DOCSLIB.ORG

Diagnostic Efficiency and Reproducibility of Hysterosalpingography

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Diagnostic Efficiency and Reproducibility of Hysterosalpingography ISSN: 2572-3235 Ahmed and Taleb. Int J Radiol Imaging Technol 2019, 5:051 DOI: 10.23937/2572-3235.1510051 International Journal of Volume 5 | Issue 2 Open Access Radiology and Imaging Technology ORIGINAL ARTICLE Diagnostic Efficiency and Reproducibility of Hysterosalpingography Shimaa Abdalla Ahmed1* and Hesham Abo Taleb2 1South Egypt Cancer Institute, Assiut University, Egypt Check for 2Women Health Hospital, Assiut University, Egypt updates *Corresponding author: Shimaa Abdalla Ahmed, Lecturer of Radiodiagnosis, South Egypt Cancer Institute, Assiut University, Assiut, el Azhar street, Egypt, Tel: 002-0100-765-3325, ORCID ID: https://orcid.org/0000-0003-0908-8865 Abstract Introduction Objective: To evaluate the accuracy of HSG compared to Hysterosalpingography (HSG) is one of the most hysteroscopy and or laparoscopy and compare intra and commonly used imaging modalities in the evaluation interobserver variability. of an infertile female [1]. It is still the gold standard in Methods: 200 infertile females underwent hysterosalpin- the evaluation of tubal patency and can also evaluate gography, hysteroscopy and/or laparoscopy as part of an infertility work up. HSG examinations were retrospectively uterine cavity abnormalities. Tubal damage represents reviewed by three radiologists, we compared inter-observ- the most important cause of infertility, it has an intrinsic er variability, differences between the two results of reading cause like salpingitis or extrinsic cause like pelvic sur- the same examination after three months were compared to gery. In a meta-analysis by Swart, et al. [2], HSG sen- calculate intra-observer variability. sitivity and specificity in evaluating tubal patency was Final diagnosis was compared to hysteroscopy and/or 65% and 83%, respectively. in peri tubal adhesions was laparoscopy. The overall sensitivity, specificity, PPV, NPV and accuracy of each HSG diagnosis was assessed. found to be below 50% and considered unreliable [2]. Results: Intra-observer reliability was variable: observer 1 (k Uterine cavity abnormalities represent 10% of sub = 0.21; observer 2 (k = 0.57); observer 3 (k = 0.65). Highest fertile women and 50% of recurrent implantation fail- agreement was seen in the detection of a normal uterus, normal tubes and uterine filling defect, lowest agreement ure [3]. seen in the detection of uterine and pelvic adhesions. Intrauterine filling defects detected by HSG includes First round results showed moderate agreement between multiple differential diagnoses like polyps, sub-mucosal the three pairs of radiologists (k = 0.53-0.42), second round results showed the substantial agreement of observer 1 (k fibroids, endometrial hyperplasia, and Asherman’s syn- = 0.62), moderate agreement was seen between radiologist drome. The sensitivity of HSG in detecting uterine cavity 2 and 3 (k = 0.44). ranged from 60-98%, while specificity ranged from 15- With consensus diagnosis of all readers combined, HSG 80% [4]. overall accuracy in tubal pathology and uterine cavitary lesions diagnosis was 93%, and 85%, respectively. Lowest Tubal damage or uterine cavity abnormality detect- accuracy was seen in uterine adhesions 71%. ed by HSG as the cause of infertility, will help the gy- Conclusion: HSG is more accurate in tubal evaluation necologist to decide which operational techniques the than the uterine cavity assessment. HSG interpretation is patients will undergo (laparoscopy, hysteroscopy or sur- somewhat subjective, although experience and training may gery) [5]. Although laparoscopy is superior to HSG in the improve reporting skills and interpretation results, however, considerable observer variability exists. The gynecologist evaluation of pelvic pathology and peritoneal factors should carefully interpret HSG results and provide future of infertility, HSG is more economical and less invasive, management based on comprehensive clinical and radio- both diagnostic methods are complementary [6]. logical data. HSG’ comment or films reading is crucial, interpre- Keywords tation of results will affect the next additional surgical Hysterosalpingogram, Hysteroscopy, Laparoscopy, Infertility, attempts that will be needed, unfortunately, these in- Inter-observer variability, Tubal obstruction, Pelvic adhesions terpretations may be affected by inter and intra-observ- Citation: Ahmed SA, Taleb HA (2019) Diagnostic Efficiency and Reproducibility of Hysterosalpingography. Int J Radiol Imaging Technol 5:051. doi.org/10.23937/2572-3235.1510051 Accepted: August 08, 2019: Published: August 10, 2019 Copyright: © 2019 Ahmed SA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Ahmed and Taleb. Int J Radiol Imaging Technol 2019, 5:051 • Page 1 of 7 • DOI: 10.23937/2572-3235.1510051 ISSN: 2572-3235 er variability in reading [5]. or bilateral hydrosalpinx [2], unilateral or bilateral cor- nual obstruction [3], unilateral or bilateral distal obst- The previous study included clinicians only de- ruction [4], pelvic adhesions [5]. scribed poor to fair interobserver reliability of the HSG [5], only two studies in the literature were designed for The results of first reading and results of second assessment of clinicians and radiologist’s observer vari- reading after three months later were recorded to ability in HSG interpretation [1,7]. Okaya, et al. [1] re- calculate inter and intra-observer variability. ported more interobserver variability by clinicians than Finally, the three radiologists interpreted all HSG radiologists and concluded that radiologists were more examinations with a consensus to reach a final diag- compatible than clinicians, in contrast to Renbaum, et nosis which compared with the gold standard (hyste- al. [7] who described the low interobserver agreement roscopy and/or laparoscopy). between readers with general good interobserver reli- ability. Statistical Analysis While keeping in mind that high reproducibility is IBM SPSS Statistics version 21 (IBM Corp., Armonk, essential for a clinical test to achieve high diagnostic NY) was used for data analysis. Interobserver and in- accuracy, also, diagnostic accuracy and reproducibility terobserver agreement were tested for the presence of of HSG may be affected by local circumstances, such a uterine cavity or tubal abnormalities, type of abnor- as experience. To the best of our knowledge, HSG mality (as stated in methodology section). Cohen’s kap- reproducibility exclusively among radiologists has not pa coefficient was used for calculation of interobserver been studied and the question can be posed, whether and interobserver agreement. Kappa value of 0.81-1.00 observer bias is responsible for variation in observed indicate excellent agreement, a k-value of 0.61-0.80 in- prevalence of uterine and tubal evaluation in an infertile dicate good agreement; a k-value of 0.41-0.60 indicate female. We conducted this study in our own setting to moderate agreement; a k-value of 0.21-0.40 indicates clarify accuracy, reproducibility, and repeatability of fair agreement; a k-value of < 0.20 indicates poor agree- HSG in diagnosing tubal pathology and uterine cavitary ment [8]. The consistency of diagnosis between readers lesions. was estimated using interclass correlation (ICC) [9]. Materials and Methods True positive results were considered if HSG diagno- sis is confirmed by hysteroscopy or laparoscopy other- Ethics Committee of the Faculty of Medicine of our wise, false positive results were considered. True neg- University approved this retrospective study conducted ative results were considered if no abnormality were at a University Hospital Center (Divisions of Reproduc- detected by HSG which confirmed by hysteroscopy and/ tive Endocrinology and Radiology), informed consent or laparoscopy; otherwise, false negative results were was not required. We searched medical records on pack considered. Sensitivity, specificity, positive, negative system over a 2-year period, 200 infertile females un- predictive values and accuracy of HSG was calculated. derwent hysterosalpingograms (HSG), hysteroscopy p-value ≤ 0.05. was considered as statistically signifi- and/or laparoscopy as part of infertility work up were cant. included in the study. Patients with a previous pelvic operation, malignancy, ectopic pregnancy were exclu- Results ded from the study. The mean duration between HSG Two hundred women were analyzed in this study, and laparoscopy was 3 ± 1.1 month, and between HSG 123 women had primary infertility (61.5%) and 77 had and hysteroscopy was 2 ± 0.5 months. secondary infertility (38.5%). Mean age of women in our Standard HSG examination with good quality (includ- study was 30.36 ± 3.79 years. ing first and second films) were included in the study, Among 200 women, hysteroscopy and HSG showed they were evaluated by three radiologists who were a normal uterine cavity in 72 (36%) and 68 in (34%) re- specifically involved in HSG reading on a weekly basis, spectively. Abnormal cavity in 128 (64%) and 132 (66%) but with various levels of experience; two years’ expe- respectively. rience [1], five years’ experience [1], and ten years’ ex- perience [1]. Among 128 women laparoscopy and HSG showed normal tubes in 89 (69.5%) and in 86 (67.1%) respec- Each reader interpreted 10 HSG examinations in each tively. Abnormal tubes in 39 (30.5%) and in 42 (32.8%), session, the duration of each session was
Load more

Recommended publications
  • Tubo-Ovarian Abscess with Hydrosalpinx
    CLINICAL MEDICINE Image Diagnosis: Tubo-ovarian Abscess with Hydrosalpinx Kiersten L Carter, MD; Gus M Garmel, MD, FACEP, FAAEM Perm J 2016 Fall;20(4):15-211 E-pub: 06/24/2016 http://dx.doi.org/10.7812/TPP/15-211 Tubo-ovarian abscess (TOA) and hydro- The most useful diagnostic imaging metronidazole with doxycycline) can usu- salpinx are complications, though uncom- studies include transvaginal ultrasonog- ally be initiated within 24 hours to 48 hours mon, of pelvic inflammatory disease (PID). raphy and computed tomography. Com- of clinical improvement to complete the Both TOA and hydrosalpinx can lead to sig- pared with ultrasonography, computed 14-day treatment course.4 The majority of nificant morbidity and, rarely, mortality, and tomography has increased sensitivity to small abscesses (< 9 cm in diameter) resolve both necessitate treatment to reduce short- detect thick-walled, rim-enhancing adnexal with antibiotic therapy alone.1 and long-term complications. Risk factors of masses, pyosalpinx, and mesenteric strand- The aim of therapeutic management is TOA include younger age, multiple sexual ing, as well as changes suggestive of ruptured to be as noninvasive as possible. However, partners, nonuse of barrier contraception, TOA.1 On computed tomography scan with if this approach fails to yield clinical im- and a history of PID.1 The clinical manifes- contrast, a hydrosalpinx is visualized as a provement within 3 days, reassessment of tations of TOA are similar to PID—lower dilated, fluid-filled fallopian tube without the antibiotic regimen, with consideration abdominal pain, fever, chills, and vaginal rim enhancement (Figures 1 and 2). for laparoscopy, laparotomy, adnexectomy, discharge, with the addition of pelvic mass Although TOA is a complication of PID, hysterectomy, or image-guided abscess noted on examination or imaging.
    [Show full text]
  • Significant Elevation in Serum CA 125 and CA 19
    Case Report Obstet Gynecol Sci 2017;60(4):387-390 https://doi.org/10.5468/ogs.2017.60.4.387 pISSN 2287-8572 · eISSN 2287-8580 Significant elevation in serum CA 125 and CA 19-9 levels with torsion of the hydrosalpinx in a postmenopausal woman Ji Hye Kim1, Hyo Jin Jung1, Seung Hun Song2 Department of Obstetrics and Gynecology, 1CHA Gangnam Medical Center, CHA University, Seoul, 2CHA Bundang Medical Center, CHA University, Seongnam, Korea Isolated torsion of the fallopian tube in postmenopausal women is rare. In this case report, we detail the case of a 53-year-old patient who presented with adenomyosis and a left hydrosalpinx with high levels of CA 125 and CA 19-9. The isolated torsion of the left hydrosalpinx was observed during the operation. The serum levels of CA 125 and CA 19-9 were reduced from 129.62 and 348 to 58.2 and 12.41 U/mL, respectively, after total laparoscopic hysterectomy with salpingectomy. On radiologic evaluation, there were no other factors that may have influenced the increase in serum levels of CA 125 and CA 19-9 in this patient, which were reduced after operation. To the best of our knowledge, this is the first case of association between perioperative changes in CA 19-9 levels and isolated torsion of the fallopian tube. Keywords: CA 125 antigen; CA 19-9 antigen; Fallopian tubes; Isolated tubal torsion Introduction Case report An isolated torsion of the fallopian tube refers to torsion of A 53-year-old postmenopausal woman presented with vagi- the fallopian tube that is not associated with any ovarian nal bleeding that occurred three times within three weeks and abnormality.
    [Show full text]
  • Hydrosalpinx Medical Appendix Definition 1
    HYDROSALPINX MEDICAL APPENDIX DEFINITION 1. Hydrosalpinx is a distension of the fallopian tubes with water fluid. The condition arises as a result of the sealing of the fimbrial end of the tube, the tubal epithelium elsewhere remaining intact. The natural secretions cannot escape and the tube gradually distends with the watery fluid. 2. An extraordinary feature of a hydrosalpinx is that the inner end of the tube is nearly always open and yet the fluid does not drain into the uterus. This feature enables the diagnosis to be made by hysterosalpingography. CLINICAL MANIFESTATIONS 3. Hydrosalpinx is often asymptomatic and commonly diagnosed during infertility investigations. The outlook as far as fertility is concerned is unfavourable, for although the endothelium is able to secrete it is functionally impaired. 4. There may be a history and symptoms of acute, subacute or chronic salpingo- oophoritis. 5. An uncomplicated hydrosalpinx is usually too soft and flaccid to be palpable on bimanual examination. AETIOLOGY 6. Hydrosalpinx may be the end result of salpingitis. When the inflammation of the fallopian tubes subsides it may leave the fimbrial end of the tube sealed. 7. The following organisms have been identified as causing salpingitis - gonococcus, streptococcus, staphylococcus and escherichia coli. The fallopian tubes may become involved as part of infection by tuberculosis, actinomycosis, schistosomiasis or chlamydia trachomatis. 8. Often when a hydrosalpinx is found there is no history of a severe previous infection or salpingitis sufficient to cause symptoms. Nevertheless, the most likely cause of this condition is a gonococcal infection whose after effects are limited to the ampullary area of the tube, one which produced few or no clinical manifestations when it happened.
    [Show full text]
  • Interpretation of Hysterosalpingography
    Interpretation of hysterosalpingography RAD Magazine, 43, 507, 9-10 salpingitis isthmica nodosa (SIN).8 An empathetic, calm environment is essential; women Professor Anne Hemingway who have researched HSGs on the internet or had a poor Consultant radiologist smear experience will be anxious. Anxiety predisposes to pain which in turn can cause vaginismus or tubal spasm Dr Katherine van Ree and an erroneous diagnosis of tubal occlusion. A simple pre- Consultant radiologist procedural checklist allows the operator to confirm all rele- Hammersmith Hospital, Imperial College Healthcare vant information, establish rapport, provide a full explanation of the procedure, record the result of the preg- NHS Trust, London nancy test and any drugs given and obtain written informed [email protected] consent. Confirmation of demographic details, date of last menstrual period together with the outcome of any previous pregnancy, ie live birth, miscarriage, termination or ectopic, is essential. We recommend performing a urine pregnancy test in all Introduction women as well as ascertaining no intercourse in that men- The advent of assisted reproduction techniques strual cycle – positive tests can occur in women who have experienced apparently cyclical bleeding in an early such as in vitro fertilisation (IVF) has led to a pregnancy. significant increase in the demand for hystero- History of post-partum complications should be sought, salpingography (HSG), a fluoroscopic imaging eg manual removal of placenta or post-partum haemorrhage; procedure involving the introduction of iodinated pelvic inflammatory disease, which may indicate tubal dis- water-soluble contrast medium into the female ease; previous pelvic or abdominal surgery such as myomec- tomy, tubal surgery, C-section or evacuation retained genital tract to delineate the endo-cervical canal, products of conception, which can all affect interpretation.
    [Show full text]
  • Role of Tubal Surgery in the Era of Assisted Reproductive Technology: a Committee Opinion
    ASRM PAGES Role of tubal surgery in the era of assisted reproductive technology: a committee opinion The Practice Committee of the American Society for Reproductive Medicine American Society for Reproductive Medicine, Birmingham, Alabama This document reviews surgical options for reparative tubal surgery and the factors that must be considered when deciding between surgical repair and in vitro fertilization. This document replaces the document of the same name, last published in 2012 (Fertil Steril 2015;103:e37–43). This document reviews surgical options for reparative tubal surgery and the factors that must be considered when deciding between surgical repair and in vitro fertilization. (Fertil SterilÒ 2021;115:1143–50. Ó2021 by American Society for Reproductive Medicine.) Key Words: Fallopian tube, hydrosalpinx, sterilization reversal, tubal disease Discuss: You can discuss this article with its authors and other readers at https://www.fertstertdialog.com/posts/32331 ubal disease accounts for 25%– mydia antibody testing is limited by raphy may have a therapeutic effect, T 35% of female factor infertility, false positives from cross-reactivity with higher fecundity rates reported with more than half of the cases with Chlamydia pneumoniae immuno- for several months after the procedure due to salpingitis (1). In addition, large globulin G and does not distinguish be- (11) when tubal flushing was performed studies report that up to 20%–30% of tween remote and persistent infection, with oil-based contrast media (11, 12). women regret having a tubal ligation and it does not indicate whether the The sensitivity of hysterosalpingo- (2–4). Thus, there is a need to infection resulted in tubal damage (5).
    [Show full text]
  • Uncommon Cause of Acute Pelvic Pain: Isolated Torsion of Hydrosalpinx
    Birth Control and Fertility Rate …….147 CASE REPORT Uncommon Cause of Acute Pelvic Pain: Isolated Torsion of Hydrosalpinx Ait Benkaddour Y 1* , Bennani R 1, Aboulfalah A 1 and Abbassi H 1 ABSTRACT Isolated torsion of hydrosalpinx is a rare cause of acute pelvic pain. Pre-operative diagnosis is very difficult because of non specific clinical presentation. Definitive diagnosis is always made at surgical exploration performed for suspected adnexal torsion and salpingectomy is performed in the majority of cases. A 34-year-old woman was admitted for acute pelvic pain with nausea and vomiting. Vaginal examination revealed a right adnexal tender mass and ultrasound revealed a well circumscribed right adnexal cystic mass. Surgical exploration has revealed torsion of a right hydrosalpinx and right salpingectomy was performed. Differential diagnosis between adnexal and tubal torsion is very difficult, however both should be managed by rapid surgical exploration which an allow precocious diagnosis and conservative treatment (Afr J Reprod Health 2009; 13[4]:147-150). RĖSUM Ė La cause peu fréquente de la douleur pelvienne aiguë : la torsion de l’hydrosalpinx isolée. La torsion de l’hydrosalpinx isolée est un cause rare de la douleur pelvienne aiguë. Le diagnostic pré- chirurgical est très difficile à cause d’une absence d’une présentation clinique spécifique. On fait un diagnostic définitif pendant l’exploration chirurgicale pratiquée pour détecter une torsion annexielle et pour la majorité des cas c’est la salpingectomie qui est pratiquée. Une femme âgée de 34 ans a été admise à l’hôpital à cause d’une douleur pelvienne aiguë accompagnée de la nausée et du vomissement.
    [Show full text]
  • Hydrosalpinx and IVF: Effect and Management
    ARC Journal of Gynecology and Obstetrics Volume 4, Issue 1, 2019, PP 21-23 ISSN 2456-0561 DOI: http://dx.doi.org/10.20431/2456-0561.0401004 www.arcjournals.org Hydrosalpinx and IVF: Effect and Management Akmal El-Mazny, MD, FICS* Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Egypt *Corresponding Author: Akmal El-Mazny, MD, FICS, Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Egypt, Email: [email protected] Abstract : Patients with a hydrosalpinx have been found to have significantly poorer IVF outcome than do patients with tubal factor infertility but no hydrosalpinx. The exact mechanism by which hydrosalpingial fluid impacts implantation and pregnancy is not clear; however, many theories exist. The rationale behind treatment of hydrosalpinx prior to IVF is to eliminate the detrimental effect of hydrosalpingel fluid either by removing the fallopian tube (salpingectomy) or by isolating it from the uterine cavity (laparoscopic or hysteroscopic occlusion, or Essure insert), or by aspirating the hydrosalpingel fluid (ultrasound-guided). Keywords: Hydrosalpinx, IVF 1. INTRODUCTION Hydrosalpingel fluid may contain inflammatory mediators such as cytokines, prostaglandins, and Tubal factor infertility accounts for up to 35% mucosal debris that may be toxic to the of female infertility, and was one of the original motivations for the development of in-vitro implanting embryo [6]. fertilization (IVF) [1]. The presence of hydrosalpingel fluid in the Hydrosalpinx is defined as fluid collection in a endometrial cavity physically inhibits blocked fallopian tube, and is found in about 10- implantation and impairs the expression of 30% of women with tubal factor infertility, factors essential for the development and corresponding to approximately 5% of infertile differentiation of the endometrium, such as women [2].
    [Show full text]
  • Cause and Effect of Asherman Syndrome Dr Rebecca Deans
    Cause and effect of Asherman syndrome Dr Rebecca Deans School of Women and Children Faculty of Medicine August 2016 Acknowledgments Firstly, I would like to express my sincere gratitude to my main supervisor, Associate Professor Jason Abbott. I am appreciative of his continuous support of my Ph.D study and the related research, as well as being grateful for his patience, motivation, and immense knowledge. His guidance helped me throughout the research and writing of this thesis. His eternal energy and motivation is truly inspirational, and although his maddening attention to detail drove me close to insanity, I could not have imagined having a better advisor and mentor for my Ph.D. Besides my main supervisor, I would like to also thank my co-supervisors: Professor William Ledger and Professor Thierry Vancaillie. I am grateful for their insightful comments and encouragement, as well as their hard questions, which drove me to widen my research from various perspectives. It was truly amazing that in spite of their extremely busy lives, they selflessly gave me time and care that was sometimes all that kept me going. My sincere thanks also goes to Dr. Daniel Moses and the team at Spectrum Radiology, whose contribution were invaluable for the perfusion MRI study. Without Dr Moses’ precious support, it would not have been possible to conduct this research. Thanks also goes to Dr Toos Sachinwala, whose great mind for the vascular pathology behind Asherman Syndrome started me along my journey towards the causes and not just the effects of Asherman Syndrome. ii I thank Jinzhu Liu, who gave me endless guidance in the statistical analysis and was always happy to meet and discuss various tests and re-tests of the data at short notice.
    [Show full text]
  • Isolated Fallopian Tubal Torsion Complicated by a Large Hydrosalpinx in a Perimenopausal Woman
    Case Report DOI: 10.7860/JCDR/2021/47106.14619 Gynaecology Section Isolated Fallopian Tubal Torsion Complicated Obstetrics and by a Large Hydrosalpinx in a Perimenopausal Woman MASANORI KANEMURA1, ATSUSHI YOSHIDA2, AKIHIKO TOJI3, YUMI MURAYAMA4, EMI IWAI5 ABSTRACT Adnexal torsion frequently causes acute pelvic pain in women. Ovarian tumour torsion is common; twisting and torsion of a fallopian tube are rare. This report presents a rare case of fallopian tubal torsion requiring the management of a large hydrosalpinx with laparoscopic surgery. A 48-year-old woman reported with acute abdominal pain and lower abdomen tenderness. Transvaginal ultrasonography and Magnetic Resonance Imaging (MRI) showed a cystic mass on the anterior uterine surface. Emergency surgery was performed for a suspected torsion of the left ovarian cyst. In the abdominal cavity, the left fallopian tube was enlarged (neonatal head size), dark purple coloured, and exhibited a 180° torsion; the left ovary was normal. Laparoscopic left salpingectomy was performed and the postoperative course was uneventful. Surgical pathology revealed hydrosalpinx with torsion. As diagnosing isolated fallopian tube torsion before surgery is difficult, laparoscopic surgery is useful in diagnosing and treating isolated tubal torsion. Keywords: Acute abdomen, Adnexal torsion, Laparoscopic surgery CASE REPORT A 48-year-old perimenopausal woman, gravida 2 para 2, visited Osakaminami Medical Centre because of two days of persistent lower abdominal pain. She had undergone surgery for breast cancer two years ago. She observed menstrual irregularity with longer menstrual cycles and her last menses occurred four months ago. On examination, her vitals were stable with pulse rate of 90/min and systemic examination was within normal limits.
    [Show full text]
  • Problem-Based Clinical Cases
    Problem-Based Clinical Cases Obstetrics and Gynecology Rotation Gyn Cases Updated March 2015 OB Cases Updated March 2015 By Medical Student and Resident Education Committee Table of Contents Section I: General Gynecology Page 4. Breast Disorders ..................................................................................................................................... 4 5. Contraception ......................................................................................................................................... 5 7. Dysmenorrhea ........................................................................................................................................ 7 8. Dyspareunia ........................................................................................................................................... 9 9. Ectopic Pregnancy................................................................................................................................ 12 10. Enlarged Uterus ................................................................................................................................... 13 19. Menorrhagia ......................................................................................................................................... 15 23. Pelvic Relaxation .................................................................................................................................. 16 25. Postmenopausal Bleeding ...................................................................................................................
    [Show full text]
  • Hydrosalpinx
    Assisted Reproductive Technology Unit Department of Obstetrics & Gynaecology The Chinese University of Hong Kong Prince of Wales Hospital Gynaecological Laparoscopy -- Hydrosalpinx Causes for Hydrosalpinx The fallopian tubes are a pair of long narrow ducts attached to the uterus (womb) on the left and right side. Each fallopian tube is about 10 cm long leading from the uterus to the ovaries. Hydrosalpinx is mainly due to pelvic inflammatory disease or endometriosis causing the blockage of the end of a fallopian tube. With the collection of secretions inside the tube causing further distension, hydrosalpinx resulted. Diagnosis and Effects of Hydrosalpinx There is no direct effect on health from hydrosalpinx and most women are asymptomatic. Hysterosalpingogram (HSG) (x-ray) is commonly used in investigating hydrosalpinx. If patients suffer from a severe hydrosalpinx, the doctor may even be able to detect it on ultrasound scan but laparoscopy remains the best way to make an accurate diagnosis. Hydrosalpinx causes infertility due to the partial or complete loss of function of the fallopian tube. In addition, some studies have shown that the success rate for IVF are reduced if women have a hydrosalpinx as the tubal fluid may contain toxic substances which will flow into the uterine cavity during/after embryo transfer. Hence, there will be lower implantation and pregnancy rates and also a higher miscarriage rate. Surgical Procedures for Hydrosalpinx A doctor will insert a laparoscope to check the fallopian tubes for the severity of the hydrosalpinx. Depends on the degree of damage, different types of operations will be performed accordingly: laparoscopic salpingostomy and salpingectomy.
    [Show full text]
  • Interventions in Women with One Blocked Oviduct, Lessons Learnt and Recommendations: a Case Report
    Vol. 9(2), pp. 7-13, May 2019 DOI: 10.5897/MCS2019.0126 Article Number: C9D6F0660934 ISSN 2141-6532 Copyright © 2018 Author(s) retain the copyright of this article Medical Case Studies http://www.academicjournals.org/MCS Full Length Research Paper Interventions in women with one blocked oviduct, lessons learnt and recommendations: A case report Cosmas Josiah Musewu Department of Pharmaceutical sciences, Faculty of Health science, Harare institute of Technology, Zimbabwe. Received 15 February, 2019; Accepted 3 April, 2019 Women can still conceive naturally or through in vitro fertilization (IVF) with the one oviduct that is properly functioning if only one oviduct is blocked, however, the chances are decreased particularly if the blockage is close to the ovary (hydrosalpinx) because of wash out phenomena and toxic fluid produced by the fallopian tube that is blocked. In situations where only a single tube has hydrosalpinx specialists should advise patients appropriately and must be given options, to choose between undergoing salpingostomy, a surgical process that involves tubal reconstruction to expand their odds of getting pregnant naturally by removing the blockage or IVF treatment. For women with one working oviduct specialists must be on the lookout for ectopic pregnancy. This will enable early diagnosis of ectopic pregnancy and a treatment technique that spares the tube can be utilized. The patient is a woman of African origin with blood group O staying at Manyame Park Harare. She has never married before and has been trying to get pregnant from 2005. She eventually got a successful pregnancy in 2014 and delivered first child in 2015 after several interventions.
    [Show full text]