Occlusion of the external cervical os after conization in a postpuerperal amenorrheic woman

Abstract

Postpuerperal amenorrheic women should be managed with care because of the increased risk of occlusion of the cervical duct after conization.

A new approach to prevent cervical stenosis in postmenopausal women after loop electrosurgical excision procedure: a randomized controlled trial

“…According to previous clinical reports, menopausal transition and postmenopause and lactation periods are considered to be high-risk periods for cervical stenosis 1,10 . Besides, amenorrhea and decreased menstrual frequency have also been associated with cervical stenosis 11 . Additionally, according to a prospective study by Houlard 12 , age is a significant independent predictor of cervical stenosis after conization.…”

“…According to Burgmann's research 3 , a history of multiple cervical operations and a large volume of conization may increase the risk of cervical stenosis. Further, Houlard 11 and Baldauf 13 et al reported that cervical stenosis occurred when the depth of excision was more than 20 mm, and Luesley 14 et al pointed out that greater conization depth (more than 2.5 cm) was associated with cervical stenosis. They recommended that the depth of excision be determined based on the size of the cone, thus reducing the complications.…”

A Novel Approach to Transmural Access to the Uterine Cavity in Cases of an Inaccessible Uterine Cavity: A Case Series

“…In rare cases, it may not be possible to access the uterine cervix because of severe stenosis or complete obliteration as a result of extensive scarring after surgery or radiation. Complete occlusion is reported to have an incidence around 1% or less [1][2][3][4][5]. This situation can lead to symptoms such as infertility and cryptomenorrhea with cyclic pain or prolonged menstrual blood loss, cause delayed diagnosis in case of endometrial pathology, or make the introduction of an intrauterine device impossible.…”

“…Examples of surgeries and other clinical conditions that have proven to be capable of causing sufficient scarification for these problems include conization [1][2][3], large loop electrosurgical excision of cervical dysplasia [4,5], Manchester repair [6], complicated induced abortion with laceration of the cervix, radiation, or severe atrophy.…”

“…One case report has described the "surgical" opening of a fully closed external os after postpuerperal conization without elaborating on the technique [1], and 1 case series has reported on a resectoscopic treatment of cervical stenosis in technically challenging embryo transfer attempts during in vitro fertilization [9]. A more sophisticated approach seems to be opening of the scar tissue with hysteroscopic scissors, preferably under ultrasound guidance, similar to the treatment of Asherman syndrome [10].…”