Malnutrition and unhealthy diets are important risk factors for non-communicable diseases. Francesco Branca and colleagues call for changes in both what and how food is produced, marketed, and consumed
• A trauma-informed lens is key to cervical cancer prevention in First Nations. • Colonization's disruption of family & community ties drives health disparities. • Ruptured intergenerational ties undermine community capacity for prevention. • Community-based prevention requires reconciliation with healthcare providers. • Increased uptake of HPV vaccination requires community engagement.
Objective
To assess the feasibility and safety of performing vaginal hysterectomy on enlarged uteri the equivalent of 14 to 20 weeks of gestation in size.
Design
A prospective observational study.
Setting
The Royal Free Hospital, London.
Participants
Fourteen consecutive women undergoing vaginal hysterectomy for uterine fibroids up to 20 weeks in size.
Interventions
Vaginal hysterectomy with or without bilateral salpingo‐oophorectomy or oophorectomy.
Main outcome measures
Uterine size and weight, techniques used to reduce uterine size, surgical outcome, operative time, estimated operative blood loss, intra‐and post‐operative complications, duration of hospitalisation.
Results
The mean uterine size was 16.3 weeks (range 14 to 20 weeks). All hysterectomies were completed successfully by the vaginal route. The uteri weighed 380 to 1100 g, with a mean of 638.7 g. Bisection combined with myomectomy and morcellation were used in most cases to obtain reduction in uterine size, whereas coring was only utilised in two cases. The mean operating time was 84.3 min with a range of 30 to 150 min. The only complications were transient haematuria (n= 6) and superficial vaginal grazes (n= 5). One of the women required a blood transfusion. The mean post‐operative hospital stay was 3.7 days (range 2 to 9 days).
Conclusion
Enlargement of the uterus to a size equivalent to 20 weeks of gestation should no longer be considered a contraindication to vaginal hysterectomy. Many more hysterectomies should be carried out vaginally without resorting to abdominal or laparoscopic surgery.
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