Emergency C-Section on Multi-Scar Uterus: Maternal and Fetal Prognosis at the Nianankoro Fomba Hospital in Segou, Mali

Background: Multi-scar uterus is a uterus with two or more scars due to surgery or trauma. Objective: The aim was to compare the maternal and fetal prognosis of emergency C-sections of bi-scar uteruses to those of uteruses with at least 3 scars at the Nianankoro Fomba Hospital in Segou. Materials and Methods: It was a descriptive and analytical cross-sectional study with prospective data collection over a 24-month period from March 20, 2018, to March 20, 2020. Results: In 2 years, we collected 103 emergency C-sections for multi-scar uterus out of 1198 C-sections with a frequency of 8.6%. The age group of 20 to 35 years was the most represented with 86.4%. The bi-scar uteruses were the most frequent with 77.7%. In 71.8% of cases, the C-section was performed during the latent phase of labor. The C-section was performed under loco-regional anesthesia in 89.3% of cases. Difficulties in hemostasis and bladder injury were the most frequent intraoperative accidents. Surgical site infection was the main postoperative complication. No maternal deaths were recorded. The perinatal prognosis was marked by 4.3% fresh stillbirths in bi-scar uterus against 3.7% in three or more scar uteruses and including 2 fresh stillbirths and 1 macerated. We did not record any early neonatal deaths after C-section. Conclusion: The frequency of emergency C-sections in patients with a multi-scar uterus remains very high in our hospital. A better awareness of the patients, their spouses and all the actors involved in the management of pregnancies and childbirth, can contribute to curb this trend.

Associated Factors with Vaginal Delivery on a Uni- or Bi-Scar Uterus in a Low-Resource Setting

Introduction: Delivery in a scar uterus is one of the most debated topics in obstetrics. The objective was to determine the uterine test and the maternal-fetal outcome in patients with uni- and bi-scared uterus who received the uterine test at Panzi General Referral Hospital. Methodology: This is a cross-sectional study with a prospective collection of patients who delivered on a uni- or bi-scareduterus at Panzi Hospital, between January 1, 2021 and August 1, 2022. Results: The average age of the patients was 27.09 years, with an age range of 25 - 34 years, they were mostly married (88.3%), with secondary educational level (60.4%). Pauciparous women, with a history of previous caesarean delivery once, represented respectively 52.2%;7.2% of parturients with an intergenital space equal to 18 months. 63.9% were overweight, 58.6% had undergone more than three ANC sessions. We noted statistically significant associations between modes of admission, water sac, type of membranes rupture, uterine height and success of uterine test (p 0.05). We did not find significant associations between parturient age, gestational age, intergestational interval, pregnancy term, surgical history, number of ANC performed, number of previous caesarean sections, number of newborns. We did not record any cases of maternal death but one case of perinatal death with 0.9% in this study. Conclusion: A good selection of patients with uni- or bi-scared uterus would allow the reduction of the fetomaternal morbidity during the uterine test.

Squamous cell carcinoma associated with endometriosis in the uterus and ovaries:A case report

BACKGROUND Endometriosis is a common benign gynecological disease that causes dysmenorrhea in women of childbearing age.Malignant tumors derived from endometriosis are rarely reported and are found in only 1%of all patients with endometriosis.Here,we report a well-differentiated squamous cell carcinoma(SCC)caused by squamous metaplasia of endometriosis that co-occurred in the uterus and ovaries.CASE SUMMARY A 57-year-old postmenopausal woman had a 6-month history of irregular uterine bleeding.The uterus and adnexa were examined by computed tomography,and there were two solid cystic masses in the pelvis and right adnexa.Histological findings of surgical specimens showed well-differentiated SCC arising from squamous metaplasia of ectopic endometrial glands in the uterus and ovaries.The patient received chemotherapy after surgery and was followed up for 3 mo without metastasis.CONCLUSION The continuity between ectopic endometrial glands and SCC supports that SCC originates from ectopic endometrial glands with metaplasia towards squamous epithelium.

Successful Reposition of an Incarcerated Gravid Uterus by Instrument:A Case Report and Literature Review

Incarcerated gravid uterus is a rare obstetric condition that contributes to pregnancy-related adverse outcomes,especially if the uterus remains incarcerated and the condition goes undiagnosed until delivery.An effective diagnosis of this condition is benefited from pelvic examination combined with imaging methods and based on suspected symptoms.We present a case of ultrasound-assisted instrument reposition of an incarcerated gravid uterus at mid-gestation and discuss its clinical characteristics,diagnosis,imaging features,and treatment.We believe that once manual reduction fails,the use of instruments will undoubtedly be a better choice.

Atypical Polypoid Adenomyomas of Uterus: A Clinicopathologic Study of 2 Cases

Atypical polypoid Adenomyomas (APA) is a rare benign tumour in uterine. It is would distinguished from well-differentiated endometrial adenocarcinoma because of his histological features. We report 2 cases of 31-year-old and 33-year-old patient whose symptom were abnormal uterine bleeding. The mass was pedunculated with a narrow pedicle connecting to the pedunculated with a narrow pedicle connecting to the cervical;the other was in the uterine prolapse without pedicle. The surgical procedure was polypectomy only in all two patients with hysteroscopy. The histopathology showed the lesions were composed of a proliferation of irregular atypical endometrial glands separated by varying amounts of cellular smooth-muscle stroma. No mitotic activity was observed in the epithelial or mesenchymal elements in APA. The treatment of APA should depend on the age and reproductive desire of patient.

Diffusion-weighted and diffusion-tensor imaging of normal and diseased uterus

Owing to technical advances and improvement of the software, diffusion weighted imaging and diffusion tensor imaging(DWI and DTI) greatly improved the diagnostic value of magnetic resonance imaging(MRI) of the pelvic region. These imaging sequences can exhibit important tissue contrast on the basis of random diffusion(Brownian motion) of water molecules in tissues. Quantitative measurements can be done with DWI and DTI by apparent diffusion coefficient(ADC) and fractional anisotropy(FA) values respectively. ADC and FA values may be changed by various physiological and pathological conditions providing additional information to conventional MRI. The quantitative DWI assists significantly in the differentiation of benign and malignant lesions. It can demonstrate the microstructural architecture and celluler density of the normal and diseased uterine zones. On the other hand, DWI and DTI are useful for monitoring the treatment outcome of the uterine lesions. In this review, we discussed advantages of DWI and DTI of the normal and diseased uterus.

Laparoscopic hysterectomy as optimal approach for 5400 grams uterus with associated polycythemia: A case report

BACKGROUND Uterine myomas are the most common benign gynecological soft tissue tumors in women but polycythemia associated with these tumors is rare.Polycythemia is significantly associated with risk of venous thromboembolism(VTE),which is further increased in case of a large pelvic mass and obesity.Here we report the surgical challenges in the case of an obese patient with a giant fibromatous uterus and associated polycythemia.CASE SUMMARY A 42-year-old obese woman was referred to our department for treatment for a huge fibromatous uterus.She suffered of pelvic pressure and abdominal distension and reported severe dyspnea from several months.Laboratory analyses including hemoglobin(Hb)19.2 g/dL and hematocrit(Hct)59.7%were indicative of polycythemia.Arterial blood gas analysis showed arterial oxygen pressure(pO2)of 81.5 mmHg.Abdominal computed tomography confirmed a giant fibromatous uterus measuring 28.2 cm×17 cm×25 cm.To reduce the thromboembolic risk,the patient underwent low molecular weight heparin,phlebotomy twice before surgery,and we opted for a laparoscopic hysterectomy.The uterus weighed 5400 g and the histology confirmed a diagnosis of leiomyoma.We did not find increased erythropoietin levels in the supernatant of the myomatous uterine tissue.There were no complications.On postoperative day 1,the Hb and the Hct levels normalized to 13.3 g/dL and 41.7%,respectively.Arterial blood gas analysis after surgery showed a pO2 of 144.7 mmHg.These results suggested the diagnosis of myomatous erythrocytosis syndrome.The patient was discharged on the second postoperative day in very good condition with no symptoms.CONCLUSION We believe this is the first reported laparoscopic hysterectomy in a patient with a giant uterus,polycythemia and obesity.Multiple VTE risk factors warranted a laparoscopic approach.

Studies of GnRH-A Active Immunization Effects on LH and FSH Secretion and Histostructure of the Ovary and Uterus in Rabbits

The objective of the study is to investigate the effects of active immunization against gonadotropin releasing hormone agonist （GnRH-A） on secretion of luteinizing hormone （LH） and follicle-stimulating hormone （FSH） in the pituitary, and to observe the histological structures and development about ovaries and uteri in female rabbits. 24 female rabbits （Oryctolagus cuniculus） were divided randomly into 4 groups （n=6）, namely, experimental group I （EG-I）, experimental II （EG-II）, experimental III （EG-III）, and control group （CG）. Rabbits were subcutaneously injected with 1.0 mL GnRH-A （alarelin） antigen respectively at concentrations of 100, 100 and 50 μg mL-1 respectively, in EG-I, EG-II and EG-III. Alarelin antigen was re-injected in EG-II and EG-III with the same dosage on 20 d. CG was a blank. The ovarian and uterine samples were collected aseptically at the end of the experiment of 70 d. The tissue slices were observed under light and electron microscopes. Serum concentrations of LH and FSH were measured with ELISA. The results showed that serum LH concentrations in EG-II and EG-III reached the peak levels on 50 and 40 d respectively, and LH level in EG-II exceeded other 3 groups on 50 d （P0.05）. FSH level in EG-II was higher than those in EG-I, CG （P0.01） and EG-III （P0.05） on 40 d. GnRH-A could increase the number of primary follicles, enlarge the primary follicle vertical diameter （PFV） and primary follicle transverse diameter （PFT）, and promote growth and maturation of follicles. The endometrial epithelium thickness （EET） and uterine wall thickness （UWT） in three EGs were less than that in CG （P0.05）. GnRH-A can increase the quantities of mitochondrial cristaes, cortex granules in cytoplasm, broaden and lengthen zona pellucidas and microvilli of oocytes. It also enlarged nuclei of ooxytes and mitochondria, thereby it promoted the development of oocytes. Re-injection of 100 μg alarelin antigen enhanced the secretion of LH and FSH. GnRH-A promoted the growth and maturation of ovaries and follicles, suppressed uterine development, and also influenced histostructure of ovaries and uteri in female rabbits.

Advances in Treatment of Myoma of Uterus

Myoma of uterus has the highest incidence in gynecological tumors.The incidence rate is increasing year by year,which is the main indication for hysterectomy.Non-surgical treatment is often adopted for young patients with fertility requirements.The treatment methods for myoma of uterus are reviewed in this article.

Three-dimensional imaging of the uterus:The value of the coronal plane

Advent in three-dimensional(3D) imaging technology has seen 3D ultrasound establish itself as a useful adjunct complementary to traditional two-dimensional imaging of the female pelvis. This advantage largely arises from its ability to reconstruct the coronal plane of the uterus, which allows further delineation of many gynecological disorders. 3D imaging of the uterus is now the preferred imaging modality for assessing congenital uterine anomalies and intrauterine device localization. Newer indications include the diagnosis of adenomyosis. It can also add invaluable information to delineate other endometrial and myometrial pathology such as fibroids and endometrial polyps.

Uterus Bicorne Cervical United: A Case of Pregnancy after Uterine Plasty (Review of the Literature)

The uterus bicorne is a uterine malformation whose pathophysiology is known but the etiology remains obscure. Few studies have been interested in this subject. This is the clinical observation of Mrs. X 26-year-old housewife nulliparous who consulted for repeated late spontaneous abortions. The clinical examination was normal. The ultrasound revealed a double uterine cavity in Y, in favor of a unicervical bicorne uterus. At hysterosalpingography, the tubes were permeable and the uterus doubled with a single cervix. The treatment consisted of a uterine plasty. The postoperative course was simple. The patient gave birth to a newborn male 20 months after surgery.

Spontaneous Resolution of Traumatic AV Malformation of the Uterus Following Hysteroscopic Cold Knife Evacuation of Retained Products of Conception

Uterine myometrial arteriovenous malformations (AVM) are reported on color doppler ultrasonography as mosaic pattern of blood flow with different peak systolic velocities (PSV) at different places. High PSV within the AVM may require arterial embolization as treatment. However, we present a case of traumatic AVM with incomplete abortion managed by hysteroscopic cold knife evacuation. This case report is of a young patient with off and on vaginal bleeding for 3 1/2 months following 2nd trimester spontaneous abortion. She had undergone dilation and evacuation (D & E) for incomplete abortion. Now the bleeding was heavy and intermittent not responding to medications. The subsequent TVS examination shows incomplete abortion with myometrial AVM with high PSV. Hysteroscopic cold knife removal of products of conception resulted in immediate resolution of Uterine AVM.

Predictive Factors of Complications of Vaginal Delivery on Scarred Uterus at the YaoundéGynaeco-Obstetric and Paediatric Hospital

Objective: This study was aimed at identifying predictive factors of complications during vaginal delivery on scarred uterus. Methodology: During 9 months, from October 1st, 2015 to June 30th, 2016, a case control study was carried out at the Yaoundé Gynaeco-Obstetric and Pediatric Hospital. Eighty nine women each with a single scarred uterus who presented with complications during delivery (cases) were compared to eighty nine others who had a successfully trial of scar (control) during the study period. Data were analyzed using the CSPro version 6.0 and SPSS version 20.0 softwares with statistical significance set at P Results: We recruited 2 groups of 89 women, aged 17 to 40 years, with an average age of 29.05 years. The majority of women with complications were married (50.6%) and unemployed (42.8%). Following univariate analysis, predictive factors of complications were: prematurity (OR = 7.4), post-term (OR = 13.7), no history of vaginal delivery on scarred uterus (OR = 4.3), inter-pregnancy spacing period greater than 60 months (five years) (OR = 2.9), History of caesarian delivery indicated for cephalo-pelvic disproportion (OR = 6.6), less than four ante-natal consultations (OR = 3.6), antenatal consultations done in a Health Centre (OR = 2.7), ante-natal follow up conducted by a nurse (OR = 2.4;IC = [1.2 - 4.7]), referral from a different health unit (OR = 4.4, IC = 2.0 - 9.4), a Bishop score less than 7 on admission (OR = 12.4, IC = 5.6 - 27.4), a meconium stained amniotic fluid (OR = 9.9;CI = [3.6 - 26.8]). After logistic regression, the retained factors associated with complications were post-term (aOR = 34.5), absence of vaginal birth after caesarian delivery, (aOR = 11.7), previous caesarean section indicated for cephalo-pelvic disproportion (aOR = 6.1), a bishop score less than 7 (aOR = 12.0), meconium stained amniotic fluid (aOR = 13.6). Conclusion: Predictive factors of complications can help anticipate negative obstetric outcomes.

Non-Laboring Uterine Rupture of an Unscared Uterus before Term Discover during Obstetric Ultrasound

Uterine rupture is defined as the occurrence of communication between the abdominal and uterine cavity and may be complete or incomplete depending on the degree of involvement of the different layers of the uterus and surrounding organs. It is a rare complication whose consequences often involve the maternal and fetal prognosis. The majority of uterine rupture occurs on the scarred uterus, its incidence in France is estimated according to the series between 1/1000 and 1/2000 births, it represents 30% of causes of maternal death in the developing countries. The authors report here a case of uterine rupture outside of labor at 33 weeks of age in 32 years old woman, gravida 9 para 8, with no history of uterine surgery discovered during obstetric ultrasound for abdominal pain. During the interrogation, she was alarge multipara and had a child of 15 months. The abdominal ultrasound showed a right lateral corporeal rupture with hemoperitoneum of medium sized and a dead fetus. The emergency laparotomy revealed a right lateral uterine wound approximately 15 cm long with intra-abdominal placenta and a haemoperitoneum of medium sized of about 600 cc and a bladder lesion. After opening the amniotic sac, there was extraction of a dead fetus. The uterine and bladder lesions were repaired followed by bilateral tubal ligation. The patient received 500 cc of whole blood during and 500 cc after the procedure. The postoperative follow-up was simple. This case contributes to the knowledge of this rare and atypical event, and emphasizes the importance of maintaining a suspicion.

Endometrial Carcinoma Arising in Didelphic Uterus Accompanied by Right Renal Agenesis： A Case Report

<正>MüLLERIAN duct anomalies(MDA)are abnormalities occurring in the müllerian duct due to abnormal development of the uterus,cervix and vagina.Reported prevalence of this malformation in general population was 4%-5%.But real figure may be greater because of unawareness of these diseases due to its asymptomatic nature.~1Bicornuate and didelphic uteri are two common

Diagnosis and treatment of diverticulum of the uterus in pregnancy through hysteroscopy and methotrexate: a case report

A 27-year-old patient was diagnosed by hysteroscopy with uterine diverticulum in pregnancy and admitted to the hospital. Under the guidance of hysteroscopy combined with methotrexate, the scraping of the uterus was done and operation successfully completed. The management of this case showed that hysteroscopy was a kind of valuable approach to the diagnosis and treatment of uterine diverticulum and curettage of the uterus under hysteroscope combined with drug was a safe, effective and conservative treatment.

PREGNANCY AND ITS OUTCOME IN WOMEN WITH MALFORMED UTERUS

Objective. To analyze the clinical characteristics of fertility and pregnancy in women with congenital uterine malformations and explore optimal treatments to improve the prognosis.Methods. A retrospective study was conducted on the fertility and obstetric outcome in 153 patients with uterine malformations treated in our hospital from January 1984 to December 1998. Twenty - seven cases with other kinds of genital and/or urinary anomalies but with normal uterus during the same period were enrolled as the control group.Results. The infertility rate was 26.6% (34/128), the miscarriage rate 44.3% (86/194), premature birth rate 9.3% (18/194), abnormal fetal presentation rate 28.4% (29/102), the cesarean section rate 61.8% (63/102), and the perinatal mortality rate 11.8% (12/102).Conclusion. Women with congenital uterine malformation usually have higher incidence of infertility and complications during pregnancy and delivery. Bicornuate and septate uterus can be associated with poor obstetric outcome.

Effects of Estradiol and Progesterone on the Numbers and Distribution of Mastocytes in the Uterus of Ovariectomized Rats

The purpose of this study was to investigate the effects of estradiol （E） and progesterone （P） on mastocyte distribution in the uterus of ovari- ectomized rats. Thirty-five adult female rats were divided randomly into seven groups：one sham operated control group （ SHAM ） ; one ovariectomized group （OVX） ;three ovariectomized plus E treatment grouPs （OVX ＋E 20,100,or 500 μg/kg body weight · d） ; and two ovariectomized plus P groups （ OVX ＋ P 2 or 10 mg/kg body weight · d）. Seven days after treatment, the contents of estradiol and progesterone in serum were detected by radioimmunoassay, and mastocytes in the uterus were stained by toluidine blue staining. Results were as following： （1） Compared to ovariectomized rat, the concent ration of estradiol in serum increased by 97. 13 % in OVX ＋ E 20 （P 〈 0.05）,204. 84 % in OVX＋E 100 （P〈0.05）,and 936.45 % in OVX ＋ E500 group （P〈0.05）;the progesterone concent ration increased by 77.25 % in OVX ＋P 2 （P 〈0.05） and 235.25 %in OVX ＋P 10 group （ P 〈 0.05 ）. （2） Compared to ovariectomized rat, the number of mast cells in uteri decreased by 32.65% in OVX ＋E 20,64.50 % in OVX ＋E 100 （P〈0.05）,74.49 % in OVX＋E500 （P〈0.05） and 70.67 % in OVX ＋P 10 groups （P〈0.05）. However, the number of mast cells increased by 66.73% in OVX ＋ P 2 group （ P 〈 0.05 ） compared with OVX. The trend of mast cells number in the rat uterus was decreased gradually with the increase of estrogen or progesterone concent ration. The number of mast cells in ovariectomized rat uterus was affected by estrogen or progesterone. These results demonstrated that estrogen or progesterone directly affected the number of mast cells in the uterus of rat.

Uteroferrin (ACP5) in the Ovine Uterus:Ⅰ. Regulation by Pregnancy and Progesterone

Uteroferrin, also known as type 5 tartrate resistant acid phosphatase （ ACP5 ） or TRAP, is an iron-containing glycoprotein secreted by uterine gland epithelium （GE） in response to progesterone and transported across the placental areoalae into the fetal circulation and aUantoic fluid to deliver iron and to stimulate hematopoeisis in pigs. This study deter- mined if ACP5 was expressed in the ovine uterus in response to pregnancy, progesterone, interferon tau, placental lactogen, and placental growth hormone. ACP5 protein was present in uterine GE of cyclic and early pregnant ewes,particularly between days 18 and 120 of pregnancy. ACP5 mRNA was expressed in uterine GE of cyclic and pregnant ewes in the same temporal and cell-specific manner. ACP5 was present in secretions from uterine glands, i. e. , uterine milk,and allantoic fluid from days 40 to 80 of pregnancy, and in uterine flushings from cyclic and early pregnant ewes. Progesterone induced expression of ACP5 mR- NA and intrauterine infusion of recombinant ovine interferon tau further stimulated ACP5 expression in uterine GE of ewes,but intrauterine injections of ovine placental lactogen and ovine growth hormone had no effect on ACP5 expression in uterine GE. These re- sults indicate that ACP5 is：1 ） expressed only in GE in response to progesterone ;2） secreted into the uterine lumen and transported into the conceptus via placental areolae during pregnancy;and 3） present in secretions from uterine GE and in allantoic fluid. The roles of ACP5 in the ovine uterus may include transport of iron across the placenta and stimulation of hematopoiesis.

Expression of Prominin-1 in Mouse Uterus During Peri-implantation

To investigate the expression of Prominin-1(Prom-1)in mouse uterus during peri-implantation.In situ hybridization and immunohistochemical staining were used to detect the mRNA and protein expression level of Prom-1 in mice uterus in early pregnancy,pseudopregnancy,estrous cycle,treated with hormone,delayed implantation and activation models.The results showed that Prom-1 was gradually weakened in uterine luminal epithelium(LE)and glandular epithelium(GE)during days 1-4 of pregnancy.During days 5-8,Prom-1 was strongly expressed in GE,and signal of Prom-1 protein was detected in matrix and decidua around the embryo.Similar to pregnancy,Prom-1 was strongly expressed in LE and GE on the 1st day and weakly expressed on the 4th day of pseudopregnancy.In addition,Prom-1 was highly expressed in LE and GE on estrus.Expression of Prom-1 was observed in the LE and the GE of delayed-implantation uterus.In activated-implantation animal model,Prom-1 was strongly expressed in the GE.In the hormone-treated model,Prom-1 expression levels were higher in the uterus of the 17β-estradiol-treated group than those in the control group.These results indicated that Prom-1 might promote the proliferation of mouse endometrial epithelium and participate in the establishment of uterine receptivity.Meanwhile,the expression of Prom-1 was up-regulated by the 17β-estradiol,indicating that Prom-1 might involve in the process of decidua development regulated by uterine glands,and Prom-1 might play an important role in mice early pregnancy.