Uterine dissection

The proglottid is examined under a dissecting microscope or with a hand lens, and the uterine branching is observed. Glycerine and beechwood creosote can also be used with good results. Cleared proglottids may be mounted or stained if desired. 

In the second case, there was sudden fetal bradycardia. Laparotomy showed a large clot overlying the previous uterine incision. Dissection through the hematoma showed complete separation of the uterine incision. After delivery, the uterine rupture site and a cervical laceration were successfully repaired. 

High output left ventricular failure has been described after hysteroscopic lysis of adhesions using dextran as a distension medium. Prolonged surgical dissection of the uterine wall (the precise duration of the operation was not stated in the report) and the large volume of dextran and fluid (2 liters of 5% dextrose and an additional 800 ml of dextran) probably caused the dextran to enter into the systemic circulation, inducing a significant shift of fluid into the intravascular compartment (2). 

Complications that can occur at the common femoral artery puncture site include formation of a hematoma, pseudoaneurysm, or arteriovenous fistula, dissection or thrombosis of the common femoral artery, and infection [53, 56]. Vessel perforation is even more unusual than arterial dissection but may be problematic in that it could either cause occlusion of the uterine artery prior to embolization or can cause bleeding from the perforated vessel which may itself require embolization as treatment (Fig. 10.4.4) [56],... 

Perforation and dissection of the uterine artery are less common causes of failure [6]. These complications can occur with the use of hydrophilic guidewires associated to the arterial tortuosity (Fig. 10.5.1). Vasospasm occurring primarily in patients undergoing hormone therapy is an important cause of vessel damage. Careful catheterization, use of a microcatheter and experience of operator performing the procedure are all important factors in reducing this type of failure. In cases where... 

Uterus-conserving surgery is hampered by the lack of a clearly defined dissection plane but may be of value in the infertile patient [133], Laparoscopic resection of adenomyosis has been shown to reduce pain, menorrhagia, and dysmenorrhea in small case series with limited follow-up [124, 214]. Recently, uterine artery embolization (UAE) has been reported to be successful in relieving menorrhagia and dysmenorrhea at short-term. The long-term benefit of UAE in patients with adenomyosis is still under investigation [93,94,141,174]. 

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