Pregnancy and Birth

Transvaginal hydro laparoscopy (THL) is a new approach to pelvic anatomic evaluation in the infertile woman. In this procedure a dilating trocar is inserted through the osterior vaginal wall for endoscopic pelvic examination. Normal saline is used to float the bowel out of the pelvis so that one can evaluate the distal Fallopian tubes, ovarian surfaces, pelvic sidewalls, and the cul-de-sac. The THL procedure makes in-office pelvic endoscopy, hysteroscopy, and dye hydrotubation a reality.

Hysteroscopy performed with liquid media at a sufficient pressure, usually between 70 mm and 90 mm Hg of true intrauterine pressure, will bring about satisfactory uterine distention, but not necessarily adequate visualization. Depending on the amount of intraoperative bleeding, an adequate flow rate of the media with separate channels of entry and egress is necessary to have a clear operative field.

For the gynecologist, the introduction of the resectoscope revolutionized the management of submucous myomata that cause uncontrollable uterine bleeding, infertility and pregnancy wastage, and the con-servative control of persistent and excessive uterine bleeding unrelated to uterine filling defects.

Laparoscopy has revolutionized the practice of modern operative gynecology and has progressed from simple diagnostic work to advanced operative procedures.[

Introduction: Intestinal endometriosis is a disabling disease present in 6% to 30% of deep endometriosis cases. It can be the cause of abdominal bloating, constipation, intestinal cramping and painful bowel movements, defecation pain and intestinal stenosis up to intestinal occlusion. Colorectal endometriosis requires surgical treatment that can be performed by abdominal route or by laparoscopy. The present study describes the total laparoscopic rectosigmoid resection in case of deep endometriosis with bowel involvement.

Vaginal hysterectomy can be the standard procedure for removing the uterus, but surgical skills and indications to vaginal surgery are variable. Laparoscopic assistance to vaginal hysterectomy is a way to change the approach to hysterectomy. In this paper we describe our retroperitoneal technique for laparoscopic securing of the uterine pedicles.

Research shows that to reduce the risk of gestational diabetes, exercise intensity should reach at least 60% of the heart rate reserve during pregnancy while gradually increasing physical-activity energy expenditure.

To interpret the literature describing the results of surgery for endometriosis, a clear understanding of the evolution and limitations of the various techniques is necessary. Up to the end of the 1970’s, minimal and mild endometriosis was destroyed endoscopically by heat application (endothermia) and by unipolar or bipolar coagulation. Treatment of more severe endometriotic disease was mostly radical by hysterectomy, often leaving some rectovaginal endometriosis which has not been fully recognised before 1989.

Endometriosis can infiltrate the surrounding tissues resulting in an important sclerotic, and inflammatory reaction which can translate clinically in nodularity, bowel stenosis and ureteral obstruction. The most severe forms such as rectovaginal endometriosis and endometriosis invading the rectum or the sigmoid have been known since the beginning of this century. These conditions, however, are relatively rare with an estimated prevalence of less than 1%.

The medical literature has reported an increase in myomectomy during caesarean section in the past decade. However, myomectomy performed during pregnancy remains a rarity. The management of uterine fibroids during pregnancy is usually expectant and surgical removal is generally delayed until after delivery. We present a case of a large, symptomatic uterine fibroid diagnosed during pregnancy which was successfully managed by antepartum myomectomy.

Objective: To evaluate the laparoscopically assisted vaginal hysterectomy (LAVH) in terms of indications, uterine size that can be operated upon, surgical procedures and their safety, intraoperative complications and blood loss, operative time, concomitant surgical procedures, postoperative period and complications, and average total cost.

The use of levonorgestrel-releasing intrauterine system (LNG-IUS) results in a remarkable decrease in endometrial proliferation and a remarkable increase in apoptosis in the endometrium ; therefore it is effective for long-term management of menorrhagic women with uterine myomas because of the striking reduction in menorrhagia.

Three Questions to the Editorials Author

Welcome to this, my first column for OBGYN.net. My hope is that my monthly articles will entertain, question and stimulate you in all areas of OBGYN. I am a general obstetrician and gynecologist working in North London, United Kingdom with particular interests in endoscopic surgery and urogynaecology. I am also an award winning medical journalist. Over the coming months I hope to share my experiences and thoughts with you, challenge our beliefs and contribute to the ongoing debate that shapes improvements in clinical care. I welcome your feedback.

Objective: To study the findings obtained by diagnostic laparoscopy in gynaecological problems in order to re-assess the role of laparoscopy in the diagnosis of gynaecological problems during the study period.

Objectives: To compare the efficiency of laparoscopic treatment versus conventional abdominal surgery in the treatment of ectopic pregnancy (EP) and to review the clinical presentation, evaluate methods of diagnosis, and identifying the risk factors.

One of the important problems in the clinical management of cancer is the early detection of its occurrence. The demonstration of immunoreactive substances, which are specific or associated with cancer and measurable in serum, provides an interesting and promising approach to cancer detection

Acute on-set of Hematometra and Hematosalpinx in a non-communicating Rudimentary Horn of an Unicornuate Uterus: Laparoscopic Management

As doctors, we often consult closely with colleagues regarding treatment and diagnosis. However, for a reproductive endocrinologist like myself, sometimes the most important colleague is one who does not have an office down the hall. Ob/gyns are likely the first specialists to field patient questions about fertility, and patients rely on ob/gyns to alert them when they need to see a fertility specialist.

In this article month’s blog I’ll discuss one of the various uterine causes of infertility, focusing specifically on a condition in which the uterus is congenitally very small in size-the hypoplastic uterus.

In a recent safety communication, the FDA has informed the public about new information they are assessing in an ongoing review of birth control pills that contain drospirenone, a type of progestin.

During pregnancy, every mother-to-be undergoes radical psychological and physiological changes (endocrinologic, immunologic, metabolic, or vascular) whose influence may trigger various skin manifestations, even during the very first weeks of gestation.

James E. Carter, MD, PhD, FACOG, OBGYN.net Editorial Advisor interviews Charles Miller, MD

The source of chronic pelvic pain may be reproductive organ, urological, musculoskeletal - neurological, gastrointestinal, or myofascial. A psychological component almost always is a factor whether as an antecedent event or presenting as depression as result of the pain.

Dr. Dubuisson stated that there is is a great demand from patients for minimally invasive surgery and it is important that the surgeon apply certain conditions to the selection of patients for successful treatment of leiomyomas by laparoscopy. Dr. Dubuisson said that the indications for a safe laparoscopic myomectomy include the following:

bout 30% of those with blocked tubes have proximal obstruction. Blockage where the tubes connect to the uterus. This may be due to adhesions, spasm of the opening from the uterus to the tube (tubal osteum) or dryed up dead cells and mucus. The first probably can't be helped. We often see it with a condition called SIN (salpingitis isthmica nodusum) seen after sever pelvic infection. Spasm means the tubes are not really blocked but they show up that way. It's the dried up stuff blocking the tube that makes a difference.

OBGYN.net Conference CoverageFrom American Association of Gynecological LaparoscopistsOrlando, Florida, November 2000. "AAGL The Founding Years" Jordan Phillips, MD, OBGYN.net Editorial Advisor and General Chairman andFounder of AAGL with Dr. Louis Keith, MD OBGYN.net Editorial Advisor

Laparoscopy has been steadily replacing laparotomy because the abdomen does not have to be opened up, resulting in faster recovery and reduction of complications. In laparoscopy, only three small incisions are made for the entry of a small camera and other instruments. Thus, the operation that is taking place inside the abdomen/pelvis can be viewed on a video screen placed next to the operating table.

An ectopic pregnancy is a pregnancy implanted in an abnormal location (outside of the uterus). During the past 40 years its incidence has been steadily increasing concomitant with increased STD rates and associated salpingitis (inflammation of the Fallopian tubes). Such abnormalities of the tubes prevent normal transport of the fertilized egg to the uterus.

Endometrium refers to the tissue lining the uterus. The primary function of the endometrium is to participate in the implantation of the fertilized ovum and the subsequent formation of the maternal portion of placenta.