title: Vaginal Pessary for Uterine Repositioning during High-Intensity Focused Ultrasound Ablation of Uterine Leiomyomas.
abstract: In order to ensure safe magnetic resonance-guided, high-intensity focused, ultrasound ablation of uterine leiomyomas, the ultrasound beam path should be free of intervening scar and bowel. Pre-treatment MRI of a 9-cm long and 7.7-cm wide leiomyomatous uterus in a 39-year-old woman with menorrhagia and abdominopelvic pain initially demonstrated a focused ultrasound treatment path without a bowel between the uterus and the abdominal wall. On the day of ablation, however, multiple loops of bowel were observed in the ultrasound beam path by MRI. Uterine repositioning was accomplished with a 76-mm donut vaginal pessary, which anteverted the fundus and successfully displaced the bowel. A vaginal pessary may aid in repositioning an axial or retroverted uterus to enable ablation of uterine leiomyomas.
authors.affiliation: Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md., USA.
authors.forename: Tajana
authors.initials: T
authors.lastname: Klepac Pulanic
authors.forename: Aradhana M
authors.initials: AM
authors.lastname: Venkatesan
authors.forename: James
authors.initials: J
authors.lastname: Segars
authors.forename: Sham
authors.initials: S
authors.lastname: Sokka
authors.forename: Bradford J
authors.initials: BJ
authors.lastname: Wood
authors.forename: Pamela
authors.initials: P
authors.lastname: Stratton
mesh_terms: D000328:Adult; D005260:Female; D057086:High-Intensity Focused Ultrasound Ablation / Q000379:methods*; D006801:Humans; D007889:Leiomyoma / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008595:Menorrhagia / Q000601:surgery; D017699:Pelvic Pain; D010570:Pessaries; D014594:Uterine Neoplasms / Q000601:surgery*; D014599:Uterus