Endometrial Ablation Reference Number: CP.MP.106 Revision Log Last Review Date: 07/19 Coding Implications
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Hysteroscopy and Endometrial Ablation Using Novasure
Hysteroscopy and Endometrial Ablation Using Novasure What is a hysteroscopy and endometrial ablation using Novasure? This is a procedure where a doctor uses a thin tube with a tiny camera to look inside the uterus. There are no incisions. Saline solution is used to expand the uterus in order to look at the inside of the uterus. The Novasure device is then used to burn the lining of the uterus. When is this surgery used? To evaluate and or treat diseases of the uterus • Painful periods. • Heavy or irregular vaginal bleeding. How do I prepare for surgery? • Before surgery, a pre-op appointment will be scheduled with your doctor at their office or with a nurse practitioner or physician assistant at Domino Farms. • Depending on your health, we may ask you to see your primary doctor, a specialist, and/or an anesthesiologist to make sure you are healthy for surgery. • The lab work for your surgery must be done at least 3 days before surgery. • Some medications need to be stopped before the surgery. A list of medications will be provided at your pre-operative appointment. • Smoking can affect your surgery and recovery. Smokers may have difficulty breathing during the surgery and tend to heal more slowly after surgery. If you are a smoker, it is best to quit 6-8 weeks before surgery. If you are unable to stop smoking before surgery, your doctor can order a nicotine patch while you are in the hospital. Department of Obstetrics and Gynecology (734) 763-6295 - 1 - • You will be told at your pre-op visit whether you will need a bowel prep for your surgery and if you do, what type you will use. -
Evaluation of the Uterine Causes of Female Infertility by Ultrasound: A
Evaluation of the Uterine Causes of Female Infertility by Ultrasound: A Literature Review Shohreh Irani (PhD)1, 2, Firoozeh Ahmadi (MD)3, Maryam Javam (BSc)1* 1 BSc of Midwifery, Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Iranian Academic Center for Education, Culture, and Research, Tehran, Iran 2 Assistant Professor, Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, Iranian Academic Center for Education, Culture, and Research, Tehran, Iran 3 Graduated, Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Iranian Academic Center for Education, Culture, and Research, Tehran, Iran A R T I C L E I N F O A B S T R A C T Article type: Background & aim: Various uterine disorders lead to infertility in women of Review article reproductive ages. This study was performed to describe the common uterine causes of infertility and sonographic evaluation of these causes for midwives. Article History: Methods: This literature review was conducted on the manuscripts published at such Received: 07-Nov-2015 databases as Elsevier, PubMed, Google Scholar, and SID as well as the original text books Accepted: 31-Jan-2017 between 1985 and 2015. The search was performed using the following keywords: infertility, uterus, ultrasound scan, transvaginal sonography, endometrial polyp, fibroma, Key words: leiomyoma, endometrial hyperplasia, intrauterine adhesion, Asherman’s syndrome, uterine Female infertility synechiae, adenomyosis, congenital uterine anomalies, and congenital uterine Menstrual cycle malformations. Ultrasound Results: A total of approximately 180 publications were retrieved from the Uterus respective databases out of which 44 articles were more related to our topic and studied as suitable references. -
(IJCRI) Abdominal Menstruation
www.edoriumjournals.com CASE SERIES PEER REVIEWED | OPEN ACCESS Abdominal menstruation: A dilemma for the gynecologist Seema Singhal, Sunesh Kumar, Yamini Kansal, Deepika Gupta, Mohit Joshi ABSTRACT Introduction: Menstrual fistulae are rare. They have been reported after pelvic inflammatory disease, pelvic radiation therapy, trauma, pelvic surgery, endometriosis, tuberculosis, gossypiboma, Crohn’s disease, sepsis, migration of intrauterine contraceptive device and other pelvic pathologies. We report two rare cases of menstrual fistula. Case Series: Case 1: A 27- year-old nulliparous female presented with complaint of cyclical bleeding from the abdomen since three years. There was previous history of hypomenorrhea and cyclical abdominal pain since menarche. There is history of laparotomy five years back and laparoscopy four years back in view of pelvic mass. Soon after she began to have blood mixed discharge from scar site which coincided with her menstruation. She was diagnosed to have a vertical fusion defect with communicating left hypoplastic horn and non-communicating right horn on imaging. Laparotomy with excision of fistula and removal of right hematosalpinx was done. Case 2: 25-year-old female presented with history of lower segment caesarean section (LSCS) and burst abdomen, underwent laparotomy and loop ileostomy. Thereafter patient developed cyclical bleeding from scar site. Laparotomy with excision of fistulous tract and closure of uterine rent was done. Conclusion: Clinical suspicion and imaging help to clinch the diagnosis. There is no recommended treatment modality. Surgery is the mainstay of management. Complete excision of fistulous tract is mandatory for good long-term outcomes. International Journal of Case Reports and Images (IJCRI) International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties. -
Endometrial Ablation
PATIENT INFORMATION A publication of Jackson-Madison County General Hospital Surgical Services Endometrial Ablation As an alternative to hysterectomy, your doctor may recommend a procedure called an endometrial ablation. The endometrium is the lining of the uterus. The word ablation means destroy. This surgery eliminates the endometrial lining of the uterus. It is often used in cases of very heavy menstrual bleeding. Because this surgery causes a decrease in the chances of becoming pregnant, it is not recommended for women who still want to have children. The advantage of this procedure is that your recovery time is usually faster than with hysterectomy. Your doctor will use general anesthesia or spinal anesthesia to perform the procedure. He will talk with you about the type of anesthesia that will be used in your case. This surgery can be done in an outpatient setting. During the procedure, a narrow, lighted viewing tube (the size of a pencil) called a hysteroscope is inserted through the vagina and cervix into the uterus. A tiny camera that is attached shows the uterus on a monitor. There are several ways the endometrial lining can be ablated (destroyed). Those methods include laser, radio waves, electrical current, freezing, hot water (balloon), or heated loop. The instruments are inserted through the tube to perform the ablation. Your doctor may also do a laparoscopy at the same time to be sure there are not other conditions that might require treatment or further surgery. In a laparoscopy, a small, lighted scope is used to look at the other organs in the pelvis. -
Endometrial Ablation
AQ The American College of Obstetricians and Gynecologists FREQUENTLY ASKED QUESTIONS FAQ134 fSPECIAL PROCEDURES Endometrial Ablation • What is endometrial ablation? • Why is endometrial ablation done? • Who should not have endometrial ablation? • Can I still get pregnant after having endometrial ablation? • What techniques are used to perform endometrial ablation? • What should I expect after the procedure? • What are the risks associated with endometrial ablation? • Glossary What is endometrial ablation? Endometrial ablation destroys a thin layer of the lining of the uterus and stops the menstrual flow in many women. In some women, menstrual bleeding does not stop but is reduced to normal or lighter levels. If ablation does not control heavy bleeding, further treatment or surgery may be required. Why is endometrial ablation done? Endometrial ablation is used to treat many causes of heavy bleeding. In most cases, women with heavy bleeding are treated first with medication. If heavy bleeding cannot be controlled with medication, endometrial ablation may be used. Who should not have endometrial ablation? Endometrial ablation should not be done in women past menopause. It is not recommended for women with certain medical conditions, including the following: • Disorders of the uterus or endometrium • Endometrial hyperplasia • Cancer of the uterus • Recent pregnancy • Current or recent infection of the uterus Can I still get pregnant after having endometrial ablation? Pregnancy is not likely after ablation, but it can happen. If it does, the risk of miscarriage and other problems are greatly increased. If a woman still wants to become pregnant, she should not have this procedure. Women who have endometrial ablation should use birth control until after menopause. -
Recurrent Hematometra with Endometriosis in an Adolescent Girl: a Case Report
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Garg R et al. Int J Reprod Contracept Obstet Gynecol. 2019 Nov;8(11):4567-4569 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20194895 Case Report Recurrent hematometra with endometriosis in an adolescent girl: a case report Sarita Agrawal, Rajshree Sahu*, Pushpawati Thakur, Vinita Singh, Pawan B. Chandramohan Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India Received: 18 August 2019 Revised: 19 September 2019 Accepted: 09 October 2019 *Correspondence: Dr. Rajshree Sahu, 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 Hematometra is a collection or retention of blood in the uterine cavity. This condition is most commonly associated with congenital uterine anomalies that result from abnormal formation, fusion or resorption of Mullerian ducts during fetal life or may be due to prior surgical procedures, causing an obstruction of the genitourinary outflow tract. We report an unusual case of hematometra with endometriosis secondary to cervical stenosis. This is a rare and important case report due to the complexity of diagnosis as cervical stenosis was not presented as primary amenorrhoea as its usual presentation. This case was successfully managed by Hysteroscopic cervical dilatation under USG guidance followed by transcervical insertion of a catheter to prevent recurrent stenosis. -
Clinical Outcomes of Hysterectomy for Benign Diseases in the Female Genital Tract
Original article eISSN 2384-0293 Yeungnam Univ J Med 2020;37(4):308-313 https://doi.org/10.12701/yujm.2020.00185 Clinical outcomes of hysterectomy for benign diseases in the female genital tract: 6 years’ experience in a single institute Hyo-Shin Kim1, Yu-Jin Koo2, Dae-Hyung Lee2 1Department of Obstetrics and Gynecology, Yeungnam University Hospital, Daegu, Korea 2Department of Obstetrics and Gynecology, Yeungnam University College of Medicine, Daegu, Korea Received: March 17, 2020 Revised: April 7, 2020 Background: Hysterectomy is one of the major gynecologic surgeries. Historically, several surgical Accepted: April 14, 2020 procedures have been used for hysterectomy. The present study aims to evaluate the surgical trends and clinical outcomes of hysterectomy performed for benign diseases at the Yeungnam Corresponding author: University Hospital. Yu-Jin Koo Methods: We retrospectively reviewed patients who underwent a hysterectomy for benign dis- Department of Obstetrics and eases from 2013 to 2018. Data included the patients’ demographic characteristics, surgical indi- Gynecology, Yeungnam University cations, hysterectomy procedures, postoperative pathologies, and perioperative outcomes. College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu Results: A total of 809 patients were included. The three major indications for hysterectomy were 42415, Korea uterine leiomyoma, pelvic organ prolapse, and adenomyosis. The most common procedure was Tel: +82-53-620-3433 total laparoscopic hysterectomy (TLH, 45.2%), followed by open hysterectomy (32.6%). During Fax: +82-53-654-0676 the study period, the rate of open hysterectomy was nearly constant (29.4%–38.1%). The mean E-mail: [email protected] operative time was the shortest in the single-port laparoscopic assisted vaginal hysterectomy (LAVH, 89.5 minutes), followed by vaginal hysterectomy (VH, 96.8 minutes) and TLH (105 min- utes). -
Page Mackup January-14.Qxd
Bangladesh Journal of Medical Science Vol. 13 No. 01 January’14 Case report: Unilateral Functional Uterine Horn with Non Functioning Rudimentary Horn and Cervico-Vaginal Agenesis: Case Report Hakim S1, Ahmad A2, Jain M3, Anees A4. ABSTRACT: Developmental anomalies involving Mullerian ducts are one of the most fascinating disorders in Gynaecology. The incidence rates vary widely and have been described between 0.1-3.5% in the general population. We report a case of a fifteen year old girl who presented with pri- mary amenorrhea and lower abdomen pain, with history of instrumentation about two months back. She was found to have abdominal lump of sixteen weeks size uterus. On examination vagina was found to be represented as a small blind pouch measuring 2-3cms in length. A rec- tovaginal fistula (2x2 cms) was also observed. Ultrasonography of abdomen revealed bulky uterus (size 11.2x6 cm) with 150 millilitre of collection. A diagnosis of hematometra with iatro- genic fistula was made. Vaginal drainage of hematometra was done which was followed by laparotomy. Peroperatively she was found to have a left side unicornuate uterus with right side small rudimentary horn. Left fallopian tube and ovary showed dense adhesions and multiple endometriotic implants. Both cervix and vagina were absent. Total abdominal hysterectomy was done and rectovaginal fistula repaired. The present case is reported due to its rarity as it involved both mullerian agenesis with cervical and vaginal agenesis along with disorder of lat- eral fusion. This is an asymmetric type of mullerian duct development in which arrest has occurred in different stages of development on two sides. -
Ultrasound-Guided Reoperative Hysteroscopy: Managing Endometrial Ablation Failures
#424 Wortman FINAL Gynecology SURGICAL TECHNOLOGY INTERNATIONAL XXII Ultrasound-guided Reoperative Hysteroscopy: Managing Endometrial Ablation Failures MORRIS WORTMAN, MD, FACOG CLINICAL ASSOCIATE PROFESSOR OF GYNECOLOGY UNIVERSITY OF ROCHESTER MEDICAL CENTER DIRECTOR, CENTER FOR MENSTRUAL DISORDERS AND REPRODUCTIVE CHOICE ROCHESTER, NEW YORK ABSTRACT ndometrial ablation and hysteroscopic myomectomy and polypectomy are having an increasing impact on the care of women with abnormal uterine bleeding (AUB). The complications of these procedures Einclude the late onset of recurrent vaginal bleeding, cyclic lower abdominal pain, hematometra and the inability to adequately sample the endometrium in women with postmenopausal bleeding. According to the 2007 ACOG Practice Bulletin, approximately 24% of women treated with endometrial ablation will undergo hysterectomy within 4 years.1 By employing careful cervical dilation, a wide variety of gynecologic resectoscopes, and continuous sonographic guidance it is possible to explore the entire uterine cavity in order to locate areas of sequestered endometrium, adenomyosis, and occult hematometra. Sonographically guided reoperative hysteroscopy offers a minimally invasive technique to avoid hysterectomy in over 60% to 88% of women who experience endometrial ablation failures.2,3 The procedure is adaptable to an office-based setting and offers a very low incidence of operative complications and morbidity. In addition, the technique provides a histologic specimen, which is essential in adequately evaluating the endometrium in postmenopausal women or women at high risk for the development of adenocarcinoma of the endometrium. - 1 - #424 Wortman FINAL Ultrasound-guided Reoperative Hysteroscopy: Managing Endometrial Ablation Failures WORTMAN INTRODUCTION It is well known that of women who Troublesome vaginal bleeding, may undergo EA a significant number will occur months or years following EA and eventually require a hysterectomy. -
Uterine Cervix and Proximal Third of Vagina Agenesis with Functional Uterus: Case Report and Literature Review
Endocrinologia Ginecológica ISSN 2595-0711 RELATO DE CASO Uterine cervix and proximal third of vagina agenesis with functional uterus: Case report and literature review Ana Luíza Fonseca Siqueira1, Marta Ribeiro Hentschke1, Martina Wagner1, Luiza Machado Kobe1, Charles Schneider Borges1, Vanessa Devens Trindade1, Marcelo Moretto1, Andrey Cechin Boeno1, Adriana Arent1 1Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas, Serviço de Ginecologia, Porto Alegre, RS, Brasil Abstract Objectives: We aimed to describe the case of a patient presenting cervix agenesis with presence of vagina and functioning uterus. Methods: A 19-year-old patient was referred to Human Reproduction service due to primary amenorrhea, cyclic pelvic pain, and dyspareunia. She was diagnosed with cervical and vaginal agenesis, and menstrual flow suppression was the chosen treatment. Results: Regarding treatment options, hysterectomy is the classic treatment; however, due to advances in minimally invasive surgery and reproductive medicine, procedures such as uterine-vaginal anastomosis have been proposed. Young patients with no current reproductive wish, may opt for hormonal suppression of the menstrual flow to minimize cyclical discomfort and prevent or treat possible foci of endometriosis. However, for those seeking pregnancy, techniques of assisted reproduction can be considered. The approach should always be individualized, considering the anatomical details, clinical aspects, and patient’s opinion. Conclusions: Management of cervical agenesis is a challenge due to the complexity of the malformation and the difficulty in restoring and preserving fertility. Lastly, report such rare conditions and its treatment options, seems to be beneficial to help other patients with similar conditions. Keywords: congenital abnormalities; mullerian ducts; assisted reproduction. -
How Gynecologic Procedures and Pharmacologic Treatments Can Affect the Uterus
IMAGES IN GYN ULTRASOUND How gynecologic procedures and pharmacologic treatments can affect the uterus Understanding and identifying possible uterine changes caused by endometrial ablation and tamoxifen use can be important for subsequent treatment decisions. In addition, Asherman syndrome and cesarean scar defect clearly alter the uterus, but what are their signs on imaging? Michelle Stalnaker Ozcan, MD, and Andrew M. Kaunitz, MD ew technology, minimally invasive defect, and altered endometrium as a result surgical procedures, and medica‑ of tamoxifen use. In this article, we provide Ntions continue to change how physi‑ 2 dimensional and 3 dimensional sono‑ cians manage specific medical issues. Many graphic images of uterine presentations of IN THIS ARTICLE procedures and medications used by gyne‑ these 4 conditions. Additional case images can cologists can cause characteristic findings be found with the online version of this article on sonography. These findings can guide at obgmanagement.com. Foreword subsequent counseling and management by Steven R. decisions and are important to accurately Goldstein, MD interpret on imaging. Among these condi‑ Asherman syndrome page 19 tions are Asherman syndrome, postendome‑ Characterized by variable scarring, or intra‑ trial ablation uterine damage, cesarean scar uterine adhesions, inside the uterine cavity Uterine changes following endometrial trauma due to surgical postablation procedures, Asherman syndrome can cause Dr. Ozcan is Assistant Professor and menstrual changes and infertility. Should page 20 Co-Program Director, Obstetrics and Gynecology Residency, Department pregnancy occur in the setting of Asherman of Obstetrics and Gynecology, at syndrome, placental abnormalities may re‑ Endometrial the University of Central Florida 1 College of Medicine−Orlando. -
Endometrial Ablation
Endometrial Ablation Endometrial ablation is a surgical procedure that removes Each month a thickening of cells occurs to produce the superficial the inside layer (the endometrium) or lining of the uterus. The part. In a usual menstrual cycle, where pregnancy does not endometrium is the part that sheds each month as a period occur and without any hormone treatments (such as the oral (menstruation ).The endometrium consists of 2 parts: contraceptive pill), the superficial part is shed and menstruation 1. A deep part (called the basalis) occurs. The deep part is always present and does not shed to allow 2. A superficial part (called the superficialis) the process to be repeated in the following month. guarantee no bleeding following the procedure. Following an endometrial ablation there are four possible outcomes: 1. No periods at all (called amenorrhea) (40% of cases) 2. Very light periods/spotting (40% of cases) 3. Reduced bleeding to what is acceptable (10% of cases) 4. No change in menstrual bleeding (10% of cases) What happens in an endometrial ablation? Endometrial ablation can be performed using different methods. Scientific studies have not shown that one method is better than others, either in terms of outcomes or complications. The method recommended by your doctor will depend on your presenting symptoms, past history (such as a history of classical caesarean delivery) and other medical considerations (such as bleeding disorders). Other factors will include the type of ablation your Sometimes, there may be excessive bleeding (causing clots, doctor is familiar with and availability of specialised equipment. flooding and pain) at the time of menstruation.