Uterine failure

Secondary amenorrhea also is caused by uterine failure. The patient with a uterine problem is normal hormonally, but does not menstruate. Ashermans syndrome, or intrauterine adhesions, is the most common outflow-tract abnormality that causes amenorrhea. Endometrial damage may occur in response to a dilatation and curettage and to infections of the endometrium. Pituitary dysfunction can cause secondary amenorrhea. This is most often caused by intrinsic pituitary tumors. However, Sheehan s syndrome and pituitary apoplexy can also restilt in hormone deficiency. 

ARF acute renal failure ASA 1-5 American Society of Anesthesiology 1-5 scoring system for anesthesia risk ASA aspirin (acetylsalicylic acid) ASAP as soon as possible AUB abnormal uterine/vaginal bleeding... 

E.K. Rofstad, K. Sundfor, H. Lyng, C.G. Trope, Hypoxia-induced treatment failure in advanced squamous cell carcinoma of the uterine cervix is primarily due to hypoxia-induced radiation resistance rather than hypoxia-induced metastasis, Br. J. Cancer 83 (2000) 354-359. 

When oxytocin is used judiciously, serious toxicity is rare. The toxicity that does occur is due either to excessive stimulation of uterine contractions or to inadvertent activation of vasopressin receptors. Excessive stimulation of uterine contractions before delivery can cause fetal distress, placental abruption, or uterine rupture. These complications can be detected early by means of standard fetal monitoring equipment. High concentrations of oxytocin with activation of vasopressin receptors can cause excessive fluid retention, or water intoxication, leading to hyponatremia, heart failure, seizures, and death. Bolus injections of oxytocin can cause hypotension. To avoid hypotension, oxytocin is administered intravenously as dilute solutions at a controlled rate. 

Marks WH, Thompson N, Appleman H. Failure of hepatic adenomas (HCA) to regress after discontinuance of oral contraceptives. An association with focal nodular hyperplasia (FNH) and uterine leiomyoma. Ann Surg 1988 208(2) 190-5. 

Premature ovarian failure can be induced in offspring exposed in utero by active metabolites such as 6-mercaptopurine. Tamoxifen (treatments for breast cancer) and clomiphene (to induce ovulation) are antiestrogens that can inhibit uterine decidual induction in pseudopregnant rats. 

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). 

In 56 women (18-20 weeks gestation), treated at the Marie Stopes Chnic in Jodhpur, India, who underwent termination of pregnancy with 0.1% ethacridine lactate 150 ml injected into the intrauterine extra-amniotic space and in whom intravenous oxytocin was used to expedite the dehvery of the abortus, ethacridine lactate induced successful abortion in 52 cases (1). Abortion failure occurred in the other four cases because of transverse lie of fetus (n = 2), cervical dystocia (n = 1), and uterine inertia (n = 1). In 41 women the abortion occurred at 12-24 hours after induction (mean 20 hours) which was shorter than that of previous reports (29.5-38 hours). There were complications in six cases three women had cervical tears and three had incomplete expulsion. There was one case each of severe bleeding and vaginal laceration. There were no cases of sepsis. The authors concluded that ethacridine lactate performed better than other instillation abortion methods. 

Although furosemide has embryotoxic properties in some animal species, it has been widely used in pregnant women without any adverse effects. Nevertheless, it should be used with great caution, since hypovolemia can lead to reduced uterine and placental blood flow. Careful monitoring of fetal heart action is necessary. Furosemide passes the placenta and increases fetal urine production. It can also increase acid concentrations in maternal serum, fetal serum, and amniotic fluid, thus masking a useful index for the development of pre-eclampsia (24). Its use in pregnant women should therefore be restricted to the treatment of cardiac failure. 

There is no characteristic menstrual pattern or history that precedes premature ovarian failure. Approximately 50% of patients with this condition have a history of oligomenorrhea or dysfunctional uterine... 

It is indicated in the management of moderate to severe vasomotor symptoms associated with menopause treatment of atrophic vaginitis, kraurosis vulvae, fanale hypogonadism, symptoms of female castration, and primary ovarian failure prevention and treatment of osteoporosis (conjugated estrogens) palliative treatment of metastatic breast or prostate cancer in selected women and men treatment of postpartum breast engorgement and abnormal uterine bleeding. 

Estrogen, possessing antineoplastic and antiosteoporotic properties, is indicated in abnormal uterine bleeding (hormonal imbalance), in castration, primary ovarian failure, and osteoporosis, in female hypogonadism, in menopausal symptoms, atrophic vaginitis, or kraurosis vulvae, in prostatic cancer, and in breast cancer (see also Figure 48). 

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