共查询到20条相似文献，搜索用时 31 毫秒
1.
Purpose
To compare the effectiveness of intravenous carbetocin to that of intravenous oxytocin for prevention of atonic postpartum hemorrhage (PPH) after vaginal delivery in high-risk singleton pregnancies.Methods
This triple-blind randomized controlled trial included singleton pregnant women who delivered at Siriraj Hospital between August 2016 and January 2017 and who were 20 years or older, had a gestational age of at least 34 weeks, had a vaginal delivery, and had at least one risk factor for atonic postpartum hemorrhage. Immediately after vaginal delivery, participants were randomly assigned to receive either 5 U of oxytocin or 100 mcg of carbetocin intravenously. Postpartum blood loss was measured objectively in mL using a postpartum drape with a calibrated bag.Results
A total of 174 and 176 participants constituted the oxytocin and carbetocin groups, respectively. The baseline characteristics were comparable between the groups. The carbetocin group had less postpartum blood loss (146.7?±?90.4 vs. 195.1?±?146.2 mL; p?<?0.01), a lower incidence of atonic PPH (0 vs. 6.3%; p?<?0.01), less usage of additional uterotonic drugs (9.1 vs. 27.6%; p?<?0.01), and a lower incidence of postpartum anemia (Hb?≤?10 g/dL) (9.1 vs. 18.4%; p?<?0.05) than the oxytocin group. No significant differences regarding side effects were evident between the groups.Conclusions
Intravenous carbetocin is more effective than intravenous oxytocin for the prevention of atonic PPH among singleton pregnancies with at least one risk factor for PPH.Clinical trial registration
TCTR20160715004.2.
Objective
To compare the effectiveness and safety of sublingual versus vaginal misoprostol on improving the Bishop score after 6 h of administration.Methods
Randomized clinical trial which includes pregnant women in gestational ages from 32/0 to 41/6, with indication of induction of labor with misoprostol. Bishop score was assessed at the time of induction and 6 h after administration of 50 µg misoprostol. Analysis was made over difference in mean Bishop score of 2 points, using a standard deviation of 2, with 90% power, reaching a 95% confidence interval.Results
102 patients were studied, 51 received sublingual misoprostol, and 51 received vaginal misoprostol. There was a statistically significant difference in cervical modifications in global terms regardless of the administration route at 6 h (P?<?0.05). When analyzing each group, there was no significant difference for the mean and standard deviation for Bishop score for sublingual and vaginal route (P?=?0.761). There was no significant difference in terms of mode of delivery, Apgar score, cord pH, nor in the presence of complications.Conclusion
There is no statistically significant difference in terms of administration route for cervical ripening using misoprostol 50 µg, whether it was sublingual or vaginal.Trial registration number
NCT02732522.Registry website: https://clinicaltrials.gov/.3.
Purpose
Reliable real-time estimation of blood loss is crucial for the prompt management of postpartum hemorrhage (PPH), which is one of the major obstetric complications worldwide. Our study aims at the validation of feasibility and precision of measured blood loss (MBL) with a quantitative real-time measurement system during (1) vaginal delivery and (2) cesarean section by comparison with a hemoglobin-based formula for blood loss as an objective control. This is the first study to include a reasonable number of patients in an everyday clinical setting.Methods
921 patients were prospectively enrolled into this study (vaginal delivery: n?=?461, cesarean delivery: n?=?460) at a tertiary care hospital in Switzerland. Blood loss was measured by quantitative fluid collection bags. “Calculated blood loss” (CBL) was determined by modified Brecher`s formula based on the drop of hemoglobin after delivery. MBL based on our measurement system was compared to CBL by correlation analysis and stratified by the mode of delivery.Results
During vaginal delivery, MBL as determined by our quantitative measurement system highly correlated with CBL (p?<?0.001, r?=?0.683). This was also true for patients with cesarean deliveries (p?<?0.001, r?=?0.402), however, in a less linear amount. In women with cesarean deliveries, objectively low blood loss tended to be rather overestimated, while objectively high blood loss was more likely underestimated.Conclusions
The technique of real-time measurement of postpartum blood loss after vaginal delivery as presented in this study is practicable, reliable and strongly correlated with the actual blood loss and, therefore, poses an actual improvement in the management of PPH.4.
Ibrahim Abd Elgafor El Sharkwy Elsayed Hamdy Noureldin Ekramy Abd Elmoneim Mohamed Sherine Attia Shazly 《Journal of obstetrics and gynaecology of India》2018,68(5):408-413
Background
To compare between the sequential and concurrent use of vaginal misoprostol plus Foley catheter for labor induction.Methods
This single-center, non-blinded randomized study was conducted at the department of Obstetrics and Gynecology, Faculty of medicine, Zagazig University. A total of 160 women with full term singleton pregnancy, cephalic presentation and bishop score ≤ 6 were randomized for labor induction with either concurrent or sequential use of vaginal misoprostol plus Foley catheter (80 cases in each group). The primary outcome measured was induction-to-delivery interval and secondary outcomes mesaured were vaginal delivery within 24 h, number of doses needed to induce labor, need of oxytocin for augmentation of labor, cesarean section rate, maternal or neonatal complications.Results
The mean induction-to-delivery interval was 22.33 ± 13.28 h versus 18.45 ± 14.34 h (p = 0.041) in sequential and concurrent group, respectively. The percentage of women who completed vaginal delivery within 24 h was 51% versus 61% (p = 0.046) in sequential and concurrent group, respectively. Other maternal and neonatal outcomes were similar in both groupsConclusion
Concurrent use of vaginal misoprostol plus Foley catheter for labor induction was associated with shorter induction-to delivery interval compared to sequential use, and it increases the rate of vaginal delivery in the first 24 h.5.
Purpose
To evaluate the effectiveness of celecoxib for pain relief and antipyresis during second trimester abortion using sublingual misoprostol.Methods
Fifty-six pregnant women of gestational age 14–24 weeks were randomly assigned in a double-blind randomized controlled trial to receive 400 mg of celecoxib or placebo just before sublingual administration of misoprostol 400 µg every 6 h. Pain and body temperature (BT) were assessed every 1 h until the abortion or 24 h after the first dose of misoprostol. Pain was assessed using a 10-cm Visual Analog Scale (VAS). BT was measured with an infrared thermometer.Results
From January 2016 through September 2016, 28 patients were randomized into each study group. The mean VAS pain score at the completion of the abortion in the celecoxib group was significantly lower than in the placebo group (4.6 ± 2.8 vs. 7.3 ± 2.2) (p = 0.012). But 42.9% of patients in both groups experienced severe pain and needed equivalent amounts of morphine rescue. The overall mean BT in the celecoxib group was significantly lower than in the placebo group [? 0.09 (SD = 0.04)] (p = 0.017). The mean BTs at 1, 2 and 6 h after each repeated dose of misoprostol in the celecoxib group were also significantly lower than in the placebo group.Conclusions
Single-dose 400 mg celecoxib had an inadequate beneficial effect on pain relief but significant antipyretic effect during second trimester abortions using sublingual misoprostol.6.
Purpose
This study was aimed to evaluate the safety and efficacy of the second-trimester medical abortions using mifepristone and ethacridine lactate in women with placenta previa and/or prior cesarean deliveries.Methods
The patients who underwent a second-trimester pregnancy termination from January 2009 to December 2015 were retrospectively analyzed. The eligible patients were assigned to four groups based on placentation and cesarean history. The abortion interval (AI), blood loss, hospital stays, incidence of curettage, and transfusion were reviewed.Results
Two women underwent cesarean sections for placenta increta. Finally, 443 patients were enrolled in this study, including 92 with placenta previa, 153 with prior cesarean deliveries, 36 with the both factors, and 236 with normal placentation and no cesarean delivery history. All the included cases had a successful vaginal delivery. There was no significant difference in AI, hospital stay, rate of hemorrhage, and transfusion among the four groups. Patients with prior cesarean section had higher blood loss than the normal group (P = 0.0017), as well as patients with both placenta previa and prior cesarean (P = 0.0018). However, there was no obvious blood loss in patients with placenta previa when compared with normal placetal patients (P = 0.23). No uterine rupture occurred in all patients.Conclusions
Mifepristone combined with ethacridine lactate is safe and effective for patients with low placentation or/and prior cesarean in the second-trimester pregnancy termination.7.
Priya Sinha Amita Suneja Kiran Guleria Richa Aggarwal Neelam B. Vaid 《Journal of obstetrics and gynaecology of India》2018,68(1):39-44
Objective
To compare the efficacy and safety of mifepristone followed by misoprostol with misoprostol alone in the management of early pregnancy failure (EPF).Study Design
A randomized double-blind placebo-controlled clinical trial.Methods
Ninety-two women with EPF ≤12 weeks were recruited and randomly allocated to receive either mifepristone 200 mg (n = 46) or placebo (n = 46). Forty-eight hours later, patients in both the groups were given 800 µg misoprostol per-vaginum. If no expulsion occurred within 4 h, repeat doses of 400 µg misoprostol were given orally at 3-hourly interval to a maximum of 2 doses in women ≤9 weeks by scan and 4 doses in women >9 weeks by scan.Results
Pre-treatment of misoprostol with mifepristone significantly increased the complete abortion rate (86.7 vs. 57.8%, p = 0.009) and, hence, reduced the need for surgical evacuation (13.3 vs. 42.2%, p = 0.002), induction to expulsion interval (4.74 ± 2.24 vs. 8.03 ± 2.77 h, p = 0.000), mean number of additional doses of misoprostol required (0.68 vs. 1.91, p = 0.000), and side effects.Conclusion
Use of mifepristone prior to misoprostol in EPF significantly improves the efficacy and reduces the side effects of misoprostol alone.8.
Jade?Kirscht Christel?Weiss Jana?Nickol Sebastian?Berlit Benjamin?Tuschy Benjamin?Hoch Amelie-Verena?Trebin Thomas?Gro?e-Steffen Marc?Sütterlin Sven?Kehl
Purpose
To assess the effects of mechanical dilatation of the cervix during cesarean section on postoperative morbidity.Methods
A total of 447 women with elective cesarean section were included in the Dondi trial (Dilatation or no dilatation of the cervix during cesarean section). The primary outcome measure of this randomized controlled trial was postpartum hemorrhage (PPH) within 6 weeks. Infectious morbidity (puerperal fever, endometritis, wound infection, and urinary tract infection), blood loss (need for blood transfusion or change in hemoglobin levels), and operating time were also evaluated.Results
The rate of PPH within 6 weeks was not different between the two groups [dilatation group: 5 (2.4 %), no dilatation group: 3 (1.2 %), p = 0.479]. Infectious morbidity, blood loss, and operating time were not diverse as well. The only significant difference between the two groups was the rate of retained products of conception with fewer cases after cervical dilatation (0 versus 6.2 %, p < 0.001).Conclusions
Dilatation of the cervix during cesarean section compared with no dilatation of the cervix did not influence the risk of postpartum hemorrhage. However, there were fewer cases with retained products of conception after dilatation.9.
Suyash S. Bhandekar Anahita R. Chauhan Arun Ambadkar 《Journal of obstetrics and gynaecology of India》2018,68(6):456-461
Background
Various medical methods for second-trimester medical termination of pregnancy (MTP) exist. Misoprostol alone has been used with myriad variations in route and dosage. Comparison between oral and vaginal routes of misoprostol forms the basis of this study.Methods
This was a prospective comparative study of misoprostol for second-trimester (14–20 weeks) MTP, comparing oral versus vaginal routes. Sixty patients were randomly allotted to two groups; 30 received oral misoprostol 400 µg 4 h up to a maximum of five doses (2000 µg), and 30 received vaginal misoprostol in the same dose and duration. In both groups, oxytocin infusion was started if abortion did not occur. Efficacy of oral versus vaginal misoprostol, induction–abortion interval (AI) and need for surgical intervention were analyzed.Results
Both groups were well matched in terms of age, parity, previous LSCS, mean gestational age and indication for MTP. Overall mean induction–abortion interval was 19.59 h (21.66 vs. 18.57 h, oral vs. vaginal, respectively), with vaginal group taking lesser time (p 0.09). Sixty percentage in oral group required five doses, while 70% in vaginal group required 3–4 doses of misoprostol (p 0.010). 23.7 versus 6.7% in oral versus vaginal group required check curettage (p 0.038). There were no major complications, and there was only one failure in oral group.Conclusions
Though both oral and vaginal misoprostol are safe, vaginal route appears to be more efficacious for second-trimester MTP.10.
Objective
The purpose of this study was: (A) to establish the effects of different ultrasound measurement methods (linear versus curved array) and measuring conditions [impact of pressure by fetal head/pelvis on the lower uterine segment (LUS)] during LUS-muscular-thickness measurement, (B) to introduce the intraoperative ultrasound measurement of LUS-muscular thickness (reference measurement method), and (C) to evaluate the correlation between different combinations of LUS-muscular-thickness measurement ultrasound techniques at birth planning and preoperative versus intraoperative measurements.Methods
A prospective clinical observational study of women with the previous cesarean delivery was conducted. LUS-muscular thickness was measured: first at birth planning and second preoperatively using linear and curved probes (transabdominal) and an endocavitar probe (transvaginal), examined with and without pressure by fetal head/pelvis on LUS during measurement and third intraoperatively during repeat cesarean. Bland–Altman plots, paired t tests, Pearson’s correlation coefficient, and scatter plots were used.Results
Thirty-three women were included in the study (ultrasound measurements: n?=?601). There was no systematic difference between LUS-muscular-thickness measurements with linear versus curved array (mean difference?=?0.06 mm; p?=?0.24; nm?=?133) but between measurements with pressure by the fetus versus without (mean difference?=???0.37 mm; p?<?0.001; nm?=?243). The highest correlation coefficients were detected for the preoperative (at the day of cesarean section), transabdominal–vaginal approach combined ultrasound measurements versus the intraoperative ultrasound measurements of LUS-muscular thickness—as long as the measurements were made without pressure from the fetal head/pelvis on the LUS [0.86, p?<?0.001, n?=?24, 95% CI (0.70, 0.94)].Conclusions
The systematic application of predetermined measuring conditions, standardized setup criteria improves the performance of LUS thickness measurement by ultrasound near term.ClinicalTrials.gov Identifier
NCT02827604.11.
Chanderdeep Sharma Anjali Soni Pawan K. Soni Suresh Verma Ashok Verma Amit Gupta 《Journal of obstetrics and gynaecology of India》2016,66(1):30-34
Objective
To investigate the role of “mifepristone” for induction of labor (IOL) in pregnant women with prior cesarean section (CS).Methods
In this retrospective study, all pregnant women with prior CS who received oral mifepristone (400 mg) for IOL (as per clear obstetric indications) [group 1] were compared with pregnant women with prior CS who had spontaneous onset of labor (SOL) [group 2], with respect to incidence of vaginal delivery, CS, duration of labor, and various maternal and fetal outcomes.Results
During the study period, 72 women received mifepristone (group 1) for IOL and 346 had SOL (group 2). In group 1 after mifepristone administration, 40 (55.6 %) women had labor onset, and 24 (33.3 %) women had cervical ripening (Bishop Score ≥ 8) within 48 h. There were no statistically significant differences with respect to duration of labor (p value: 0.681), mode of delivery (i.e., normal delivery or CS—p value: 0.076 or 0.120, respectively), or maternal (blood loss or scar dehiscence/rupture uterus), or fetal outcomes (NICU admission) compared to women with previous CS with SOL (group 2). However, the need of oxytocin (p value 0.020) and dose of oxytocin requirement (p value 0.008) were more statistically significant in group 1.Conclusion
Mifepristone may be considered as an agent for IOL in women with prior CS.12.
Jameela?PonMalar Santosh?Joseph?Benjamin Anuja?Abraham Swati?Rathore Visalakshi?Jeyaseelan Jiji?Elizabeth?Mathews
Objective
To compare the efficacy of preinduction outpatient use of a single dose of 25 μg vaginal misoprostol between 381/2 and 40 weeks with that of placebo, to decrease the interval from intervention to delivery after stretch and sweep in low-risk gravid women with Bishop’s score <4.Method
Sixty three women received 25 μg vaginal misoprostol and 63 women received placebo after stretch and sweep.Results
The duration from intervention to delivery was 3.35 (1.12–9.46) days in the misoprostol group and 5.42 (2.39–10.11) days in the placebo group which was statistically significant (p = 0.029). Spontaneous labor was seen in 39 women (61.9 %) in the misoprostol group and 35 women (55.6 %) in the placebo group (p = 0.531). Eight women in the misoprostol group and 18 in the placebo group had Lower Segment Caesarean Section (LSCS) and this difference was also statistically significant (p = 0.027). There were no major maternal and neonatal complications in both groups.Conclusion
Preinduction use of 25 μg vaginal misoprostol after stretch and sweep in the outpatient setting decreased the intervention to delivery interval when compared to placebo.13.
Mahmoud Thabet Mohamed Sayed Abdelhafez Emad Ahmed Fyala 《Journal of obstetrics and gynaecology of India》2018,68(3):185-191
Objective
To describe the use of intrauterine inflated Foley’s catheter balloon for control of postpartum hemorrhage (PPH) during cesarean section (CS) in cases of abnormally invasive placenta previa aiming to preserve the uterus.Methods
Retrospective case–control study of the data of women who underwent elective CS on abnormally adherent placenta previa was carried out. Women in whom inflated Foley’s catheter balloon was used for control of PPH during CS (n = 40) were compared with a control group of women who underwent elective CS by the same technique but without use of intrauterine catheter balloon (n = 38).Results
Use of intrauterine inflated Foley’s catheter balloon significantly reduced the estimated amount of blood loss (P = 0.008), amounts of crystalloids, colloids and packed red blood cells transfusion (P = 0.025, 0.017 and 0.022, respectively), and the need for bilateral internal iliac artery (IIA) ligation (P = 0.016). No significant difference was observed between both groups regarding the use of massive transfusion protocol, performing cesarean hysterectomy, relaparotomy, and admission to the intensive care unit.Conclusion
Application of an intrauterine inflated Foley’s catheter balloon during CS in cases of morbidly adherent placenta previa helps to control PPH with preservation of the uterus and decreases the need for the invasive IIA ligation.14.
Purpose
To evaluate changes in hemodynamic effects of intramyometrial epinephrine injection for blood loss reduction in laparoscopic myomectomy.Methods
A total of 185 women with symptomatic uterine fibroids who underwent laparoscopic myomectomy were enrolled in this study. Eighty-six women (study collective) received an intramyometrial injection of epinephrine and were compared to ninety-nine women (control collective) who underwent laparoscopic myomectomy without an intramyometrial epinephrine injection. Demographic parameters, change of hemodynamic parameters during surgery as well as hemoglobin drop after surgery were analyzed.Results
In the study collective maximum systolic blood pressure (p?<?0.001), maximum increase of the systolic blood pressure within 5 min (p?=?0.003), duration of hypertension (p?=?0.012), maximal (p?<?0.001) and mean heart rate (p?=?0.005), maximal increase of heart rate within 5 min (p?=?0.003) and difference of mean to maximal heart rate (p?<?0.001) were higher compared to the control collective. There was no difference in pre- and postoperative hemoglobin levels in both collectives and no intraoperative clinically relevant complication occurred due to intramyometrial epinephrine injection.Conclusion
The intramyometrial application of epinephrine seems to be safe but leads to significant alterations of hemodynamic parameters without a significant change in postoperative hemoglobin levels.15.
Jorge?Duro-Gómez María?Fernanda?Garrido-Oyarzún Ana?Belén?Rodríguez-Marín Antonio?Jesús?de la Torre González José?Eduardo?Arjona-Berral Camil?Castelo-Branco
Background and objectives
To compare effectiveness and safety of dinoprostone, misoprostol and Cook’s balloon as labour-inducing agents in women with intrauterine growth restriction (IUGR) at term.Methods
Retrospective cohort chart review of women diagnosed with foetal growth restriction at term in Reina Sofia Hospital, Cordoba, Spain from January 2014 to December 2015. Registration of baseline characteristics and method of induction was made. The main outcome was time from induction to delivery. Obstetric and perinatal outcomes were also collected.Results
A total of 99 women were diagnosed with IUGR in the mentioned period. Of them, 21 women were induced with dinoprostone [dinoprostone group (DG)], 20 with misoprostol (MG) and in 58 with Cook’s balloon (CG). Groups were homogeneous regarding pre-induction Bishop score and parity. The CG required more time (24.36 vs. 19.23 h; p = 0.02) and more oxytocin dose for conduction of labour from induction to delivery (6.75 vs. 1.24 mUI; p < 0.01) than DG. Moreover, the CG also needed more oxytocin than MG, 6.75 vs. 2.37 mUI (p < 0.001). Caesarean rate was 5, 14.9 and 17.3% in MG, DG and CG, respectively. No differences were observed in rates of uterine tachysystole, non-reassuring foetal status and neonatal adverse events.Interpretation and conclusions
Prostaglandins were more effective than Cook’s balloon to induce labour and achieve vaginal birth in this sample of women with IUGR at term, with a similar safety profile.16.
Evelien M. Sandberg Sara R. C. Driessen Evelien A. T. Bak Nan van Geloven Judith P. Berger Mathilde J. G. H. Smeets Johann P. T. Rhemrev Frank Willem Jansen 《Gynecological surgery》2018,15(1):8
Background
Pelvic endometriosis is often mentioned as one of the variables influencing surgical outcomes of laparoscopic hysterectomy (LH). However, its additional surgical risks have not been well established. The aim of this study was to analyze to what extent concomitant endometriosis influences surgical outcomes of LH and to determine if it should be considered as case-mix variable.Results
A total of 2655 LH’s were analyzed, of which 397 (15.0%) with concomitant endometriosis. For blood loss and operative time, no measurable association was found for stages I (n?=?106) and II (n?=?103) endometriosis compared to LH without endometriosis. LH with stages III (n?=?93) and IV (n?=?95) endometriosis were associated with more intra-operative blood loss (p =?<?.001) and a prolonged operative time (p =?<?.001) compared to LH without endometriosis. No significant association was found between endometriosis (all stages) and complications (p?=?.62).Conclusions
The findings of our study have provided numeric support for the influence of concomitant endometriosis on surgical outcomes of LH, without bowel or bladder dissection. Only stages III and IV were associated with a longer operative time and more blood loss and should thus be considered as case-mix variables in future quality measurement tools.17.
Purpose
To compare the rates of wound-related complications among women undergoing a cesarean section when the surgical team used intra-operative glove changing versus usual care.Methods
All women undergoing a cesarean section at a single, county hospital were randomized to usual care or intra-operative glove changing prior to abdominal closure. Participants were randomized at the time of decision for cesarean section; surgeons were not blinded to the randomization arm. The primary outcome was any wound-related complication, including wound hematoma, seroma, skin separation of at least 1 cm, wound infection, or other incisional abnormality requiring treatment within 8 weeks of surgery. To detect a reduction in the primary outcome from 17% in the control group to 9% in the intervention group with 80% power, a total of 554 women (277 per group) were required. Secondary outcomes included other infectious complications including endometritis and other superficial or deep soft tissue infections.Results
From August 2015 to November 2016, 277 women were randomized to usual care and 276 women were randomized to intra-operative glove changing. The two groups were well balanced in terms of demographic data, comorbid conditions and surgical characteristics. Intra-operative glove changing led to a significant decrease in composite wound complications from 13.6% in the control group to 6.4% in the intervention group (p?=?0.008).Conclusion
Intra-operative glove changing prior to abdominal closure during cesarean section significantly reduced the incidence of post-operative wound complications.18.
Objective
To study the effect of cervical priming with misoprostol on cervical entry in women undergoing diagnostic hysteroscopy for evaluation of abnormal uterine bleeding.Methods
Randomized controlled trial conducted in teaching hospital and tertiary referral center on 122 women requiring diagnostic hysteroscopy for evaluation of abnormal uterine bleeding. Women were randomized into two equal groups (n?=?122). Study group received 200-μg vaginal misoprostol, 3 h prior to vaginoscopic hysteroscopy. No drug was used in control group. No analgesia or anesthesia was used in either group. Outcome measure included (i) ease of cervical entry (Likert scale), and (ii) pain scoring (Visual Analog Scale) and procedural entry time.Results
Forty-six (75.41%) patients in the study group and 17 (27.87%) in control group had easy or very easy entry (Likert scale-4 and 5) (p?<?0.001). Median pain scoring by VAS and the median procedural entry time was significantly lower in the study group compared to the control group (p?<?0.001).Conclusion
Use of 200-μg vaginal misoprostol, administered vaginally 3 h before diagnostic vaginoscopic hysteroscopy, was found to be simple and effective method of cervical priming in facilitating cervical entry with minimal side effects.Clinical Trial registry of India (CTRI): (CTRI/2015/04/005666) (website: http://ctri.nic.in).19.
Background
In clinical practice, the current trend for surgical hysterectomy for the large uterus is by laparotomy, where vaginal hysterectomy is not feasible. The benefits of a laparoscopic approach to hysterectomy are well documented, but limited literature is available on laparoscopic hysterectomy in the larger uterus. A supracervical hysterectomy should be considered for women, where there is no contraindication to a residual cervix.Objective
To compare surgical outcomes for laparoscopic supracervical hysterectomy (LSH) in the large uterus (equal or greater than 500 g) compared with normal (<500 g), results were compared to the limited literature on this topic.Methods and study design
A retrospective review was undertaken of 207 women who underwent an LSH between 2005 and 2015 at Whipps Cross University hospital. The operative outcome of patients undergoing surgery, for uteri both greater than 500 g and less than 500 g, was analysed. Data included patient demographics, intra-operative details, and complications. A literature search was performed using keywords ‘laparoscopic supracervical hysterectomy’ and ‘laparoscopic sub-total hysterectomy’ which yielded six informative articles.Results
In the study group of 207 patients, 67 had a large uterus (56 patients 500–1000 g, 11 patients >1000 g). The operation time and intra-operative blood loss were both greater in the larger uterus cohort (P < 0.0001 and P = 0.0021, respectively). The hospital stay and intra-operative complication rate were similar for the two study cohorts (six for the study, n = 207). Review of the literature revealed six relevant studies evaluating patients with uteri greater than 500 g. There was an agreement between all the studies that a larger uterus resulted in an increase in both intra-operative time and blood loss, but this did not translate to increase in hospital stay or intra-operative complications.Conclusion
The use of LSH for the larger uterus is feasible and safe due to the low level of operative complications as demonstrated in our study and following a review of the literature.20.