Endometriosis is defined as the presence of endometrial-like tissue (glands and stroma) outside the uterus, which induces a chronic inflammatory reaction, scar tissue, and adhesions that may distort a woman’s pelvic anatomy. Endometriosis is primarily found in young women, but its occurrence is not related to ethnic or social group distinctions. Patients with endometriosis mainly complain of pelvic pain, dysmenorrhea, and dyspareunia. Endometriosis is a very common debilitating disease that occurs in 6 to 10% of the general female population; in women with pain, infertility, or both, the frequency is 35-50%. This is an evidence based narrative review conducted by searching Medline up to (2017) and other online articles from Pubmed, Google scholar by using terms like Endometriosis, management, evidence based, updated treatment, pharmacoceutical hormon treatment and non-hormonal treatment. Articles were selected based on their currency and relevance to the discussion. Numerous cofactors can play a role in the progression and maintenance of endometriosis, which is thus a complex multifactorial disease. Hormonal therapy represents the treatment of choice in patients with endometriosis; with this in mind, we could consider CAM a supplementary option to be added to hormonal treatment, or as a valuable opportunity for those women in whom medical therapy is contraindicated.
Background:The objective of this study is to assess the efficacy and safety of Fahmy's four quadrant suture technique (FFQS) in controlling blood loss during cesarean delivery for placenta previa (PP). Methods:The study was carried out in a tertiary University Hospital between January 2017 to December 2017 involved 12 women with heavy bleeding occurred after removal of the placenta from the lower section during cesarean delivery for PP. The FFQS technique consisted of two sutures to ligate the uterine branches on both sides and two sutures on the anterior and posterior wall of the lower uterine segment. Details regarding the management and maternal outcomes were recorded. Results: The mean age of the study participants was 29.58±5.29 years and the mean parity was 2.25±1.14. The mean gestational age at termination of pregnancy was 36.91±1.38 weeks. The mean duration of the whole surgery was 78.75±43.28 minutes, while the mean duration of FFQS technique was only 10±2.09 minutes. The technique was exclusively effective in 8 out of 12 cases (66.67%) while 2 cases needed bilateral internal iliac artery ligation and 2 cases needed hysterectomy. The mean amount of blood loss in all cases was 2433.33±833.76 ml. the mean amount of transfused packed RBCs was 3.92±1.68 units and fresh frozen plasma (FFP) was 3.42±1.44 units. All cases had uneventful postoperative course and no mortality cases in present series. Conclusions: The new technique; FFQS represents a rapid, effective, and inexpensive opportunity for women with bleeding from the lower segment of uterus due to PP. This simple procedure should be attempted before other complex measures to achieve good hemostasis.
Background: Uterine rupture (UR)is one of the most serious obstetrical emergencies necessitating prompt diagnosis and management, as it en-dangers the maternal and fetal life. Uterine rupture (scarred/ unscarred) may occur at any stage of pregnancy. In developed countries, with good antenatal care and good supervision during labour, (UR) has become rare except by dehiscence of a caesarean scar. The objective of present study was to find out risk factors, management, related complications and associated maternal and fetal outcomes with rupture uterus.Methods: A retrospective study, data files and the case notes was retrieved from the medical records department at Aswan university hospital from January 1 2013 to December 31 2013 in the form of data relating to the age, parity, gestational age, method of termination, perinatal outcomes, and related maternal complications.Results: There were 4284 deliveries during the period under review among them 5 cases of uterine rupture. Thus, the incidence of uterine rupture was 1.1/1000 deliveries.3 cases (60%) of them had no antenatal care at any hospital or primary care center. The risk factors in these cases are in majority 4 (80%) of cases uterine rupture occurred in women with previous scar, 1case (20%) of cases uterine rupture occurred in women with none scarred uterus. As regard surgical management 3 cases (60%) managed by hysterectomy and 2cases (40%) managed by repair. As regard maternal and fetal outcome all women required blood transfusion. Associated bladder rupture was repaired in two cases (40%). After excluding fetal wastage before the age of viability, perinatal mortality was 100% (5/5).Conclusions: Present retrospective analytical study has concluded that rupture uterus is a life-threatening complication. Proper antenatal and intrapartum care, identification of high risk factors, promotion of skilled attendance at birth and institutional delivery are key factors in reduction and early diagnosis.
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