERSITATIS OULUENSIS ACTA UNIVERSITATIS OULUENSIS ACTA SERIES EDITORS DMEDICA Sari Ahonkallio ASCIENTIAE RERUM NATURALIUM Sari Ahonkallio Senior Assistant Jorma Arhippainen ENDOMETRIAL THERMAL BHUMANIORA ABLATION University Lecturer Santeri Palviainen CTECHNICA A CHOICE FOR TREATMENT OF HEAVY Docent Hannu Heusala MENSTRUAL BLEEDING DMEDICA Professor Olli Vuolteenaho ESCIENTIAE RERUM SOCIALIUM University Lecturer Hannu Heikkinen FSCRIPTA ACADEMICA Director Sinikka Eskelinen GOECONOMICA Professor Jari Juga EDITOR IN CHIEF Professor Olli Vuolteenaho PUBLICATIONS EDITOR Publications Editor Kirsti Nurkkala UNIVERSITY OF OULU GRADUATE SCHOOL; UNIVERSITY OF OULU, FACULTY OF MEDICINE, ISBN 978-952-62-0142-9 (Paperback) INSTITUTE OF CLINICAL MEDICINE, ISBN 978-952-62-0143-6 (PDF) DEPARTMENT OF OBSTETRICS AND GYNECOLOGY; ISSN 0355-3221 (Print) OULU UNIVERSITY HOSPITAL ISSN 1796-2234 (Online) ACTA UNIVERSITATIS OULUENSIS D Medica 1205 SARI AHONKALLIO ENDOMETRIAL THERMAL ABLATION A choice for treatment of heavy menstrual bleeding Academic dissertation to be presented with the assent of the Doctoral Training Committee of Health and Biosciences of the University of Oulu for public defence in Auditorium 4 of Oulu University Hospital, on 7 June 2013, at 12 noon UNIVERSITY OF OULU, OULU 2013 Copyright © 2013 Acta Univ. Oul. D 1205, 2013 Supervised by Docent Markku Santala Professor Hannu Martikainen Reviewed by Doctor Jyrki Jalkanen Docent Maritta Hippeläinen ISBN 978-952-62-0142-9 (Paperback) ISBN 978-952-62-0143-6 (PDF) ISSN 0355-3221 (Printed) ISSN 1796-2234 (Online) Cover Design Raimo Ahonen JUVENES PRINT TAMPERE 2013 Ahonkallio, Sari, Endometrial thermal ablation. A choice for treatment of heavy menstrual bleeding University of Oulu Graduate School; University of Oulu, Faculty of Medicine, Institute of Clinical Medicine, Department of Obstetrics and Gynecology, P.O.
    [Show full text]
  • Radiological Findings of Uterine Arteriovenous Malformation
    Farias MS et Caseal. / Uterine Report arteriovenous malformation: a case report Radiological findings of uterine arteriovenous malformation: a case report of an unusual and life-threatening cause of abnormal vaginal bleeding* Aspectos radiológicos da malformação arteriovenosa uterina: relato de caso de uma causa incomum e perigosa de sangramento vaginal anormal Marcela Sales Farias1, Clara Campagnaro Santi1, Aline Aparecida A. de A. Lima2, Sabrina Mendes Teixeira3, Tatiana Co Gomes De Biase4 Farias MS, Santi CC, Lima AAAA, Teixeira SM, De Biase TCG. Radiological findings of uterine arteriovenous malformation: a case report of an unusual and life-threatening cause of abnormal vaginal bleeding. Radiol Bras. 2014 Mar/Abr;47(2):122–124. Abstract Uterine arteriovenous malformations may cause life-threatening abnormal genital bleeding in women at childbearing age. Transvaginal Doppler ultrasonography is a widely available, noninvasive and excellent diagnostic method. The authors report the case of a patient with history of gestational trophoblastic disease and multiple curettage procedures who developed uterine arteriovenous malformations, with remission of the lesions after treatment with methotrexate. Keywords: Arteriovenous malformations; Doppler; Abnormal genital bleeding. Resumo Malformações arteriovenosas uterinas podem causar sangramento genital anormal, representando risco de morte nas mulheres em idade reprodutiva. O ultrassom transvaginal com Doppler é um método não invasivo amplamente disponível e excelente ferramenta diagnóstica.
    [Show full text]
  • Niche Role of MRI in the Evaluation of Female Infertility
    Published online: 2021-07-19 OBS AND GYNECOLOGY Niche role of MRI in the evaluation of female infertility Shabnam Bhandari Grover, Neha Antil, Amit Katyan, Heena Rajani, Hemal Grover1, Pratima Mittal2, Sudha Prasad3 Departments of Radiology and Imaging and 2Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, 3Department of Obstetrics and Gynecology, Maulana Azad Medical College, New Delhi, India, 1Department of Radiology, Icahn School of Medicine at Mount Sinai West, New York, USA Correspondence: Dr. Shabnam Bhandari Grover, E-81, Kalkaji, New Delhi - 110 019, India. E-mail: [email protected] Abstract Infertility is a major social and clinical problem affecting 13–15% of couples worldwide. The pelvic causes of female infertility are categorized as ovarian disorders, tubal, peritubal disorders, and uterine disorders. Appropriate selection of an imaging modality is essential to accurately diagnose the aetiology of infertlity, since the imaging diagnosis directs the appropriate treatment to be instituted. Imaging evaluation begins with hystero‑ salpingography (HSG), to evaluate fallopian tube patency. Uterine filling defects and contour abnormalities may be discovered at HSG but usually require further characterization with pelvic ultrasound (US), sono‑hysterography (syn: hystero‑sonography/saline infusion sonography) or pelvic magnetic resonance imaging (MRI), when US remains inconclusive. The major limitation of hysterographic US, is its inability to visualize extraluminal pathologies, which are better evaluated by pelvic US and MRI. Although pelvic US is a valuable modality in diagnosing entities comprising the garden variety, however, extensive pelvic inflammatory disease, complex tubo‑ovarian pathologies, deep‑seated endometriosis deposits with its related complications, Mulllerian duct anomalies, uterine synechiae and adenomyosis, often remain unresolved by both transabdominal and transvaginal US.
    [Show full text]
  • New Trends in Diagnosis and Management of Early Pregnancy Failure
    ESHRE Campus workshop NEW TRENDS IN DIAGNOSIS AND MANAGEMENT OF EARLY PREGNANCY FAILURE Poznan - Poland 15 to 16 December 2006 Contents Organisation p. 2 Course description & objectives p. 3 Program p. 4 Speakers’ contributions 1. Early pregnancy failure, a review – N. Exalto et al p.6 2. Cytogenetic aspects of early pregnancy failure – M. Goddijn p.19 3. Early pregnancy units: ESHRE 2006 – R. Farquharson p.30 4. Management of first trimester miscarriage – W.N. Ankum p.37 5. Gestational trophoblastic disease (GTD) – E. Jauniaux p.42 6. Pregnancies of unknown location (PULs) – E. Kirk p.53 7. Methotrexate for ectopic pregnancy – T. Paszkowski p.72 8. Evidence-based guidelines for the investigation and medical treatment of recurrent miscarriage – E. Jauniaux et al p.82 9. Recurrent miscarriage in Poznan – J. Skrzypczak p.89 10. Congenital uterine anomaly and recurrent miscarriage – J. Kotarski p.100 11. Infection and early pregnancy loss – T. Niemiec p.116 12. Recurrent miscarriage: failure of nature’s selection – S. Quenby p.119 13. Leukemia inhibitory factor and implantation – M. Mikolajczyk p.131 NOTES p.141 Page 1 of 150 Organisation Organising Committee • Professor Jana Skrzypczak (PL) - Local Organiser • Dr Roy Farquharson (UK) - Coordinator of the SIG Early Pregnancy • Professor Eric Jauniaux - Past coordinator of the SIG • Dr Ole Christiansen (DK) - Deputy of the SIG • Dr Niek Exalto (NL) - Deputy of the SIG Faculty • P. Ankum P, Amsterdam (NL) • G. Breborowicz, Poznan (PL) • O.B. Christiansen, Copenhagen (DK) • N. Exalto, Hoofddorp (NL) • R. Farquharson, Liverpool (UK) • M. Goddijn, Amsterdam (NL) • E. Jauniaux, London (UK) • M. Jerzak (PL) • E.
    [Show full text]
  • OHVIRA Syndrome with Hematosalpinx and Pyocolpos
    FACTS VIEWS VIS OBGYN, 2017, 9 (3): 167-170 Case report Uncommon presentations of an uncommon entity: OHVIRA syndrome with hematosalpinx and pyocolpos Z. SLEIMAN1, T. ZREIK1, R. BITAR1, R. SHEAIB1, A. AL BEDERI2, V. TANOS3 1Lebanese American University, Department of Obstetrics and Gynecology, Beirut, Lebanon, 2Tiba IVF center, Hilla, Irak., 3St. George’s Medical School, Nicosia University, Nicosia, Cyprus Correspondence at: Zaki Sleiman, Lebanese American University, Department of Obstetrics and Gynecology. Zahar Street, Achrafieh. Beirut, Lebanon P.O. Box: 11-3288. Tel: 0096170567354; [email protected] Abstract Müllerian malformations result from defective fusion of the Müllerian ducts during development of the female reproductive system. The least common form of these malformations is Herlyn-Werner-Wunderlich syndrome characterized by obstructed hemivagina and ipsilateral renal anomaly (OHVIRA). The most common presentation of this syndrome is a mass secondary to hematocolpos, pain, and dysmenorrhea. Clinical diagnosis is very challenging and requires imaging studies in which ultrasound and MRI play an essential role in the diagnosis, classification and treatment plan. We report two cases of this syndrome, featuring two very rare clinical presentations: hematosalpinx and pyocolpos. The clinical course of the pathology is not standard and each patient is treated accordingly. Key words: OHVIRA, pyocolpos, hematosalpinx, hysteroscopy, laparoscopy, MRI, ultrasound. Introduction Case presentation A didelphic uterus with an obstructed hemivagina We present two cases of OHVIRA syndrome with and ipsilateral renal agenesis (OHVIRA) is a rare two different rare clinical presentations. congenital anomaly constituting 0.16–10% of all The first case is a 16 year-old Iraqi patient referred Müllerian duct abnormalities described only in to our clinic for chronic pelvic pain and progressive case reports in medical literature (Noviella et al., painful distention of the lower abdomen.
    [Show full text]
  • SOGC CLINICAL PRACTICE GUIDELINE Abnormal Uterine
    Journal of Obstetrics and Gynaecology Canada The official voice of reproductive health care in Canada Le porte-parole officiel des soins génésiques au Canada Journal d’obstétrique et gynécologie du Canada Volume 35, Number 5 • volume 35, numéro 5 May • mai 2013 Supplement 1 • supplément 1 Abstract. .S1 Introduction . .S4 Chapter 1: Definitions. .S5 Chapter 2: Evaluation. .S7 Chapter 3: Medical Treatment. .S12 Chapter 4: Surgical Management. .S18 Chapter 5: Special Scenarios. .S21 Abnormal Uterine Appendix . .S25 Bleeding in Pre-Menopausal Women Publications mailing agreement #40026233. Return undeliverable Canadian copies and change of address notifications to SOGC Subscriptions Services, 780 Echo Dr. Ottawa, Ontario K1S 5R7. Editor-in-Chief / Rédacteur en chef Timothy Rowe CPL Editor / Rédactrice PPP Vyta Senikas Translator / Traducteur Martin Pothier Assistant Editor / Rédactrice adjointe Jane Fairbanks Editorial Assistant / Adjointe à la rédaction Daphne Sams Editorial Office / Bureau de la rédaction Journal of Obstetrics and Gynaecology Canada Room D 405A Women's Health Centre Building 4500 Oak Street Vancouver BC V6H 3N1 [email protected] Tel: (604) 875-2424 ext. 5668 Fax: (604) 875-2590 http://www.jogc.com The Journal of Obstetrics and Gynaecology Canada (JOGC) is owned by the Society of Obstetricians and Gynaecologists of Canada (SOGC), published by the Canadian Psychiatric Association (CPA), and printed by Dollco Printing, Ottawa, ON. Le Journal d’obstétrique et gynécologie du Canada (JOGC), qui relève de la Société des obstétriciens et gynécologues du Canada (SOGC), est publié par l’Association des psychiatres du Canada (APC), et imprimé par Dollco Printing, Ottawa (Ontario). Publications Mail Agreement no. 40026233. Return undeliverable Canadian copies and change of address notices to SOGC, JOGC Subscription Service, 780 Echo Dr., Ottawa ON K1S 5R7.
    [Show full text]
  • Epidemiology of Abnormal Uterine Bleeding 25 Michael Zinger 5
    Modern Management…Uterine Bleeding rev2:Modern Management…Uterine Bleeding rev2 9/1/08 10:24 Page 1 Modern Management of O’Donovan O’Donovan ABNORMAL • UTERINE BLEEDING Miller Modern Management of Modern Management of Abnormal Uterine Bleeding is written by an internationally recognized team of experts – many of whom are at the forefront of developing 'second-generation' endometrial ablation techniques as well as ABNORMAL UTERINE BLEEDING Modern Management of standard practice. The book covers the full range of surgical and medical treatments, including the background, diagnosis and treatment. ABNORMAL This must have book will help gynecologists refine their operative techniques and consider new approaches to this highly challenging condition. UTERINE BLEEDING Edited by Peter Joseph O`Donovan FRCOG FRCS (ENG) Consultant Gynaecologist and Gynaecological Cancer Lead Director MERIT Centre, Bradford Teaching Hospitals NHS Trust, Bradford and Professor of Medical Innovation, Bradford University, Bradford,UK Charles E Miller MD FACOG Director of Minimally Invasive Gynecologic Surgery, Lutheran General Hospital, Park Ridge, and Clinical Associate Professor, Department of Obstetrics and Gynecology, University of Chicago, and Clinical Associate Professor, Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, USA Cover illustration: ‘The Uterine’ by Elizabeth Gray © UK 2008 Edited by ISBN 978-0-415-45479-7 Peter Joseph O’Donovan www.informahealthcare.com 9 78041 5 454797 Charles Miller MODERN MANAGEMENT OF ABNORMAL
    [Show full text]