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1.
Boshra Hosseini Marli Leibl Jayson Stoffman Amanda Morris 《Journal d'obstetrique et gynecologie du Canada》2019,41(5):660-665
Objective
To discuss the finding of hypercalcemia in pediatric ovarian dysgerminoma.Methods
Two cases of pediatric ovarian dysgerminoma that presented with hypercalcemia are discussed.Results
Hypercalcemia is a rare finding in ovarian dysgerminoma.Conclusion
Ovarian dysgerminoma should be considered in pediatric patients presenting with signs of hypercalcemia. Parathyroid hormone, parathyroid hormone related protein, and 1,25 dihydroxyvitamin D may elucidate the cause of hypercalcemia. 相似文献2.
Ahmet Kale Gulfem Basol Taner Usta Isa Cam 《Journal of minimally invasive gynecology》2019,26(2):360-361
Study Objective
To demonstrate the laparoscopic approach to malformed branches of the vessels entrapping the nerves of the sacral plexus.Design
A step-by-step explanation of the surgery using video (educative video) (Canadian Task force classification II). The university's Ethics Committee ruled that approval was not required for this video.Setting
Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey.Patient
A 26-year-old patient who had failed medical therapy and presented with complaints of numbness and burning pain on the right side of her vagina and pain radiating to her lower limbs for a period of approximately 36 months.Intervention
The peritoneum was incised along the external iliac vessels, and these vessels were separated from the iliopsoas muscle on the right side of the pelvis. The laparoscopic decompression of intrapelvic vascular entrapment was performed at 3 sites: the lumbosacral trunk, sciatic nerve, and pudendal nerve. The aberrant dilated veins were gently dissected from nerves, and then coagulated and cut with the LigaSure sealing device (Medtronic, Minneapolis, Minn).Measurements and Main Results
The operation was completed successfully with no complications, and the patient was discharged from the hospital 24 hours after the operation. At a 6-month follow-up, she reported complete resolution of dyspareunia and sciatica (visual analog scale score 1 of 10).Conclusion
A less well-known cause of chronic pelvic pain is compression of the sacral plexus by dilated or malformed branches of the internal iliac vessels. Laparoscopic management of vascular entrapment of the sacral plexus has been described by Possover et al 1, 2 and Lemos et al [3]. This procedure appears to be feasible and effective, but requires significant experience and familiarity with laparoscopy techniques and pelvic nerve anatomy. 相似文献3.
Axelle Charavil Aubert Agostini Caroline Rambeaud Andy Schmitt Claire Tourette Patrice Crochet 《Journal of minimally invasive gynecology》2019,26(4):695-701
Study Objective
To evaluate the feasibility of an en-bloc salpingectomy at the time of vaginal hysterectomy for removal of Essure inserts.Design
Prospective observational study (Canadian Task Force classification II-1).Setting
Monocenter study at the Conception University Hospital Center, Marseille, France.Patients
Women seeking removal of the Essure device and candidate for vaginal hysterectomy from January 1, 2017 to January 31, 2018.Interventions
Patient underwent a total hysterectomy and bilateral salpingectomy by the vaginal route (VH-S) with en-bloc removal of each hemiuterus with the ipsilateral fallopian tube, thereby allowing for removal of the Essure inserts without fragmentation.Measurements and Main Results
Twenty-six VH-S were performed. There was no converted case to laparoscopy or laparotomy because of issues regarding feasibility or complications. Removal of each hemiuterus with the ipsilateral tube as a single unit was feasible in all cases. There was 1 Clavien-Dindo grade 1 perioperative complication: a bladder injury that required 10days of urinary catheterization. There were 2 grade 2 postoperative complications: 1 case of metrorrhagia of a granuloma on the vaginal fundus that was treated with silver nitrate and 1 case of acute urinary retention that required urinary catheterization for 24hours.Conclusion
Performing a VH-S with en-bloc removal of the hemiuterus with the ipsilateral tube without fragmentation orsectioning of the Essure inserts appears to be feasible. The vaginal route can hence be an approach for women who undergo hysterectomy during Essure insert surgery removal. 相似文献4.
Study Objective
To demonstrate a mesh-free laparoscopic uterosacral suture sacrohysteropexy (LUSSH).Design
Technical video demonstrating LUSSH for uterine prolapse (Canadian Task Force classification III).Setting
University hospital.Patient
A 37-year-old woman with grade 3 uterine descent requested uterine-sparing surgery for symptomatic prolapse. The patient declined all mesh procedures.Intervention
Mesh-free laparoscopic uterosacral suture sacrohysteropexy (LUSSH).Measurements and Main Results
Laparoscopic sacrohysteropexy is a uterine-preserving technique for uterine prolapse with high cure rates (92%) but with a mesh erosion risk of up to 2.5% 1, 2. Complications have resulted in reclassification of transvaginal meshes as restricted-use high-risk medical devices 3, 4. Sacrospinous hysteropexy and uterosacral ligament suspension are mesh-free alternatives, but they have increased rates of anterior-compartment failures and a 20% recurrence rate in the latter 5, 6. Laparoscopic suture sacrohysteropexy has been described with reported success rates of 95% [7]. This video demonstrates a modified-technique offering a simple, robust, and reproducible mesh-free approach to uterine-preserving prolapse surgery. We used 2 horizontal loop mattress sutures acting as a pulley to distribute the force evenly throughout the suture strand, leading to a significantly stronger and more secure hold and reducing risk of avulsion [8]. The technique starts with a careful dissection of the peritoneum from the sacral promontory to the cervix. Two permanent sutures are used, taking bites at the anterior longitudinal ligament, the uterosacral, a loop mattress in the midline at the cervix, the uterosacral on the way back, and finally at the sacral promontory. Damage to the uterine vessels is minimized by maintaining a central uterine position. The stitch is tied with caudal pressure on the uterus, applied via the uterine manipulator, approximating the cervix to the sacral promontory. The peritoneum is closed with dissolvable sutures, burying the Ethibond to prevent exposure and bowel obstruction.Conclusion
Post-procedure, the uterus was well supported with a vaginal length of 15 cm. 相似文献5.
Gokhan Boyraz Alper Karalok Derman Basaran Taner Turan 《Journal of minimally invasive gynecology》2019,26(4):602
Study Objective
To demonstrate a method of vaginal closure with the EndoGIA surgical stapler (Medtronic, Istanbul, Turkey) to prevent tumor spillage in laparoscopic radical hysterectomy.Design
A step-by-step explanation of the procedure using a video.Setting
Women's health teaching and research hospital.Patient
A 40-year-old woman with clinical stage IBI cervical squamous cell carcinoma.Interventions
Laparoscopic type C radical hysterectomy with pelvic lymph node dissection and ovarian transposition. Institutional ethical committee approval was not sought. However, the patient signed an informed consent that allows us to use her clinical data.Measurements and Main Results
Minimally invasive surgery is increasingly being used in cervical cancer surgery. However, there is a current and significant debate regarding the safety of these methods. Colpotomy, which is the last step of laparoscopic radical hysterectomy, could be related to an increased risk for tumor spillage. Vaginal closure before colpotomy may be an option to prevent this spillage. In this method, after completion of the radical hysterectomy steps, the initial 5-mm left lower quadrant trocar was changed to a 15-mm trocar to allow for the placement of an EndoGIA with a green cartridge. The uterine manipulator was removed, and the uterus was elevated with a myoma screw. Then, the stapler was placed, and we checked that no other unintended structure was included in the jaws of the stapler before the firing. The EndoGIA surgical stapler was fired 2times to close the vagina. The stapler places 2 triple-staggered rows of titanium staples and knife blade cuts simultaneously between them. Once the vagina was divided, the stapler was released. The upper part of the vaginal cuff was excised and sent to pathology as a surgical margin, and the uterus was removed through the vagina. Finally, the vaginal cuff was closed with intracorporeal suturing.Conclusion
Vaginal closure with the EndoGIA surgical stapler before colpotomy provides a safe and easy method to prevent tumor spillage and could improve the unfavorable results related to minimally invasive surgery in patients with cervical cancer. 相似文献6.
Sarah L. Cohen Nisse V. Clark Mobolaji O. Ajao Douglas N. Brown Antonio R. Gargiulo Xiangmei Gu Jon I. Einarsson 《Journal of minimally invasive gynecology》2019,26(4):702-708
Study Objective
To compare the number of days required to return to daily activities after laparoscopic hysterectomy with 2 tissue extraction methods: manual morcellation via colpotomy or minilaparotomy. Secondary outcomes were additional measures of patient recovery, perioperative outcomes, containment bag integrity, and tissue spillage.Design
Multicenter prospective cohort study and follow-up survey (Canadian Task Force classification II-2).Setting
Two tertiary care academic centers in northeastern United States.Patients
Seventy women undergoing laparoscopic hysterectomy with anticipated need for manual morcellation.Interventions
Tissue extraction by either contained minilaparotomy or contained vaginal extraction method, along with patient-completed recovery diary.Measurements and Main Results
Recovery diaries were returned by 85.3% of participants. There were no significant differences found in terms of average pain at 1, 2, or 3 weeks after surgery or in time to return to normal activities. Patients in both groups used narcotic pain medication for an average of 3 days. After adjusting for patient body mass index, history of prior surgery, uterine weight, and surgeon, there were no differences found for blood loss, operative time, length of stay, or incidence of any intra- or postoperative complication between groups. All patients had benign findings on final pathology. More cases in the vaginal contained extraction group were noted to have bag leakage on postprocedure testing (13 [40.6%] vs 3 [8.3%] tears in vaginal and minilaparotomy groups, respectively; p?=?.003).Conclusion
Regarding route of tissue extraction, contained minilaparotomy and contained vaginal extraction methods are associated with similar patient outcomes and recovery characteristics. 相似文献7.
Haley F.M. Augustine Christopher J. Coroneos Marie K. Christakis Katerina Pizzuto James R. Bain 《Journal d'obstetrique et gynecologie du Canada》2019,41(3):312-315
Objective
Although Caesarean section (CS) is protective for brachial plexus birth injury (BPBI), the incidence is not zero. A trial of labour with unfavourable intrauterine positioning is hypothesized to result in excessive force on the brachial plexus. The purpose of this study was to determine the risk of BPBI in emergent CS versus elective CS.Methods
This was a retrospective cohort study. The authors used a nationwide demographic sample of all infants born in Canada from 2004 to 2012. BPBI diagnoses, risk factors, and national incidence data were obtained from the Canadian Institute for Health Information Discharge Abstract Database and Hospital Morbidity Database. The primary outcome was risk of BPBI in emergent CS versus elective CS.Results
BPBI incidence was 1.24 per 1000 live births. Known biases may have underestimated the incidence. CS (elective and emergent) was protective for BPBI as compared with vaginal delivery (odds ratio [OR] 0.15; 95% confidence interval [CI] 0.13–0.18, P?<?0.0001). Emergent CS was a moderately strong risk factor for BPBI versus elective CS (OR 3.14; 95% CI 1.79–5.10, P?=?0.0001).Conclusion
Emergent CS is a moderate risk factor for BPBI compared with elective CS. Intrauterine positioning with a trial of labour may provide an antenatal etiology in these distinct cases. 相似文献8.
Femke van Zanten Jan J. van Iersel Francis E. Hartog Karin I.M. Aalders Egbert Lenters Ivo A.M.J. Broeders Steven E. Schraffordt Koops 《Journal of minimally invasive gynecology》2019,26(4):636-642
Study Objective
To prospectively evaluate the mesh exposure rate after robot-assisted laparoscopic pelvic floor surgery for the treatment of female pelvic organ prolapse (POP) in a large cohort.Design
Prospective observational cohort study (Canadian Task Force classification II-2).Setting
Two large teaching hospitals with a tertiary referral function for pelvic floor disorders.Patients
Patients with symptomatic POP and simplified POP quantification (S-POP) stage ≥2. Patients with a history of mesh repair or concomitant insertion of a tension-free vaginal tape were excluded.Interventions
Robot-assisted laparoscopic sacrocolpopexy or robot-assisted laparoscopic supracervical hysterectomy with a sacrocervicopexy.Measurements and Main Results
A blinded vaginal examination with the aid of a transparent speculum was performed to look for mesh-related complications. Mesh exposures were described following the International Urogynecological Association/International Continence Society classification system. One hundred and ninety-two patients were included, of whom 166 (86.5%) were seen for follow-up examination. The median duration of follow-up was 15.7 months (range, 8.2–44.4 months). Two vaginal mesh exposures (1.2%) were detected, both of which were treated in the outpatient clinic. One patient without any complaints had a suture exposure, which was removed in the outpatient clinic.Conclusion
The safety of the use of mesh in pelvic floor surgery is a matter of debate owing to the occurrence of mesh-related complications. Based on the current literature, mesh-related complications seem to be lower in transabdominal mesh surgery than in transvaginal mesh surgery. In this study, a low mesh exposure rate was observed in robot-assisted abdominal pelvic floor surgery for POP. 相似文献9.
Abigail A. Armstrong Lindsay Kroener Meredith Brower Zain A. Al-Safi 《Journal of minimally invasive gynecology》2019,26(4):667-670.e1
Study Objective
To analyze and investigate reports associated with uterine artery embolization used for treatment of myomas using this database.Design
A retrospective review of the Manufacturer and User Facility Device Experience (MAUDE) database for events related to uterine artery embolization (Canadian Task Force Classification III).Setting
The MAUDE database was accessed online.Patients
Patients with myomas undergoing uterine artery embolization.Interventions
The MAUDE database was accessed online and searched for events related to uterine artery embolization reported between 1998 and 2018. These reports were reviewed and analyzed, reported events were categorized, and other relevant information was collected and tabulated.Measurements and Main Results
A total of 193 reports published during the study period were identified. Pain was the most frequently reported event (68 events; 35.2%), followed by vaginal discharge (45 events; 23.3%), operational misfire (37 events; 19.2%), and fever or infectious complications (36 events; 18.7%). A surgical procedure was required in 27 events (14.0%), with hysterectomy reported in 7.8% of the events. Death following this procedure was mentioned in 5 events (2.6%).Conclusion
The MAUDE database may be useful for clinicians using a Food and Drug Administration–approved medical device to identify the occurrence of adverse events and complications. A variety of adverse events associated with the use of uterine artery embolization were reported to the MAUDE database related to its use in the treatment of uterine myomas. We encourage physicians to review the MAUDE database when using medical devices, because this is an important tool to assess uncommon but major problems that could be associated with a medical device. 相似文献10.
Study Objective
To demonstrate a technique of performing laparoscopic resection of a post–cesarean section scar uterine cyst.Design
Technical video (Canadian Task Force classification III).Setting
University Hospital.Patient
A 38-year old woman.Intervention
Laparoscopic excision of a uterine cyst within a cesarean section scar.Measurements and Main Results
A 38-year-old woman presented with secondary subfertility requesting removal of a cesarean section scar defect to prepare the uterine cavity for in vitro fertilization. Preoperative ultrasound demonstrated a 17.7?×?12.2?mm scar defect. At rigid hysteroscopy the anterior uterine wall cyst was observed and noted to be narrowing the uterine cavity. A laparoscopic approach was used to excise the uterine cyst. We carefully mobilized the bladder from its adhesions at the site of the previous cesarean section scar. The uterine cyst was located and margins of the defect identified. An ultrasonic-energy device was used to enucleate and excise the cyst. A uterine manipulator helped to identify the cervical canal and protect the posterior wall from inadvertent suture placement. The defect was closed with 1 vicryl interrupted sutures, being careful to incorporate the full thickness of the uterine wall to an able maximal opposition. An adhesion barrier was applied to the area. Transvaginal ultrasound scanning performed 6 weeks postoperatively demonstrated full healing with no residual defect.Conclusion
Niches are recognized complications of cesarean sections resulting from incomplete healing of the scar and more likely in single-layer closures [1]. They can be associated with postmenstrual spotting, dysmenorrhea, chronic pain, subfertility, and poorer reproductive and obstetric outcomes 1, 2, 3, 4, 5. Laparoscopic resection of niches is well established, showing symptomatic relief and an increase in residual myometrium [6]. Although cesarean section scar defects have been described as niches, we presented a further variety of defect that has not been previously described, a uterine cyst. 相似文献11.
Objective
To evaluate if the use of lidocaine gel applied to the cervix prior to manual vacuum aspiration (MVA) in addition to paracervical blockade is useful in reducing the level of pain associated with the procedure.Methods
A total of 88 patients were randomized to receive either 5?mL of lidocaine gel or a placebo applied topically to the cervix 5 minutes prior to paracervical blockade. Both groups received the same drugs for pain control (tramadol hydrochloride, diazepam, and sodium diclofenac). A visual analogue scale (VAS) was used for evaluation of pain intensity at two times: 2 minutes before the blockade (directly after tenaculum clamping of the anterior aspect of the cervix) and after MVA of the uterine cavity.Results
There was a statistically significant difference in pain intensity between the arms of the study. At the first evaluation time (cervical clamping), VAS pain score for the placebo group (control) was 3.6 (2.1) and that for the lidocaine gel group (case) was 1.2 (1.4) (P?<?0.01). At the second evaluation time (after manual vacuum aspiration), VAS pain score perceived by the control group was 5.3 (2.5) and that for the case group was 3.1 (1.9) (P?<?0.01). The use of lidocaine gel was not associated with any adverse effects of interest.Conclusion
The use of a topical lidocaine gel plus paracervical blockade was effective in reducing the intensity of pain associated with MVA when compared to paracervical blockade alone. 相似文献12.
Patricia Hannaford Namita Mittal Farah Sethna Jane E. Dahlstrom 《Journal d'obstetrique et gynecologie du Canada》2019,41(3):344-347
Background
Chronic intervillositis (CI) is a rare placental condition involving diffuse infiltration of intervillous spaces by CD68- or CD45-positive maternal mononuclear inflammatory cells. Because no validated clinical or biochemical markers are specific to CI, the diagnosis is purely histopathological and is made postpartum.Case
This report describes a case of recurrent CI associated with adverse complications in two successive pregnancies. Both pregnancies were complicated by intrauterine growth restriction. Coexistent massive perivillous fibrin deposition was present in the first placenta. This case highlights the importance of CI in explaining and predicting adverse perinatal outcomes.Conclusion
CI is associated with adverse pregnancy outcomes and a high risk of recurrence, and it can coexist with massive perivillous fibrin deposition. Pathologists must ensure that the significance of these diagnoses is adequately conveyed to clinicians, to optimize management of subsequent pregnancies. 相似文献13.
Alberto Morales Osvaldo Reyes Gerardo Cárdenas 《Journal d'obstetrique et gynecologie du Canada》2019,41(3):306-311
Objective
To evaluate two techniques of uterine incision expansion (cephalad-caudad vs. transverse) during Caesarean section (CS).Methods
A total of 839 patients were randomized to either a cephalad-caudad blunt expansion of uterine incision during CS versus a transverse (lateral-lateral) expansion. The primary outcome was blood loss, measured with the descent of hemoglobin level. Secondary outcomes were the need for blood transfusion and the number of surgical or postoperative complications presented in both groups.Results
There was no statistical difference with regard to decrease in hemoglobin level, but there was a higher number of surgical complications in the transverse expansion group (Cephalad-caudad: 11.53% vs. transverse: 16.42%; odds ratio [OR] 0.66; 95% confidence interval [CI] 0.45–0.98; P?=?0.04). There were more cases of unintended extensions of uterine incision (10.35% vs. 16.18%; OR 0.6; 95% CI 0.4–0.9; P?=?0.01) but no statistical difference in the number of hematomas, uterine vessel injury, or the need to transfuse.Conclusion
The cephalad-caudad blunt expansion technique of the low transverse uterine incision is safer than the transverse expansion. There was no difference in regard to decrease in hemoglobin level, but there is a lower risk of surgical complications not associated with an increased need for blood transfusions when compared with the transverse expansion. 相似文献14.
David Shveiky Loral Patchen Henry H. Chill Marieta Pehlivanova Helain J. Landy 《Journal of pediatric and adolescent gynecology》2019,32(2):135-138
Study Objective
The objective of this study was to describe prevalence and location of obstetric lacerations in adolescents.Design
Retrospective cohort study.Setting
We performed an analysis of the Consortium on Safe Labor database including tertiary care university-affiliated urban hospitals.Participants
All primiparous women who delivered vaginally were included.Interventions
Vaginal and perineal lacerations were compared between age groups 15 or younger, 16-21, 22-34, 35-39, and older than 40 years.Main Outcome Measures
Outcome measures included vaginal, perineal, labial, and periurethral lacerations. χ2 and Fisher exact tests were used as appropriate, with P < .05 considered significant.Results
A total of 9777 patients were included in the analysis. Young adolescents and adolescents had significantly higher rates of labial and periurethral lacerations compared with individuals aged 22-34 years. The prevalence of third- and fourth-degree perineal tears increased with age.Conclusion
Adolescent primiparous women are less likely to have severe perineal obstetric tears, but have higher rates of labial and periurethral tears. 相似文献15.
Haider Jan Michael Katesmark Vishalli Ghai 《Journal of minimally invasive gynecology》2019,26(4):600-601
Study Objective
To demonstrate our approach to laparoscopic excision of a noncommunicating rudimentary horn (AmericanSociety for Reproductive Medicine classification II(b), European Society of Human Reproduction and Embryology/European Society of Gynaecological Endoscop classification class U4a).Design
Technical video (Canadian Task Force classification level III).Setting
University Hospital.Patient
A 25-year-old women with a left-sided pelvic mass.Intervention
Laparoscopic excision of noncommunicating rudimentary horn with hysteroscopy and cystoscopy. Institutional Review Board/Ethics Committee ruled that approval was not required for this study.Measurements and Main Results
Noncommunicating rudimentary horns are present in 20% to 25% of women with a unicornuate uterus [1]. Noncommunicating rudimentary horns may be associated with dysmenorrhea, pelvic pain, subfertility, and poor obstetric outcomes. Laparoscopic excision of rudimentary horns can be challenging and complex. Factors to consider in relation to the rudimentary horn are attachment to the uterus, presence and course of the ureter, and vascular supply. In this video we demonstrate our approach to laparoscopic excision of a rudimentary horn including preoperative imaging to plan surgical care. A 25-year-old women presented with pelvic pain and underwent a laparotomy for a left-sided pelvic mass. Intraoperatively, a rudimentary horn was suspected, and she was started on a gonadotropin-releasing hormone analogue pending diagnostic imaging and definitive surgery. Computed tomography demonstrated an absent left kidney and ureter. Intraoperatively, we began with a cystoscopy to identify and confirm an efflux from ureteral openings. A real-time hysteroscopy was performed to identify the unicornuate uterus from the rudimentary horn and to exclude vaginal or cervical anomalies. Through hysteroscopic transillumination the plane of dissection was identified between the rudimentary horn and uterus 2, 3. This technique is especially useful when the rudimentary horn is densely fused to the unicornuate uterus. Retroperitoneal dissection was performed ipsilateral to the rudimentary horn. A lateral approach was used to coagulate the uterine artery at its origin. The bladder was reflected from the horn to allow excision. A Thunderbeat device (Olympus Medical Systems, Tokyo, Japan) was used to excise the rudimentary horn, keeping very close to the specimen to ensure no penetration of the unicornuate uterus. Hemostasis was achieved, and no additional sutures were required. The specimen was removed using in-bag morcellation.Conclusion
A stepwise hysteroscopic and laparoscopic approach can be used to safely resect a rudimentary horn as demonstrated by this case. 相似文献16.
Olga Bougie Sukhbir S. Singh Innie Chen Ellen P. McCarthy 《Journal of minimally invasive gynecology》2019,26(3):456-462
Study Objective
To examine the association between race/ethnicity, route of hysterectomy, and risk of inpatient surgical complications.Design
Cross-sectional analysis (Canadian Task Force classification III).Setting
Inpatient hospitals in the United States.Patients and Interventions
There were 114 719 women aged 18 and older from the Nationwide Inpatient Sample who underwent an elective hysterectomy for benign indications using International Classification of Diseases codes.Measurements and Main Results
Multivariable logistic regression was performed to examine the association between race/ethnicity and route of hysterectomy and surgical complications, after adjusting for patient characteristics, clinical factors, and hospital characteristics. Analyses were weighted to provide national estimates of prevalence. The rate of minimally invasive hysterectomy was 55.0% in white women, 28.6% in black women, 50.1% in Hispanic women, and 45.6% in other race/ethnic categories. Compared with white women, black women had a .55 odds (95% confidence interval, .52–.59) of undergoing minimally invasive hysterectomy, after adjusting for patient, clinical, and hospital characteristics. This finding remained consistent across quartiles of median household income of residence, primary payer, and diagnosis of myomas. Among women who had an elective hysterectomy, 6091 experienced a complication, representing an estimated 30 455 women nationwide. The rate of surgical complications was 5.3% in white women, 5.9% in black women, 4.6% in Hispanic women, and 5.1% in women of other racial/ethnic groups. There was no difference in odds of experiencing a surgical complication between white and black women (odds ratio, 1.03; 95% confidence interval, .93–1.13) after adjusting for patient, clinical, and hospital characteristics. This finding remained consistent across quartiles of median household income of residence, primary payer, and route of hysterectomy.Conclusion
Among women undergoing an elective hysterectomy, black women were less likely to receive minimally invasive hysterectomy compared with white women. However, the rate of inpatient surgical complications did not vary significantly by race/ethnicity. Further research is encouraged to identify and address the influential factors behind the disparity in minimally invasive hysterectomy use among black women in the United States. 相似文献17.
Stéphanie Roberge Amélie Boutin Emmanuel Bujold Eric Dubé Simon Blouin Nils Chaillet 《Journal d'obstetrique et gynecologie du Canada》2019,41(5):608-615
Objectives
This study estimated the effect that a multifaceted intervention aiming to improve the quality of obstetrical care and reduce Caesarean section (CS) had on the rate of vaginal birth after Caesarean (VBAC).Methods
This is a secondary analysis of the cluster randomized controlled trial Quality of Care, Obstetrics Risk Management, and Mode of Delivery involving (1) audits regarding the indications for CS, (2) provision of feedback to health professionals, and (3) implementation of best practices to reduce CS rates in Quebec. The impact of intervention on VBAC, trial of labour (TOL), and maternal and neonatal morbidity was reported using adjusted odds ratios (ORs) with 95% confidence intervals (CIs).Results
Out of 105 351 women who delivered during the pre- and postintervention period, 12 493 (11.9%) had a previous CS. We observed no significant impact of the multifaceted intervention on the rates of TOL (adjusted OR 1.22; 95% CI 0.96–1.56, P?=?0.11) and VBAC (adjusted OR 1.20; 95% CI 0.97–1.48, P?=?0.10) in women with one previous CS. However, the rate of TOL was reduced (adjusted OR 0.38; 95% CI 0.14–0.99) in women with more than one previous CS. The intervention has no influence on maternal and neonatal morbidity.Conclusions
A multifaceted intervention including audits, feedback to health professionals, and implementation of best practices did not affect VBAC rates or maternal and neonatal morbidity. Our results pointed out the need for decision-making processand risk management tools specific to women with previous CS. 相似文献18.
Alexandre Fillion Amélie Boutin Audrée Gareau-Léonard Laurence Labine Cédric Gasse Caroline Gaudreau Suzanne Demers Emmanuel Bujold 《Journal d'obstetrique et gynecologie du Canada》2019,41(3):300-305
Objectives
Antenatal corticosteroids (ACS) received within 7 days of delivery reduce perinatal morbidity and mortality associated with preterm birth. We aimed to describe the trends of ACS administration over the last decade.Methods
A cohort study of women who received ACS in 2006, 2011, and 2016 at the CHU de Québec–Université Laval was conducted. The indication, GA at ACS, and GA at birth, were collected in 150 women randomly selected in each studied year. Our main endpoints were the frequency of ACS administration within 7 days of delivery and between 48 hours and 7 days before delivery.Results
We included 447 women who received ACS at a median GA of 31.4 (range 23.6–39.0) weeks. No women received ACS after 35 weeks in 2006 and 2011. The administration of ACS for indicated delivery between 35 and 39 weeks occurred only in the last study period. Among women for whom ACS was initiated before 35 weeks, 31% received ACS in the 7 days before delivery, and only 13% received ACS between 48 hours and 7 days before birth (varying from 12% to 16%, P?=?0.57). Threatened preterm labour or short cervix were the indication for ACS initiation in 39% women who received ACS before 35 weeks, but less than 5% of these women delivered between 2 and 7 days and more than 90% delivered after 14 days.Conclusions
Administration of ACS remains suboptimal. Threatened preterm labour and short cervix are poorly related to optimal use of ACS therapy. 相似文献19.
Chyi-Long Lee Jiah-Min Lee Chih-Hui Lin Yi-Pin Chen Chen-Yin Huang Pei-Shan Lee Kai-Yun Wu Chih-Feng Yen 《Journal of minimally invasive gynecology》2019,26(4):657-666
Study Objective
To study the outcome of a novel method of laparoscopic neovaginal reconstruction using rudimentary uterine horn serosa and the pelvic peritoneum as a graft.Design
Canadian Task Force classification II-1.Setting
A university hospital.Patients
A retrospective study of 14 patients from 2000 to 2014 of patients with vaginal agenesis who underwent laparoscopic neovagina reconstruction using rudimentary uterine horn serosa and the pelvic peritoneum as a graft.Intervention
Patients with vaginal agenesis associated with müllerian agenesis who requested surgery. Tertiary referral center and laparoscopic unit. The creation of a neovagina using rudimentary uterine horn serosa and the pelvic peritoneum as a graft via a combined laparoscopic and vaginal route.Measurements and Main Results
Data were collected retrospectively including postoperative vaginal length and width, complications, stenosis or reoperations, dyspareunia, and sexual satisfaction. There were no major complications from the surgery with no rectal perforation or bladder or ureteric injury. The postoperative mean (±SD) vaginal length was 6.0±0.7 cm and a width of 2 fingerbreadths. The mean operation time was 142.7±45.9 min. Median blood loss was 100 ml (range: 10 to 300 mL). The mean duration of the hospital stay was 6.6±1.6 days. The follow-up period ranged from 3 to 84 months with a median follow-up of 11 months.Conclusion
Lee's method of neovaginoplasty using rudimentary uterine horn serosa and the pelvic peritoneum as a graft is a good method for neovagina creation with minimal morbidity, fast recovery, and minimal complications. This method results in good anatomic and functional outcome and can be a method that is widely used. 相似文献20.
Pavan Gill Charlotte Axelrod Crystal Chan Heather Shapiro 《Journal d'obstetrique et gynecologie du Canada》2019,41(3):283-291