26.09.2013

Hysterectomy to treat uterine cancer jewelry

Synthetic progestin which are a form of hormone progesterone, are used for the treatment of uterine cancer. Traditionally, the most common treatment for uterine fibroid tumors is to remove the entire uterus in a surgical procedure called hysterectomy. A 2 percent risk of post-operative bleeding, a 15 percent to 38 percent risk of postoperative fever and a 0.5 percent risk of injury to a nearby pelvic organ.
The incidence of cardiovascular disease increases three-fold in premenopausal women undergoing hysterectomy. From 15 percent to 30 percent of women report decreased sexual function after hysterectomy, and there is an increase in the reported incidence of depression following the surgery. The surgery also adds to the high cost of treating uterine fibroid tumors, which accounts for billions of health care dollars each year. With UFE, many women no longer have to choose between living with severe fibroid symptoms and losing their uterus. In the past, hysterectomy was the only option for many women suffering from the chronic pain and other debilitating symptoms that a uterine fibroid tumor can cause. A study published in the journal Obstetrics and Gynecology concluded that 70 percent of hysterectomies are recommended inappropriately. Further, recent research indicates that natural hormone replacement therapy may also help to delay the onset and progression of Alzheimera€™s Disease. Typically, bio-identical hormone replacement therapy includes progesterone, estrogens (estrone, estradiol and estriol), dehydroepiandosterone (DHEA) and testosterone. Unfortunately, doctors are frequently confused about the differences between progestin (synthetically produced progesterone) and bio-identical progesterone, which is typically included in natural hormone therapy. Two large European studies (Unequal Risks for Breast Cancer Associated with Different Hormone Replacement Therapies: Results from the E3N Cohort Study and Pregnancy, Progesterone and Progestins in Relation to Breast Cancer Risk) confirm that bio-identical hormone replacement therapy is not only effective, but also safe. Many of our patienta€™s thought they were going to have to struggle through everyday dealing with the symptoms related to hormone deficiencies. There are several types of hysterectomy, depending on the precise structures of the pelvis that are surgically removed. Total hysterectomy: complete removal of the uterus and cervix, with or without the uterine (Fallopian) tubes. Radical hysterectomy: removal of the uterus, cervix, tubes, ovaries, and a small part of the upper vagina.
A hysterectomy is a major operation, and the decision to proceed with this form of treatment requires a careful evaluation and discussion.
The suitability of other treatment options depend on you particular medical condition, your needs for fertility, and your personal wishes.
There are several ways a hysterectomy may be performed, depending on the indication for the hysterectomy, whether other procedures are required at the same time (e.g. The length of stay in hospital depends on the type of hysterectomy, but most women are able to go home the day after surgery. Complications are possible with any surgical procedure although, thankfully, they are uncommon.
David is a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and undertook his specialist training in Queensland. Hysterectomy is the surgical removal of uterus in order to treat cancer, severe endometriosis or uterine fibroids. One of the side effects of hysterectomy is gaining weight due to change of hormonal levels. The women who has undergone through hysterectomy might be facing from depression of not having children. Science, Technology and Medicine open access publisher.Publish, read and share novel research. B-Lynch Compression Suture as an Alternative to Paripartum HysterectomyChristopher Balogun-Lynch1 and Tahira Aziz Javaid2[1] Milton Keynes General Hospital, Oxford Deanery, UK[2] Wexham Park Hospital, Slough, UKAbstract: Obstetrics haemorrhage is a major killer of women of all categories of class, religion, social and economic status. Keriakos R, Mukhopadhyay A.The use of the Rusch balloon for management of severe paripartum haemorrhage. Many physicians continue to recommend hysterectomy as the standard in uterine fibroid tumor treatment, sometimes because they are not familiar with newer, less invasive options. For many women, the permanent loss of fertility after fibroid tumor treatment with hysterectomy is an unacceptable tradeoff for the relief of fibroid symptoms.
UFE results in fewer, less serious complications and much shorter recovery times compared to surgical removal of the uterus with hysterectomy. Hysterectomy also is a widely available treatment for uterine fibroid tumors, and every gynecologist is trained to perform the operation. This is one of many reasons why more and more women with symptomatic uterine fibroid tumors are looking for alternatives to hysterectomy.
Recently, the American College of Obstretrics and Gynecology issued a statement (link to ACOG site) approving UFE to treat fibroid tumors.
Since this surgical procedure will prevent her body from producing critical sex hormones, one of these aspects is whether or not to take hormone supplements.
A study conducted in the United States found that women undergoing BHRT are between 30 and 40 percent less likely to develop this disease compared to women who do not take hormone supplements.
Precursor to other hormones, including testosterone, estrogens and cortisone, progesterone helps the body to function properly. Made in laboratories, progestin is actually the hormone that contributes to breast cancer, heart attack, stroke and other terrible conditions. According to these studies, all women, whether they have or have not undergone a hysterectomy, following an individualized natural hormone therapy plan face a decreased risk of developing hormone imbalance-related diseases, including osteoporosis, heart disease, stroke, cancer and Alzheimera€™s Disease. They were unaware that they could restore those depleted hormone levels and renew that feeling of youth and vitality.
The accuracy, completeness, adequacy, or currency of the content is not warranted or guaranteed. Women of third world countries suffer the most adversity because of poor resources and infrastructure. The B-Lynch surgical technique for the control of massive paripartum haemorrhage: An alternative to hysterectomy? B-Lynch uterine compression suture for paripartum haemorrhage due to placenta praevia accreta.
Parallel vertical compression sutures: a technique to control bleeding from placenta praevia or accreta during caesarean section.
Hemostatic cervical suturing technique for management of uncontrollable paripartum haemorrhage originating from the cervical canal. Fertility and pregnancy outcome following pelvic arterial embolization for severe post-partum haemorrhage. Menses, fertility, and pregnancy after arterial embolization for the control of paripartum haemorrhage. The Portrait Collection of Johns Hopkins Medicine: A Catalog of Paintings and Photographs at The Johns Hopkins University School of Medicine and The Johns Hopkins Hospital.
Trends in postpartum haemorrhage in high resource countries: A review and recommendations from the international paripartum haemorrhage collaborative group.


Why Mothers Die: Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 2002-2004 Triennial Report.
Obstetric Surveillance System (UKOSS), uterine compression sutures for the management of severe PPH. Optimizing outcomes through protocols, multidisciplinary drills, and simulation, Semin Perinatol. Successful reduction of massive paripartum haemorrhage by use of guidelines and staff education. Multidisciplinary team training in a simulation setting for acute obstetric emergencies: A systematic review. This fact means a huge step for women who want to become a mother and do not have their own uterus, a hopeful advance in this field.
I hope this technique evolves enough to be a common one among the ones who can't conceive in any other way. These types of tumors are diagnosed by cervical pap smear test but this test rarely catches uterine cancer cells as they are dislodged to the cervix.
Women can be cured by radiation therapy alone after taking a decision against hysterectomy. Because UFE is a relatively new fibroid tumor treatment performed by interventional radiologists, some gynecologists are not well acquainted with the procedure.
This procedure is usually recommended to women suffering from uterine fibrosis, chronic pelvic pain, uterine prolapse, adenomyosis, endometriosis and cancer of the uterus, cervix or ovaries.
Although the adrenal glands produce specific sex hormones (estrogens and testosterone), these hormones are secreted in very small quantities, insufficient to make a womana€™s body function properly. Since progesterone is a known cause of breast cancer, heart attack, stroke and many other diseases, should it be substituted?
While cortisone sustains healthy stress and immune function, testosterone is known to decrease fatigue and improve sense of well-being. Since this chemical compound confuses the human body, it can cause a series of unwanted side effects, which may lead to any of the conditions mentioned above.
After finding Nova Health, they rejoice in the ability to recapture their youth and restore relationships and lifestyles they thought were lost forever.
In partial hysterectomy, only uterus is removed whereas in full hysterectomy, fallopian tubes and ovaries are also removed along with uterus.
In major substandard care, haemorrhage emerges as the major cause of severe maternal morbidity in almost all ‘near miss’ audits in both developed and developing countries [1, 2, 24].Paripartum Haemorrhage (PPH) is a serious medical problem. Although more than a century has passed since he first aired this concept, and the practice of medicine both at the bedside and in the office has changed radically, his statement remains entirely true with regard to the management of PPH.Specifically, in recent years training in emergency obstetric skills (including PPH training) has moved from the traditional clinical teaching, normally conducted in the labour ward to specific, targeted skills and scenario-based courses that utilise mannequins and simulators most often away from the bedside. The Seventh Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom, 2005-2007 Triennial Report.
Women having higher grade of uterine cancer require a radiation therapy course after surgery which would kill any remaining cancer cells.
What most women do not know is that natural hormone therapy can alleviate the symptoms associated with hormonal imbalances, reducing the risk of developing specific diseases, including osteoporosis, depression, heart disease, stroke and cancer.
Conversely, bio-identical progesterone does not have any negative effect on the human body. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Remember that hysterectomy might also be required in order to stop vaginal bleeding which is not stopping after a child birth. You are required to learn its risk and compare with its benefits before undergoing through this therapy.
There are about 14 million case occurrences worldwide each year, with a fatality rate of 1%. Are there indications that transplants will lead to more full term pregnancies in the near future?
In case of more widespread cancer, radiation therapy is preferred over surgery or hysterectomy for uterine cancer treatment. To help women treat menopause symptoms, more and more specialists recommend natural hormone therapy, also referred to as bio-identical hormone replacement therapy (BHRT). Evidently, a compound that gives rise to all these hormones is very important to your health. Unlike progestin, natural progesterone can be used safely to treat specific conditions, including infertility and menopause symptoms. Users should always seek the advice of their qualified health providers with any questions regarding a medical condition. Besides these you can talk about her feelings which will help her cope with the pain she suffered. The drivers for paripartum haemorrhage trainingThe incidence of PPH is increasing in both developed and developing countries [23, 24]. The World Health Organization (WHO) has set a goal to reduce maternal mortality by 75% by 2015, mainly by reducing maternal deaths related to PPH by training health workers in both developing and developed countries [25]. Recently, further initiatives have been undertaken by WHO in addressing women’s health crisis in Africa by providing a report on women’s health in the African Region [26].Prior to these efforts, the Federation of Gynaecology and Obstetrics (FIGO), together with the Confederation of Midwives (ICM), advocated the Global Initiative on the Prevention of Post-partum Haemorrhage in 2004. Hysterectomy for PPH needs experts who have technical skills as usually the patients are already in a compromised condition. In addition, both organizations recommend that every skilled attendant (doctors, nurses, and midwives) likely to be present at birth have training in uterine massage and bimanual compression. In the near future, more women with uterus transplantation would be able to hold a whole pregnancy.
The same document also advises that all skilled birth attendants have access to technical training in administering uterotonics and other techniques such as intravenous infusions and tamponade balloons, and that every doctor who can perform laparotomy be provided with surgical training to perform ‘simple conservative surgery’ for PPH including compression sutures and sequential devascularisation [27].In the UK, successive Confidential Enquiries into Maternal Deaths have linked the increased numbers of deaths from PPH to recent changes in medical training. Specifically, the reduction in the overall length of obstetric training and in working hours during training may have reduced the amount of experience gained compared with the experiences obtainable in the past. Moreover, these reports have shown a trend towards sub-specialization among consultants in the UK, and those with a special interest in obstetrics do not necessarily have highly developed surgical skills. Medical managementThe medical management of PPH includes using ecbolic such as syntometrin, carboprost, and misoprostol.
These reports recommend regular ‘fire drills’ or ‘skills drills’ for the modern management of PPH for all grades of staff in every obstetric unit.The 2004 and 2007 Confidential Enquiry into Maternal and Child Health (CEMACH) reports repeatedly highlight the role of inadequate clinical care, as well as poor communication and teamwork, within labour ward teams and suggest that as many as half of all maternal deaths might be prevented with better care [28, 29]. Following this line of thought, the 2011 CEMACH report recommended that all units should have protocols in place for the identification and management of PPH and that all clinicians responsible for the care of pregnant women, antenatal, postnatal, and intrapartum, including those practicing in the community, should carry out regular skills training for such scenarios [30]. The need for such a recommendation follows the 2007 survey among obstetric trainees in London that documented a reported decline in the numbers of individuals who could manage major PPH. Additionally, a few respondents were less confident in performing any surgical procedure necessary in the management of major obstetric haemorrhage.
Various balloons have been tried and tested, but we choose to discuss the common varieties [4-6, 8, 9]. This finding may have serious implications in the provision of out of hours senior cover for maternity units in the future (32).The Scottish Confidential Audit of Severe Maternal Morbidity 2008 highlighted errors and substandard care in the management of women who have sustained PPH.
It is essential that blood transfusion service and laboratory test results are obtained and not ignored.


Often, the first noticeable sign of MRKH syndrome is that menstruation does not begin by age 16 (primary amenorrhea).
Women with MRKH syndrome have a female chromosome pattern (46,XX) and normally functioning ovaries. The capacity of the balloon is important to correlate with the tension that must be created to maintain adequate haemostasis. Any deficiency could be improved with adequate and target training.The UK Obstetric Surveillance System (UKOSS) publication [34] echoes the growing recognition articulated that prompt action is essential in managing PPH.
They also have normal female external genitalia and normal breast and pubic hair development. Those who provide care should try to do so within the first 2 hours of the diagnosis and certainly not beyond a delay of 6 hours.
Although women with this condition are usually unable to carry a pregnancy, they may be able to have children through assisted reproduction in a future. Morbidity rises sharply after 2 hours, when it becomes much more likely that hysterectomy will be necessary.3.
Before its complete removal, the balloon could be deflated but left in place to ensure that bleeding does not re-occur.Sengstaken-Blakemore Oesophageal CatheterOriginally used to control gastro-oesophageal bleeding (haematemesis).
Modalities of training: Hands-on trainingHands-on training is a simple method for an on-the-job facilitator who works with small numbers of participants to teach them certain procedural applications. The working concept is to prepare the trainee at a workstation to mimic the procedure or scenario, let them practice it, and then review their competency.This model of training is suitable for teaching practical skills such as the application of bimanual compression of the uterus, the uterine brace suture, uterine tamponade, etc. Haemostatic compression sutureA review published in 2005 of 32 cases of B-Lynch suture reported success in all but one case [13].
However, because of the small number of participants, it is not suitable to teach communication skills.4. Lecture-based trainingPPH is one of the catastrophic events where proper management requires a variety of hospital workers with different unique expertise. It is often difficult to get all these people together to arrange a simulation or hands-on training, and lecture-based teaching may be more appropriate. All staff should attend, obstetric physicians, midwives, nurses, house staff, anaesthesia providers, scrub technicians, and unit secretaries participate in the same formal classroom instruction. The purpose is for all team members to hear the same material, to learn the same teamwork language and behaviours, and to feel empowered to flatten hierarchy. The participants from varying disciplines should be allowed ample opportunity for conversation and sharing of varying points of view. It is mandatory that the team should be able to understand each other’s roles and competing interests that may not be self-evident.5. Other surgical techniquesInternal iliac artery ligationA recent case series describes 84 women with PPH from various causes who underwent internal iliac artery ligation as the first-line surgical intervention. The high fidelity type is often used to describe computer driven simulators, whereas the term low fidelity is used to describe simulators that are not computer controlled.
High fidelity is desirable in simulation, because the more contextually accurate is the simulation-based instruction, the more likely the learning that takes place will transfer to the reality of applied practice.
The disadvantages of this type of training include costs, the need to remove clinicians from clinical care, and a lack of realism compared with the clinicians’ own experience [35, 36].Simulation-based training is an appropriate proactive approach for reducing errors and risk in obstetrics, improving teamwork and communication, and giving students a multiplicity of transferable skills to improve their performances. The drivers for simulation include patient safety, limitation of current educational processes, shortening of the training period, high risk emergencies, and the pressure of health care agencies in an attempt to reduce malpractice concerns [37, 38, 39]. However, larger fibroids can press against the pelvic organs and may cause bleeding, pain during sex, anaemia, pelvic pain or bladder pressure. Haemorrhage drills and simulation-based training may help providers achieve timely and coordinated responses [40].
Protocols may help to standardise management in cases of PPH, thereby minimizing unnecessary errors or delays in care [41].Only a few models have been used for PPH training.
The authors found that the majority were unable to correct the haemorrhage within 5 minutes and half made at least one error, either in the dose or the route of administration of medications used to arrest the bleeding [41, 42].Teamwork training in a simulation setting resulted in improvement of knowledge, practical skills, communication, and team performance in acute obstetric situations.
The condition may lead to urinary incontinence, pelvic pressure or difficulty with bowel movements. Training in a simulation centre did not further improve outcome compared with training in a local hospital [40].A simple low fidelity model has been used for the past few years by the authors. Childbirth, obesity, persistent cough or straining, and hormonal changes (loss of oestrogen after menopause) are typical causes.
It is made of knitted wool and has an incision-like opening in the lower part to give the impression of a Paripartum uterus after the baby and the placenta have been expelled, along with the blood supply of the uterus and the ovaries.
It is a useful tool to learn the placement of a B-Lynch or other type of compression suture and it also gives one the ability to practice a form of step-wise devascularisation.6. Related symptoms may include heavy or long periods, bleeding between periods or bleeding after menopause. A special leaflet or wall chart summarising the immediate action that needs to be taken when PPH occurs.
This first standalone textbook describes a comprehensive guide to evaluation, management, and surgical intervention for PPH.
For a lot of women, getting pregnant is a biological need and having a problem that compromises their fertility (which can be not having uterus) can be an important source of psychological problems.
These are available as either separate or part of other obstetric emergencies such as Advanced Life Support in Obstetrics (ALSO) [45], Maternal Obstetrics Emergency Trauma (MOET) [46] and Practical Obstetric Multi Professional Training (PROMPT) course [47]. The International Training and Workshop for the Management of Massive PPH Group was set up in 2009 in London with the objective to provide hands-on training and workshops in the management of PPH.
The group is chaired by the senior author and includes experts who are renowned for their expertise in the management of PPH across the world.The International Training Group has organized and run regular courses in Milton Keynes and South Wales, UK, all of which were very successful.
Recently, the group has run a series of study days and workshops in both Cairo and Alexandria with successful feedback response. All are necessary, as it is clear that the traditional methods of reading or attending a lecture are insufficient to prepare the trainee for responsible action when it is needed in an emergency situation.
Like many other skills in medicine, the training necessary to attend to a patient who has a life-threatening haemorrhage cannot be thought of as ‘see one, do one, and teach one’.8. Intensive and high-dependency unitOnce the bleeding has been controlled and initial resuscitation has been completed, continuous close observations in either intensive care unit or high-dependency unit is required.
The recording of the observation on an obstetric early-warning score system would help in the early identification of continuous bleeding, especially in cases that are not apparent, as recommended by CEMACH [2].10. DebriefingTo avoid future complications and need of care, an action plan should be prepared for all subsequent pregnancy management.11. ConclusionB-Lynch suture has been the most effective and successful haemostatic compression suture to prevent maternal morbidity and mortality by controlling severe PPH and in reducing the need for hysterectomy.



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