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Papers by Courtney Ritchie
American Journal of Perinatology, Sep 1, 2021
Case Reports in Women's Health, Jul 1, 2020
Background: Leiomyomas are usually easily identifiable on routine imaging. However, there is incr... more Background: Leiomyomas are usually easily identifiable on routine imaging. However, there is increasing difficulty with diagnosing leiomyomas following degeneration. Subserosal leiomyomas that undergo cystic degeneration can imitate ovarian pathology. Case: We present the case of a 39-year-old nulligravid woman who underwent surgery for a large pelvic mass originally suspected to be of ovarian origin. Intraoperatively, the mass was found to originate from the uterus and determined to be a large pedunculated, fluid-filled cyst arising from a fibroid which had undergone cystic degeneration. The mass was successfully removed laparoscopically through a single, two-centimeter port. Conclusion: Gynecologists and radiologists should take into account this presentation when encountering suspected enlarged ovarian cysts without clearly identifying an origin. Laparoscopic intervention should be considered as the first line of management.
Journal of Minimally Invasive Gynecology, Nov 1, 2021
Study Objective The objective of this video is to demonstrate the use of operative hysteroscopy f... more Study Objective The objective of this video is to demonstrate the use of operative hysteroscopy for persistent retained products of conception after failure of medical and/or surgical (i.e., suction, dilation & curettage) methods. Design N/A. Setting Academic Medical Center – A 22-year-old G3P1011 multigravida with one prior vaginal delivery presented to the emergency room with vaginal bleeding and was incidentally found to be pregnant with a serum bHCG value greater than 200,000. The patient was diagnosed with an embryonic pregnancy via transvaginal ultrasound and counseled on medical versus surgical management. The patient opted for a suction, dilation and curettage under ultrasound guidance. The procedure was uncomplicated, and the endometrial stripe was noted to be thin and uniform at the conclusion of the procedure. The patient continued to have vaginal bleeding and persistent serum bHCG levels in the post-operative period. Repeat transvaginal ultrasound demonstrated a thickened endometrium without a gestational sac and a small amount of free fluid in the pelvis. The bilateral adnexa were normal in appearance. The patient underwent operative hysteroscopy with successful resection of densely adhered, fibrotic-appearing retained products of conception. The patient had resolution of her vaginal bleeding and persistent serum bHCG levels with resumption of her normal menses. Patients or Participants N/A. Interventions Operative hysteroscopy with a tissue removal system. Measurements and Main Results N/A. Conclusion We propose that operative hysteroscopy be given consideration as a safe and effective surgical intervention option in a premenopausal, hemodynamically stable patient, with absent or stable vaginal bleeding, and diagnosed with one of the following: anembryonic pregnancy, missed abortion, retained products of conception, or an abnormally developing intrauterine pregnancy as demonstrated by inappropriate rise in serum bHCG, to offer more targeted treatment while considering future fertility goals.
Obstetrics & Gynecology, Apr 5, 2022
Journal of Minimally Invasive Gynecology, Nov 1, 2020
Journal of Minimally Invasive Gynecology, 2020
initial surgery were considered "retreatment." Both medical and surgical managements were include... more initial surgery were considered "retreatment." Both medical and surgical managements were included. Measurements and Main Results: Cumulative incidence curves were calculated for time to retreatment event and log-rank tests used to compare curves between: route of laparoscopic myomectomy, age group, BMI, race, parity, diagnosis group, FIGO grade, and myoma weight. Overall incidence of retreatment was 5.96% per year. Women less than 40 years of age were significantly more likely to require retreatment, 8.22% per year, compared to those older than 40, 4.18% per year (p=0.003). There were no significant differences between time to treat based on any other demographic. Thirteen percent of patients required retreatment and the majority (26, 44%) of these 59 patients underwent hysterectomy, followed by repeat myomectomy (13, 22%), and medical management (13, 22%). Conclusion: The incidence of retreatment was found to be less than 6% per year for minimally invasive myomectomy, and only 13% of patients required some form of re-intervention demonstrating that minimally invasive myomectomy is a durable procedure for treatment of symptomatic fibroids. Further, the longevity of this treatment is greater in patients older than 40, as compared to their younger counterparts.
13th Philadelphia Prenatal Virtual Conference—Selected Abstracts, 2021
Case Reports in Women's Health, 2020
Background: Leiomyomas are usually easily identifiable on routine imaging. However, there is incr... more Background: Leiomyomas are usually easily identifiable on routine imaging. However, there is increasing difficulty with diagnosing leiomyomas following degeneration. Subserosal leiomyomas that undergo cystic degeneration can imitate ovarian pathology. Case: We present the case of a 39-year-old nulligravid woman who underwent surgery for a large pelvic mass originally suspected to be of ovarian origin. Intraoperatively, the mass was found to originate from the uterus and determined to be a large pedunculated, fluid-filled cyst arising from a fibroid which had undergone cystic degeneration. The mass was successfully removed laparoscopically through a single, two-centimeter port. Conclusion: Gynecologists and radiologists should take into account this presentation when encountering suspected enlarged ovarian cysts without clearly identifying an origin. Laparoscopic intervention should be considered as the first line of management.
Obstetrics & Gynecology
American Journal of Perinatology, Sep 1, 2021
Case Reports in Women's Health, Jul 1, 2020
Background: Leiomyomas are usually easily identifiable on routine imaging. However, there is incr... more Background: Leiomyomas are usually easily identifiable on routine imaging. However, there is increasing difficulty with diagnosing leiomyomas following degeneration. Subserosal leiomyomas that undergo cystic degeneration can imitate ovarian pathology. Case: We present the case of a 39-year-old nulligravid woman who underwent surgery for a large pelvic mass originally suspected to be of ovarian origin. Intraoperatively, the mass was found to originate from the uterus and determined to be a large pedunculated, fluid-filled cyst arising from a fibroid which had undergone cystic degeneration. The mass was successfully removed laparoscopically through a single, two-centimeter port. Conclusion: Gynecologists and radiologists should take into account this presentation when encountering suspected enlarged ovarian cysts without clearly identifying an origin. Laparoscopic intervention should be considered as the first line of management.
Journal of Minimally Invasive Gynecology, Nov 1, 2021
Study Objective The objective of this video is to demonstrate the use of operative hysteroscopy f... more Study Objective The objective of this video is to demonstrate the use of operative hysteroscopy for persistent retained products of conception after failure of medical and/or surgical (i.e., suction, dilation & curettage) methods. Design N/A. Setting Academic Medical Center – A 22-year-old G3P1011 multigravida with one prior vaginal delivery presented to the emergency room with vaginal bleeding and was incidentally found to be pregnant with a serum bHCG value greater than 200,000. The patient was diagnosed with an embryonic pregnancy via transvaginal ultrasound and counseled on medical versus surgical management. The patient opted for a suction, dilation and curettage under ultrasound guidance. The procedure was uncomplicated, and the endometrial stripe was noted to be thin and uniform at the conclusion of the procedure. The patient continued to have vaginal bleeding and persistent serum bHCG levels in the post-operative period. Repeat transvaginal ultrasound demonstrated a thickened endometrium without a gestational sac and a small amount of free fluid in the pelvis. The bilateral adnexa were normal in appearance. The patient underwent operative hysteroscopy with successful resection of densely adhered, fibrotic-appearing retained products of conception. The patient had resolution of her vaginal bleeding and persistent serum bHCG levels with resumption of her normal menses. Patients or Participants N/A. Interventions Operative hysteroscopy with a tissue removal system. Measurements and Main Results N/A. Conclusion We propose that operative hysteroscopy be given consideration as a safe and effective surgical intervention option in a premenopausal, hemodynamically stable patient, with absent or stable vaginal bleeding, and diagnosed with one of the following: anembryonic pregnancy, missed abortion, retained products of conception, or an abnormally developing intrauterine pregnancy as demonstrated by inappropriate rise in serum bHCG, to offer more targeted treatment while considering future fertility goals.
Obstetrics & Gynecology, Apr 5, 2022
Journal of Minimally Invasive Gynecology, Nov 1, 2020
Journal of Minimally Invasive Gynecology, 2020
initial surgery were considered "retreatment." Both medical and surgical managements were include... more initial surgery were considered "retreatment." Both medical and surgical managements were included. Measurements and Main Results: Cumulative incidence curves were calculated for time to retreatment event and log-rank tests used to compare curves between: route of laparoscopic myomectomy, age group, BMI, race, parity, diagnosis group, FIGO grade, and myoma weight. Overall incidence of retreatment was 5.96% per year. Women less than 40 years of age were significantly more likely to require retreatment, 8.22% per year, compared to those older than 40, 4.18% per year (p=0.003). There were no significant differences between time to treat based on any other demographic. Thirteen percent of patients required retreatment and the majority (26, 44%) of these 59 patients underwent hysterectomy, followed by repeat myomectomy (13, 22%), and medical management (13, 22%). Conclusion: The incidence of retreatment was found to be less than 6% per year for minimally invasive myomectomy, and only 13% of patients required some form of re-intervention demonstrating that minimally invasive myomectomy is a durable procedure for treatment of symptomatic fibroids. Further, the longevity of this treatment is greater in patients older than 40, as compared to their younger counterparts.
13th Philadelphia Prenatal Virtual Conference—Selected Abstracts, 2021
Case Reports in Women's Health, 2020
Background: Leiomyomas are usually easily identifiable on routine imaging. However, there is incr... more Background: Leiomyomas are usually easily identifiable on routine imaging. However, there is increasing difficulty with diagnosing leiomyomas following degeneration. Subserosal leiomyomas that undergo cystic degeneration can imitate ovarian pathology. Case: We present the case of a 39-year-old nulligravid woman who underwent surgery for a large pelvic mass originally suspected to be of ovarian origin. Intraoperatively, the mass was found to originate from the uterus and determined to be a large pedunculated, fluid-filled cyst arising from a fibroid which had undergone cystic degeneration. The mass was successfully removed laparoscopically through a single, two-centimeter port. Conclusion: Gynecologists and radiologists should take into account this presentation when encountering suspected enlarged ovarian cysts without clearly identifying an origin. Laparoscopic intervention should be considered as the first line of management.
Obstetrics & Gynecology