Purpose: The purpose is to identify risk factors for perioperative blood transfusion in patients undergoing hysterectomy for benign disease.Methods: This study is a retrospective chart review including all the patients who underwent hysterectomy for benign disease between January 1 st 2018 and December 31 st 2019. Patients who received perioperative blood transfusion were identi ed and compared to those who did not. The following risk factors for blood transfusion were analyzed: route of hysterectomy, BMI, presence of adhesions, history of cesarean section, uterine weight. Descriptive statistics was used to analyze the data.Results: A total of 517 patients were identi ed and included in the study. Forty-seven patients (9.09 %) received a perioperative blood transfusion. The abdominal hysterectomy route (TAH) was a signi cant risk factor for receiving blood transfusion (p=0.012). Other identi ed risk factors for blood transfusion included: Body mass index above 33.0 (p=0.002), and uterine weight (p=0.002). There was no association between the presence of pelvic adhesions (p=0.91) or a personal history of cesarean section (p=0.89) and receiving perioperative blood transfusion. When analyzing only the patients who underwent TLH, the presence of pelvic adhesion was found as a risk factor for perioperative blood transfusion (p=0.024) Conclusion: The abdominal hysterectomy route, the presence of a large uterus, and obesity are risk factors for receiving a blood transfusion. Early identi cation of the patient at risk of requiring perioperative blood transfusion provides better patient counseling and surgical preparation.
Objective To correlate genital hiatus (GH) size with surgical failures in patients undergoing sacrospinous ligament fixation (SSLF) and compare anatomic outcomes after classification based on GH size. Methods A retrospective review of 81 patients who underwent SSLF for apical prolapse from 2010 to 2016 at a teaching hospital. Anatomical outcome is reported using the Pelvic Organ Prolapse Quantifications System. A comparison of parametric continuous variables was performed using unpaired Student t test. Categorical variables were evaluated using Pearson's χ2 test and Fisher's exact test. A P value <0.05 was considered significant. Results Among the 81 patients, no difference in age, parity, body mass index, preoperative prolapse stage or follow‐up time was noted between those whose surgery succeeded and those with failed surgery. Postoperatively, a widened GH was significantly associated with recurrent prolapse (P < 0.001). When the preoperative size of the GH was dichotomized into widened (≥4 cm) or normal (<4 cm), there was a non‐significant (P = 0.444) trend of more failures in the widened GH group. A posterior colporrhaphy did not improve success. Conclusion Both preoperative and postoperative widened GH correlated with having more surgical failures following SSLF. Importantly, postoperatively a normal size GH was significantly associated with more surgical success.
INTRODUCTION: Hysteroscopy allows direct visualization of the uterine cavity. Traditionally, in office hysteroscopy is performed using a speculum and tenaculum to hold the cervix. However, the emergence of smaller diameter hysteroscopes along with the vaginoscopy no touch technique without the need of speculum or tenaculum has contributed for the procedure to be done in the office setting without the use of analgesia. This study reviews our experience of in office hysteroscopy using the vaginoscopy "no touch" approach. METHODS: Retrospective chart review of 22 in office hysteroscopies performed without analgesia using the vaginoscopy “No touch” technique from June 1, 2017 to January 31, 2018. Patients received 200 mcg of oral Misoprostol 30 minutes before the procedure. Data gathered included age, body mass index, prior vaginal deliveries, and pain during the procedure. Success was measured as the ability to enter the endometrial cavity and perform the expected procedure. RESULTS: The median age 45 SD ±10.0 and BMI of 26.9 SD ±4.4. Hysteroscopic indications were: 2 (9.1%) postmenopausal bleeding, 5 (22.7%) retained IUD, 7 (31.8%) for suspected polyp, 8 (36.4%) for abnormal uterine bleeding. Of the 22 procedures, 18 were successful completed (80%). The median pain on VAS scale reported immediately after the procedure was 3.8 SD ±0.8 All four of the unsuccessful procedures were in postmenopausal females, two of which due to severe cervical stenosis. There were no complications. CONCLUSION: In office hysteroscopies using the vaginoscopy “no touch” technique is a feasible and safe procedure. We recommend adopting this innovative, painless technique.
Purpose of reviewThe 2022 Supreme Court ruling in Dobbs vs Jackson marks a frightening new reality in America. Physicians and patients have been left confused and concerned regarding the broader implications of this ruling. Now that the constitutional right to an abortion has been overturned and the power has been relinquished to individual states, there is justifiable concern regarding the impact on in-vitro fertilization (IVF). This review explores the ways IVF and fertility care are at risk in the context of our new reality. Recent findingsThe decision to overturn the right to an abortion without specifying a viability standard opens the door to interpretation of when 'life' begins. Laws that do not specifically exempt IVF, or that include language suggesting that 'life begins at fertilization' pose a real threat to IVF. The potential for personhood laws poses a threat to embryo freezing and disposition, preimplantation genetic testing and culpability among other concerns.
Purpose: The purpose is to identify risk factors for perioperative blood transfusion in patients undergoing hysterectomy for benign disease. Methods: This study is a retrospective chart review including all the patients who underwent hysterectomy for benign disease between January 1st 2018 and December 31st 2019. Patients who received perioperative blood transfusion were identified and compared to those who did not. The following risk factors for blood transfusion were analyzed: route of hysterectomy, BMI, presence of adhesions, history of cesarean section, uterine weight. Descriptive statistics was used to analyze the data. Results: A total of 517 patients were identified and included in the study. Forty-seven patients (9.09 %) received a perioperative blood transfusion. The abdominal hysterectomy route (TAH) was a significant risk factor for receiving blood transfusion (p=0.012). Other identified risk factors for blood transfusion included: Body mass index above 33.0 (p=0.002), and uterine weight (p=0.002). There was no association between the presence of pelvic adhesions (p=0.91) or a personal history of cesarean section (p=0.89) and receiving perioperative blood transfusion. When analyzing only the patients who underwent TLH, the presence of pelvic adhesion was found as a risk factor for perioperative blood transfusion (p=0.024) Conclusion: The abdominal hysterectomy route, the presence of a large uterus, and obesity are risk factors for receiving a blood transfusion. Early identification of the patient at risk of requiring perioperative blood transfusion provides better patient counseling and surgical preparation.
Summary The finding of conjoined oocytes is a rare occurrence that accounts for only 0.3% of all human retrieved oocytes. This phenomenon is quite different from that of a traditional single oocyte emanating from one follicle, and may result in dizygotic twins and mosaicism. Given the insufficient evidence on how to approach conjoined oocytes, their fate is variable among different in vitro fertilization (IVF) centres. In this observational report, we propose a new protocol for the use of these conjoined oocytes using intracytoplasmic sperm injection (ICSI), laser-cutting technique and next-generation sequencing (NGS). The first case report demonstrates that conjoined oocytes can penetrate their shared zona pellucida (ZP) at Day 6. The second case is that of a 25-year-old female patient who underwent a successful embryo transfer cycle after removal of one oocyte in which a pair of conjoined human oocytes underwent ICSI, laser-cutting separation and NGS testing. The patient achieved pregnancy and gave birth to single healthy female originally derived from conjoined oocytes. This case provided a means through which normal pregnancy may be achieved from conjoined oocytes using laser-cutting separation techniques. The protocol described may be especially beneficial to patients with a limited number of oocytes.
surgical pathology were abstracted from the electronic medical record. Multivariate logistic regression was used to identify independent predictors of persistent pelvic pain 6 months following hysterectomy, defined as <50% improvement in pelvic pain severity. RESULTS: Among 176 participants with pelvic pain prior to hysterectomy, 126 (71.6%) were retained at 6-months, and 15 (11.9%) reported persistent pelvic pain. There was no difference in age (P ¼ 0.59), race (P ¼ 0.23), average pain severity (P ¼ 0.59) or pain duration (P ¼ 0.80) in those with and without persistent pelvic pain. While intraoperative findings of endometriosis (P ¼ 0.045) and uterine fibroids (P ¼ 0.03) were associated with a higher incidence of persistent pain, surgical route (P ¼ 0.46), pelvic adhesions (0.51), uterine weight (P ¼ 0.66), and adenomyosis on histopathology (P ¼ 0.27), were not related to risk of persistent pain. Higher preoperative centralized pain scores (P ¼ 0.01), but not depression (P ¼ 0.13) or anxiety (P ¼ 0.28) were more common in women with persistent pelvic pain. Multivariate logistic regression controlling for age, preoperative pain severity, anxiety, depression, and operative findings of endometriosis and fibroids indicated that every 1-point increase in centralized pain prior to hysterectomy was associated with a 27% increase in odds of persistent pelvic pain (OR ¼ 1.27, 95% CI ¼ 1.03, 1.57) 6-months after surgery. CONCLUSION: While the majority of women with CPP report considerable improvement in pain following hysterectomy, higher degrees of centralized pain prior to hysterectomy is a robust predictor of persistent pelvic pain, even among women whose score falls below the diagnostic criteria for fibromyalgia.
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