مقاله انگلیسی رایگان در مورد یافته های سونوگرافی لگن در زنان مبتلا به فیستول – هینداوی 2018

Obstetric 0stula (OF) is a devastating condition that occurs when women experience prolonged obstructed labor. ,e soft tissues of the pelvis undergo tissue necrosis, resulting in an abnormal communication between the vagina and the bladder and/or rectum. Women with OF continually leak urine and/or feces from their vagina until they are surgically repaired [1]. Many women with OF develop secondary infertility or amenorrhea, although some become pregnant again, before or after surgical repair. For those who do become pregnant, their pregnancies are often associated with high rates of preterm birth and spontaneous abortion, particularly in the second trimester [2–4]. ,e reasons for this are not well understood, although experts have hypothesized that women with OF have higher rates of preterm birth because of severe cervical damage and avulsion that occur during prolonged obstructed labor, which leads to cervical insu@ciency [5]. In extreme cases, 0stula surgeons have noted that patients have no identi0able cervical tissue [1, 6, 7]. A case series of 22 OF patients found that, on vaginal exam, 40% of patients had a normal cervix, 23% had cervical erosion, 18% had only a cervical dimple, 14% had a nonidenti0able cervix (because it was bound to the pubic symphysis), and 5% had a “harelip” defect of the anterior cervix. On transabdominal ultrasound, 68% had a normal-appearing cervix and 9% had anterior cervical defects [7]. No published study has assessed the use of endovaginal ultrasound to evaluate the cervix in OF patients. Cervical length measurement is often performed during pregnancy to assess for short cervix, which is associated with preterm birth [8]. Women found to have a short cervix due to structural weakness of the cervix, as in the case of prior cone biopsy or a Mullerian duct anomaly, may bene0t from ¨ placement of a prophylactic cerclage [9–11]. No published studies have examined the use of prepregnancy cervical length as a predictor for preterm birth in women at risk for having a short or abnormal cervix. ,e cervix lengthens during the 0rst trimester of pregnancy, so pregnant women generally have longer cervices than nonpregnant women [12, 13]. ,e prepregnancy cervical length may have some predictive value, particularly in women with prior cervical trauma or surgery. For OF patients, pregnancy is uncommon, and they interface with the health care system infrequently. It is more practical to assess their pelvic anatomy by ultrasound at the time of their repair. If OF patients are found to have compromised pelvic anatomy, this could result in counseling on future pregnancy risk or potential interventions to prevent early pregnancy loss or other complications.