Supravaginal Hysterectomy Research Articles

Case Study: Placenta Previa, Accreta, Hypertension, and Anemia in Pregnant Women at 35-36 Weeks Gestation with Previous Cesarean Section

Intoduction : Placenta accreta is a rare but serious pregnancy complication where the placenta attaches abnormally in the uterus. It affects around 0.9% of pregnancies and is linked to risks like placenta previa and prior C-sections, with its incidence rising due to increased C-section rates. Prompt diagnosis is essential as it contributes to 7-10% of global maternal deaths. Case report : This case study involves a 39-year-old pregnant woman at 35-36 weeks with placenta previa and suspected accreta. Vaginal bleeding and pain raised concerns. Anemia and gestational hypertension further complicated matters. Ultrasound and MRI confirmed total placenta previa and suspected accreta, with a PAI score of 4. A cesarean section and supravaginal hysterectomy successfully managed the situation. FIGO grade II placenta accreta was found.
 Conclusion : Early detection and management are key for neonatal maturity and maternal safety.Imaging and risk factor identification and diagnosis. Multidisciplinary teamwork among obstetricians, radiologists, and specialists is crucial. This case underscores diagnosing and managing placenta accreta, using imaging and teamwork for optimal outcomes. It highlights the importance of addressing abnormal placental conditions, emphasizing accurate diagnosis, and a collaborative approach for effective management.
 Conclusion: this case underscores the urgent need for early diagnosis, multidisciplinary management, and advanced imaging techniques to address the life-threatening

Adenomyosis, Multiple, and Intraligamentery (Sacro Uterine) Fibroids: A Rare Case

Background: Uterine leiomyomata, often known as fibroids, are frequently accompanied by symptoms that are common to a variety of different pelvic disorders. When considering treatment choices, it is critical to correctly identify myomata and rule out other disorders, including malignancies. In this case report, the author emphasizes the difficulty in establishing a preoperative diagnosis and the actions taken during the operation.Case report: Female, 46 years old, has three children who live with two children. She was complaining of left abdominal pain and penetrating to the waist. There were no complaints of defecation or urination. A mass in the lower abdomen, solid springy, and half of the symphysis center tend to the right with limited mobility. The preoperative diagnosis is pedunculated uterine myoma. It was decided to do a Supravaginal Hysterectomy and Bisalphingo-oforectomy. The pelvic cavity still looks bulging, and exploration was carried out to find uterine myomas of the intrasacrouterina ligament. Then, it was decided to do a Myomectomy.Conclusion:Pedunculated uterine myoma intrasacrouterina ligament performed Supravaginal Hysterectomy and Myomectomy

Manajemen Beberapa Fibroid Rahim Pada Kehamilan

ABSTRACT Uterine Fibroids is a benign tumors originating from the smooth muscle of the uterus. In general, uterine myomas are asymptomatic and are found incidentally during ultrasound examination of pregnancy. We report that a 39-year-old woman with G2P1001 who admitted she was 40 weeks pregnant came with complaints of intermittent abdominal pain since 04.00 in the morning, which was getting worse 2 hours before being admitted to the hospital. Complaints are accompanied by the discharge of blood mucus through the vagina. The patient was married 2 times and the distance between the first child and the second was 19 years. The patient's vital signs were within normal limits. On physical examination, there was a palpable mass with a smooth surface that seemed to stick to the uterus. Obstetrical examination revealed: uterine fundal height: 32cm, HIS + adequate, fetal heart rate 140 beats/minute, performance; head position. When a vaginal touch was performed, it was found that there was an opening of 1 cm with 25% thinning, and the membranes were still intact. The patient was diagnosed with G2P10001 40-41 weeks of gestation + single alive Intra uterine + old secondary primary + uterine fibroids. The patient underwent a cesarean section, and the outcome of the baby and mother was good. Intraoperative findings found that 2 uterine myomas were measuring more than 5 cm located in the subserosa and intramural so the patient underwent a supravaginal hysterectomy. The age of the patient above 35 years is one of the considerations for tubectomy.

MANAGEMENT MULTIPLE UTERINE MYOMA IN PREGNANCY: A CASE REPORT

Uterine myoma is a benign tumor originating from the smooth muscle of the uterus. In general, uterine myomas are asymptomatic and are found incidentally during ultrasound examination of pregnancy. We report that a 39-year-old woman with GIIP1001 admitted that she was 40 weeks pregnant and came with complaints of intermittent abdominal pain that started at 04.00 in the morning, getting worse 2 hours before MRS. Complaints accompanied by the discharge of blood mucus through the vagina. The patient was married 2 times and the distance between the first child and the second is 19 years. The patient's vital signs were within normal limits. On physical examination, there was a palpable mass with a smooth surface that seemed to stick to the uterus. Obstetrical examination revealed: uterine fundal height: 32cm, HIS + adequate, fetal heart rate 140 beats/minute, performance; head position. When a vaginal touch was performed, it was found that there was an opening of 1 cm with 25% thinning, the membranes were still intact. The patient was diagnosed with GIIP1001 UK 40-41 weeks+ Single live intra uterine + Primary old secondary + uterine myoma. The patient underwent cesarean section, the outcome of the baby and mother was good. Intraoperative findings found that there were 2 uterine myomas measuring more than 5 cm located in the subserosa and intramural so that the patient underwent a supravaginal hysterectomy. The age of the patient above 35 years is one of the considerations for tubectomy.

A Rare Case of Spontaneous Uterine Rupture in Second Trimester Pregnancy with Bicornuate Uterus: A Case Report

Eighteen weeks gestation of 34 years-old-woman with abdominal pain in the last 12 hours because of uterine rupture. Abdominal pregnancy was found with 2D ultrasound. On laparotomy exploration, bicornuate uterus was found with uterine rupture and an unviable fetus. Supravaginal hysterectomy was performed to control haemorrhage. Uterine anomaly is rare. However, the complications that occur will be an obstetric emergency. Screening uterine anomalies at premarital or early antenatal care is needed for predicting the risk of maternal mortality.

Three cases of supravaginal excision of the uterus and similar cases used by electrolysis

In a 48-year-old woman, the author removed the uterine fibroma, which had existed for 6 years, with a supravaginal hysterectomy. Tumor weight was 20 lbs; its dimensions: anteroposterior circumference = 231/2 inches, transverse = 223/4 in., diameter from leg to apex = 13 in., transverse diameter = 12, and vertical diameter 91/2 in. The microscope showed the predominance of fibrous tissue; numerous lymphatic spaces were filled with fibrin.

Supravaginal hysterectomy in Curaçao prevalence and impact on screening for cervical cancer.

In Curaçao, hysterectomies are frequently performed. A common reason for this procedure is the high incidence of leiomyomatosis. However in some cases the cervix is conserved. Following supravaginal hysterectomy most women discontinue cervical cancer screening because they think the cervix is not conserved. We aimed to get insight in the proportion of supravaginal hysterectomies and the level of awareness on the necessity to continue with cervical cancer screening in case of retained cervix.In 2014, data from all hysterectomies performed between 2003 and 2013 on Curaçao were collected. Information about: type of hysterectomy (supravaginal or not), age of the patient, reason for a hysterectomy and incidence of cervical cancer post-hysterectomy were obtained from the nationwide pathology database. In addition, 600 hysterectomised volunteers answered a questionnaire in which the awareness of their type of hysterectomy and continuation of screening for cervical cancer after surgery were investigated. In the at-risk population (≥ 15 years old), 6.0 per1000 women (95% CI 5.9–6.2) had a hysterectomy between 2003 and 2013 (n = 692,304). From the performed hysterectomies, 2.9% were supravaginal and no cases of cervical cancer post-hysterectomy were reported. The majority (55.3%) of women were unaware of their cervical status post-hysterectomy. About one-third (34.3%) of these women had their last Pap-smear pre-hysterectomy. Information campaigns are needed to raise awareness in women, to continue cervical-screening after supravaginal hysterectomy.

ЛЕЙКОЦИТАРНІ ІНДЕКСИ У ПРОГНОЗУВАННІ КЛІНІЧНИХ НАСЛІДКІВ ЗАПАЛЬНИХ ПРОЦЕСІВ ЖІНОЧИХ СТАТЕВИХ ОРГАНІВ

Мета дослідження – оцінка діагностичної цінності лейкоцитарних індексів у прогнозуванні клінічних наслідків запальних захворювань органів таза (ЗЗОТ) у жінок.Матеріали та методи. Проведений аналіз клінічних вислідів у 75 жінок із гнійно-запальними захворюваннями органів малого таза. Всім жінкам проведено дослідження загальноклінічних та біохімічних показників, а також фізикальні дослідження за стандартними методиками. На підставі одержаних даних розраховували стандартні лейкоцитарні індекси.Результати дослідження та їх обговорення. Усім хворим протягом двох перших діб виконані оперативні втручання (екстирпація матки, надпіхвова ампутація матки, аднексектомія, тубектомія). Післяопераційні ускладнення спостерігались у 16 (76,2 %) хворих у вигляді проявів інфекції рани, гіпертермії. Після проведеного лікування відбулася нормалізація показників лейкоцитарних індексів у більшості (88,0 %) пацієнтів. Найбільш прогностично цінними в прогнозуванні клінічних наслідків були у пацієнток із гнійно-запальними захворюваннями органів малого таза саме гематологічний показник інтоксикації (ГПІ) та лейкоцитарний індекс інтоксикації за Кальф-Каліфом.Висновки. 1. Для жінок, хворих на запальні захворювання органів малого таза характерні помірно виражена анемія, гіповолемія, лейкоцитоз із зсувом вліво, відносна моноцитопенія. 2. Найбільш високі прогностичні характеристики щодо оцінки тяжкості захворювання при даній патології має ГПІ (J=0,38), якому незначно поступається ЛІІКК (J=0,37).

Combined surgery for locally advanced colorectal cancer

To study the types and early outcomes of combined interventions for locally advanced colorectal cancer. Since 2009 four hundreds and ninety eight patients underwent surgery in the Rostov Research Institute of Oncology for locally advanced colorectal cancer. Most cases of surgical procedures on adjacent organs included resection of small intestine (23.69%), supravaginal hysterectomy (16.47%), resection of bladder (12.25%), total hysterectomy (11.45%). Postoperative complications occurred in 178 (35.7%) patients. Their incidence was significantly lower in case of laparoscopic approach (12.5%). Functional-sparing interventions on bladder followed by its augmentation with enteric graft improves rehabilitation. Laparoscopic approach and functional-sparing surgery improve the results of locally advanced colorectal cancer management.

Hyperplastic processes of endometrium: what's new?

According to the extended today WHO classification (1994) there are simple and complex endometrial hyperplasia non-atypical; simple and complex atypical endometrial hyperplasia; adenocarcinoma. In numerous studies of the last decades it has been proven that the simple and complex non-atypical endometrial hyperplasia are the result of absolute or relative hyperestrogenism, and atypical endometrial hyperplasia is a progressive monoclonal mutational damage with the independent hormonal effects of local growth. With this in mind, it has been proposed the term “endometrial intraepithelial neoplasia” (EIN), which should be viewed as precancer. Based on this approach, EIN-classification also provides a simple and complex non-atypical endometrial hyperplasia interpreted as endometrial hyperplasia (endometrial hyperplasia), which is the result of estrogenic stimulation and, therefore, lends itself well to hormone therapy. In terms of diagnosis and treatment of endometrial hyperplastic processes the most appropriate are recommendations of the American College of Obstetrics and Gynecology (ACOG) and the Society of Gynecologic Oncology (SGO) at 2015: • preferred fencing material at hysteroscopy, separate diagnostic curettage (suspicious areas and all endometrium must be histological exanimated); • there are insufficient data on the efficacy of progestin therapy and monitoring the endometrial intraepithelial neoplasia; • in the progestin treatment it is need histological control every 3–6 months, 7–10 days after withdrawal bleeding; • supravaginal hysterectomy, morcellation, endometrial ablation are unacceptable in the case of endometrial intraepithelial neoplasia. In Ukraine, the treatment of endometrial hyperplasia regulated by the order of the Ministry of Health of Ukraine of 31.12.2004 № 676, which includes I stage – the removal of endometrial changes, followed by a morphological study. According to the recommendations of ACOG and SGO, the II stage of treatment of endometrial hyperplasia without atypia includes conservative therapy with progestins also permissible resectoscope endometrial ablation. Stage III involves the normalization of estrogen/progesterone ratio. The main method of treatment of endometrial hyperplasia with atypia, according to the ACOG and SGO recommendations, is total hysterectomy with/without adnexal.

Use of Bakri Balloon Tamponade in the Treatment of Postpartum Hemorrhage

Objective. Massive postpartum hemorrhage (PPH) is one of the most serious complications during delivery. Hysterectomy is commonly performed when other conventional treatment attempts fail. Bakri balloon tamponade (BBT) is a novel conservative management option for PPH. Little is known of the effectiveness of this procedure. We report a large case series from a tertiary teaching hospital. Design. Retrospective case series (October 2008–June 2011). Setting. University teaching hospital. Population. Forty-four women with massive PPH (blood loss >1000 mL) and six other women with expected high risk of PPH (blood loss <1000 mL) managed by BBT. Methods. Chart review. Main outcome measures. Achievement of definitive hemostasis by BBT among the study population. Results. Among the women treated with BBT, the cause of PPH was uterine atony (16%), cervical rupture (14%), vaginal rupture and/or paravaginal hematoma (22%), placenta previa (18%) and placental retention (30%). The overall success rate was 86%. Seven of the 50 patients needed additional procedures. Of the seven failures, supravaginal uterine amputation or hysterectomy was required in four cases and embolization of the uterine arteries in three cases. Conclusions. BBT is a simple, readily available, effective and safe procedure for the management of PPH in selective cases. BBT does not exclude the use of other procedures if necessary. Even if BBT failed, it may provide temporary tamponade and time to prepare for other interventions or transportation from local hospital to tertiary centre. We suggest that BBT should be included in the PPH protocol. Abbreviations: BBT, Bakri balloon tamponade; CS, cesarean section; PPH, postpartum hemorrhage.

Spontaneous uterine perforation of pyometra presenting as acute abdomen.

Pyometra is the accumulation of pus in the uterine cavity, and spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. We report a rare case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 66-year-old postmenopausal woman with diffuse abdominal pain and vomiting was admitted to our institution. She had a history of mixed connective-tissue disease and had been taking steroids for 20 years. Under a diagnosis of generalized peritonitis secondary to perforation of the gastrointestinal tract or uterus, supravaginal hysterectomy and bilateral salpingo-oophorectomy were performed. Unfortunately, wound dehiscence and infection occurred during the postoperative course, which were exacerbated by her immunocompromised state. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on the 36th postoperative day. Although correct diagnosis, early intervention, and proper treatment can reduce morbidity and mortality of spontaneous perforation of pyometra, if severe infection occurs, this disease can be life threatening for immunocompromised hosts.

Novel modification of B-Lynch uterine compression sutures for management of atonic postpartum hemorrhage: VV uterine compression sutures.

The aim of this study was to demonstrate a novel modification of uterine compression sutures for use in women with primary postpartum hemorrhage and to evaluate its effectiveness. This was a prospective observational study. Nineteen patients with atonic postpartum hemorrhage were subjected to the novel VV uterine compression sutures at the time of cesarean delivery. The procedure was successful in 18 out of 19 women (94.7%) in controlling the bleeding and preserving the patient's uterus. Only one patient required supravaginal hysterectomy. VV compression sutures comprise an easy, safe and effective procedure that can be applied in cases of atonic postpartum hemorrhage.

Combined Robotic Supra Vaginal Hysterectomy, Sacrocolpopexy and Ventral Rectopexy for Severe Combined Prolapse

Combined Robotic Supra Vaginal Hysterectomy, Sacrocolpopexy and Ventral Rectopexy for Severe Combined Prolapse

Prophylactic pelvic irradiation as part of primary therapy in uterine sarcomas

In a complete geographic series of 155 cases of primary uterine sarcomas, prophylactic pelvic irradiation was used as standard postoperative therapy in the majority of the cases. Vaginal brachytherapy was also added as a boost. The histology was leiomyosarcoma in 62 cases (40%), carcinosarcoma in 60 (39%), endometrial stromal sarcoma in 25 (16%), and other types in 8 cases (5%). The primary surgery was extended hysterectomy in 11 cases (7%), simple hysterectomy in 110 (71%), and supravaginal hysterectomy in 12 (8%). In 22 cases (14%) no major surgery was possible. In the complete series, 62 recurrences (40%) were recorded. Local (9%), regional (9%), and distant recurrences (28%) were the most frequent. The type of surgery was associated with the risk of tumor recurrence. Extended surgery reduced the risk of local and regional recurrences. The 5-year overall survival rate was 42% and the recurrence-free survival (RFS) was 37%. The number of mitoses was significantly (P=0.007) associated with survival. The locoregional RFS rate was 75% for patients treated with adjuvant irradiation and 83% for patients treated with primary surgery alone. Serious late tissue reactions from the bladder and intestine occurred in 7% of the irradiated cases. The locoregional tumor control rate was high in this series of patients, but no significant difference was found between patients treated with surgery alone and surgery plus postoperative pelvic irradiation. This was true for all histological subtypes of the uterine sarcomas. However, this was not a randomized study and selection bias cannot be ruled out.

Recombinant human activated factor VII in postpartum hemorrhagic shock: the dark side

Sir: A 38-year-old woman (gravida 2, para 3) was referred to our hospital because of intractable postpartum hemorrhagic shock. During this gemelli pregnancy she was admitted to the hospital three times for vaginal blood loss. Ultrasonography revealed a hematoma and a placenta close to the cervical ostium. Coagulation and platelets were normal. Because of fetal distress during spontaneous labor at 34 weeks an emergency cesarean section was performed. Vaginal hemorrhage began after abdominal closure. Management consisted of uterotonic drugs, intravenous fluids, red blood cells, and fresh frozen plasma without effect. Supravaginal hysterectomy was deemed necessary. Because of pelvic oozing the abdomen was closed after packing of the pelvis. She was still in hemorrhagic shock. Recombinant human activated factor VIIa (rFVIIa; NovoSeven) was administered twice as a 7.2-mg intravenous bolus at an interval of 120 min, but bleeding continued from almost all orifices. The next day she was referred. Hemodynamic instability persisted, and multiorgan failure developed. Angiography of the pelvic arteries resulted in coiling of three small arteries, but hemostasis was not achieved. On the third day tranexamic acid was added and, after lack of effect, a 9-mg intravenous bolus of rFVIIa (90 μg/kg). Coagulation parameters improved and for several hours the hemoglobin level was stable, but she developed blistering of arms, fingers, and feet with slow capillary refill. Toes, heel, and sole of the right foot became black and cold. On laparotomy packings and 9 l blood and cloths were removed. Afterwards there was no bleeding. The ischemia worsened in a few days and spread to the fore foot (Fig. 1) resulting in amputation of the lower extremity. Necrosis also developed on the dorsal side of the left fore arm. Other acra were cyanotic but did not become necrotic. Since delivery she had received 48 U red blood cells, 30 U fresh frozen plasma and 17 U five donors each of platelets. Multiorgan failure improved, and 19 days after admission the patient was discharged to the ward. Fig. 1 Right foot of the patient rFVIIa use has been reported for severe postpartum hemorrhage [1, 2]. Immediately after administration of the third dose of rFVIIa hemostasis was indeed reached. However, severe thromboembolic complications occurred. Although there seems to be a relationship in time between the onset of complications and moment of drug administration, it is hard to confirm this relationship. rFVIIa overdosing or sepsis may also play a role. However, there was no positive confirmation of infection. The incidence of thrombotic complications in licensed use is 1–2%. Most thromboembolic events have followed off-label use of rFVIIa [3]. Off-label rFVIIa is used principally in desperate situations. However, to make a balanced choice, even then we need to have an impression of the complication rate. Safety and efficacy in off-label use must be studied [4]. Pregnant and postpartum women should receive special attention in these studies because of their particular coagulation condition.

No Difference in Length of Hospital Stay Between Laparoscopic and Abdominal Supravaginal Hysterectomy???A Preliminary Study

Numerous trials have concluded that laparoscopic hysterectomy, compared with total abdominal hysterectomy, causes less postoperative pain and shortens the hospital stay. Many view this approach as being more cost-effective, but a recent large, randomized trial demonstrated more major complications after the laparoscopic procedure. The present study compared the length of time in the hospital, time to convalescence, and long-term patient satisfaction in 47 consecutive women who were to have supravaginal hysterectomy. Twenty-three of them were randomized to undergo abdominal supravaginal hysterectomy (ASH) and 24 laparoscopic supravaginal hysterectomy (LSH). Pre- and postoperative procedures were comparable in the 2 groups, and there were no significant differences in demographic features or physical characteristics. The postoperative hospital stay was comparable after ASH and LSH. Operating times were significantly longer with LSH, but estimated blood loss was greater in the ASH group. No intraoperative complications occurred in either group, and no patient was transfused. Self-rated pain 6 hours postoperatively was less in women having LSH. Follow up at 6 weeks showed that patients having ASH required approximately 10 more disability days than those in the LSH group. There were no differences in the number of days analgesics were required or the time needed to resume normal activities. At 6 months, 87% of women having ASH and 91% of those in the LSH group were satisfied or very satisfied with the overall results. More than 90% of women in both groups would recommend their procedure to others. When using a multimodal intervention program of postoperative care, the choice between ASH or LSH may be less important than is generally believed with regard to postoperative time in the hospital and long-term patient satisfaction.

No difference in length of hospital stay between laparoscopic and abdominal supravaginal hysterectomy – a preliminary study

Although a number of well-designed studies have concluded that laparoscopic hysterectomy is associated with less postoperative pain, reduced hospital stay, and shorter periods of sick leave, thus far, studies on the perioperative and postoperative outcomes of laparoscopic supravaginal hysterectomy (LSH) versus abdominal supravaginal hysterectomy (ASH) are lacking. By applying multimodal intervention program for the postoperative care of patients, the primary aim of the current study was to compare length of hospital stay, time to convalescence, and long-term patient satisfaction between LSH and ASH. The study was conducted at the departments of Obstetrics and Gynecology, Skellefteå Hospital and Lycksele Hospital. Forty-seven consecutive women scheduled for supravaginal hysterectomy were randomly assigned to LSH or ASH. Perioperative and postoperative parameters were compared between the two groups. The length of the postoperative hospital stay did not differ between patients undergoing LSH and ASH, but the number of disability days was greater in the ASH group. The operating time was significantly longer in the LSH group compared with the ASH group, whereas the estimated perioperative bleeding was greater in the ASH group. At the 6-month follow-up, 87.0% of patients in the ASH group and 91.3% in the LSH group were satisfied or very satisfied with the overall result of the surgical procedure. The present study has indicated that by applying a multimodal intervention program for the postoperative care of patients undergoing supravaginal hysterectomy, the surgical procedure per se is of less importance than generally considered for the length of postoperative hospital stay and long-term patient satisfaction.

Placental mRNA in Maternal Plasma and Its Clinical Application to the Evaluation of Placental Status in a Pregnant Woman with Placenta Previa-Percreta

Fetal and/or placental mRNA in maternal plasma has been detected during pregnancy, and such mRNA tends to be stable against degradation (1). A quantitative study of plasma mRNA for γ-globin and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) showed significantly higher concentrations in pregnant women than in nonpregnant women (2). These findings suggest that the quantitative analysis of placental mRNA in maternal plasma may be a useful method to monitor placental status. In this study, we measured placental mRNA in maternal plasma to evaluate residual placenta in a pregnant woman with placenta previa-percreta (PPP) and bladder invasion that was diagnosed by both magnetic resonance imaging and pathology examination. Although a supravaginal hysterectomy just after the cesarean section (the first surgery) was done at 37 weeks of gestation, a 16-cm placental mass close to the internal os of the uterus could not be removed. Therapy with methotrexate (MTX) was therefore initiated on days 1–4, days 14–17, and days 33–36 after the first surgery (on day 0) to aid resorption of the placental residue, and a second surgery was performed to complete the hysterectomy …

Supravaginal hysterectomy—a less invasive procedure

SummaryA partial hysterectomy technique is described which aims to reduce tissue trauma and speed recovery. The first 50 women who underwent this supravaginal hysterectomy were compared with 50 who had a routine total abdominal hysterectomy. The groups were not allocated at random. The supravaginal hysterectomy involved shorter operating time (45 minutes versus 57 minutes mean), and a shorter stay in hospital. Although no differences in urinary symptoms were noted, sexual satisfaction following the supravaginal procedure was found to be more than after the total abdominal hysterectomy.