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Peer Reviewed

Title: The management of failed second-trimester termination of pregnancy.
Author: Basu JK; Basu D
Source: Contraception. 2009 Aug;80(2):170-3.
Abstract: BACKGROUND: Management of failed medical second-trimester termination of pregnancy (TOP) is a challenge with best therapy not determined. STUDY DESIGN: This was a cross-sectional study using retrospective record review of all women requesting medical TOP in the second trimester from January to June 2005. A comparative analysis was done to determine differences in demography, surgical methods and complications between two groups: (a) women who successfully aborted (first-admission group) and (b) women who failed to abort during their first admission (repeat-admission group). RESULTS: Study sample included 567 subjects [523 (92%) in the first-admission group and 44 (8%) in the repeat-admission group]. There were no significant differences in gestational age (p=.99), parity (p=.24) and previous history of cesarean section (p=.38) between the two groups. All of them successfully aborted, but the women in the repeat-admission Group 4 (9%) had more surgical interventions than those in the first-admission Group 6 (2%) (p<.0001). CONCLUSION: Failure to abort pregnancies in the second trimester with misoprostol is not uncommon. Our hospital protocol of adequate counseling and early repeat admission with good clinical selection criteria might be an alternative in a resource-constraint environment where resources and skills to perform surgical dilatation and evacuation are not available.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | COMPARATIVE STUDIES | ABORTION | MISOPROSTOL | PREGNANCY, SECOND TRIMESTER | CERVICAL DILATATION | CURETTAGE | HYSTEROTOMY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Surgery | Gynecologic Surgery | Urogenital Surgery
Document Number: 342391 Notification

Peer Reviewed

Title: Risk factors for the development of vesicovaginal fistula after incidental cystotomy at the time of a benign hysterectomy.
Author: Duong TH; Gellasch TL; Adam RA
Source: American Journal of Obstetrics and Gynecology. 2009 Aug 14;
Abstract: OBJECTIVE: We sought to evaluate risk factors for vesicovaginal fistula (VVF) after incidental cystotomy during benign hysterectomies. STUDY DESIGN: All benign hysterectomies between January 2000 and May 2004 were reviewed. Demographic and operative data were abstracted. Cystotomies were graded using the American Association for the Surgery of Trauma (AAST) system. Patients developing VVF after cystotomy were compared to those who did not. Categorical variables were analyzed with Fisher exact test while Student t test was used for continuous data. RESULTS: A total of 1317 benign hysterectomies were reviewed (46% abdominal, 48% vaginal, and 6% laparoscopically assisted vaginal). In all, 34 cystotomies occurred with 4 (11.7%) developing a VVF. Patients developing VVF were more likely to have an AAST grade V cystotomy (75% vs 7%; P = .004). Patients developing VVF trended toward greater tobacco use, larger uterine size, and more operative blood loss. CONCLUSION: Patients with an AAST grade V cystotomy are at increased risk for VVF formation.
Language: English
Keywords:
UNITED STATES OF AMERICA | DEVELOPED COUNTRIES | RESEARCH REPORT | WOMEN | HYSTERECTOMY | FISTULA | RISK FACTORS | North America | Americas | Demographic Factors | Population | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Diseases
Document Number: 342547

Title: Transvaginal endoscopic tubal sterilization.
Author: Kondo W; Noda RW; Branco AW; Rangel M; Branco Filho AJ
Source: Journal of Laparoendoscopic and Advanced Surgical Techniques. Part A. 2009 Feb;19(1):59-61.
Abstract: BACKGROUND: Tubal sterilization is one of the most widely used options for female contraception. It can be performed by laparotomy, minilaparotomy, colpotomy, laparoscopy, and hysteroscopy. In this paper, we report the use of the transvaginal endoscopic approach to perform tubal ligation. CASE: The access to the abdomen was obtained by a 1.5-cm colpotomy. The flexible endoscope was introduced into the peritoneal cavity, and carbon dioxide was instilled to get the pneumoperitoneum. Fallopian tubes were identified and electrocauterized with a 40-W coagulation current. Total procedure time was 45 minutes. A single dose of intravenous dypirone was administered for pain. She was discharged 10 hours after the procedure. CONCLUSION: Transvaginal endoscopic tubal ligation is feasible and can be considered an alternative approach to perform female sterilization.
Language: English
Keywords:
BRAZIL | SUMMARY REPORT | CASE HISTORIES | CLIENTS | TUBAL LIGATION | COLPOTOMY | ENDOSCOPY | South America, Eastern | South America | Latin America | Americas | Developing Countries | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | Female Sterilization | Sterilization, Sexual | Family Planning | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Physical Examinations and Diagnoses | Examinations and Diagnoses
Document Number: 341431

Peer Reviewed

Title: Intraoperative placement of the Copper T-380 intrauterine devices in women undergoing elective cesarean delivery: a pilot study.
Author: Nelson AL; Chen S; Eden R
Source: Contraception. 2009 Jul;80(1):81-3.
Abstract: BACKGROUND: The purpose of this pilot project was to test the feasibility of a technique designed to place a copper intrauterine device (IUD) through the hysterotomy incision of an elective cesarean delivery to minimize possible contamination and to guarantee that tailstrings were visible in the vagina for easy removal should complications occur. STUDY DESIGN: Women were monitored in the hospital for signs of infection or excessive blood loss. At the time of hospital discharge and at 2 and 6 weeks postpartum, they were examined to determine the status of the tailstrings. The position of the IUD was assessed by ultrasound at week 6. RESULTS: All seven of the subjects had successful placement. The sutures tied to the IUD strings were visible on vaginal examination in each case. The original tailstrings were visible in the vagina at 6 weeks and each IUD was fundally positioned. CONCLUSION: Successful intraoperative placement of Copper T-380A IUDs through incision at the time of cesarean birth is possible.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | PILOT PROJECTS | POSTPARTUM WOMEN | IUD, COPPER RELEASING | INSERTION | HYSTEROTOMY | CESAREAN SECTION | ULTRASONICS | CONTRACEPTIVE REMOVAL | IUD EXPULSION | Developed Countries | North America | Americas | Studies | Research Methodology | Puerperium | Reproduction | IUD | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Gynecologic Surgery | Urogenital Surgery | Surgery | Obstetrical Surgery
Document Number: 342788

Peer Reviewed

Title: Scheduled hysterectomy for second-trimester abortion in a patient with placenta accreta.
Author: Tocce K; Thomas VW; Teal S
Source: Obstetrics and Gynecology. 2009 Feb;113(2 Pt 2):568-70.
Abstract: BACKGROUND: As cesarean deliveries increase, so does placenta accreta. There is little evidence regarding management of patients with known or suspected abnormal placentation seeking abortion. CASE: A medically complicated patient with evidence of placenta increta on magnetic resonance imaging presented for pregnancy termination at 15 weeks of gestation. Scheduled hysterectomy was performed to avoid hemorrhage and subsequent complications. The patient did well postoperatively; her course was complicated only by a wound infection treated as an outpatient. Pathology was consistent with placenta increta. CONCLUSION: Placenta accreta has increased 13-fold in the past 30 years. In select patients with evidence of abnormal placentation, scheduled hysterectomy for termination of pregnancy is an option that may be considered.
Language: English
Keywords:
COLORADO | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | PREGNANT WOMEN | ABORTION | CESAREAN SECTION | PREGNANCY, SECOND TRIMESTER | PREGNANCY COMPLICATIONS | HYSTERECTOMY | INFECTIONS | United States of America | North America | Americas | Developed Countries | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Pregnancy | Reproduction | Diseases | Gynecologic Surgery | Urogenital Surgery
Document Number: 330356 Notification

7.
Title: Ineffective attempt to preserve fertility with a levonorgestrel-releasing intrauterine device in a young woman with endometrioid endometrial carcinoma: a case report and review of the literature.
Author: Vandenput I; Van Eygen K; Moerman P; Vergote I; Amant F
Source: European Journal of Gynaecological Oncology. 2009;30(3):313-6.
Abstract: BACKGROUND: The treatment of endometrial cancer in young women who want to preserve their fertility is challenging. CASE: A 25-year-old woman (A0P0G0) was diagnosed with grade 1 endometrioid endometrial carcinoma (EEC). Imaging studies including transvaginal ultrasound (TVS), computed tomography and magnetic resonance imaging (MRI) could not detect myometrial invasion or metastatic disease. The immunohistochemical expression of the estrogen and progesterone receptor in the tumor was strongly positive, whereas p53 staining was negative. After extensive counseling, we decided to use a levonorgestrel-releasing intrauterine device to preserve her fertility. Follow-up was organized every three months and consisted of serum CA125 levels, TVS, endometrial biopsy and MRI. The tumor regressed after ten months and the intrauterine device was removed. However, nine months later, recurrent EEC was diagnosed and a hysterectomy performed. Pathological examination confirmed Stage Ia EEC. CONCLUSION: Despite the presence of favorable prognostic factors of EEC as determined by grade and immunohistochemistry, the levonorgestrel-releasing intrauterine device was unable to preserve fertility.
Language: English
Keywords:
BELGIUM | SUMMARY REPORT | LITERATURE REVIEW | CASE HISTORIES | CLIENTS | ENDOMETRIAL CANCER | TREATMENT | FECUNDITY | IUD, HORMONE RELEASING | LEVONORGESTREL | ULTRASONICS | HYSTERECTOMY | Europe, Western | Europe | Developed Countries | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | Cancer | Neoplasms | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Gynecologic Surgery | Urogenital Surgery | Surgery
Document Number: 342780

Title: Oral contraceptives, salpingo-oophorectomy and hormone replacement therapy in BRCA1-2 mutation carriers.
Author: Biglia N; Mariani L; Ponzone R; Sismondi P
Source: Maturitas. 2008 Jun;60(2):71-77.
Abstract: Germline mutations in BRCA1 or BRCA2 genes predispose to hereditary breast and ovarian cancers. The estimated lifetime risk of breast cancer in BRCA1 mutation carriers ranges from 50% to 80%, while the estimated lifetime risk of ovarian cancer ranges from 20% to 65%. Although breast cancer risk is similar in women who inherit BRCA2 mutations, the lifetime risk of ovarian cancer is approximately 20%. In the general population reproductive factors (such as parity, age at menopause, use of exogenous steroid hormones as contraceptives or after menopause) influence the risk of breast and ovarian cancer. In BRCA mutation carriers, these issues are much more complicated and not completely understood. Nonetheless, a growing number of data show that estrogens may modulate the risk of breast cancer in women with BRCA mutations. In these women estrogens may increase the probability of mutation due to enhanced proliferation and direct genotoxic effects of estrogen metabolites. Women carrying BRCA1 and BRCA2 mutations face difficult decisions during the reproductive life. In the younger age period, they may be reluctant to using oral contraceptives (OCs) for the possible influence of these compounds on breast cancer incidence. After completion of childbearing, they may be offered the option of prophylactic oophorectomy, that is associated with a strong reduction of cancer risk, but also with the early onset of menopausal symptoms and the long-term consequences of estrogen deprivation. (excerpt)
Language: English
Keywords:
LITERATURE REVIEW | ORAL CONTRACEPTIVES | BREAST CANCER | OVARIAN CANCER | GENETICS | HEREDITARY DISEASES | OVARIECTOMY | HORMONE REPLACEMENT THERAPY | RISK ASSESSMENT | RISK REDUCTION BEHAVIOR | Contraceptive Methods | Contraception | Family Planning | Cancer | Neoplasms | Diseases | Biology | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Evaluation | Behavior
Document Number: 327496

Title: Use of recombinant activated factor VII in massive postpartum haemorrhage.
Author: Bouma LS; Bolte AC; van Geijn HP
Source: European Journal of Obstetrics, Gynecology and Reproductive Biology. 2008 Apr;137(2):172-177.
Abstract: Postpartum haemorrhage (PPH) remains an important cause of maternal morbidity and mortality. With regard to morbidity, preservation of the uterus is of paramount importance in fertile women. The objective of the study was to describe the cumulative experience of a cohort of women that were treated with recombinant factor VIIa. In this retrospective, descriptive study we approached all departments of obstetrics and gynaecology in the Netherlands to find out if they had used rFVIIa for this indication. Twenty-seven cases were reported to us. To evaluate each case, we used a standardized case record form. The main cause of PPH was uterine atony (82%). In 21 cases rFVIIa was explicitly given to prevent a hysterectomy. This was successful in 16 cases (76%). Relevant reduction or complete cessation of bleeding after rFVIIa was noted in 24/27 cases (89%). There was a reduction in blood product requirements following rFVIIa administration. The dose of rFVIIa was variable and ranged from 16 to 128 mg/kg. There appears to be a role for the use of rFVIIa in PPH unresponsive to conventional therapy. Recombinant FVIIa can be helpful and avoid an emergency hysterectomy. (author's)
Language: English
Keywords:
NETHERLANDS | DEVELOPING COUNTRIES | RESEARCH REPORT | COHORT ANALYSIS | POSTPARTUM WOMEN | BLEEDING | HYSTERECTOMY | Developed Countries | Europe, Western | Europe | Research Methodology | Puerperium | Reproduction | Signs and Symptoms | Diseases | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 325919

10.

Peer Reviewed

Title: An historical overview of second trimester abortion methods.
Author: Bygdeman M; Gemzell-Danielsson K
Source: Reproductive Health Matters. 2008 May;16(31 Suppl):196-204.
Abstract: The methods used for abortion in the second trimester have changed considerably in recent years. The surgical procedure dilatation and evacuation (D&E) has replaced hysterotomy. Instead of injecting different compounds, such as hypertonic saline, prostaglandin analogues are administered by non-invasive routes. The most effective medical method is combining a prostaglandin analogue with mifepristone. The consequence of these developments is that abortion in the second trimester can be be performed significantly more effectively and that the currently recommended methods being used are associated with fewer side effects and complications.
Language: English
Keywords:
SWEDEN | RESEARCH REPORT | LITERATURE REVIEW | WOMEN | HYSTEROTOMY | ABORTION | PREGNANCY, SECOND TRIMESTER | PROSTAGLANDINS | CHANGES | Europe, Northern | Europe | Developed Countries | Demographic Factors | Population | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Endocrine System | Physiology | Biology | Social Change | Sociocultural Factors
Document Number: 330090 Notification

11.

Peer Reviewed

Title: Psychiatric morbidity following hysterectomy in Egypt.
Author: Helmy YA; Hassanin IM; Elraheem TA; Bedaiwy AA; Peterson RS
Source: International Journal of Gynecology and Obstetrics. 2008 Jul;102(1):60-64.
Abstract: The objective of this study was to evaluate psychiatric morbidity in Egyptian women before and after hysterectomy for benign indications. This was a 2-year prospective observational study at Sohag University Hospital, Egypt, in which 96 women scheduled for hysterectomy were assessed for psychiatric comorbidity before and after the operation using the General Health Questionnaire (GHQ-28), Beck Depression Inventory, and Hamilton Anxiety Scale. Of these, 35 (36.5%) had scores of 4 or higher, signifying psychiatric comorbidity (group 1), and 61 (63.5%) had scores less than 4, suggesting no psychiatric comorbidity (group 2). Postoperatively, severe anxiety and depressive symptoms were common in group 1. In group 2, 48 (78.7%) of the 61 women had scores of 4 or higher. In that subgroup, depressive and anxiety symptoms were more common among nulliparas whereas women with a high parity experienced the least psychiatric comorbidity. As women undergoing hysterectomy risk psychiatric morbidity, gynecologists should consider less invasive interventions to treat benign conditions. (author's)
Language: English
Keywords:
EGYPT | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | WOMEN | HYSTERECTOMY | MENTAL HEALTH | ANXIETY DISORDERS | DEPRESSION | Developing Countries | Africa, North | Africa | Research Methodology | Studies | Demographic Factors | Population | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Psychological Factors | Behavior | Mental Disorders | Diseases
Document Number: 327045

12.
Title: [Dysfunctional uterine bleeding--diagnostics and treatment] Czynnosciowe krwawienia maciczne--diagnostyka i leczenie.
Author: Jakimiuk AJ; Grzybowski W; Beta J
Source: Ginekologia Polska. 2008 Apr;79(4):254-8.
Abstract: Dysfunctional uterine bleeding (DUB) occurs frequently in women at the reproductive age and is unrelated to structural uterine abnormalities. It significantly impairs the quality of life for many otherwise healthy women. Evaluation of patients with abnormal uterine bleeding and identification of those with DUB is based on medical records, physical examination, laboratory tests, uterine imaging and endometrial sampling. Surgical treatment options include hysterectomy and conservative surgery (endometrial resection or ablation). Medical therapy, with the avoidance of possibly unnecessary surgery, is an attractive treatment option. However, there is considerable variation in practice and lack of consensus regarding the most effective therapy.
Language: Polish
Keywords:
BRAZIL | SUMMARY REPORT | WOMEN | BLEEDING | UTERINE EFFECTS | LABORATORY EXAMINATIONS AND DIAGNOSES | REPRODUCTIVE AGE | HYSTERECTOMY | ENDOMETRIAL EFFECTS | SURGERY | TREATMENT | Developing Countries | South America, Eastern | South America | Latin America | Americas | Demographic Factors | Population | Signs and Symptoms | Diseases | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction | Gynecologic Surgery | Urogenital Surgery | Endometrium
Document Number: 328920

13.

Peer Reviewed

Title: Peripartum hysterectomy in Taiwan.
Author: Jou HJ; Hung HW; Ling PY; Chen SM
Source: International Journal of Gynecology and Obstetrics. 2008 Jun;101(3):269-272.
Abstract: The objective was to investigate the incidence and associated risk factors for peripartum hysterectomy in singleton pregnancies. A retrospective cohort study of all women with singleton pregnancies admitted for delivery in 2002 taken from the National Healthcare Insurance database. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for maternal and hospital characteristics using logistic regression. There were 287 peripartum hysterectomies in 214 237 singleton pregnancies (0.13%). Cesarean delivery, vaginal birth after cesarean (VBAC), and repeat cesarean delivery had higher hysterectomy rates than vaginal delivery, with adjusted ORs of 12.13 (95% CI 8.30-17.74), 5.12 (95% CI 1.19-21.92), and 3.84 (95% CI 2.52-5.86), respectively. Pregnancies complicated with placenta previa, gestational diabetes mellitus (GDM), and premature labor were associated with significantly increased risks for peripartum hysterectomy (P less than 0.05). Risk factors for peripartum hysterectomy included cesarean delivery, VBAC, repeat cesarean, placenta previa, GDM, and premature labor. VBAC and repeat cesarean had a similar risk. (author's)
Language: English
Keywords:
TAIWAN | RESEARCH REPORT | RETROSPECTIVE STUDIES | PREGNANT WOMEN | CHILDBIRTH | HYSTERECTOMY | RISK FACTORS | CESAREAN SECTION | PREGNANCY COMPLICATIONS | PREMATURE LABOR | DIABETES | Asia, Eastern | Asia | Developed Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Biology | Obstetrical Surgery | Diseases
Document Number: 326721

14.

Peer Reviewed

Title: Emergency peripartum hysterectomy in a a tertiary Istanbul hospital.
Author: Kayabasoglu F; Guzin K; Aydogdu S; Sezginsoy S; Turkgeldi L
Source: Archives of Gynecology and Obstetrics. 2008 Sep;278(3):251-256.
Abstract: The objective of this study was to evaluate the incidence, risk factors, indications, outcomes and complications of emergency peripartum hysterectomy performed after cesarean and vaginal deliveries. We analyzed retrospectively 28 cases of emergency peripartum hysterectomy operations performed between February 2001 and February 2007 at the Istanbul Goztepe Training and Research Hospital, which is a teaching hospital operating under the Turkish Ministry of Health. The indications, risk factors and the associated complications were compared with control groups. Statistical analysis was performed using the STATA version 7.0 statistical package (Stata Corporation, College Station, TX, USA). The overall incidence of emergency peripartum hysterectomy at our hospital is 0,37 in 1,000 deliveries. Abnormal placental adherence and uterine atony comprised 85% of the indications for peripartum hysterectomy. Postoperative maternal morbidity occurred in 15 cases (54%). Most had a febrile morbidity and depression. Seven patients underwent postpartum hysterectomy due to consumptive coagulopathy. There was one maternal mortality (4%) and five perinatal mortalities (18%). The maternal death was due to consumptive coagulopathy after placental abruption. All patients had to receive blood transfusions. The median number of postoperative hospitalization days was 7. Peripartum hysterectomy is still a dramatic life-saving operation with high risks. The most common reason for abnormal placental adherence is previous uterine procedures. (author's)
Language: English
Keywords:
TURKEY | RESEARCH REPORT | RETROSPECTIVE STUDIES | POSTPARTUM WOMEN | HYSTERECTOMY | CESAREAN SECTION | EMERGENCY SERVICES | RISK FACTORS | COMPLICATIONS | Developing Countries | Europe, Southeastern | Europe | Studies | Research Methodology | Puerperium | Reproduction | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Biology | Diseases
Document Number: 327979

15.

Peer Reviewed

Title: Goserelin versus leuprolide before hysterectomy for uterine fibroids.
Author: Lim SS; Sockalingam JK; Tan PC
Source: International Journal of Gynecology and Obstetrics. 2008 May;101(2):178-183.
Abstract: The objective was to compare goserelin and leuprolide given before hysterectomy for symptomatic large fibroid uteri. A randomized study of 66 premenopausal women with fibroid uteri at least 14 weeks of gestation in a gravid uterus. Women were randomized to receive either subcutaneous depot 3.6 mg goserelin or 3.75 mg leuprolide every 4 weeks for a total of 3 doses. Hysterectomy was performed within 1 month of the last dose. A total of 34 women randomized to the goserelin group and 31 women to the leuprolide group were available for analysis. Preoperative hemoglobin level (P=0.89), operative blood loss (P=0.72), and operating time (P=0.39) were not different between the 2 groups. Postoperative hemoglobin was higher in the leuprolide group (P=0.003), but blood transfusion requirement was not different between the groups (P=1.0). Other outcomes and side effects of the drugs were similar. Goserelin and leuprolide administered before hysterectomy for uterine fibroids have similar perioperative outcomes. (author's)
Language: English
Keywords:
MALAYSIA | RESEARCH REPORT | WOMEN | UTERINE EFFECTS | FIBROIDS | DRUGS | ADMINISTRATION AND DOSAGE | GONADOTROPINS | HYSTERECTOMY | HEMOGLOBIN LEVEL | SIDE EFFECTS | Developing Countries | Asia, Southeastern | Asia | Demographic Factors | Population | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Neoplasms, Benign | Neoplasms | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hormones | Endocrine System | Gynecologic Surgery | Urogenital Surgery | Surgery | Hemic System
Document Number: 325981

16.

Peer Reviewed

Title: Relation between vaginal and endocervical pH in patients undergoing cold-knife conization and hysterectomy.
Author: Murta EF; Perfeito PB; Oliveira TM; Michelin MA; Maluf PJ
Source: Archives of Gynecology and Obstetrics. 2008 Jan;277(1):43-46.
Abstract: This study aimed to investigate the influence of endocervical pH on vaginal pH, and also the changes in these pH values following hysterectomy and cold-knife conization. Vaginal pH is important for maintaining the equilibrium of the vaginal microflora. Two groups of women were studied: the first (n = 20, median age 45, range 33-50 years-old), before and after hysterectomy (without ovariectomy) for myomatosis; the second group (n = 18, median age 38.5, range 37-65 years-old), before and after cold-knife conization for cervical intraepithelial neoplasia (CIN) grade II or III. Four samples (before and 90 days after surgery) were collected from the women by means of swabs: (1) anterior vaginal fornix, (2) posterior vaginal fornix, (3) posterior wall of lower vagina, and (4) endocervix (except in cases after hysterectomy). The pH was measured using a digital pH-meter (Sentron). We observed that endocervical pH was less acidic than were all the vaginal locations measured, before both surgeries. After both surgeries, all vaginal pH measurements were higher, but without reaching statistical significance. Endocervical pH correlated with vaginal pH. We concluded that recent hysterectomy does not alter vaginal pH and that vaginal and endocervical pH values are related. (author's)
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | CASE CONTROL STUDIES | WOMEN | CERVICAL EFFECTS | VAGINA | HYSTERECTOMY | SURGERY | MENOPAUSE | MENSTRUAL CYCLE | South America, Eastern | South America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Gynecologic Surgery | Urogenital Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction | Menstruation
Document Number: 322614

17.

Peer Reviewed

Title: Sexual violence-related fistulas in the Democratic Republic of Congo.
Author: Onsrud M; Sjoveian S; Luhiriri R; Mukwege D
Source: International Journal of Gynecology and Obstetrics. 2008 Sep 22;:[5] p.
Abstract: Objective: To determine the magnitude of traumatic gynecologic fistulas caused by sexual violence in the Democratic Republic of Congo. Methods: A retrospective analysis of hospital records from 604 consecutive patients who received treatment for gynecologic fistulas at Panzi Hospital between November 2005 and November 2007. Results: Of the 604 patients, 24 (4%) reported that their fistulas had been caused by sexual violence; of these, 5 (0.8%) had developed fistulas as a direct result of forced penetration with foreign objects and/or gang rapes. Of the remaining patients, 6 had a fistula before they were raped, 9 developed iatrogenic fistulas following inappropriate instrumentation to manage rape-induced spontaneous abortion or stillbirth, or after abdominal hysterectomy, and 4 developed fistulas after prolonged and obstructed labor. Conclusion: Traumatic fistulas are rare compared to obstetric fistulas. Fistulas indirectly related to sexual violence are likely to be more common than those directly related. All fistulas resulting from sexual violence, whether direct or indirect, should be considered traumatic and special care should be given to these women.
Language: English
Keywords:
DEMOCRATIC REPUBLIC OF THE CONGO | RESEARCH REPORT | RETROSPECTIVE STUDIES | EXAMINATIONS AND DIAGNOSES | RECORDS | SEXUAL ABUSE | SEX BEHAVIOR | VIOLENCE | VIOLENCE AGAINST WOMEN | RAPE | FISTULA | ABORTION, SPONTANEOUS | HYSTERECTOMY | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Information Processing | Information | Crime | Social Problems | Sociocultural Factors | Behavior | Domestic Violence | Diseases | Pregnancy Complications | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment
Document Number: 328492

18.

Peer Reviewed

Title: Primary carcinoid tumor of the ovary: A case report.
Author: Somak R; Shramana M; Vijay S; Nita K
Source: Archives of Gynecology and Obstetrics. 2008 Jan;277(1):79-82.
Abstract: Carcinoid tumors commonly occur in the gastrointestinal tract and lungs. However, carcinoid tumors of the ovary are rare, primary carcinoid tumors being even rarer, forming 0.3% of all carcinoid tumors. We present a case of a 55-year-old woman presented with symptoms of abdominal discomfort, weakness and fatigue. Pelvic ultrasound revealed a left-sided lobulated ovarian mass, which was solid with occasional internal scattered fluid areas. No other abnormality was detected on pelvic and abdominal ultrasonography. The findings of biochemical investigations were within normal limits. The patient underwent total abdominal hysterectomy and bilateral salphingo-oophorectomy for a clinical suspicion of ovarian tumor. Gross examination revealed a large tumor completely replacing the ovary, which was predominantly solid with few cystic areas and yellowish in color. Microscopically, the tumor was composed of uniform population of polygonal cells with abundant granular cytoplasm, arranged in small acini, solid sheets, ribbons and trabecular pattern. No teratomatous component was seen either grossly or microscopically. The tumor cells showed the strong expression of Chromogranin A and synaptophysin on immunohistochemistry. On the basis of this, a diagnosis of primary ovarian carcinoid was made. We conclude that it is important to be aware of this entity in the pathological diagnosis of ovarian tumors, even in the absence of any clinical indicator of carcinoid tumor/syndrome, as it carries a markedly better prognosis and clinical outcome in comparison with most other malignant ovarian tumors. (author's)
Language: English
Keywords:
INDIA | SUMMARY REPORT | CASE HISTORIES | NEOPLASMS | OVARIAN CANCER | EXAMINATIONS AND DIAGNOSES | HYSTERECTOMY | HISTOLOGY | ULTRASONICS | Developing Countries | Asia, Southern | Asia | Data Collection | Research Methodology | Diseases | Cancer | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Biology
Document Number: 322618

19.

Title: Reproductive, menstrual, and other hormone-related factors and risk of renal cell cancer.
Author: Zucchetto A; Talamini R; Dal Maso L; Negri E; Polesel J
Source: International Journal of Cancer. 2008 Nov 1;123(9):2213-6.
Abstract: A role of hormone-related factors in renal cell cancer (RCC) etiology has been hypothesized, but the epidemiological evidence is inconsistent. The present study aimed at evaluating the effect of reproductive, menstrual and other gender-specific variables on RCC risk among women. This study is part of a larger hospital-based, case-control study on RCC risk, conducted in northern, central and southern Italy. Cases were 273 women, below age 80, with histologically confirmed, incident RCC. Controls were 546 women hospitalized for acute, nonneoplastic conditions, frequency-matched to cases by age and center. Odds ratios (OR) and 95% confidence intervals (CI) were computed using multiple logistic regression models. RCC risk was inversely related to age at first birth (OR = 0.7, 95% CI 0.5-1.0, for >/= 25 years vs. <25 years). Hysterectomy was found to double RCC risk (OR = 2.3, 95% CI 1.3-4.2). A negative association of borderline-statistical significance emerged for age at menarche, whereas, no associations were found between RCC risk and parity, menopausal status, age at menopause and use of hormone replacement therapy or oral contraceptives. Our findings give support to a role of hysterectomy in increasing RCC risk without corroborating, however, a major role of female hormone-related factors.
Language: English
Keywords:
ITALY | RESEARCH REPORT | CONTROL GROUPS | WOMEN | RENAL EFFECTS | CANCER | MENSTRUATION | REPRODUCTIVE BEHAVIOR | HYSTERECTOMY | HORMONES | Developed Countries | Europe, Southern | Europe | Research Methodology | Demographic Factors | Population | Urogenital Effects | Urogenital System | Physiology | Biology | Neoplasms | Diseases | Reproduction | Fertility | Population Dynamics | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Endocrine System
Document Number: 328660

20.

Peer Reviewed

Title: Unusual presentation of cervical cancer as advanced ovarian cancer.
Author: Abdulhathi MB; Al-Salam S; Kassis A; Ghazal-Aswad S
Source: Archives of Gynecology and Obstetrics. 2007 Oct;276(4):387-390.
Abstract: Ovarian metastases from cervical cancers are uncommon. In most cases, the primary site of cervix is known before the occurrence of metastasis. We report a case of cervical adenocarcinoma presenting primarily as advanced ovarian cancer with the primary site totally silent. A 47-year old multiparous patient presented to her local hospital with vague abdominal pain for 2 months. Initial investigations with abdominal ultrasound and computerized tomography scan suggested right ovarian dermoid cyst. Her CA125 was 12 �/ml (0-35). Right salpingo-oophorectomy was performed with the histologic diagnosis of dermoid cyst. Follow-up after 5 months showed a higher level of serum CA 125 (1,594 �/ml) and a negative cervical smear. Exploratory laparotomy was done with the intent to progress to total abdominal hysterectomy, left salpingo-oophorectomy and omentectomy with staging. Surprisingly, the histologic features of the specimen obtained at laparotomy were consistent with a moderately differentiated cervical adenocarcinoma with metastases to corpus uterus, ovaries, left fallopian tube, omentum and pleural cavity. The final stage was stage IV cervical cancer. Following this, the patient was referred to medical oncologist for chemotherapy. Cervical carcinoma should be suspected in any patient presented with bilateral ovarian tumors and positive ascitic fluid cytology. Negative cervical smears do not exclude the possibility of primary cervical carcinoma. (author's)
Language: English
Keywords:
UNITED ARAB EMIRATES | RESEARCH REPORT | WOMEN | MIDDLE AGED ADULTS | PAIN | ULTRASONICS | OVARIAN CYSTS | LAPAROTOMY | HYSTERECTOMY | CERVICAL CANCER | OVARIAN CANCER | Middle East | Developed Countries | Demographic Factors | Population | Adults | Age Factors | Population Characteristics | Signs and Symptoms | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Surgery | Treatment | Gynecologic Surgery | Urogenital Surgery | Cancer | Neoplasms
Document Number: 320760

21.

22.

Peer Reviewed

Title: The value of frozen sectioning for the evaluation of resection margins in cases of conization.
Author: Behtash N; Zarchi MK; Hamedi B; Ardalan FA; Tehranian A
Source: Archives of Gynecology and Obstetrics. 2007 Nov;276(5):529-532.
Abstract: The objectives were to determine the role of frozen section examination (FSE) of the cone specimen in the evaluation of the resection margin status and to rule out invasion in patients with high-grade cervical intraepithelial neoplasia. Thirty patients with cervical intraepithelial neoplasia underwent conization followed by FSE and planned hysterectomy. The results of the definitive paraffin exam were compared with FSE. In evaluation of the margins by FSE, 4 patients (13%) had positive cone margines and 26 (87%) had negative margins. The definitive of paraffin examination of margin status was concordant in all the cases. Intraoperative diagnosis of invasion was made in three cases such that all of them were invasive squamous cell carcinoma. Among the remaining 27 cases, we detected five CIN1, two CIN2 and three CIN3, so the diagnosis of the FSE was concordant with paraffin section in 26 out of 30 cases (87%). Also we detected four additional CIN (one CIN 1, two CIN2 and one CIN3) after paraffin study, whose frozen specimens were reported normal. Frozen section examination can provide immediate and precise evaluation of the cone margin status in high-grade cervical intraepithelial neoplasia. It can identify frank invasion and permit adequate treatment in a one-stage procedure and reliably detect clear resection margins. (author's)
Language: English
Keywords:
IRAN | RESEARCH REPORT | PROSPECTIVE STUDIES | WOMEN | EXAMINATIONS AND DIAGNOSES | HYSTERECTOMY | PREVALENCE | CERVICAL CANCER | TREATMENT | EVALUATION | Developing Countries | Middle East | Studies | Research Methodology | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Gynecologic Surgery | Urogenital Surgery | Surgery | Measurement | Cancer | Neoplasms | Diseases
Document Number: 320763

24.
Peer Reviewed

Title: Characterization of surgically transposed ovaries in integrated PET / CT scan in patients with cervical cancer.
Author: Chung HH; Kang WJ; Kim JW; Park NH; Song YS
Source: Acta Obstetrica et Gynecologica Scandinavica. 2007 Jan;86(1):88-93.
Abstract: The purpose of this study was to determine the ovarian findings on integrated positron emission tomography/ computed tomography scans during follow-up in cervical cancer patients with ovarian transposition. We retrospectively reviewed the clinical data and integrated 18/F-fluorodeoxyglucose positron emission tomography/computed tomography of women with ovarian transposition during radical hysterectomy for cervical cancer between December 2003 and March 2006. Eighty-four premenopausal women had ovarian transposition performed during the study period. Twelve positron emission tomography/computed tomography scans from 11 patients were registered for the current study and three women were diagnosed with metastasis: two in lung and one in pelvis. Two patients complained of menopausal symptoms during follow-up, and the hormonal tests were consistent with it. In the current study, an integrated positron emission tomography/computed tomography scan detected one patient with right lower abdominal mass with increased 18F-fluorodeoxyglucose uptake, which was identified as a transposed right ovary. Clinical information of ovarian transposition was helpful in interpretation of the lesion. In the patient, transposed ovary was associated with increased fluorodeoxyglucose uptake, with standard uptake values ranging from 3.7 to 5.5. Other positron emission tomography/computed tomography scans did not show abnormal uptake of 18/F-fluorodeoxyglucose. Transposed ovary in premenopausal women may appear on integrated positron emission tomography/computed tomography scan as a mass with increased 18/F-fluorodeoxyglucose uptake, which may be associated with preserved ovarian function. Clinical information regarding transposition should be noted in order not to interpret these as recurrent or metastatic lesions. (author's)
Language: English
Keywords:
REPUBLIC OF KOREA | RESEARCH REPORT | RETROSPECTIVE STUDIES | WOMEN | OVARY | SURGERY | HYSTERECTOMY | CERVICAL CANCER | EXAMINATIONS AND DIAGNOSES | NEOPLASMS | SIGNS AND SYMPTOMS | Developed Countries | Asia, Eastern | Asia | Studies | Research Methodology | Demographic Factors | Population | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Gynecologic Surgery | Urogenital Surgery | Cancer | Diseases
Document Number: 309967

25.

Title: Does physical intimate partner violence affect sexual health? A systematic review.
Author: Coker AL
Source: Trauma, Violence, and Abuse. 2007 Apr;8(2):149-177.
Abstract: Forty years of published research (1966-2006) addressing physical intimate partner violence (IPV) and sexual health was reviewed (51 manuscripts) and synthesized to determine (a) those sexual health indicators for which sufficient evidence is available to suggest a causal association and (b) gaps in the literature for which additional careful research is needed to establish causality and explain mechanisms for these associations. Sexual health was defined as a continuum of indicators of gynecology and reproductive health. IPV was consistently associated with sexual risk taking, inconsistent condom use, or partner nonmonogamy (23 of 27 studies), having an unplanned pregnancy or induced abortion (13 of 16 studies), having a sexually transmitted infection (17 of 24 studies), and sexual dysfunction (17 of 18 studies). A conceptual model was presented to guide further needed research addressing direct and indirect mechanisms by which physical, sexual, and psychological IPV affects sexual health. (author's)
Language: English
Keywords:
DEVELOPING COUNTRIES | LITERATURE REVIEW | RESEARCH REPORT | VIOLENCE AGAINST WOMEN | DOMESTIC VIOLENCE | SEX BEHAVIOR | SEXUALLY TRANSMITTED DISEASES | REPRODUCTIVE TRACT INFECTIONS | CERVICAL CANCER | NEOPLASMS | INFERTILITY | PAIN | PELVIC INFECTIONS | HYSTERECTOMY | Crime | Social Problems | Sociocultural Factors | Behavior | Infections | Diseases | Cancer | Reproduction | Signs and Symptoms | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 320820

26.
Peer Reviewed

Title: Risk factors for abdominal scar endometriosis after obstetric hysterotomies: a case-control study.
Author: de Oliveira MA; Ponce de Leon AC; Freire EC; de Oliveira HC
Source: Acta Obstetrica et Gynecologica Scandinavica. 2007 Jan;86(1):73-80.
Abstract: The objective was to identify risk factors that are associated with the development of scar endometriosis after obstetric hysterotomies. The hypothesis is that early hysterotomy in pregnancy (before 22nd week) is the main risk factor for the development of scar endometriosis. The authors conducted a case-control study between April 2000 and June 2003. A total of 117 women were selected, including 39 cases and 78 controls. Exposure and confounding variables were measured by a standardized questionnaire, which included sociodemographic characteristics, reproductive/physiologic history, past pathological history, history of obstetric surgeries, family history, and social history. The odds ratio (OR) and its 95% confidence interval (CI) were calculated using bivariate analysis for each possible risk factor. These estimates were obtained by multivariate analysis using unconditional logistic regression. Tests were made to assess the fit of the final model. In the multivariate analysis, positive associations were observed between scar endometriosis and hysterotomy type (early versus late: OR = 42.99; CI 8.77-210.81), amount of the menstrual blood flow (heavy versus light/normal: OR = 11.97; CI 2.35-60.82), and alcoholic consumption (yes versus no: OR = 5.31; CI 1.22-23.11). Negative association was observed between scar endometriosis and parity (OR = 0.61; CI 0.31-1.23), however it was not statistically significant (p > 0.05). Early hysterotomy in pregnancy is the main risk factor for scar endometriosis. Increased menstrual flow and alcohol consumption are also risk factors, while high parity may be a protecting factor. (author's)
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | CASE CONTROL STUDIES | QUESTIONNAIRES | WOMEN | PREGNANCY | HYSTEROTOMY | RISK FACTORS | MENSTRUATION DISORDERS | ENDOMETRIOSIS | ALCOHOL USE AND ABUSE | South America, Eastern | South America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Reproduction | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Biology | Diseases | Behavior
Document Number: 309965

27.

Title: Comparison of the use of electrothermal bipolar vessel sealer with harmonic scalpel in total laparoscopic hysterectomy.
Author: Demirturk F; Aytan H; Caliskan AC
Source: Journal of Obstetrics and Gynaecology Research. 2007 Jun;33(3):341-345.
Abstract: The aim of the present study was to compare the use of electrothermal bipolar vessel sealer (EBVS) with harmonic scalpel (HS) during total laparoscopic hysterectomy with respect to operation time, estimated blood loss and related complications. A retrospective study was conducted in the university hospital. Forty patients who underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy were enrolled. Nineteen hysterectomies were performed with HS and in 21 patients the same surgeons used EBVS. Data about the characteristics of the patients, operation time, estimated blood loss, uterine weights, related complications and length of hospital stay were registered and compared. Mean procedure time and estimated blood loss were significantly less in the EBVS arm (59.57 � 3.71 vs 90.95 � 5.73 min, P < 0.001; 87.76 � 25.48 vs 152.63 � 60.90 mL; P < 0.001, respectively). The change in hemoglobin and hematocrit values was found to be more significant in the HS group. EBVS was found to be less time-consuming and caused less bleeding when compared with HS. (author's)
Language: English
Keywords:
TURKEY | RESEARCH REPORT | CLINICAL RESEARCH | COMPARATIVE STUDIES | RETROSPECTIVE STUDIES | WOMEN | HYSTERECTOMY | LAPAROSCOPY | TIME FACTORS | BLEEDING | COMPLICATIONS | HEMOGLOBIN LEVEL | HEMATOCRIT | Europe, Southeastern | Europe | Developing Countries | Research Methodology | Studies | Demographic Factors | Population | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Population Dynamics | Signs and Symptoms | Diseases | Hemic System | Physiology | Biology | Laboratory Procedures | Laboratory Examinations and Diagnoses
Document Number: 317820

28.

Peer Reviewed

Title: Laparoscopic hysterectomy with retroperitoneal uterine artery sealing using LigaSure: Gazi hospital experience.
Author: Gol M; Kizilyar A; Eminoglu M
Source: Archives of Gynecology and Obstetrics. 2007 Oct;276(4):311-314.
Abstract: The aim of this study was to evaluate the efficacy and safety of laparoscopic hysterectomy by retroperitoneal sealing of the uterine arteries with LigaSure. Laparoscopic hysterectomy by retroperitoneal uterine artery sealing with LigaSure was performed by four-puncture laparoscopy in 50 women with various indications for hysterectomy. The mean operation time, amount of intraoperative bleeding, drop in hemoglobin concentration, weight of removed uterus, major and minor per-post operative complications, and the rate of conversion to classical abdominal approach were analyzed prospectively. The mean operation time was 85 min (range 60-125 min). The mean weight of removed uterus was 180 g (range 60-650 g). There was one major complication; one patient had cystotomy due to difficulty in dissecting severe adhesions because of two previous cesarean sections that were repaired laparoscopically. Only one patient converted to laparotomy because of severe bowel adhesions due to rectovaginal endometriosis. All patients were discharged on the first postoperative day. No minor complications occured. Hemoglobin decreased a mean of 0.4 g/dl (range 0.2-1.4 g/dl) by postoperative day 1. Laparoscopic hysterectomy by retroperitoneal uterine artery sealing with LigaSure is an effective, safe, and fast procedure with less intra operative bleeding, short operation time and hospital stay. (author's)
Language: English
Keywords:
TURKEY | RESEARCH REPORT | WOMEN | LAPAROSCOPY | HYSTERECTOMY | PERITONEAL DISEASES | COMPLICATIONS | HEMOGLOBIN LEVEL | CONTRACEPTIVE USE-EFFECTIVENESS | SAFETY | Europe, Southeastern | Europe | Developing Countries | Demographic Factors | Population | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Diseases | Hemic System | Physiology | Biology | Contraceptive Effectiveness | Contraception | Family Planning | Public Health
Document Number: 320754

29.

30.

Title: Laparoscopic-assisted vaginal hysterectomy for patients with extensive pelvic adhesions: A strategy to minimise conversion to laparotomy.
Author: Hsu WC; Chang WC; Huang SC; Sheu BC; Torng PL
Source: Australian and New Zealand Journal of Obstetrics and Gynaecology. 2007 Jun;47(3):230-234.
Abstract: The aim was to evaluate a strategy for successful laparoscopic-assisted vaginal hysterectomy (LAVH) in patients with extensive pelvic adhesion. Two hundred and thirty-six patients who underwent LAVH at National Taiwan University Hospital were retrospectively enrolled. Twenty-three patients (9.7%) had unexpected extensive pelvic adhesions. A special procedure of uterine artery preligation through retroperitoneal downstream ureter tracking was applied to overcome this problem. The clinical characteristics of the study group were analysed. The operative parameters and the outcome were compared between those with and without extensive pelvic adhesions. Having extensive adhesions, 17 patients were associated with endometriosis and the other six were secondary to previous Caesarean delivery or pelvic inflammation. The cul-de-sac was partially and totally obliterated in 10 and 13 patients, respectively. These 23 patients had longer operation time (184 vs 146 min, P less than 0.05), more blood loss (146 vs 89 mL, P less than 0.05), but smaller extirpated uteri (278 vs 372 g, P = 0.063), compared with the other 213 patients. The average hospital stay was comparable (3.2 vs 3.4 days) and there were no ureteral injuries or excessive bleeding. Most importantly, not a single case was converted to laparotomy. Pelvic adhesions of various underlying diseases are associated with increased complication and conversion rates during LAVH. Although this technique is not new, we believe that the special procedure of uterine artery preligation through retroperitoneal downstream ureter tracking may provide a safe approach for general gynecologists to complete successful LAVH in patients with unexpected extensive pelvic adhesions. (author's)
Language: English
Keywords:
TAIWAN | RESEARCH REPORT | RETROSPECTIVE STUDIES | WOMEN | PELVIC INFECTIONS | UTERINE EFFECTS | HYSTERECTOMY | PREGNANCY COMPLICATIONS | Asia, Eastern | Asia | Developed Countries | Studies | Research Methodology | Demographic Factors | Population | Infections | Diseases | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 313590


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