The safety of women undergoing childbirth with prior caesarean delivery is a major public health concern. Most of the earlier studies focused on the success rate of vaginal birth after caesarean section; later focus shifted to maternal and neonatal safety, and presently, each factor that would influence the outcome of trial of labour is being considered on both the success and the safety of vaginal birth following caesarean delivery. The contribution of induction of labour to uterine rupture is not entirely clear. Although large multi-center randomised trials comparing planned elective repeat caesarean delivery vs vaginal delivery following prior caesarean delivery are required for conclusive evidence; current evidence suggests that, in properly selected women, vaginal birth can be safely achieved if adequate facilities to monitor the foetus and immediate caesarean can be performed. Unbiased evidence-based information should be given to patients in making decisions about mode of delivery based on individual characteristics. The purpose of this review is to understand each factor that would influence the success and safety of vaginal birth after caesarean delivery.
We present a case of endometrioid adenocarcinoma arising from extragonadal endometriosis 18 years after total abdominal hysterectomy with bilateral salpingo-oophorectomy. After the primary surgery the patient received 11 years of unopposed oestrogen hormone replacement therapy. She presented with symptoms of urinary retention and pelvic mass. Following resection, histopathology identified the mass as an endometrioid adenocarcinoma. The association between persistent endometriosis and the development of endometrial cancer are discussed here together with the risks of unopposed oestrogen in the development of such lesions.
A woman in her mid-40s with a body mass index (BMI) of 70 presented with lower abdominal pain of 24-h duration. The trans-abdominal scan revealed a large cystic ovarian mass. Laparoscopic salpingo-oophrectomy was performed by placing six ports in the upper abdomen; initial Verres needle entry and pneumoperitoneum were established through the left upper quadrant. A low CA-125 and the benign appearance of the ovary allowed the operation to continue laparoscopically with fewer perioperative complications. The histology of the specimen demonstrated a benign epithelial serous cystadenoma of the ovary with torsion.A 45-year-old woman presented with acute lower abdominal pain for 24 h, but with a history of dull aching over the preceding six weeks. Her menstrual cycles were irregular. She is a mother of a 12-year-old child, born by normal vaginal delivery. She was morbidly obese with a body mass index (BMI) of 69.2 (i.e. with weight 162.5 kg and height 153 cm). Her medical history revealed a hiatus hernia, hypercholesterolemia, non-insulin-dependant diabetes mellitus and panic attacks. On admission, her vital signs were normal and abdominal examination revealed a large, soft, tender and regular mass arising from the pelvis. Full blood count, renal and liver function tests were within the normal range, with CA-125 at 1.4 U/ml, CEA 12 U/ml and α-fetoprotein 2.6 U/ml. The trans-abdominal scan revealed a multiloculated cyst larger than 20 cm, suggesting ovarian origin, with a low-risk malignancy index. Twelve days later, she underwent planned laparoscopic right salpingooophrectomy, cystoscopy, intravenous pyelogram (IVP) and stenting of the right ureter under general anaesthesia. The initial entry with Verres needle and pneumoperitoneum were established through the left subcostal region. The procedure was carried out by the six-port technique, with all ports placed in the upper abdomen.Intraoperative findings revealed a large ovarian cyst with surface petechial haemorrhages, areas of necrosis, chronic torsion with ten loops and right hydrosalphix. Five litres of fluid were aspirated from the cyst. The excised right fallopian tube and ovary were placed into two separate bags, and the pedicle was tied with an endoloop. In order to check the integrity of the right ureter, two intra-operative IVPs were performed. As these test findings were inconclusive, cystoscopy and right ureteric stenting were carried out.Finally, two drains were left in the pelvis and deep fascial layers were closed at 10-mm laparoscopic ports. Overall, the operation took six and half hours, including three hours of laparoscopic work; the remaining time was spent with ureteric checks and stenting. Postoperatively, she was observed in the high dependency unit for 24 h. Her recovery was uneventful and she was discharged five days later. Histology of the specimen revealed a benign epithelial serous cystadenoma of the ovary with torsion.
Objective To determine the proportion of hysterectomies done by the vaginal route for all benign gynaecological indications, at our centre, and to assess our performance with respect to the feasibility of bilateral salpingo‐oöphorectomy, and also to identify any major complications. Design A retrospective analysis of case notes on 99 consecutive hysterectomies done for benign gynaecological indications. Setting A district general hospital. Results Out of 99 hysterectomies, 92 were done by the vaginal route, (excluding four laparoscopy‐assisted vaginal hysterectomies), with no significant major complications except for one conversion to laparotomy. Bilateral salpingo‐oöphorectomy was successfully performed in 98.3% of patients in whom it was planned. There was no significant uterine prolapse in 78% of patients undergoing vaginal hysterectomy, and the largest uterus removed vaginally weighed 1146 g. Conclusions Vaginal hysterectomy is feasible in most patients with benign gynaecological indications. Where possible contraindications exist, the use of preliminary laparoscopy should be encouraged, to help in the proper selection of patients and perhaps to remedy any relative contraindications. Gynaecologists need to appraise the vaginal route, and there is a strong need to address training issues as far as vaginal surgery is concerned.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.