Unnecessary Hysterectomies Research Articles

Die Uterustamponade als einfache und effiziente Therapie der schweren postpartalen Blutung

Between 1988 and 1996 a total of 17 uterine packings and 3 postpartum hysterectomies were performed at our institution. During the same period 7900 deliveries were registered. In 13 of 17 cases, postnatal haemorrhage could be successfully treated with uterine packing. Secondary hysterectomy was necessary in four cases. In the meantime, two women became pregnant again, and delivered spontaneously. If the indication is correct, uterine packing can be considered as a simple and effective procedure to control postnatal haemorrhage without major complications, and will help to avoid unnecessary hysterectomies.

Endometrial ossification in a postmenopausal woman.

A case of endometrial ossification in a 62 year old woman is reported. The patient presented with increased vaginal discharge. On transvaginal ultrasonography, a hyperechoic area within the uterine cavity,...

Irritable bowel syndrome. Diagnosis in the managed care era.

The common occurrence of irritable bowel syndrome underscores the importance of an accurate diagnostic evaluation without unnecessary expense. A preliminary diagnosis can usually be made with the Manning symptom criteria and additional history data in patients without warning signs of organic disease. A confident diagnosis can often be made with the addition of a physical examination and only limited laboratory and structural studies, such as a proctosigmoidoscopy and complete blood count. Tests that may be indicated in some patients include fecal examination for parasites and occult blood, dietary lactose exclusion or a lactose-hydrogen breath test, and a complete colon structural study. Other tests are occasionally indicated. Routine rectal biopsy and abdominal ultrasonography are unnecessary in patients with only typical symptoms, and large bowel motility testing is not useful. After a confident diagnosis, further testing for recurrent symptoms can be minimized. Investigation for psychosocial factors, while not necessary to diagnose irritable bowel syndrome, is important in treatment and may reduce medical costs. Misdiagnosis can result in unnecessary hysterectomy and other surgery, and it may be reduced by closer collaboration with gynecologists and general surgeons in the evaluation of patients.

Is tubal sterilization associated with an increased risk of subsequent hysterectomy but a decreased risk of ovarian cancer? A review of recent literature

Recent epidemiologic studies have suggested that tubal sterilization (TS) may lead to an increased incidence of subsequent hysterectomy but a decreased risk of ovarian cancer. This review evaluates the nature and magnitude of these two relationships, which should be of great concern and interest to women, clinicians and the administrators of family planning programs. The positive relationship between TS and subsequent hysterectomy is more likely to be of a motivational rather than biological nature, and a considerable number of unnecessary hysterectomies after TS could be avoided by changing the attitudes of physicians and women. The inverse relationship between TS and ovarian cancer appears causal, although the exact biological mechanisms remain to be clarified. Theoretically, this non-contraceptive beneficial effect of TS could be used as a primary preventive measure to curb the incidence of the highly fatal ovarian cancer. However, a number of medical, ethical, and economic questions attending use of a generally irreversible contraceptive procedure as a preventive measure must first be answered. The issue of whether TS is associated with any long-term sequelae, and, if so, whether the association is of a cause-and-effect nature or a by-product of time passage and aging of the woman, should be addressed by well-designed studies.

What is the role of hysteroscopy in the management of abnormal uterine bleeding?

Many otherwise healthy women will experience a significant disruption in lifestyle from abnormal uterine bleeding. Most of those seeking medical attention will not be at risk for developing anemia. In each case, a thorough search for underlying systemic, hormonal, and organic causes should be instituted. The use of blind endometrial sampling to evaluate the uterine cavity, by itself, is an inaccurate technique for diagnosing pathologic conditions commonly associated with menorrhagia, such as endometrial polyps, submucous myomata, and focal endometrial abnormalities including adenocarcinoma and its precursors. The supplementary application of diagnostic hysteroscopy with directed biopsy will ensure the recognition of these intracavitary lesions. The majority of women found to have endometrial polyps and submucous myomata can gain a successful reduction in their menstrual flow without hysterectomy by undergoing hysteroscopic removal of these lesions. Those without other uterine or pelvic pathology and who are closer to perimenopause are more likely to sustain long-lasting relief from these procedures. Medical therapy should be the first line of treatment for premenopausal women who are found to have no obvious cause for their abnormal uterine bleeding. Many of those who do not respond to, are unable to tolerate, or are unwilling to attempt this approach will undergo hysterectomy as the final answer. The absence of uterine pathology in most of these cases places an absolute demand on our specialty to innovate, and, whenever suited, to use more conservative surgical solutions. Our efforts to alter this behavior will undoubtedly be closely monitored by agents of managed care aiming to reward measures that reduce cost and improve the quality of care. The use of hysteroscopic ablation and resection to treat women suffering from intractable menorrhagia can safely and effectively reduce menstrual blood flow and should significantly curtail the performance of unnecessary hysterectomy. The comparative benefits and long-term advantages of these techniques beyond hysterectomy await the results of further studies. Furthermore, the risks of these hysteroscopic procedures to produce iatrogenic adenomyosis or to conceal or delay the usual signs of adenocarcinoma have yet to be ascertained. Vigilance for endometrial disease must not dwindle in the face of amenorrhea, as evidenced by a recent case report describing the development of endometrial carcinoma after 5 years of amenorrhea following endometrial electrocoagulation. Future methods of endometrial destruction for the control of abnormal uterine bleeding may include the nonhysteroscopic use of radio frequency, thermal transfer, hyperthermia, and photodynamic therapy.(ABSTRACT TRUNCATED AT 400 WORDS)

Endometriosis Awareness Week.

At least 1.5 million women in the UK are affected by endometriosis, The Endometriosis Society claimed last week. The charity, bunching International Endometriosis Awareness Week, said the lives of women affected were being mined by the failure to diagnose the condition and by unnecessary hysterectomies carried out in attempted 'cures'. Pictured is an ovarian cyst caused by the condition.

Mismanagement of choriocarcinoma due to a false low HCG measurement.

Accurate measurement of HCG is essential for the diagnosis and management of patients with choriocarcinoma. It is therefore important that clinicians are aware of the possible analytical problems associated with the HCG assay if delay in the diagnosis of this curable tumor is to be avoided. We describe the case of a 43-year-old woman with extensive lung metastases who had an unnecessary hysterectomy and lung biopsy and in whom the diagnosis of this potentially rapidly fatal tumor was delayed because of a falsely low HCG level measured by a commercial kit. This underestimation of HCG was due to the 'high dose hook' effect, which is described in detail, and methods for avoiding this analytical problem are described.

Hysteroscopic findings after unsuccessful dilatation and curettage for abnormal uterine bleeding

In recent years numerous articles have reported on the inaccuracies of the dilatation and curettage procedure, citing a false-negative rate of up to 10% to 15%. Indeed, several articles have reported that, in this era of simplified endoscopy, the blind dilatation and curettage should no longer play a significant role in gynecologic diagnosis, but should be replaced by hysteroscopic evaluation and directed biopsy. We report the hysteroscopic findings in 29 patients for whom a blind curettage was performed within the previous year for the purpose of diagnosing the cause of abnormal uterine bleeding and attempting its cure. The remarkably high incidence of apparently missed pathologic factors (mainly submucous myomata) adds to the data confirming the lack of precision of dilatation and curettage, and supports the contention that diagnostic hysteroscopy is an essential tool in the management of abnormal uterine bleeding and the prevention of unnecessary hysterectomies.

Surgical management of life-threatening obstetric and gynecologic hemorrhage.

Life-threatening obstetric or gynecologic hemorrhage can often be controlled by ligation of the uterine arteries or the internal iliac arteries. Following a description of the pelvic blood supply, the distribution and capacity of the collateral system and the hemodynamic changes after ligation, attention is called to these procedures of treatment and the consequent results, as described in the literature. There is no reason to fear tissue necrosis after ligation and knowledge of the above mentioned possibilities of ligation may contribute to the avoidance of unnecessary emergency hysterectomy.

Hysterectomy Among Women of Reproductive Age-Reply

In Reply.— Dr Fribourg has ascribed loftier intentions to our report than we had. Our primary objective was to report the annual number and rate of hysterectomy among women of reproductive age by age, race, geographic region, and surgical approach. Our only purpose in citing the controversy over unnecessary hysterectomy and the recent reports of cardiovascular disease was to indicate that factual information on the trends and differences in hysterectomy rates by important demographic variables might be helpful to those who want to study the determinants of hysterectomy. We agree with Dr Fribourg that the subject of justifiability of surgical procedures is a difficult one. Before branding a given procedure unnecessary, one should be able to distinguish between honest differences in competent clinical decision making, good but misguided intentions, and dishonorable motives on the part of the physician. One also should know the duration and degree of the patient's disability,

Unnecessary hysterectomy?

Medical Journal of AustraliaVolume 2, Issue 8 p. 389-389 Forum Unnecessary hysterectomy? H. B Woolford, H. B Woolford Nairana Rest, Noosa Heads, 4567Search for more papers by this author H. B Woolford, H. B Woolford Nairana Rest, Noosa Heads, 4567Search for more papers by this author First published: 01 October 1981 https://doi.org/10.5694/j.1326-5377.1981.tb101019.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume2, Issue8October 1981Pages 389-389 RelatedInformation

Preventive hysterectomy versus paragraphs 224 and 225 of the german penal code (author's transl)

Serious legal consequences are pointed out in cases of unnecessary hysterectomies which recently have increased in number in West Germany. The Supreme Court's 1894 decision classified hysterectomy, as bodily harm. Although criticized in legal and medical literature, the physician has to accept it since the Federal High Court upholds this decision. The illegality of this bodily harm is nullified by the patient's consent. Consent must be preceded by full disclosure of possible adverse effects. Paragraph 226a of the German Penal Code holds that despite informed consent the bodily harm remains illegal if it violates "good customs." This is not easy to determine and the Federal High Court continues to expand and explain this concept. The Court's opinion of 6-29-1976 holds that voluntary sterilization is not necessarily bodily harm. The freedom to chose for or against parenthood is seen as a more humane life style. Sterilization is more than just a method of contraception. The intervention in the reproductive function is as a rule irreversible, especially in hysterectomy. It might put the woman in a conflict situation. Despite the 1976 Court decision, which applies to individual cases, the permissibility of voluntary sterilization is disputed by the Court, Christian church, and physicians when there is no medical, criminal, genetic, or social indication. This is especially true for preventive hysterectomy which goes against the values of public opinion. Public opinion takes offense in those cases where hysterectomy is proposed to save the bother of pill taking; or worse to provide study material for prospective gynecologists. Patient's consent to this kind of medical intervention violates "good customs" and is therefore void. These actions can not only lead to liability claims but can be seen as criminal. This also concerns nonmedically indicated tubal ligation. Conviction can lead to imprisonment of 2 to 10 years, in lesser cases of 6 months to 5 years because it concerns a crime according to paragraphs 224 and 225 of the German Penal Code.

The unnecessary hysterectomy.

After a short statement on unnecessary surgery, the background of the ripple effect of the McCarthy report of 1974 was briefly summarized. A review of the vaginal hysterectomies on my service for 1971 through 1976 revealed that hysterectomies for functional diagnoses comprised 46% of the total and that hysterectomy for sterilization is now the third major category. Many patients had anatomic lesions such as fibroids, adenosis, or relaxation, but indications for hysterectomy, as agreed on by patient and physician, were functional. The operations should be consistent with the preoperative diagnoses. Second opinions are only a second physician's opinion, but they can be very helpful in controversial problems. Hysterectomy per se can offer more to the "quality of life" than any other single operation.

The value of laparoscopy in the differential diagnosis between uterine fibromyomata and adnexal tumours.

Abstract. Out of a total of 2098 laparoscopies, 90 (4.3%) were made to settle the diagnostic questions: I. fibromyomata of the uterus or adnexal tumour? and II. fibromyomata of the uterus concomitant with adnexal tumour or uterine fibromyomata only? A diagnosis was obtained in 83 patients (92%). Adnexal disease was found in 28/83 (34%) and fibromyomata of the uterus only were present in 55/83 (66%). Neoplastic tumours were found in 19/83 (24%). Doubts regarding fibromyoma of the uterus versus adnexal disease can quickly be resolved by laparoscopy. Adnexal operations can be performed immediately after the laparoscopy. When only uterine fibromyomata are found that do not require surgery, explorative laparotomy and unnecessary hysterectomies are avoided.

Uterine artery ligation in the control of intractable postpartum hemorrhage

The technique and merits of bilateral uterine artery occlusion for obstetrical hemorrhage have been described. Ten new cases are reported, and the literature reviewed. Some unnecessary emergency hysterectomies may be avoided by the use of this operation. The technique is simple, may be rapidly performed, and will be more effective than hypogastric artery ligation in the control of uterine hemorrhage.

Roentgenography as an aid in obstetrical diagnosis

Roentgenography has proved its value in obstetrics principally for the following diagnostic purposes: 1. 1. For the positive diagnosis of pregnancy in obscure cases. This can be accomplished by the fourteenth week, sometimes earlier. In some of the author's cases, the clinical findings strongly suggested uterine fibromyomata and only the roentgenogram saved the patient from an unnecessary hysterectomy. 2. 2. For the recognition of twins. Particularly in obese patients, there may be difficulty in hearing two separate fetal hearts or palpating a multiplicity of fetal parts; vice versa, the same fetal heart may sometimes be heard clearly in widely separated locations, leading to an erroneous diagnosis of twin pregnancy. In such cases, roentgenography gives a definite answer. 3. 3. For differentiation between pregnancy and tumors. Here roentgenography supplements findings by the Aschheim-Zondek test. 4. 4. For diagnosis of tubal and ovarian pregnancy. 5. 5. For revealing the presence of a fetal monster. The recognition of anencephalus and other forms of fetal monstrosity is greatly facilitated by x-ray study. 6. 6. For giving information as to the presentation and position of the fetus. As shown by several of the author's films, the exact presentation and position are revealed with far greater accuracy than can be determined by physical examination alone. This also obviates the need of a pelvic examination. 7. 7. For demonstrating the mechanism of labor. 8. 8. For supplying a more accurate method of pelvimetry than any heretofore proposed and furnishing a means of cephalometry in utero. This subject will be discussed in a subsequent paper appearing in a future issue of The American Journal of Surgery.