pituitrin and Uterine-Hemorrhage

Submucosal uterine leiomyomas are a common benign pelvic tumor that can cause abnormal uterine bleeding and may contribute to infertility and miscarriage. Hysteroscopic myomectomy is the treatment of choice to alleviate bleeding from these myomas and to normalize the uterine cavity. This review discusses the techniques and recent evidence for hysteroscopic myomectomy and examines the two primary surgical tools employed today: the bipolar resectoscope and hysteroscopic mechanical morcellator.. Hysteroscopic myomectomy has been a popular treatment for symptomatic submucosal fibroids for decades; it is a minimally invasive, low-cost, low-risk procedure, and is associated with high patient satisfaction. There have been rapid advances in the surgical technology available for this procedure. Both the bipolar resectoscope and the hysteroscopic mechanical morcellator are appropriate tools to remove submucosal myomas. Although the hysteroscopic morcellators have been associated with shortened operative time and a decreased learning curve, the data are limited for their use on type 2 fibroids. The strength of the bipolar resectoscope lies in its ability to resect deeper type 2 fibroids.. The evidence suggests that no one technique should be used for all patients, but rather a choice of technique should be taken on a case-by-case basis, depending on the myoma number, size, type, and location. Gynecologists must become knowledgeable about each of these techniques and their associated risks to safely offer these surgeries to their patients.

Topics: Embolism, Air; Female; Humans; Hysteroscopy; Intraoperative Care; Morcellation; Operative Time; Preoperative Care; Uterine Hemorrhage; Uterine Myomectomy; Vasopressins

To compare the effectiveness and safety of vasopressin with epinephrine for reducing blood loss during laparoscopic myomectomy.. Sixty patients undergoing laparoscopic myomectomy were allocated at random to receive either dilute vasopressin or epinephrine into the serosal and/or overlying myometrium, and just around the myoma. The surgeon was blinded to the group allocation. Blood loss, duration of surgery, degree of surgical difficulty, postoperative pain scores and complications were compared.. Patient characteristics (e.g. age, body mass index, demographic data), number of myomas, and location and size of the largest myoma were similar between the two study groups. There were no differences in operative blood loss, operative time, subjective surgical difficulty or postoperative pain between the two groups. Transient and non-serious increases in systolic and diastolic blood pressure and heart rate following intra-operative intramyometrial and/or perimyometrial injection of the vasoconstrictive agent only occurred in the epinephrine group, but the difference between the groups was not significant (13% vs 0%, p=0.112). No significant postoperative complications were observed in either group.. Injection of dilute epinephrine before laparoscopic myomectomy was comparable to injection of dilute vasopressin in terms of operative blood loss, operative time, subjective surgical difficulty, postoperative pain and complications.

Topics: Adult; Blood Loss, Surgical; Epinephrine; Female; Humans; Laparoscopy; Leiomyoma; Middle Aged; Neoplasms, Multiple Primary; Uterine Hemorrhage; Uterine Myomectomy; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins

To examine the effect of paracervical injection of vasopressin on the absorption of glycine during transcervical endometrial ablation.. Thirty-three consecutive women scheduled for elective hysteroscopic endometrial ablation were randomized to either the study or control group. All procedures were performed with a myoma resectoscopy using 1.5% glycine as the irrigating medium at a flow rate of 100 mL/minute. In the study group, a solution of 0.2 mg vasopressin diluted with 20 mL saline was injected paracervically. Blood samples were obtained through an indwelling intravenous catheter every 5 minutes until the completion of the operation. Serum sodium, potassium, and magnesium levels were measured at 20-minute intervals. In addition, glycine concentrations were determined by both rapid screening and quantitative amino acid analysis.. Plasma glycine maximal concentrations were significantly lower (P < .001) in patients who received vasopressin, compared with controls (8.8 +/- 4.5 versus 16.0 +/- 6.3 mmol/L, respectively). The calculated extent of glycine absorption within the first 20 minutes of the procedure was 59.6 +/- 30.0 versus 179.8 +/- 66.2 mmol/L.minute in the study and control groups, respectively (P < .001). The differences in plasma sodium, potassium, and magnesium levels were not significant.. Intracervical vasopressin administration significantly decreased systemic glycine absorption in patients undergoing hysteroscopic endometrial ablation.

Topics: Absorption; Adult; Cervix Uteri; Endometrium; Female; Glycine; Humans; Hysteroscopy; Injections; Magnesium; Middle Aged; Potassium; Sodium; Therapeutic Irrigation; Uterine Hemorrhage; Vasoconstrictor Agents; Vasopressins

Two women, one with refractory postabortion hemorrhage and the other with refractory postpartum hemorrhage, were managed with vasopressin, operative hysteroscopy, and a dilute vasopressin pack. Both patients had been treated by standard methods (i.e., dilation and curettage) and both were being prepared for a surgical intervention procedure. It was decided in both cases to try to slow the bleeding by injection of vasopressin paracervically and then performance of operative hysteroscopy. In both cases, the injection of dilute vasopressin paracervically when coupled with operative hysteroscopy was quite effective in determining the cause of the bleeding and was instrumental in avoiding major operative procedures.. Obstetrician-gynecologists from the University of California at Davis have managed uterine bleeding in 2 cases using vasopressin and hysteroscopy. The postabortion case began hemorrhaging 4 days after suction curettage at 13 weeks gestation. At the hospital, she received packed blood cells and underwent dilation and curettage (D&C). After 3 days of bed rest at home, she began rehemorrhaging. In the emergency room, she again underwent a transfusion. They prepared her for a laparotomy and either hypogastric artery ligation or hysterectomy. Before surgery, however, they opted to inject vasopressin around the cervix and to use a resectoscope to determine the cause of bleeding. The bleeding diminished after injection of vasopressin. They observed arterial bleeding. They used an electrode set at 100 W to coagulate bleeding points, then packed the uterus with gauze soaked in dilute vasopressin solution. They removed the pack 18 hours later. After 2 hours bed rest with no additional bleeding, she became ambulatory. Since no additional bleeding occurred, she was discharged. After 8 months, she continued to experience normal menses. The postpartum case began to bleed profusely 21 days after a cesarean section. Physicians handled her case similarly to the postabortion case. They tried a hysteroscopy, but being unable to see due to heavy bleeding they injected vasopressin paracervically. The blood flow decreased substantially within a few minutes allowing them to use a resectoscope. Placental tissue and amniotic membranes were still present in the uterus and removed. Using the same procedures of the postabortion case, they coagulated the bleeding points and packed the uterus with gauze. She did not experience any significant bleeding for 24 hours so she was discharged. Normal menses resumed and, as of 4 months after discharge, she was fine.

Topics: Abortion, Induced; Adult; Female; Humans; Hysteroscopy; Postpartum Hemorrhage; Pregnancy; Uterine Hemorrhage; Vasopressins

This prospective, randomized study compares, for the first time, measured blood loss at conization and within 24 hours after using either the cold knife technique or the carbon dioxide laser scalpel. One hundred and ten consecutive patients were evaluated. The median blood loss in the laser group of 55 patients was 4.6 milliliters at, and within, 24 hours after operation compared with 30.1 milliliters in the cold knife group of 55 patients. More important, however, is that the corresponding figures for the range of bleeding were 0.4 to 155.4 milliliters and 5.6 to 1,570.9 milliliters, respectively. The incidence rate for bleeding complications requiring surgical intervention was 1.8 per cet for the laser group and 14.6 per cent for the cold knife group. This difference was statistically significant, p less than 0.015--Fischer's exact test. Conization for treatment of premalignant changes of the cervix uteri will probably remain the treatment of choice for some time to come. It is our opinion that, in the future, laser conization will replace cold knife conization.

Topics: Carcinoma in Situ; Cervix Uteri; Female; Humans; Laser Therapy; Methods; Postoperative Complications; Prospective Studies; Random Allocation; Uterine Cervical Dysplasia; Uterine Cervical Neoplasms; Uterine Hemorrhage; Vasopressins

Our objective was to document current practices of abortion providers on the use of medications to decrease bleeding during surgical abortion.. We emailed surveys to 336 abortion providers through a professional listserv to elicit information on their use of medications to prevent and treat bleeding during first- and second-trimester surgical abortion.. One hundred sixty-eight (50%) providers responded to our survey. The majority were obstetrician-gynecologists (83%) working in an academic practice (66%). Most completed a fellowship in family planning (87%) and currently perform abortions up to 22 or 24weeks of gestation (63%). Seventy-two percent routinely used prophylactic medications for bleeding. Providers who routinely used medications to prevent bleeding most commonly chose vasopressin (83%). Providers preferred methylergonovine as a treatment for excessive bleeding in the second trimester, followed by misoprostol.. We found that most providers routinely use medications to prevent bleeding and use several different regimens to treat bleeding during abortion.. We found that surgical abortion providers use a range of medications to prevent and treat hemorrhage at the time of surgical abortion. Scant evidence is available to guide abortion providers on the use of medications to decrease hemorrhage during surgical abortion. To provide evidence-based recommendations for the prevention and treatment of clinically significant bleeding, researchers should target the most commonly used interventions.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Blood Loss, Surgical; Family Planning Services; Female; Gestational Age; Gynecology; Hemostatics; Humans; Methylergonovine; Misoprostol; Obstetrics; Oxytocics; Practice Patterns, Physicians'; Pregnancy; Surveys and Questionnaires; United States; Uterine Hemorrhage; Vasopressins

A 26-year-old woman presented with an incomplete miscarriage and was scheduled for curettage at 21 weeks of gestation. She received curettage under spinal anesthesia and vaginal hemorrhage could not be controlled due to placenta percreta and cesarean section was immediately performed. Profuse bleeding continued and the patient developed hemorrhagic shock. For the purpose of circulatory and respiratory management, general anesthesia was induced and a hysterectomy was performed. For treatment of hemorrhage-induced hypotension, dobutamine and norepinephrine were administrated, while fluid replacement was continued with packed blood cells. Hemorrhagic shock, however, was not responsive to catecholamines, and her arterial pressure decreased to 40/20 mmHg. She received a bolus injection of vasopressin, 1 U, by i.v. push. Her arterial pressure increased to 140/65 mmHg after vasopressin administration, and catecholamines were tapered off before operation was finished. The patient's total blood loss was estimated to be approximately 6,000 ml. She recovered without complications and was discharged on the 7th postoperative day. Vasopressin may be an option to stabilize cardiocirculatory function in patients with uncontrolled hemorrhagic shock.

Topics: Abortion, Spontaneous; Abortion, Therapeutic; Adult; Anesthesia, General; Anesthesia, Obstetrical; Anesthesia, Spinal; Cesarean Section; Female; Humans; Hysterectomy; Injections, Intravenous; Intraoperative Care; Placenta Accreta; Pregnancy; Pregnancy Trimester, Second; Shock, Hemorrhagic; Uterine Hemorrhage; Vasopressins

Hemorrhage from a cervical pregnancy is a time-sensitive matter. Effective temporization measures for the initial management of this hemorrhage have not previously been reported in the literature.. A 43-year-old woman, gravida 0, underwent in vitro fertilization and embryo transfer. She subsequently presented to the office with sudden onset of vaginal hemorrhage due to a cervical pregnancy. Cervical artery sutures were placed, and a cervical vasoconstricting agent was injected, at which point the patient's bleeding stopped. She then underwent successful treatment with dilation and curettage.. Conservative measures to manage hemorrhage due to cervical pregnancy can be initiated, with possible rapid establishment of hemostasis until definitive treatment can be achieved.

Topics: Adult; Cervix Uteri; Female; Hemostatics; Humans; Injections; Ligation; Pregnancy; Pregnancy, Ectopic; Suture Techniques; Uterine Hemorrhage; Vasopressins

Topics: Blood Loss, Surgical; Female; Hemostatics; Humans; Myometrium; Uterine Hemorrhage; Vasopressins

A case of transient myocardial ischemia following subendometrial vasopressin infiltration in intractable intra-operative postpartum bleeding due to placenta accreta is described. In our experience, the rate of this side effect is one in 14 patients (rate of 7.1%). We believe that the benefits of the treatment outweigh the risks, since the uterus was saved in all 14 patients. Nevertheless, this case emphasises that extreme precaution is needed with subendometrial vasopressin infiltration. It should be emphasised that the needle must not be within a blood vessel because intravascular injection of vasopressin solution can precipitate acute arterial hypertension, bradycardia and even death. We suggest that local vasopressin infiltration into the placental site is indicated in cases of intractable bleeding at cesarean section after other conventional obstetric and pharmacological maneuvers have failed.

Topics: Blood Loss, Surgical; Cesarean Section; Female; Hemostatics; Humans; Myocardial Ischemia; Placenta Accreta; Pregnancy; Uterine Hemorrhage; Vasopressins

Topics: Absorption; Endometrium; Female; Glycine; Humans; Hysterectomy; Injections; Therapeutic Irrigation; Uterine Hemorrhage; Vasoconstrictor Agents; Vasopressins

The authors' experience in the management of postoperative vaginal hemorrhage from 1975 to 1980 was reviewed. Recently, success has been achieved using angiographic arterial embolization with the Gianturco minicoil. The results of embolization are compared with those achieved through other more conventional methods. The authors have found angiographic embolization to be safe, simple, and effective, and they recommend that the procedure be performed before laparotomy for intractable postoperative vaginal bleeding.

Topics: Adult; Angioplasty, Balloon; Embolization, Therapeutic; Female; Femoral Artery; Humans; Hysterectomy; Middle Aged; Postoperative Complications; Uterine Hemorrhage; Vasopressins

Topics: Female; Humans; Ornipressin; Uterine Hemorrhage; Vagina; Vasopressins

Topics: Adult; Aged; Biopsy; Cervix Uteri; Female; Humans; Methods; Middle Aged; Postoperative Complications; Pregnancy; Uterine Cervical Neoplasms; Uterine Hemorrhage; Vasopressins

Topics: Abortion, Therapeutic; Blood Vessels; Female; Humans; Muscle Contraction; Ornithine; Pregnancy; Uterine Hemorrhage; Uterus; Vasopressins

Topics: Abortion, Criminal; Abortion, Legal; Adult; Amniocentesis; Amnion; Amniotic Fluid; Female; Humans; Hydatidiform Mole; Hypernatremia; Hypertonic Solutions; Intestinal Perforation; Maternal Mortality; Oxytocin; Postoperative Complications; Potassium; Pregnancy; Punctures; Sodium; Surgical Wound Infection; Uterine Hemorrhage; Uterine Rupture; Vasopressins; Water-Electrolyte Balance

Topics: Abortion, Therapeutic; Adult; Age Factors; Anesthesia, Local; Drug Synergism; Female; Humans; Ornithine; Pregnancy; Uterine Hemorrhage; Vasopressins

Topics: Arginine Vasopressin; Female; Hemorrhage; Humans; Uterine Hemorrhage; Uterus; Vasopressins

Topics: Arginine Vasopressin; Female; Genital Diseases, Female; Hemorrhage; Humans; Pituitary Gland; Pituitary Hormones; Uterine Hemorrhage; Uterus; Vasopressins