scholarly journals The Trend in Cesarean Myomectomies and The Risk of Obstetrical Complications in Korea

2021 ◽  
Author(s):  
Min Jeong Kim ◽  
Kyungeun Lee ◽  
Jae Young Park ◽  
Ji Hye Jo ◽  
In Yang Park
Keyword(s):  
Cesarean Section ◽  
Preterm Labor ◽  
Treatment Guidelines ◽  
Uterine Fibroids ◽  
Operation Time ◽  
Adverse Outcomes ◽  
University Hospitals ◽  
Standardized Treatment ◽  
History Of ◽  
Cesarean Myomectomy

Abstract Background To evaluate the pregnancy outcomes and the risk of adverse obstetrical outcomes from cesarean myomectomy (CM) compared to cesarean section (CS)-only and to investigate the trend of surgeons in choosing CM. Methods A retrospective cohort study was done of all patients who underwent CS that was complicated with leiomyoma at two university hospitals from January 2010 to May 2020. All patients were categorized into the CM group or the CS-only group. We analyzed the demographic factors, obstetric factors, surgical outcomes, and possible risk factors for adverse outcomes between the two groups. Results A total of 438 women in the CS-only group and 341 women in the CM group were included. Women who underwent CS-only had significantly more history of a previous myomectomy and multiple leiomyomas compared to women who underwent CM. The gestational days at delivery and the pregnancy complications were significantly higher in the CS group. The mean size of the leiomyomas was larger in the CM group than in the CS only group (5.8 ± 3.2 cm vs 5.2 ± 3.1 cm, P = 0.005). Operation time and history of previous CS and preterm labor were higher in the CM group. It seems that preterm labor and abnormal presentation were relatively higher in the CM group than in the CS group due to the presence of leiomyoma. There were no significant differences in the pre and postoperative hemoglobin levels. The size of the leiomyoma (odds ratio [OR] = 1.162; 95% confidence interval [CI]: 1.07 – 1.25; P < 0.001) and operation time > 60 minutes (OR = 2.461; 95% CI: 1.45 – 4.15) were significant independent predictors of adverse outcomes after CM. Conclusions Cesarean myomectomy is a reliable and safe approach to prevent the need for another operation for remnant leiomyoma. In this study, surgeons seemed to perform CM when uterine leiomyomas were large, the subserosal type, or few in number. Standardized treatment guidelines for myomectomy during cesarean section in pregnant women with uterine fibroids should be established.

scholarly journals A case series of caesarean myomectomy

2021 ◽  
Vol 10 (9) ◽  
pp. 3580
Author(s):  
Shazia Parveen ◽  
Nasreen Noor ◽  
Iti Madan ◽  
Ummay Kulsoom
Keyword(s):  
Smooth Muscle ◽  
Caesarean Section ◽  
Observational Study ◽  
Cesarean Section ◽  
Patient Selection ◽  
Uterine Fibroid ◽  
Uterine Fibroids ◽  
Case Series ◽  
Operative Morbidity ◽  
Cesarean Myomectomy

Uterine fibroids are benign, monoclonal tumors of smooth muscle cells of the myometrium. Most fibroids do not increase in size during pregnancy and are not always removed when encountered during cesarean section. Objective was to see the outcome of patients undergoing cesarean myomectomy. The study design was observational study. All patients undergoing cesarean section with uterine fibroid of size more than 5 cm. In carefully selected patients and with use of intraoperative vasopressin, myomectomy may be safely accomplished at the time of caesarean section by experienced surgeons. cesarean myomectomy is safe and successful if patient selection is done carefully and does not add to any additional post-operative morbidity.

scholarly journals The Number of Myomas Is the Most Important Risk Factor for Blood Loss and Total Operation Time in Robotic Myomectomy: Analysis of 242 Cases

2021 ◽  
Vol 10 (13) ◽  
pp. 2930
Author(s):  
Sa Ra Lee ◽  
Ju Hee Kim ◽  
Sehee Kim ◽  
Sung Hoon Kim ◽  
Hee Dong Chae
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Abdominal Surgery ◽  
Operation Time ◽  
Postoperative Fever ◽  
Factors Affecting ◽  
Maximal Diameter ◽  
Estimated Blood Loss ◽  
History Of ◽  
Robotic Myomectomy

To identify factors affecting blood loss and operation time (OT) during robotic myomectomy (RM), we reviewed a total of 448 patients who underwent RM at Seoul Asan Hospital between 1 January 2019, and 28 February 2021, at Seoul Asan Hospital. To avoid variations in surgical proficiency, only 242 patients managed by two surgeons who each performed >80 RM procedures during the study period were included in this study. All cases of RM were performed with a reduced port technique. We obtained the following data from each patient’s medical chart: age, gravidity, parity, body mass index, and history of previous abdominal surgery including cesarean section. We also collected information on the maximal diameter and type of myomas, number and weight of removed myomas, concomitant surgery, total OT from skin incision to closure, estimated blood loss (EBL), and blood transfusion. Data on preoperative use of gonadotropin-releasing hormone agonists (GnRHas) and perioperative use of hemostatic agents (tranexamic acid or vasopressin) were also collected. Data on the length of hospital stay, postoperative fever within 48 h, and any complications related to RM were also obtained. The primary endpoint in this study was the identification of factors affecting EBL and the secondary endpoint was the identification of factors affecting the total OT during multiport RM. Univariate and multivariate analyses were used to identify the factors affecting EBL and OT during multiport RM. The medians of the maximal diameter and weight of the removed myomas were 9.00 (interquartile range [IQR], 7.00 to 10.00) cm and 249.75 (IQR, 142.88 to 401.00) g, respectively. The median number of myomas was two (IQR, one to four), ranging from 1 to 34. Of the cases, 155 had low EBL and 87 had high EBL. Most myomas were of the intramural type (n = 179). The odds of EBL > 320 mL increased by 251% (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.16–5.42) for five to nine myomas and by 647% (OR, 6.47; 95% CI, 1.87–22.33) for ≥10 myomas. The odds of subserosal-type myomas decreased by 67% compared with intramural-type myomas (OR, 0.33; 95% CI, 0.14–0.80). History of abdominal surgery other than cesarean section was positively correlated with EBL. The weight of the removed myomas and a history of previous cesarean section were not correlated with the EBL. Conclusion: The number of myomas (5–9 and ≥10), maximal myoma diameter, and history of abdominal surgery other than cesarean section affect the EBL in RM.

scholarly journals Outcomes of Myomectomy at the Time of Cesarean Section among Pregnant Women with Uterine Fibroids: A Retrospective Cohort Study

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Rong Zhao ◽  
Xin Wang ◽  
Liying Zou ◽  
Weiyuan Zhang
Keyword(s):  
Birth Weight ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Statistical Significance ◽  
Mainland China ◽  
Uterine Fibroids ◽  
Multivariate Logistic Regression Analysis ◽  
Fetal Distress ◽  
Common Procedure ◽  
Cesarean Myomectomy

Objective. A retrospective study was performed to evaluate the safety and feasibility of cesarean myomectomy among pregnant women with uterine fibroids (UFs). Methods. Upon data collection, the pregnant women with UF underwent cesarean section in the 39 hospital divided into two groups: cesarean myomectomy group, receiving cesarean section and myomectomy; cesarean group, receiving cesarean section only. Information about the type, location, and number of UFs was collected from the medical records or the prenatal ultrasound examinations. Results. In the cesarean myomectomy group, the proportion of subserous UFs was significantly higher than the cesarean group (65.6% versus 49.3%, P < 0.0001). The comparison of postpartum hemorrhage, neonatal weight, fetal distress, and neonatal asphyxia showed no statistical significance. Multivariate logistic regression analysis demonstrated that birth weight ≥4000 g (OR 3.1, 95% CI:1.6–6.0) and presence of diameter > 5 cm fibroids (OR 2.2, 95%CI:1.3–4.0) were high risk factors for PPH ≥1,000 ml. Conclusions. Myomectomy during cesarean section was a common procedure in mainland China. Myomectomy cesarean could be safe and feasible based on the estimation by experienced obstetricians. During the procedure, special attention should be paid to a large-sized leiomyoma ≥5cm and birth weight ≥4,000 g.

scholarly journals Use of the base purse-string suture approach to remove giant uterine fibroids during cesarean section

2019 ◽  
Vol 48 (4) ◽  
pp. 030006051989386
Author(s):  
Dan Liu ◽  
Min Han ◽  
Pu Huang ◽  
Chunfang Li ◽  
Xuelan Li
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Uterine Fibroids ◽  
Uterine Wall ◽  
Purse String Suture ◽  
Purse String ◽  
Operative Duration ◽  
Estimated Blood Loss ◽  
The Mean ◽  
Cesarean Myomectomy

Objective This study aimed to investigate the optimal strategy for myomectomy for removing giant uterine fibroids when necessary in women undergoing cesarean section. Methods This study was retrospective in design, and assessed outcomes in 26 patients who underwent myomectomy using a “base purse-string suture” during cesarean section. The operative duration, blood loss, uterine involution, and duration of postpartum lochia were analyzed. Results This suture was associated with a mean operative duration of 11.17 ± 5.36 minutes and the mean estimated blood loss was 11.15 ± 6.05 mL. The mean postpartum duration of lochia was 34.92 ± 7.55 days and there were no cases of postpartum hemorrhage. Uterine size returned to normal within 6 weeks of delivery, without any apparent defects or abnormalities in the uterine wall as shown by an ultrasonic examination. Conclusion This novel implementation of a base purse-string suture during cesarean myomectomy for removal of giant fibroids is a simple, safe, and effective intervention that should be considered for implementation in appropriate patients.

Maternal and Perinatal Outcome in Pregnancies Following Infertility

2010 ◽  
Vol 1 (1) ◽  
pp. 25-29
Author(s):  
Chitra Thyagarajan ◽  
Papa Dasari
Keyword(s):  
Preterm Labor ◽  
Perinatal Outcome ◽  
Care Center ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Increased Risk ◽  
Significant Difference ◽  
History Of

ABSTRACT Context General practitioners as well as obstetricians are coming across a large number of pregnant women whose conceptions are following a period of infertility or treatment for the same. There is a controversy in the literature regarding the occurrence of adverse outcomes of pregnancy in such women. Aims To assess the maternal and perinatal outcome in pregnancies that occurred after a period of infertility and to compare the outcome in spontaneous conceptions with the conceptions following treatment for infertility Settings and Design Retrospective analysis of hospital records of 200 pregnancies following infertility during the year 2009 in a tertiary care center in South India. Material and Methods All the women were divided into two groups, viz: Group 1—those who had history of infertility but conceived spontaneously and Group 2—those with history of infertility and conceived only after treatment for infertility. The main outcome measures were antenatal complications and adverse neonatal complications. Statistical analysis The statistical package SSPS version 15.0. Chi-square and student ‘t’ test was used for nonparametric and parametric variables. Results The incidence of hypertension was 60% and that of gestational diabetes was 7%. Obstetric complications included increased incidence of preterm labor (23.5%) and premature rupture of membranes (38%). There was no statistically significant difference in both groups though the medical complications especially hypertension was high in the pregnancies following spontaneous conceptions, i.e. untreated group. There was a greater demand for the NICU care mainly because of prematurity. The PNMR was (40/1000) less than the institutional rate of 72/1000 births. Conclusions There is increased incidence of hypertension premature rupture of membranes and preterm delivery in pregnancies following infertility. There is no significant statistical difference in the adverse pregnancy outcomes between spontaneous conception and those treated for infertility. Key Messages Pregnancies following infertility are at increased risk of developing hypertension and preterm labor and hence these women should be screened for the same and preventive measures to be undertaken to achieve good maternal and perinatal outcome.

scholarly journals Do Large Uterine Fibroids Impact Pregnancy Outcomes?

2021 ◽  
Vol 36 (4) ◽  
pp. e292-e292
Author(s):  
Ruqaiya Al Sulaimani ◽  
Lovina Machado ◽  
Munira Al Salmi
Keyword(s):  
Preterm Delivery ◽  
Postpartum Hemorrhage ◽  
Uterine Fibroids ◽  
Neonatal Outcomes ◽  
Control Group ◽  
Study Group ◽  
Significant Difference ◽  
History Of ◽  
The Mean ◽  
Cesarean Myomectomy

Objectives: We sought to assess the prevalence of fibroids complicating pregnancy among Omani women who delivered and were followed-up at Sultan Qaboos University Hospital (SQUH) and correlate the presence of large fibroids (> 5 cm) with maternal and neonatal outcomes. Methods: This retrospective cohort study was conducted at the Department of Obstetrics and Gynecology, SQUH, from 1 January 2011 to 31 December 2016. Demographic data included maternal age, gravidity, parity, body mass index (BMI), and history of preterm delivery. Ultrasonographic data included the total number of fibroids, number of fibroids > 5 cm in diameter, and location. The main outcomes measured were preterm delivery, preterm premature rupture of membranes (PPROM), malpresentation, intrauterine growth restriction (IUGR), mode of delivery, postpartum hemorrhage, retained placenta, and cesarean myomectomy. Fetal outcomes included birth weight and Apgar score. We used the chi-square test and t-test to calculate significant outcomes. Results: The total number of deliveries over the study period was 24 800. Among these, 62 women had fibroids complicating pregnancy, giving an overall prevalence of 0.3%. Of the 62 women with documented uterine fibroids, 41 had fibroids > 5 cm in diameter and formed the study group, while the control group included 88 women with no fibroids and normal singleton pregnancies. The mean age, parity, BMI, and history of preterm delivery were comparable. The mean age of the study group was 32.6 years. There was no statistically significant difference in obstetric outcomes between the study and control group in terms of preterm labor (p =0.381), PPROM (p =0.536), malpresentation (p =0.237), IUGR (p =0.059), and retained placenta (p =0.296). Postpartum hemorrhage was significantly higher in the study group (p =0.018), the commonest cause was uterine atony (p =0.007). Women with large fibroids had a significantly increased cesarean section rate (p =0.002), the main indications were obstructed labor and failure to progress (62.5%). Five of the 44 women in the study group (12.8%) underwent cesarean myomectomy. Regarding neonatal outcomes, a statistically significant difference was noted in the Apgar scores. Conclusions: Fibroids measuring > 5 cm in diameter are more likely to cause obstetric complications and are associated with higher cesarean rates. Pre-conception myomectomy is recommended for women with large fibroids.

scholarly journals Optimal Use of Ganciclovir and Valganciclovir in Transplanted Patients: How Does It Relate to the Outcome?

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Maryam Mozaffar ◽  
Shahrzad Shahidi ◽  
Marjan Mansourian ◽  
Shirinsadat Badri
Keyword(s):  
Opportunistic Infections ◽  
Treatment Guidelines ◽  
Adverse Outcomes ◽  
First Episode ◽  
Transplant Recipients ◽  
Cmv Infection ◽  
University Hospitals ◽  
Duration Of Treatment ◽  
Treatment Protocols ◽  
Increased Risk

Objective. Organ transplant recipients receive immunosuppressive regimens to prevent transplant rejection, which put them at increased risk for opportunistic infections like cytomegalovirus (CMV). Ganciclovir and Valganciclovir are mostly used to prevent or treat CMV. Any incorrect use of the drug may have serious consequences for patients. In this study, the outcome of transplant recipients was assessed in relation to the optimal or suboptimal use of Ganciclovir or Valganciclovir.Methods. This study was performed on 148 hospitalized patients who received Ganciclovir or Valganciclovir in the nephrology and kidney transplantation departments of our university hospitals, from March 2012 to December 2016. Patients’ demographic and clinical data including dose and duration of treatment were collected and then analyzed in comparison with the standard CMV treatment protocols.Findings. About 94.6% of patients received Ganciclovir or Valganciclovir therapy consistent with the standard defined indications. The mean ratio of prescribed daily dose to the optimal dose was 2.9 in the first dose, 2.0 in the second dose, 1.3 in the third dose, and 1.5 in the fourth dose. From 148 included patients, 26.5% experienced CMV infection once, 7.2% experienced CMV infection twice, and 1.2% had CMV infection for 3 times, within six-month follow-up after first episode of antiviral therapy during hospitalization.Conclusion. In this study, empiric anti-CMV therapy was initially given. The doses used were generally higher than recommended but we could not find more adverse events in the patients receiving high initial doses. In any case, it seems necessary to advocate use of standard treatment guidelines to avoid adverse outcomes.

History of uterine fibroids reported by California women

2008 ◽  
Author(s):  
Zipora Weinbaum ◽  
Terri Throfinnson
Keyword(s):  
Uterine Fibroids ◽  
History Of

EFFECT OF OPERATING TIME OF THE WELLS IN THE STEADY DRAINAGE MODE BEFORE STOPPING ON THE RESULTS OF THE STUDY OF PRESSURE BUILD-UP CURVES

2017 ◽  
pp. 48-50
Author(s):  
E. F. Gilfanov
Keyword(s):  
Operating Time ◽  
Previous History ◽  
Operation Time ◽  
Pressure Recovery ◽  
Recovery Curve ◽  
History Of ◽  
Accuracy Of Results ◽  
Theoretical Pressure

Operation time of the well before stopping for investigating the pressure recovery curve in hydrodynamic studies is an important parameter affecting the quality and accuracy of results of research processing. Comparing the actual and theoretical pressure curves and the derivative, it’s possible to eliminate the uncertainty in the choice of previous history of the well operation.

scholarly journals Evaluation of factors that predict the success rate of trial of labor after the cesarean section

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yang Mi ◽  
Pengfei Qu ◽  
Na Guo ◽  
Ruimiao Bai ◽  
Jiayi Gao ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cesarean Section ◽  
Receiver Operating Characteristic Curve ◽  
Success Rate ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Predictive Ability ◽  
Training Set ◽  
History Of ◽  
Operating Characteristic Curve

Abstract Background For most women who have had a previous cesarean section, vaginal birth after cesarean section (VBAC) is a reasonable and safe choice, but which will increase the risk of adverse outcomes such as uterine rupture. In order to reduce the risk, we evaluated the factors that may affect VBAC and and established a model for predicting the success rate of trial of the labor after cesarean section (TOLAC). Methods All patients who gave birth at Northwest Women’s and Children’s Hospital from January 2016 to December 2018, had a history of cesarean section and voluntarily chose the TOLAC were recruited. Among them, 80% of the population was randomly assigned to the training set, while the remaining 20% were assigned to the external validation set. In the training set, univariate and multivariate logistic regression models were used to identify indicators related to successful TOLAC. A nomogram was constructed based on the results of multiple logistic regression analysis, and the selected variables included in the nomogram were used to predict the probability of successfully obtaining TOLAC. The area under the receiver operating characteristic curve was used to judge the predictive ability of the model. Results A total of 778 pregnant women were included in this study. Among them, 595 (76.48%) successfully underwent TOLAC, whereas 183 (23.52%) failed and switched to cesarean section. In multi-factor logistic regression, parity = 1, pre-pregnancy BMI < 24 kg/m2, cervical score ≥ 5, a history of previous vaginal delivery and neonatal birthweight < 3300 g were associated with the success of TOLAC. The area under the receiver operating characteristic curve in the prediction and validation models was 0.815 (95% CI: 0.762–0.854) and 0.730 (95% CI: 0.652–0.808), respectively, indicating that the nomogram prediction model had medium discriminative power. Conclusion The TOLAC was useful to reducing the cesarean section rate. Being primiparous, not overweight or obese, having a cervical score ≥ 5, a history of previous vaginal delivery or neonatal birthweight < 3300 g were protective indicators. In this study, the validated model had an approving predictive ability.

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