Ed's GYN 7 Lecture

What is the clinical presentation of Enhanced myometrial vascularity (EMV) (Uterine Arteriovenous Malformations (AVM)).

Abnormal vagina bleeding

What is the clinical presentation of Retained Products of Conception (RPOC)?

Abnormal, excessive, sustained postpartum vaginal bleeding

What are some differential diagnoses of ovarian/adnexal torsion?

Appendicitis, hemorrhagic cyst

What C-section complication is due to bleeding in the LUS or in between the LUS and bladder?

Bladder flap hematoma

What are some complications of Retained Products of Conception (RPOC)?

Bleeding, infection

What are some causes and risk factors of Pelvic congestion syndrome?

Incompetent ovarian vein, incompetency of internal iliac vein, nutcracker syndrome, May-Thurner syndrome, pregnancy

Where is the thrombus usually found in Postpartum Ovarian Vein Thrombosis (Thrombophlebitis)?

Junction of the right renal vein with the IVC

What is the treatment for ovarian/adnexal torsion?

Laparoscopic detorsion

Describe the sonographic appearance of a subfascial hematoma

Large heterogeneous mass anterior to the uterus

Does Pelvic congestion syndrome more commonly affect the left or right side?

Left

What are the treatments for Pelvic congestion syndrome?

Medical management, litigation of incompetent ovarian vein, ablation of incompetent veins

When does Retained Products of Conception (RPOC) usually occur?

Mostly after 2nd trimester spontaneous abortion, medical termination of the pregnancy

Describe the sonographic appearance of Pelvic congestion syndrome

Multiple dilated peri-uterine and peri-ovarian veins or slow venous flow changing to reversed flow with valsalva

What are some causes/risk factors of ovarian/adnexal torsion?

Ovarian lesion/cyst, pregnancy (1st trimester/immediately postpartum), ovulation induction or hyperstimulated ovaries

What is the complete/partial rotation of an ovary on its vascular pedicle?

Ovarian/adnexal torsion

What is chronic pelvic pain associated with dilatation of the pelvic veins (pelvic varices)?

Pelvic congestion syndrome

What is the location of a subfascial hematoma?

Posterior to the recuts abdominis muscle

What condition is uncommon and sometimes seen 48-96 hours after delivery or miscarriage/abortion?

Postpartum Ovarian Vein Thrombosis (Thrombophlebitis)

When is Enhanced myometrial vascularity (EMV) (Uterine Arteriovenous Malformations (AVM)) commonly diagnosed?

Postpartum or after miscarriage

How is Enhanced myometrial vascularity (EMV) (Uterine Arteriovenous Malformations (AVM)) mostly acquired?

Prior uterine instrumentation

Is Enhanced myometrial vascularity (EMV) (Uterine Arteriovenous Malformations (AVM)) rare or common?

Rare

What is the incomplete expulsion of miscellaneous products of conception?

Retained Products of Conception (RPOC)

Which ovarian vein is more commonly affected with Postpartum Ovarian Vein Thrombosis (Thrombophlebitis)?

Right ovarian vein

Describe the sonographic appearance of an abdominal wall endometrial implant

Round hypoechoic mass with internal vascularity

Describe the sonographic appearance of Enhanced myometrial vascularity (EMV) (Uterine Arteriovenous Malformations (AVM))

Serpiginous tubular structures in the myometrium, color Doppler: moderately increased flow, spectral Doppler: low resistance, high velocity flow

Describe the normal sonographic appearance of a C-section in the initial postpartum period

Small echogenic foci, possibly heterogeneity in LUS

What C-section complication is due to disruption of the inferior epigastric vessels?

Subfascial hematoma

What is the clinical presentation of ovarian/adnexal torsion?

Sudden onset of severe pelvic pain, nausea/vomiting

Can Enhanced myometrial vascularity (EMV) (Uterine Arteriovenous Malformations (AVM)) consist with RPOC?

Yes

What is the patient demographic of ovarian/adnexal torsion?

Young women under 30, children with ovarian lesions

Describe the normal sonographic appearance of a C-section after several months

C-section/hysterotomy scar: thin linear echo/hypoechoic line, C-section niche/defect: fluid extending into a triangular defect in anterior LUS

What is the treatment for Retained Products of Conception (RPOC) if the products are large (over 2cm)?

D&C

Describe the sonographic appearance of Postpartum Ovarian Vein Thrombosis (Thrombophlebitis)

Dilated tubular structure extending superiorly from the adnexa, intraluminal echogenic material in ovarian vein with partial/complete absence of flow

Describe the sonographic appearance of a bladder flap hematoma

Heterogenous mass in the LUS

What is the clinical presentation of Pelvic congestion syndrome?

Dull chronic pain

Describe the sonographic appearance of Retained Products of Conception (RPOC)

Echogenic mass/tissue within endometrial cavity, blood flow differentiates RPOC from a blood clot, calcifications

Describe the sonographic appearance of ovarian/adnexal torsion

Enlarged edematous ovary, multiple peripheral follicles, absent venous flow but arterial is variable, twisted/torsed pedicle (grayscale: target sign, color: whirlpool sign)

Describe the normal findings of most C-section deliveries

Transverse incision in LUS

Is ovarian/adnexal torsion usually always unilateral or bilateral?

Unilateral

What is the gold standard for diagnosing Pelvic congestion syndrome?

Venography

What are the causes of Postpartum Ovarian Vein Thrombosis (Thrombophlebitis)?

Venous stasis postpartum, spread of puerperal infection

In ovarian/adnexal torsion, is venous/lymphatic flow or arterial flow obstructed first?

Venous/lymphatic flow