Management of uterine fibroids in pregnancy

Vitale, Salvatore; Padula, Francesco; Gulino, Ferdinando Antonio

doi:10.1097/gco.0000000000000220

Cited by 63 publications

(47 citation statements)

References 60 publications

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“…Usually the treatment of fibroids in pregnant women, if it is necessary, is based on medical therapy [44]. However, myomectomy has a significant role in women desiring future pregnancy because the surgical removal of fibroids can increase the fertility rate, restore the uterine anatomical structure, reduce the local tissue inflammation reaction, and promote the adequate uterine blood provisions [45]. …”

Section: Discussionmentioning

confidence: 99%

What Is the Role of Barbed Suture in Laparoscopic Myomectomy? A Meta-Analysis and Pregnancy Outcome Evaluation

Gardella

Dominoni

Iacobone

et al. 2018

Gynecol Obstet Invest

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Background: This work analyzes the feasibility and effectiveness of barbed suture during laparoscopic myomectomy. Methods: Eight works have been carefully examined for the meta-analysis from all papers published online until November 2017. Results: Barbed suture proved to be superior to traditional suture technique in blood loss in laparoscopic myomectomy (Standardized Mean Difference [SMD] –0.650, 95% CI –1.420 to –0.119, p = 0.098, test for heterogenity p < 0.0001, I² = 95.54%), Hb drop (SMD –1.452, 95% CI –3.590 to 0.687, p = 0.183, test for heterogenity p < 0.0001, I² = 99.08%), suturing difficulty (SMD –0.638, 95% CI –0.935 to –0.342, p ≤ 0.001, test for heterogenity p = 0.25, I² = 27.84%), suturing time (SMD –1.197, 95% CI –1.848 to –0.549, p ≤0.001, test for heterogenity p = 0.0001, I² = 83.30%) and total operative time (SMD –0.687, 95% CI –0.804 to –0.569, p ≤ 0.001, test for heterogenity p = 0.292, I² = 17.44%). Barbed suture demonstrated to be better in comparison with the control group even with regard to the length of hospitalization (SMD –0.278, 95% CI –0.543 to 0.012, p = 0.040, test for heterogenity p = 0.025, I² = 61.85%), and to perioperative complications (SMD 0.708, 95% CI 0.503–0.996, p = 0.048, test for heterogenity p = 0.79, I² = 0%). Conclusion: Barbed suture significantly facilitates laparoscopic myomectomy by reducing the total operative/suturing time, estimated blood loss/Hb drop, and reduction of perioperative complications.

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Section: Discussionmentioning

confidence: 99%

What Is the Role of Barbed Suture in Laparoscopic Myomectomy? A Meta-Analysis and Pregnancy Outcome Evaluation

Gardella

Dominoni

Iacobone

et al. 2018

Gynecol Obstet Invest

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“…It has been estimated that between 15% and 25% of gynecologists in the United States perform office hysteroscopy and, thanks to an easy-to-improve learning curve, the amount of young and senior operators is still increasing [6]. Nonetheless, hysteroscopy plays a crucial role in the most challenging topics of women's health, from infertility diagnostic work-up [7,8] to post-menopausal abnormal uterine bleeding and uterine pathologies [9,10]. Currently, available technologies allow one to perform several diagnostic and operative procedures without the need for anesthesia and without any pain or distress for the patient [11,12].…”

Section: Introductionmentioning

confidence: 99%

Concordance between the Hysteroscopic Diagnosis of Endometrial Hyperplasia and Histopathological Examination

et al. 2019

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The goal of this paper is to assess the concordance between the clinical diagnosis of Endometrial Hyperplasia (EH), suspected by senior gynecologists throughout outpatient office hysteroscopy, and the results from histopathological examination, in order to evaluate hysteroscopic accuracy for EH. A prospective cohort study was done at a Tertiary University Hospital. From January to December 2018, we enrolled women with the following criteria: abnormal uterine bleeding in post-menopause and endometrial thickening in pre-or post-menopause. Patients underwent office hysteroscopy with a 5 mm continuous-flow hysteroscope, and endometrial biopsies were taken using miniaturized instruments. Senior operators had to foresee histopathological diagnosis using a questionnaire. Histopathological examination was conducted to confirm the diagnosis. This study was approved by the local ethical and registered in the ClinicalTrials.gov registry (ID no. NCT03917147). In 424 cases, 283 clinical diagnoses of EH were determined by senior surgeons. A histopathological diagnosis was then confirmed in 165 cases (58.3%; p = 0.0001). Furthermore, 14 endometrial carcinoma and atypical hyperplasia were found. The sensitivity, positive predictive value, and negative predictive values for EH were, respectively, 90.4, 58.4, and 86.6%. Subdivided by clinical indication, the sensitivity was higher in patients with post-menopause endometrial thickening. The diagnostic accuracy of office hysteroscopy in the diagnosis and prediction of endometrial hyperplasia was high. Senior operators could foresee EHs in more than half the cases.

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“…In multiple studies, the clinically aggressive behavior of CS has been attributed to the epithelial component of the tumor and, as a result, CS has undergone a recent declassification to metaplastic carcinomas [18,19]. Contrary to other gynecological conditions that require, in selected cases, fertility sparing treatment [20,21,22,23,24], patients affected by uterine CS are not currently considered for this approach and radical surgery is the cornerstone of treatment.…”

Section: Introductionmentioning

confidence: 99%

Target Therapies for Uterine Carcinosarcomas: Current Evidence and Future Perspectives

Vitale

Laganà

Capriglione

et al. 2017

IJMS

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Carcinosarcomas (CS) in gynecology are very infrequent and represent only 2–5% of uterine cancers. Despite surgical cytoreduction and subsequent chemotherapy being the primary treatment for uterine CS, the overall five-year survival rate is 30 ± 9% and recurrence is extremely common (50–80%). Due to the poor prognosis of CS, new strategies have been developed in the last few decades, targeting known dysfunctional molecular pathways for immunotherapy. In this paper, we aimed to gather the available evidence on the latest therapies for the treatment of CS. We performed a systematic review using the terms “uterine carcinosarcoma”, “uterine Malignant Mixed Müllerian Tumors”, “target therapies”, “angiogenesis therapy”, “cancer stem cell therapy”, “prognostic biomarker”, and “novel antibody-drug”. Based on our results, the differential expression and accessibility of epithelial cell adhesion molecule-1 on metastatic/chemotherapy-resistant CS cells in comparison to normal tissues and Human Epidermal Growth Factor Receptor 2 (HER2) open up new possibilities in the field of target therapy. Nevertheless, future investigations are needed to clarify the impact of these new therapies on survival rate and medium-/long-term outcomes.

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Management of uterine fibroids in pregnancy

Cited by 63 publications

References 60 publications

What Is the Role of Barbed Suture in Laparoscopic Myomectomy? A Meta-Analysis and Pregnancy Outcome Evaluation

What Is the Role of Barbed Suture in Laparoscopic Myomectomy? A Meta-Analysis and Pregnancy Outcome Evaluation

Concordance between the Hysteroscopic Diagnosis of Endometrial Hyperplasia and Histopathological Examination

Target Therapies for Uterine Carcinosarcomas: Current Evidence and Future Perspectives

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