week 2 Flashcards
What is a niche?
A cavity that can form if a ceserean section doesn’t heal properly. It is a radiographic description.
… % has a big niche, … % has a small one
30% big, 70% small
How can a woman have 2 niches at different hights?
Different terms –> 1 a terme, one premature
What is the best way to diagnose a niche?
With ultrasonography > Indentation of at least 2 mm in the myometrium at the uterine CS scar.
What are other ways to diagnose it?
MRI, HSG (SIS/GIS)
What are complaints of a niche?
Gynaecological: spotting, dysmenorrhea
Obstetrics: malplacentation, CS pregnancy and UVB
Subfertility: Lower PR’s
What is a niche pregnancy and what is the prevelence?
An ectopic pregnancy, implantation in the cavity of the CS. Is important to diagnose soon and treat. 1:1800
What is the pathofysiology of niche?
You see it more often in women with adenomyose (can influence wound healing), poor wound healing because of HBP, DM, pre-eclampsia. Adhesions
IS the way you stitch the CS an influence on getting a niche?
No
What is NOT a typical symptom of a niche?
Uterine rupture during labour
When do you treat a niche?
When there are symptoms
What do you do if a woman has symptoms but no children wish?
Mirena IUD or OC
What if the IUD or OC doesn’t work?
> 2.5 mm: hysniche
<2.5 mm: VH/TLH
What treatment do you give when the woman has symptoms, but a fertility wish?
> 2.5: hysniche
<2.5: lapniche
What is a Hysniche?
Hysteroscopic niche resection. Is the least invasive. Resection of the distal rim aims at improving outflow of menstrual blood (which reduces pain), also superficial coagulation (reducing bloodloss). Thickness should at least be 3 mm, because of risk for bladder
What is a Lapniche?
Laproscopic niche resection. First you do hysteroscopic evaluation with a light, then you fill up the bladder. After identifying the arteries you open up the niche and resect it.
For how long can’t woman get pregnant after niche operation?
6 months
What is a myoma?
Monoclonal smooth muscle cells from uterus, benigne.
When do myoma’s specifically grow and why?
In fertile period. Grow under influence of estrogenes and progestagene. In the menopause the myoma’s shrink.
Who are at risk to develop myoma’s?
Nulliparous, early menarche, african genes, familliar.
What are the symptoms of myoma’s?
75% don’t have any symptoms. Symptoms can be: dysmenorrea, heavy menstrual blood loss, mechanical complaints, subfertility.
What is the classification according to FIGO?
- Type 0,1,2: are submuceus. Grow inside the cavum of the uterus.
- Type 3, 4 and 5: Intra mural myoma’s.
Type 6 en 7: grow on the outside; subsereus. Only mechanical complaints.
Relation to the endometrium; myoma’s.
Type 0: 0%
Type 1: <50%
Type 2: > 50%
Type 3: 100%
How can you diagnose a myoma?
Feel, US, HSG, MRI
What is STUMP?
Smooth Muscle Tumor of Uncertain Malignant Potential. TCN or 1 of the other features. Mostly uterus is removed.
What treatment can you give with myoma’s aimed at blood loss?
Tranexaminezuur (remt fibrinolyse)
COC/IUD mirena: Everything with hormones.
What treatment can you give aimed at volume reduction?
GnRH agonist (lucrin) Selective progestagene inhibitors (Esmya).
What are side effects op lucrin?
Hot flushes, sweating, headache, CVR on long term.
What types of surgery’s are there for myoma’s?
- TCRM: type 0, 1, 2 (3) > Can’t be bigger than 3 cm.
- Myomectomy: Best option for women who want to have children.
- Hysterectomy: Whole uterus is removed. When there are no fertility whishes.
- Embolisation: Less blood to the myoma’s
- Ablation: HIFU. 30% volume reduction with MRI.
- Vizablate/ sonata: Reconstruct myoma with deciver.
What is the clinical pregnancy rate RR when you have myoma’s?
0.85 > so 15% less chance on pregnancy.
Subserosal myoma’s (7,6,5): have … effect on fertility
No
Submucosale myoma’s (0,1,2) have a clincal pregnancy rate of …. live birth rate of …, micarriage of …
CPR: 0.30, LBR 0.32, MC: 1.68-3.95
Intramural myoma’s (3,4) have a CPR of …, IVF outcome of …, LBR of …
CPR: 0.8, IVF 0.77-0.94, LBR 0.7
Embolization of myoma’s leads to more..
Pre-term births
