The study shows vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy can be performed in women with uterine weight of at least 450 g. Preoperative ultrasonographic examination can provide the surgeon with valuable information on the size of the fibroid and the estimated weight of the enlarged uterus before implementing a suitable surgical method.

Background. The purpose of this study was to compare peri-operative morbidity, preoperative sonographic estimation of uterine weight and postoperative outcomes of women with uterine fibroids larger than 6 cm in diameter or uteri estimated to weigh at least 450 g, undergoing either vaginal, laparoscopically assisted vaginal or abdominal hysterectomies. Method. Ninety patients who met the criteria of uterine fibroids larger than 6 cm by ultrasonographic examination were included in our prospective study. Patients were randomized into laparoscopic-assisted vaginal hysterectomy (30 patients), vaginal hysterectomy (30 patients) and abdominal hysterectomy (30 patients) groups. Results. The laparoscopically assisted vaginal hysterectomy group had significantly longer operative times than the abdominal and vaginal hysterectomy groups (109 ∫ 22 min, 98 ∫ 16 min, and 74 ∫ 22 min, respectively, p Ͻ 0.001). Blood loss for vaginal hysterectomy was significantly lower than for either abdominal or laparoscopically assisted vaginal hysterectomies (215 ∫ 134 ml, 293 ∫ 182 ml, and 343 ∫ 218 ml, respectively, p Ω 0.04). Vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy groups had shorter hospital stays, lower postoperative pain scores, more rapid bowel recovery and lower postoperative antibiotic use than the abdominal hysterectomy group. Uterine weight in the abdominal hysterectomy group was significantly heavier than in the vaginal and laparoscopically assisted vaginal hysterectomy groups (1020 ∫ 383 g, 835 ∫ 330 g, and 748 ∫ 255 g, , respectively, p Ω 0.02). We estimated that when a myoma measured between 8 and 10 cm, the uterus weighed approximately 450 g, and the sensitivity of this prediction was 57.5%. For a myoma larger than 13 cm, the estimated uterine weight was more than 900 g and the sensitivity of this prediction was 71%. Conclusion. The study shows vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy can be performed in women with uterine weight of at least 450 g. Preoperative ultrasonographic examination can provide the surgeon with valuable information on the size of the fibroid and the estimated weight of the enlarged uterus before implementing a suitable surgical method.

This study demonstrates that this new protocol is feasible for couples with male-factor infertility undergoing ICSI.

A 31-year-old multipara woman pregnant at gestational age 32+ weeks with twins encountered hemoperitoneum resulting from superficial uterine vessel rupture during tocolytic course. The initial presentations were unspecific and sonographic examination was negative. Later the aggravated symptoms led to an impression of abruption placentae and emergent cesarean section was performed. A superficial venous bleeder was located on the posterior uterine wall and the internal bleeding was up to 3 L. Maternal and fetal outcome were good. Hemoperitoneum during pregnancy is rare but life-threatening to both mother and fetus, and it mimics placenta abruption in many ways. However, by careful investigations with cardiotocogram and bedside echo, they are quite distinguishable. Aggressive fluid replacement and immediate surgical intervention after rapid diagnosis provides the best prognosis.

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