Behavior of Leiomyoma during Pregnancy as Evaluated by Ultrasound
|
|
- Peregrine Hill
- 7 years ago
- Views:
Transcription
1 Behavior of Leiomyoma during Pregnancy as Evaluated by Ultrasound July 7, By Samir Fouad Abdel Aziz, MD [] and Mohamed K. Al-Sharkawy [] One hundred and six pregnant women diagnosed with Leiomyoma during pregnancy were evaluated clinically and by ultrasound. Leiomyoma size changes were analyzed on the basis of trimesters. The common echotexture pattern and the different echotextures as well as any changes in the echogenicity were noticed during the follow up. The number and location of the myomata were observed with their impact on pregnancy outcome. Published in The Scientific Journal of Al-Azhar Medical Faculty (Girls) vol.7 No., July (suppl), 996 Page of 8
2 Abstract Objective: To evaluate the behavior of uterine leiomyoma and their impact on the course of pregnancy. Setting: Al-Hussein University Hospital, Cairo. Subjects and Method One hundred and six pregnant women diagnosed with Leiomyoma during pregnancy were evaluated clinically and by ultrasound. Leiomyoma size changes were analyzed on the basis of trimesters. The common echotexture pattern and the different echotextures as well as any changes in the echogenicity were noticed during the follow up. The number and location of the myomata were observed with their impact on pregnancy outcome. Results: Out of 74 patients with fibroids, 5 (67.6%) showed increase in fibroid size during the first and second trimester and % showed increase in size in the third trimester. Thirty-seven patients (5%) showed retroplacental fibroids, but only 3(4%) had antepartum hemorrhage. The most common echo pattern was hypoechoic pattern, occurred in 79% in the first trimester, in 53% in the second trimester and in 43.5% in the third trimester. The second common echo pattern was heterogeneous echotexture occurred in 4.3%,.6% and 8.8% during the three trimesters respectively. There was no relation between the size of fibroid and its echo pattern changes.the changes in size of fibroid during pregnancy had no significant effect on the course of pregnancy. Introduction Uterine leiomyoma occur in -4% of women beyond 3-35 years of age(7). In one study, only 4% of fibroids diagnosed during pregnancy were clinically detectable(7). With increasing age of obstetric population and the wide spread use of, uterine fibroids are more frequently detected during pregnancy. Uterine leiomyomata are associated with numerous obstetric complications including; abortion, disseminated intravascular coagulation, hemoperitoneum, premature rupture of membranes, preterm labor, dystocia, uterine inertia, interference with placental separation and postpartum hemorrhage. About 7% of pregnant women with fibroid go into preterm labor(3). The mechanism by which leiomyomas interfere with fertility, gestation and delivery are not fully understood. We used serial ultrasound (US) to analyze the behavior of leiomyomas during pregnancy. Subjects and Methods One hundred and six (6) pregnant patients with a definitive or probable uterine fibroid were seen at Al-Hussein University Hospital during a period of 3 months. The age range was 3-45 years. Seventy-seven (A) patients were seen in the first trimester and follow up ultrasound examination was done in the late first, second and third trimesters. Twenty-four (B) patients were seen for the first time during the second trimester and follow up was done in third trimester. Five patients (C) were examined in the last trimester for the first time, one of them presented with acute abdomen which was due to fibroid red degeneration, follow up was done in the late third trimester. The machines used for examination were General Electric 3 RT. And Esaote Biomedica AU 53, with focus 3.5 MHz sector and linear transducer. The following parameters for the fibroid were recorded: Location: Either in the lower uterine segment or the uterine corpus, also the location in relation to the placental site was noted. Retroplacental location was considered when an intramural or submucus mass was present deep to the placenta. Size: Each fibroid was measured in three dimensions, antero-posterior, transverse and longitudinal. On follow up examination each fibroid was evaluated for change in average diameter. The change was considered significant when there is increase of at least -cm average diameter. If a previously measured fibroid could not be identified on follow up examination, this was considered as late non-detection. Echotexture: The echotexture of each fibroid was compared to the myometrium. Six types were defined:)hypoechoic, )heterogeneous, 3)echogenic rim, 4)discrete anechoic or cystic spaces, 5)isoechoic and 6) hyperechoic. Changes in echotexture during pregnancy were noticed. All patients were followed up by US examination every 4-8 weeks from the first visit to the time of delivery. Patients who were aborted or with preterm delivery were excluded. Results Table. Size changes in 77 fibroids seen from the first trimester Page of 8
3 Trimester No changes Increase Decrease First 4(3.4%) 5(67.6%) No Second 8(37.8%) 46(6.%) No Third 69(93.%) 5(6.8%) NO Table. Size changes in fibroids seen from the second trimester (n=4) Trimester No changes Increase Decrease Second 4(6.7%) (83.3%) NO Third 4(%) o(%) No Group A comprised 77 patients during the first trimester, 3 cases (4%) aborted and 74 cases was followed. 5(67.6%) patients showed increase in size and 4 (3.4%) showed no significant change in size during the second trimester. Examination during the third trimester showed that out of the 5 cases who had increase in size 46(9%) had increase in size and only 4(8%) had no significant increase during the third trimester. Out of 4 cases that had no increase in size of fibroid no one showed increase in size on the third examination(fig.) but 5(%) showed increase in size on the fourth examination. Fig. : 4 x 4mm Fibroid seen at 8 weeks. Fig. : Same fibroid seen at 4 weeks, no change in size, fibroid became hypoechoic. Page 3 of 8
4 Fig.3 : Same fibroid seen at 3 weeks, no significant change in size. Group B comprised 4 patients seen for the first time during the second trimester. Subsequent US examination (4-8weeks), (83%) cases showed increase in size while 4(7%) cases showed no change in size. The third US examination done 4-8 weeks later showed no change in size. Group C comprised 5 patients seen for the first time during the third trimester. Subsequent US examination showed no increase in size. During the course of pregnancy 5(67.6%) of fibroids increase in size during the first trimester and 66(67%) showed increase in size during the second trimester and only 5(4.8%) of fibroids showed increase in size during the third trimester.(fig.) Fig. : 53 x 6mm hyperechoic fibroid seen at 5 weeks. Fig. : Same fibroid seen at 4 weeks, hypoechoic but enlarged 78 x 77mm. Out of 37 patients with retroplacental fibroid, 3(8%) cases had antepartum hemorrhage, which responded to conservative treatment. Echotexture of Fibroid during Pregnancy Table 3. Echotexture changes during the second trimester (N=77, aborted =3) Page 4 of 8
5 Initial appearance Hypoechoic (No. of fibroid) Hypoechoic 35 (6) Heteroechoic () Echogenic rim () Anechoic/Cystic spaces (3) Isoechoic Total 36 (77) Heterogeneo Echogenic Anechoic/ us rim Cystic Isoechoic changes % 8 7.3% % 33.3% % N/A Table 4. Echotexture changes during the third trimester (Group A=74,Group B=4) Initial appearance Hypoechoic (No. of fibroid) Hypoechoic 4 (36+5) Heteroechoic (6+5) Echogenic rim (+) Anechoic/Cystic spaces (6+) Isoechoic (5+) Total 43 (98) Heterogeneo Echogenic Anechoic/ us rim Cystic 6 Isoechoic changes 8.5% % 3 % 7 % 3 5% N/A In group, A which comprised 77 patients, 6 had hypoechoic texture, had heteroechoic texture, 3 anechoic, isoechoic and no case had echogenic rim(table 3). In-group B which comprised 4 patients, 5 were hypoechoic, 5 heteroechoic, echogenic rim, anechoic and isoechoic. In-group C the 5 patients seen showed hypoechoic pattern in 3 cases and echogenic rim in cases. The most common pattern of fibroids in pregnancy was hypoechoic compared with myometrium. This pattern was present in 69% of cases seen during the first trimester, 53% of cases seen during the second trimester and 43.5% of cases seen during the third trimester The second most common pattern was the heterogeneous echotexture comprising 4.3%,.6% and 8.8% during the three trimesters respectively. The third most common appearance is an echogenic rim. This echogenic rim (Fig.3) constitutes the periphery of fibroids with diverse internal echotexture most commonly hypoechoic(3). This pattern was present in 4.8% of cases in the second trimester and in.8% of cases in the third trimester and no single case noticed in the first trimester. This echogenic rim sometimes is complete but usually it is incomplete. Page 5 of 8
6 Fig 3 : Fibroid with echogenic rim. Fig. 4 : Fibroid with Cystic Changes Another patterns were observed; fibroids with anechoic or cystic spaces (Fig.4), isoechoic fibroid and only two cases of hyperechoic texture. Changes in echotexture were frequently observed during the three trimesters. Some fibroids showed cystic spaces, other became heterogeneous and other became isoechoic. Some fibroids developed complete or incomplete echogenic rim. The development of this rim appears to be a final change with no cases progressing to any other pattern. Calcification was also observed in some fibroids. The echotexture changes were not accompanied by significant changes in size. Discussion Ultrasound is useful in the detection of uterine leiomyomas and is especially useful in screening, however, it has its limitations in the assessment of the obese patients(). In our study we found that difficulty to visualize the fibroid was limited to the obese patients only during the first trimester, but with advancing of the pregnancy no difficulties encountered, as the gravid uterus stretches the abdominal wall and displaces the bowel. The predominant view in obstetric literature is that fibroids enlarge during pregnancy and inviolate during the puerperium(3). However, several clinical histologic studies refute this concept of true fibroid growth during pregnancy(6). One group reported no significant size change in 38 of 4 fibroids during the second half of pregnancy (). Another group reported that 3 of 54 fibroids developed red degeneration during pregnancy without any size change while the remaining fibroids tended to increase in size rapidly during pregnancy(9). In the present study we monitored size changes during the three trimesters of pregnancy. The results showed that about 67% of fibroids diagnosed in the first trimester increase in size and about 6% increase in size during the second trimester and only 6.8% increase in size during the third trimester. It was noticed that fibroids which increase in size during the first trimester usually increase during the second trimester. Anna et al () found that about half of all fibroids do not change significantly in size and growth changes demonstrated by the remainder of fibroids depend on their previous size, they found that small fibroids tend to increase in size during the first and second trimesters and decrease in size during the third trimester. They also found that large fibroids tend to increase in size only in the first trimester and decrease in size during the second and third trimesters. In our study we found no decrease in size during the three trimesters. True increase in fibroid size during pregnancy may not be explained by myoma cell proliferation because no proliferation takes place during pregnancy (4). Myoma cell hypertrophy, does occur during pregnancy and possibly explain the measured fibroid growth trends. The cells in small fibroids hypertrophy during pregnancy and shrink in late pregnancy () The decrease in size observed in late pregnancy, by other studies, could be explained in part by the decrease in cell size. Page 6 of 8
7 Myoma cells have a greater number of estrogen receptors than surrounding normal myometrial cells(6). Therefore, these cells should be more responsive to the increased concentrations of estrogens present during pregnancy and exceed the growth of the surrounding myometrium. Progesterone on the other hand may inhibit the growth of fibroids(8) and even induce degenerative changes and involution(6). The increasing progesterone level in late pregnancy could explain the decrease in fibroid size during that period. Another theory implicates the arterial supply of fibroid as a cause of degenerative and size changes (5). Fibroids are supplied by one or more nutrient arteries entering from the periphery and encircling the tumor. As the tumor rotates as a result of passive stretching of the uterine wall and active muscle contraction these arteries may be twisted. Also upward migration of fibroids out of the pelvis may also result in vessel torsion comprising the blood supply to fibroid(4). In the present study, The echo characteristics in more than two thirds of fibroids showed no changes during pregnancy. However, anechoic cystic spaces and coarse heterogenicity patterns represent a special clinical group. The available data suggest that red degeneration appears on sonogram as an area of high through transmission with moderate to marked echoes. In the present study, this echotexture pattern was infrequent, only two cases were reported and diagnosed as red degeneration. The frequency of this echotexture pattern. In a study done by Anna et al () out of 3 cases diagnosed as having red degeneration. Faulkner et al (5) found that red degeneration occurs in medium-size fibroids in pregnant state as opposed to large fibroids in the nonpregnant state. Location of the fibroid in the lower uterine segment predispose towards a higher frequency of Cesarean section by obstruction of the birth canal(5). Also, it predisposes to retained placenta, which may be related to some degree of mechanical obstruction. In the present study only 3 cases out of 37 with retroplacental fibroid reported antepartum hemorrhage (Fig.5). Anna et al () showed that cases with retroplacental fibroids had no significant increase in cases with antepartum hemorrhage. However, Winer-Muram et al (7) reported antepartum hemorrhage in 5 of 35 patients with defined retro-placental fibroids. Fig. 5 : Retroplacental Fibroid To summarize, the most common type of echogenic pattern of fibroid during pregnancy was the hypoechoic texture. The echogenic changes were more common towards the echogenic rim and the heterogeneous types. It was noticed that the size and echogenic changes were predominant in the second trimester. Also, it was found that there was no relationship between the size and echo pattern changes. In conclusion, fibroids may adversely affect the course of pregnancy depending on their location. The changes in size during pregnancy has no significant effect on the course of pregnancy. Page 7 of 8
8 References: References. Anna S,. Leiomyomas in pregnancy. Radiology, 987,64: Bezjion AA. Pelvic masses in pregnancy. In: Sobbegha R,ed. Diagnostic Ultrasound applied to obstetrics & Gynecology. New York: Harper & Row, 98: Christine M, David A: Uterine Leiomyomas in the infertile patient. Radiology, 988,67: Fulkner RL. The blood vessels of the myomatous uterus. Am J. Obstet.Gynecol. 944, 47: Hulkner RL. Red degeneration of uterine myomas. Am J. Obstet. Gynecol 947,53: Goldzieher JW. Induction of degenerative changes in uterine myomas by high dose progestin therapy. Am.J. Obstet.Gynecol 7. Gomple C. Pathology in Gynecology and Obstetrics, nd ed. Philadelphia, Lippincott 977: Goodman AI. Progesterone therapy in uterine fibromyomata. J Clin Endocrinol Metab. 946,6: Hsddsni SAN. US changes of uterine fibroids in pregnancy and degeneration. In : White D, Lyons E, eds. U.S. In medicine.vol.4. New York:Plenum, 978: Lamb JE. Microscopic study of the growth of leiomyomas of the uterus during pregnancy. Sug Gynecol Obstet. 959,8: Muram D. Myomas of the uterus in pregnancy. US follow up. Am J obstet gynecol 98,38:6-9..Parks J. The myomatous uterus complicated by pregnancy. Am J Obstet Gynecol 95,63: Pritchard JA. Williams Obstetrics 7th ed. New York: appleton-centruy Crofts, Randal JH. Fibroids in pregnancy. Am J Obstet Gynecol 943,4: Sampson JA. The blood supply of uterine myomata. Sug Gynecol Obstet 9,4: Tamaya T. Comparison of cellular levels of steroid receptor in uterine leiomyoma and myometrium. Acta Obstet Gynecol. 985,64: Winer-Muram HT. Uterine myomas in pregnancy. Can Med Assoc. J. 983,8: Source URL: und Links: [] [] Page 8 of 8
Gynecology Abnormal Pelvic Anatomy and Physiology: Cervix. Cervix. Nabothian cysts. cervical polyps. leiomyomas. Cervical stenosis
Gynecology Abnormal Pelvic Anatomy and Physiology: (Effective February 2007) pediatric, reproductive, and perimenopausal/postmenopausal (24-28 %) Cervix Nabothian cysts result from chronic cervicitis most
More informationPrognosis of Very Large First-Trimester Hematomas
Case Series Prognosis of Very Large First-Trimester Hematomas Juliana Leite, MD, Pamela Ross, RDMS, RDCS, A. Cristina Rossi, MD, Philippe Jeanty, MD, PhD Objective. The aim of this study was to evaluate
More informationUterine fibroids (Leiomyoma)
Uterine fibroids (Leiomyoma) What are uterine fibroids? Uterine fibroids are fairly common benign (not cancer) growths in the uterus. They occur in about 25 50% of all women. Many women who have fibroids
More informationUse of Transvaginal Ultrasonography to Monitor the Effects of Tamoxifen on Uterine Leiomyoma Size and Ovarian Cyst Formation
Use of Transvaginal Ultrasonography to Monitor the Effects of Tamoxifen on Uterine Leiomyoma Size and Ovarian Cyst Formation Lisa Barrie Schwartz, MD, Nicole Rutkowski, BS, Camille Horan, RDMS, Lila E.
More informationFrom this site: http://www.energeticnutrition.com /vitalzym/fibroid_tumors.html Uterine Fibroid Tumors
From this site: http://www.energeticnutrition.com /vitalzym/fibroid_tumors.html Uterine Fibroid Tumors Uterine Fibroid Tumors A woman s fibroisis condition usually associated with estrogen dominance. Uterine
More informationOvarian Torsion: Sonographic Evaluation
J Clin Ultrasound 17:327-332, June 1989 Ovarian Torsion: Sonographic Evaluation Mark A. Helvie, MD,* and Terry M. Silver, MDI Abstract: The sonographic and clinical findings of 13 patients with surgically
More informationPlacenta, Cord, & Fluid
, Cord, & Fluid Abruption Accreta/Increta/Percreta Chorioangioma Complete Partial Not generally Relevant to U/S Gestational Age (Weeks) Distance from 16-23.9 24 to Internal Os >20 mm No No 11-20 mm 0-10
More informationObjective. Indications for IUDs. IUDs 3 types. ParaGard IUD. Mirena IUD. Sonographic Evaluation of Intrauterine Devices (IUDs) Inert
Sonographic Evaluation of Intrauterine Devices (IUDs) Anna S. Lev-Toaff, MD FACR Department of Radiology Hospital of the University of Pennsylvania Philadelphia, Pennsylvania Leading Edge in Diagnostic
More informationSUBSEROSAL FIBROIDS TREATMENT
INTRODUCTION Uterine fibroids, also known as leiomyomas, are the most common pelvic mass found in women. Fibroids are benign tumors that arise from the uterine muscular tissue (myometrium). They occur
More information1 st Trimester OB Ultrasound
Indications/Goals: 1 st Trimester OB Ultrasound Geoffrey E. Hayden, MD Director of Emergency Ultrasonography Vanderbilt Emergency Medicine Primary objective is to identify an intrauterine pregnancy Secondary
More informationEastern Mediterranean Health Journal, Vol. 10, No. 3, 2004 437
Eastern Mediterranean Health Journal, Vol. 10, No. 3, 2004 437 Report Normal uterine size in women of reproductive age in northern Islamic Republic of Iran S. Esmaelzadeh, 1 N. Rezaei 1 and M. HajiAhmadi
More informationPrediction of Pregnancy Outcome Using HCG, CA125 and Progesterone in Cases of Habitual Abortions
Prediction of Pregnancy Outcome Using HCG, CA125 and Progesterone in * (MBChB, FICMS, CABOG) **Sawsan Talib Salman (MBChB, FICMS, CABOG) ***Huda Khaleel Ibrahim (MBChB) Abstract Background: - Although
More informationVariations in Appearance of Endometriomas
CME rticle Variations in ppearance of Endometriomas Elizabeth sch,, Deborah Levine, MD Objective. ecause of the range of patient ages with endometriosis, the persistence of endometriomas, and the degradation
More informationClinical Policy Title: Leiomyosarcoma and Laparoscopic Power Morcellation
Clinical Policy Title: Leiomyosarcoma and Laparoscopic Power Morcellation Clinical Policy Number: 12.03.01 Effective Date: January 1, 2015 Initial Review Date: August 20, 2014 Most Recent Review Date:
More informationConsidering Surgery for Fibroids? Learn about minimally invasive da Vinci Surgery
Considering Surgery for Fibroids? Learn about minimally invasive da Vinci Surgery The Condition: Uterine Fibroid (Fibroid Tumor) A uterine fibroid is a benign (non-cancerous) tumor that grows in the uterine
More informationUterine Fibroid Symptoms, Diagnosis and Treatment
Fibroids and IR Uterine Fibroid Symptoms, Diagnosis and Treatment Interventional radiologists use MRIs to determine if fibroids can be embolised, detect alternate causes for the symptoms and rule out misdiagnosis,
More informationMRI of the Uterus BENIGN. Jeffrey C. Weinreb, M.D. FACR jeffrey.weinreb@yale.edu Yale University School of Medicine
MRI of the Uterus BENIGN Jeffrey C. Weinreb, M.D. FACR jeffrey.weinreb@yale.edu Yale University School of Medicine Normal Anatomy M Junctional JZ Zone EE Junctional Zone is the inner layer or the myometrium
More informationUse of Ultrasound in the Provision of Abortion. Juan E. Vargas, MD Assistant Professor of Clinical Obstetrics and Gynecology and Radiology, UCSF
Use of Ultrasound in the Provision of Abortion Juan E. Vargas, MD Assistant Professor of Clinical Obstetrics and Gynecology and Radiology, UCSF Overview Uses and indications of ultrasound in the provision
More informationEffects of Pregnancy & Delivery on Pelvic Floor
Effects of Pregnancy & Delivery on Pelvic Floor 吳 銘 斌 M.D., Ph.D. 財 團 法 人 奇 美 醫 院 婦 產 部 婦 女 泌 尿 暨 骨 盆 醫 學 科 ; 台 北 醫 學 大 學 醫 學 院 婦 產 學 科 ; 古 都 府 城 台 南 Introduction Pelvic floor disorders (PFDs) include
More informationWhy would you need a hysterectomy?
Why would you need a hysterectomy? Removal of the uterus is performed to prevent, alleviate, or treat pain, pressure, bleeding, or cancer. Each reason is described in detail in the following pages. Benign
More informationAMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE
AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE UTERINE FIBROIDS A Guide for Patients PATIENT INFORMATION SERIES Published by the American Society for Reproductive Medicine under the direction of the Patient
More informationCornual ruptured pregnancy with placenta increta CORNUAL RUPTURED PREGNANCY WITH PLACENTA INCRETA A RARE CASE
142 CORNUAL RUPTURED PREGNANCY WITH PLACENTA INCRETA A RARE CASE Agarwal NR 1, Rani A 1 *, Batra S 1 1. Department of Obststetrics and Gynaecology, Institute of Medical Sciences, Banares Hindu Univarsity.
More informationPlacenta Accreta: Clinical Risk Factors, Accuracy of Antenatal Diagnosis and Effect on Pregnancy Outcome
ORIGINAL ARTICLE Placenta Accreta: Clinical Risk Factors, Accuracy of Antenatal Diagnosis and Effect on Pregnancy Outcome S Sofiah, MMed*, Late Y C Fung, FRCOG** *Department of O & G, Medical Faculty,
More informationClinical Significance of First Trimester Umbilical Cord Cysts
Clinical Significance of First Trimester Umbilical Cord Cysts Waldo Sepulveda, MD, Sergio Leible, MD, Angel Ulloa, MD, Milenko Ivankovic, MD, Carlos Schnapp, MD A cystic mass of the umbilical cord was
More informationSchool of Diagnostic Medical Sonography
Semester 1 Orientation - 101 This class is an introduction to sonography which includes a basic anatomy review, introduction to sonographic scanning techniques and physical principles. This curriculum
More informationGYNAECOLOGY. Ahmed Mohamed Abbas*, Mohamed Khalaf*, Abd El-Aziz E. Tammam**, Ahmed H. Abdellah**, Ahmed Mwafy**. Introduction ABSTRACT
Thai Journal of Obstetrics and Gynaecology April 2015, Vol. 23, pp. 113-117 GYNAECOLOGY The Diagnostic Value of Saline Infusion Sonohysterography Versus Hysteroscopy in Evaluation of Uterine Cavity in
More informationEFFECT OF INCREASED TESTOSTERONE LEVEL ON WOMAN S FERTILITY
1 Nada Polyclinic, Po ega, Croatia 2 School of Medicine, University of Zagreb, Zagreb, Croatia Preliminary Communication Received: April 15, 2004 Accepted: June 16, 2004 EFFECT OF INCREASED TESTOSTERONE
More informationLaparoscopy and Hysteroscopy
AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE Laparoscopy and Hysteroscopy A Guide for Patients PATIENT INFORMATION SERIES Published by the American Society for Reproductive Medicine under the direction of
More informationUterus myomatosus. 10-May-15. Clinical presentation. Incidence. Causes? 3 out of 4 women. Growth rate vary. Most common solid pelvic tumor in women
Uterus myomatosus A.J. Henriquez March 14, 2015 Uterus myomatosus Definition, incidence, clinical presentation and diagnosis. New FIGO classification for uterine leiomyomas Brief description on treatment
More informationSonographic Evaluation of the Lower Uterine Segment in Patients With Previous Cesarean Delivery
Article Sonographic Evaluation of the Lower Uterine Segment in Patients With Previous Cesarean Delivery Vincent Y. T. Cheung, MBBS, FRCOG, FRCSC, RDMS, Oana C. Constantinescu, MD, RDMS, Birinder S. Ahluwalia,
More informationOvarian Teratomas Appearing as Solid Masses on Ultrasonography
Ovarian Teratomas Appearing as Solid Masses on Ultrasonography Dong Kyung Lee, MD, Seung Hyup Kim, MD, Jeong Yeon Cho, MD, Sang Joon Shin, MD, Kyung Mo Yeon, MD The purposes of this study were to evaluate
More informationANS 3319C Reproductive Physiology and Endocrinology Pregnancy Diagnosis via Rectal Palpation in Cattle and Horses
ANS 3319C Reproductive Physiology and Endocrinology Pregnancy Diagnosis via Rectal Palpation in Cattle and Horses Objectives 1) To introduce the management practice of rectal palpation for pregnancy diagnosis
More informationFetal Therapy Center. Phone: 305-585-6636 Fax: 305-325-1282 www.uhealthobgyn.com www.jhsmiami.org AMNIOPATCH INFORMATION PACKET
Fetal Therapy Center Phone: 305-585-6636 Fax: 305-325-1282 www.uhealthobgyn.com www.jhsmiami.org AMNIOPATCH INFORMATION PACKET 2 AMNIOPATCH FOR TREATMENT OF PREVIABLE PREMATURE RUPTURE OF MEMBRANES Premature
More informationSpontaneous Uterine Rupture in the Second Trimester of Pregnancy Associated with Red Degeneration of Fibroid
Bahrain Medical Bulletin, Vol. 28, No. 1, March 2006 Spontaneous Uterine Rupture in the Second Trimester of Pregnancy Associated with Red Degeneration of Fibroid Khalil E Rajab, MBChB, MFFP, FRCOG* Eftikhar
More informationOB/GYN. Clerkship Learning Objectives. Office for Clinical Affairs Department of OB/GYN (515) 271-1629 (515) 271-1421 FAX (515) 271-1727
OB/GYN Clerkship Learning Objectives Rebecca Shaw, MD, FACOG Office for Clinical Affairs Department of OB/GYN (515) 271-1629 (515) 271-1421 FAX (515) 271-1727 General Description Required Rotation This
More informationPelvic Pain and In Vitro Fertilization
September 2006 Pelvic Pain and In Vitro Fertilization Celeste Lopez, Harvard Medical School Year III September 18, 2006 Mrs. G 37yo with IVF oocyte retrieval the day before presentation to the ED Complains
More informationThree-Dimensional Sonography of the Endometrium and Adjacent Myometrium
Technical dvance Three-Dimensional Sonography of the Endometrium and djacent Myometrium Preliminary Observations Rochelle F. ndreotti, MD, rthur C. Fleischer, MD, Lawrence E. Mason, Jr, MD Objective. y
More informationCrohn's disease and pregnancy.
Gut, 1984, 25, 52-56 Crohn's disease and pregnancy. R KHOSLA, C P WILLOUGHBY, AND D P JEWELL From the Gastroenterology Unit, Radcliffe Infirmary, Oxford SUMMARY Infertility and the outcome of pregnancy
More informationGuidance for Preconception Care of Women with Thyroid Disease
Before, Between & Beyond Pregnancy The National Preconception Curriculum and Resources Guide for Clinicians Guidance for Preconception Care of Women with Thyroid Disease Avi Alkalay, MD Department of Obstetrics
More informationAssessment of Fetal Growth
Assessment of Fetal Growth Unit / Trust: 1. INTRODUCTION The aim of this guideline template is to outline the methods used to assess fetal growth and the referral pathways utilising customised antenatal
More informationApplications of Doppler Ultrasound in Fetal Growth Assessment. David Cole
Applications of Doppler Ultrasound in Fetal Growth Assessment David Cole Aims The aim of this presentation is to consider the use of Doppler ultrasound to investigate and monitor those pregnancies at risk
More informationDiagnosis Codes for Pregnancy and Complications of Pregnancy
This list is for informational purposes only and is not a binding or definitive list of covered conditions. It is not a guarantee of coverage; coverage depends on the available benefits and eligibility
More informationRural Health Advisory Committee s Rural Obstetric Services Work Group
Rural Health Advisory Committee s Rural Obstetric Services Work Group March 15 th webinar topic: Rural Obstetric Patient and Community Issues Audio: 888-742-5095, conference code 6054760826 Rural Obstetric
More informationPercutaneous drainage as the treatment of choice for neonatal ovarian cysts
Pediatr Radiol DOI 10.1007/s00247-006-0240-0 ORIGINAL ARTICLE Ada Kessler. Hagith Nagar. Moshe Graif. Liat Ben-Sira. Elka Miller. Drora Fisher. Irith Hadas-Halperin Percutaneous drainage as the treatment
More informationABSTRACT LABOR AND DELIVERY
ABSTRACT POLICY Prior to fetal viability, intentionally undertaking delivery of a fetus is the equivalent of abortion and is not permissible. After fetal viability has been reached, intentionally undertaking
More informationICD-10 OVERVIEW Coding Guidelines For OB/GYN
ICD-10 OVERVIEW Coding Guidelines For OB/GYN ICD-10 Chapter 15 Pregnancy, Childbirth and the Puerperium (O00-O9A) Note: Codes from this chapter are for use only on maternal records, NEVER on newborn records.
More informationMedical criteria for IUCD s Based on the WHO MEC (2004- Annexure 3) system a woman s eligibility for IUCD insertion falls in 4 categories. These categ
CLIENT ASSESSMENT Ensure that the woman is not pregnant Determine the length and direction of uterus. Ensure that she does not have gonorrhea and chlamydia, and is not a high risk case of STI s Identify
More informationda Vinci Myomectomy Changing the Experience of Surgery Are you a candidate for the latest treatment option for uterine fibroids?
da Vinci Myomectomy Changing the Experience of Surgery Are you a candidate for the latest treatment option for uterine fibroids? Your doctor may be able to offer you a new, minimally invasive surgical
More informationAdvanced ICD-10-CM/PCS Coding for OB/Pregnancy
Advanced ICD-10-CM/PCS Coding for OB/Pregnancy October 14, 2014 Karen Feltner, RHIA, CCS Plan for Today What are we discussing today? What is different in ICD-10-CM for pregnancy? What about ICD-10-PCS
More informationUNC FIBROID CARE CLINIC. Department of Obstetrics and Gynecology Division of Advanced Laparoscopy & Pelvic Pain
The purpose of the Fibroid Care Clinic at the University of North Carolina is to provide up-to-date, comprehensive medical information and care for the treatment of women with uterine fibroids. We offer
More informationClinical Policy Title: Home uterine activity monitoring
Clinical Policy Title: Home uterine activity monitoring Clinical Policy Number: 12.01.01 Effective Date: August 19, 2015 Initial Review Date: July 17, 2013 Most Recent Review Date: July 15, 2015 Next Review
More informationDisclosure Information. What You Need to Know: Changes in OB/GYN Coding. Invalid Codes. Revised Diagnosis Codes. New Diagnosis Codes
Disclosure Information What You Need to Know: Changes in OB/GYN Coding Joan Slager, DNP, CNM, CPC, FACNM slagerj@bronsonhg.org I have the following financial relationship to disclose: Speaker s Bureau:
More informationRed Flags that should not be ignored
Pregnancy that should not be ignored If a pregnant woman tells you she is experiencing any of the following symptoms during pregnancy, assist her to contact her emergency care professional right away.
More informationThe Impact and Management of Fibroids for Fertility
The Impact and Management of Fibroids for Fertility An Evidence-Based Approach Xiaoxiao Catherine Guo, BS, James H. Segars, MD* KEYWORDS Leiomyoma Infertility Assisted reproductive technology (ART) Myomectomy
More informationBenign Ovarian Masses
Benign Ovarian Masses Anthony Hanbidge Learning Objectives Describe technique for assessment of ovarian masses Explain importance of transvaginal scan List the common benign masses Specify distinguishing
More informationWOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500. Endometriosis
Endometriosis WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 The lining of the uterus is called the endometrium. Sometimes, endometrial tissue grows elsewhere in the body. When this happens
More informationAbnormal Uterine Bleeding
Abnormal Uterine Bleeding WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 Abnormal uterine bleeding is one of the most common reasons women see their doctors. It can occur at any age and has
More informationSafe and Effective Surgery for Endometriosis Including Detection and Intervention for Ovarian Cancer
Safe and Effective Surgery for Endometriosis Including Detection and Intervention for Ovarian Cancer Camran Nezhat,, MD, FACOG, FACS Stanford University Medical Center Center for Special Minimally Invasive
More information8/13/2014. Blood, Sweat (and Tears): Delayed Cord Clamping and Delivery Room Temperature. Delayed Cord Clamping
8/13/2014 Blood, Sweat (and Tears): Delayed Cord Clamping and Delivery Room Temperature James F. Smith, Jr., MD Professor and Chair Obstetrics and Gynecology Creighton University School of Medicine The
More informationExamination of the Pregnant Abdomen
Medical students often find the examination of the pregnant abdomen daunting. This document provides a framework for you to develop a comprehensive understanding of the pregnant abdomen examination at
More informationDevelopment of Education Program for Reproductive Health Management for Unmarried Women over age 35
, pp.231-235 http://dx.doi.org/10.14257/astl.2015.116.47 Development of Education Program for Reproductive Health Management for Unmarried Women over age 35 Ju-Young Ha 1, So-Young Jeon 2, Hyo-Jin Park
More informationPlacental Surface Cysts Detected on Sonography
Article Placental Surface Cysts Detected on Sonography Histologic and Clinical Correlation Douglas L. Brown, MD, Donald N. DiSalvo, MD, Mary C. Frates, MD, Karen M. Davidson, MD, David R. Genest, MD Objective.
More informationLuteoma of Pregnancy: Sonographic Findings in Two Cases
Luteoma of Pregnancy: Sonographic Findings in Two Cases J. Richard Choi, ScD, MD, Deborah Levine, MD, Harris Finberg, MD ABBREVIATIONS hcg, Human chorionic gonadotropin Received June 15, 2000, from the
More informationSumma Health System. A Woman s Guide to Hysterectomy
Summa Health System A Woman s Guide to Hysterectomy Hysterectomy A hysterectomy is a surgical procedure to remove a woman s uterus (womb). The uterus is the organ which shelters and nourishes a baby during
More informationFetal Prognosis in Varix of the Intrafetal Umbilical Vein
Fetal Prognosis in Varix of the Intrafetal Umbilical Vein Waldo Sepulveda, MD, Antonio Mackenna, MD, Jorge Sanchez, MD, Edgardo Corral, MD, Eduardo Carstens, MD To assess the clinical significance of varix
More informationCHAPTER 10 Uterine Synechiae
CHAPTER 10 Uterine Synechiae Uterine synechiae are intrauterine adhesions. They may involve small focal areas of the endometrium (Figures 10.1a e), or they can be so extensive that they obliterate the
More informationEvaluation and Follow-up of Fetal Hydronephrosis
Evaluation and Follow-up of Fetal Hydronephrosis Deborah M. Feldman, MD, Marvalyn DeCambre, MD, Erin Kong, Adam Borgida, MD, Mujgan Jamil, MBBS, Patrick McKenna, MD, James F. X. Egan, MD Objective. To
More informationUterine Fibroids. More than half of all women have fibroids. They are a common, benign, uterine growth.
Uterine Fibroids More than half of all women have fibroids. They are a common, benign, uterine growth. Fibroids are not a disease. Much like the genetic blueprint that determines the color of your eyes
More informationPlacenta Accreta. An Association With Fibroids and Asherman Syndrome. Case Series
Case Series Placenta Accreta An Association With Fibroids and Asherman Syndrome Amal Al-Serehi, MD, Anna Mhoyan, MD, Michelle Brown, MD, Kurt Benirschke, MD, Andrew Hull, MD, Dolores H. Pretorius, MD Objective.
More informationMonochorionic twin delivery after conservative surgical treatment of a patient with severe diffuse uterine adenomyosis without uterine rupture
Case Report Obstet Gynecol Sci 2016;59(4):311-315 http://dx.doi.org/10.5468/ogs.2016.59.4.311 pissn 2287-8572 eissn 2287-8580 Monochorionic twin delivery after conservative surgical treatment of a patient
More informationHow do I know if I need to have surgery?
How do I know if I need to have surgery? Deciding whether or not to have surgery for your bladder, bowel and/or prolapse problems is an individual decision. The success or failure of someone else's operation
More informationAbigail R. Proffer, M.D. October 4, 2013
Abigail R. Proffer, M.D. October 4, 2013 Topics Human Papillomavirus (HPV) Vaccines Pap smears Colposcopy Contraception Polycystic Ovary Syndrome (PCOS) Can I get pregnant? Miscarriage Abnormal Uterine
More informationInformation for you A low-lying placenta (placenta praevia) after 20 weeks
Information for you A low-lying placenta (placenta praevia) after 20 weeks Published in December 2011 Who is this information for? This information is intended to help you if you have, or have been told
More informationCONFIDENT CODING FOR OB/GYN CONFIDENT CODING FOR OB/GYN
Arlene J. Smith, CPC AAPC National Advisory Board 2007-2009 1 So when exactly does the global period start? Unraveling the confusion in antepartum care coding Correct coding for multiple gestations! Vaginal
More informationOutcome of Patients with an Indeterminate Emergency Department First-trimester Pelvic Ultrasound to Rule Out Ectopic Pregnancy
912 Tayal et al. d INDETERMINATE US AND ECTOPIC PREGNANCY Outcome of Patients with an Indeterminate Emergency Department First-trimester Pelvic Ultrasound to Rule Out Ectopic Pregnancy Abstract Vivek S.
More informationInterrupted Pregnancy Coding
Interrupted Pregnancy Coding American College of Obstetricians and Gynecologists Terry Tropin, RHIA, CPC, CCS-P, ACS-OB, PCS Content Development Expert, DecisionHealth ACOG Committee on Coding and Nomenclature
More informationDiagnosis of Ovarian Torsion with Color Doppler Sonography: Depiction of Twisted Vascular Pedicle
Diagnosis of Ovarian Torsion with Color Doppler Sonography: Depiction of Twisted Vascular Pedicle Eun Ju Lee, MD, Hyuck Chan Kwon, MD, Hee Jae Joo, MD, Jung Ho Suh, MD, Arthur C. Fleischer, MD The purpose
More informationAnalysis of the Thymus in 151 Healthy Infants From 0 to 2 Years of Age
Article Analysis of the Thymus in 151 Healthy Infants From 0 to 2 Years of Age Ensar Yekeler, MD, Ahmet Tambag, MD, Atadan Tunaci, MD, Hakan Genchellac, MD, Memduh Dursun, MD, Gulbin Gokcay, MD, Gulden
More informationProSono Copyright 2006. Ovarian Pathology
Ovarian Pathology Physiologic cysts: Functional cysts Pathology: A simple cyst is a sac containing fluid or semi-solid material. Physiologic cysts are generic types of hormonally active cysts that result
More informationCaring for Mom and Child: Trauma in the Pregnant Patient
Caring for Mom and Child: Trauma in the Pregnant Patient George Koenig DO, FACS Assistant Professor of Surgery, Division of Trauma & Critical Care Associate Medical Director JeffSTAT Thomas Jefferson University
More information4/15/2013. Maribeth Inturrisi RN MS CNS CDE Perinatal Diabetes Educator mbturris@comcast.net
Maribeth Inturrisi RN MS CNS CDE Perinatal Diabetes Educator mbturris@comcast.net List the potential complications associated with diabetes during labor. Identify the 2 most important interventions essential
More informationWhat are the differences between fibroid and ovarian cyst?
DR LEE KEEN WHYE MBBS (Singapore), FRCOG (U.K), FAMS (Singapore) Consultant Obstetrician & Gynaecologist Advisor, Endometriosis Association, Singapore KW Lee Clinic & Surgery For Women No. 6 Napier Road,
More informationFree Echogenic Pelvic Fluid: Correlation with Hemoperitoneum
Free Echogenic Pelvic Fluid: Correlation with Hemoperitoneum G. Kimberly Sickler, MD, Phebe C. Chen, MD, Theodore J. Dubinsky, MD, Nabil Maklad, MD, PhD Echogenic fluid is an important extrauterine finding
More informationLippes Loop intrauterine device left in the uterus for 50 years. Case report
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Lippes Loop intrauterine device left in the uterus for 50 years Case report Background.The first Lippes Loop intrauterine device was distributed in 1962. It was a
More informationSonographic Spectrum of Hemorrhagic Ovarian Cysts
Image Presentation Sonographic Spectrum of Hemorrhagic Ovarian Cysts Kiran A. Jain, MD Objective. To present the spectrum of sonographic findings associated with hemorrhagic ovarian cysts. Methods. Experience
More informationA report of 300 cases using vacuum aspiration for the termination of pregnancy
A report of 300 cases using vacuum aspiration for the termination of pregnancy Wu, Yuantai and Wu, Xianzhen Chinese Journal of Obstetrics and Gynaecology (1958:447-9) More than 100 years after Recamier
More informationBELIEVE MIDWIFERY SERVICES, LLC
, LLC TITLE: ADENOMYOSIS EFFECTIVE DATE: May, 2012 POLICY STATEMENT Adenomyosis is a common benign gynecologic disorder that any certified nurse-midwife who provides gynecologic care is likely to see on
More informationUltrasound in the First Trimester of Pregnancy. Elizabeth Lipson, HMS III
Ultrasound in the First Trimester of Pregnancy Elizabeth Lipson, HMS III First Trimester Sonography Localization of Gestational Sac Intrauterine vs. ectopic Identification of abnormalities Embryonic demise
More informationMyomas and Assisted Reproductive Technologies: When and How to Act?
Obstet Gynecol Clin N Am 33 (2006) 145 152 Myomas and Assisted Reproductive Technologies: When and How to Act? Aytug Kolankaya, MD a, T, Aydin Arici, MD b a Infertility and IVF Unit, Department of Obstetrics
More informationWhat Does Pregnancy Have to Do With Blood Clots in a Woman s Legs?
Patient s Guide to Prevention of Blood Clots During Pregnancy: Use of Blood-Thinning A Patient s Guide to Prevention of Blood Clots During Pregnancy: Use of Blood-Thinning Drugs to Prevent Abnormal Blood
More informationGet the Facts, Be Informed, Make YOUR Best Decision. Pelvic Organ Prolapse
Pelvic Organ Prolapse ETHICON Women s Health & Urology, a division of ETHICON, INC., a Johnson & Johnson company, is dedicated to providing innovative solutions for common women s health problems and to
More informationThe position of hysteroscopy in current fertility practice is under debate.
The position of hysteroscopy in current fertility practice is under debate. The procedure is well tolerated. No consensus on effectiveness of HSC in improving prognosis of subfertile women. systematic
More informationThe following chapter is called "Follow-ups with a Positive or a Negative Pregnancy Test".
Slide 1 Welcome to chapter 7. The following chapter is called "Follow-ups with a Positive or a Negative Pregnancy Test". The author is Professor Pasquale Patrizio. Slide 2 This chapter has the following
More informationLEIOMYOMA REMOVAL: A CASE REPORT. Nykol Bailey, RN, BSN. A capstone project submitted in partial fulfillment. of the requirement for the degree
LEIOMYOMA REMOVAL: A CASE REPORT by Nykol Bailey, RN, BSN A capstone project submitted in partial fulfillment of the requirement for the degree of Master of Science in Nurse Anesthesia Westminster College
More informationCOMPLICATIONS OF PREGNANCY, CHILDBIRTH AND THE PUERPERIUM
COMPLICATIONS OF PREGNANCY, CHILDBIRTH AND THE PUERPERIUM PREGNANCY WITH ABORTIVE OUTCOME (630 639.9) 630 HYDATIDIFORM MOLE 631 OTHER ABNORMAL PRODUCT OF CONCEPTION 632 MISSED ABORTION 633 ECTOPIC PREGNANCY
More informationFirst-Trimester Cesarean Scar Pregnancy Evolving Into Placenta Previa/Accreta at Term
Case Report First-Trimester Cesarean Scar Pregnancy Evolving Into Placenta Previa/Accreta at Term Jara Ben Nagi, MD, Dede Ofili-Yebovi, MD, Mike Marsh, MD, Davor Jurkovic, MD Placenta accreta is a rare
More informationGynecology Abnormal Physiology of the ovaries. Simple Cystic Masses
Gynecology Abnormal Physiology of the ovaries (Effective February 2007) pediatric, reproductive, and perimenopausal/postmenopausal (24-28 %) Simple Cystic Masses ovary s function is to mature oocytes until
More informationNorth Carolina Medicaid Special Bulletin
North Carolina Medicaid Special Bulletin An Information Service of the Division of Medical Assistance Visit DMA on the web at http://www.ncdhhs.gov/dma Number 1 (Revised 8/23/11) July 2011 Pregnancy Medical
More informationThis Protocol is adapted from the University of Colorado Protocol dated August 26, 2009.
Protocol for Post-Placental IUD insertion July 14, 2010 This Protocol is adapted from the University of Colorado Protocol dated August 26, 2009. Background Post-placental intrauterine device (IUD) insertion
More information