Uterine Size Research Articles

Measurement of Uterus Sizes Of Multiparous Women using Ultrasound

Human uterus is a pear-shaped fibromuscular organ. The measurements of a typical uterus are 7.6x4. 5x3cm. The uterus grows slowly during fetal life until the end of the first trimester when it grows at a higher rate due to increased maternal oestrogen production. As a result of this continuation of the maternal oestrogen the uterus shrinks immediately after delivery. Objective: To evaluate uterus size in multiparous women using ultrasound. Methods: It was a cross-sectional study carried out at private sector hospital of Gujrat over 4 months period from December 2021 to March 2022. The sample size was 41 calculated via a convenient sampling approach from previously published studies. Multiparous women following ultrasound examination during the study period were included after receiving informed consent. The patients’ demographic statistics were collected on a specially designed data collecting sheet. The data was analyzed using the SSPS V20 program. Results: The average length was 7.9±1.15, width was 4.3±0.77, and thickness 3.5±0.66. There was no significant correlation between uterine size (length, width, thickness) and many parities because the value in the "Sig. (2-tailed)" is 0.607, 0.640, and 0.983 respectively which is more than 0.05.Conclusion: The current study found no correlation between the number of parities and the length, width, and thickness diameters of the uterus.

Frequency Of Uterine Anomalies Associated with Persistent Miscarriages in Pregnancy on Ultrasound

Miscarriages is when an embryo/foetus expires before the tenth week of gestation. It occurs most commonly early during pregnancy. Women who had a miscarriage looked to be more likely to die before the age of 70 than those who had any other pregnancy outcomes. Objective: To determine the frequency of uterine abnormalities related with persistent miscarriages in pregnancy on ultrasound. Methods: It was a cross-sectional study conducted over a period of 4 months from February 2022 to May 2022. A sample size of 70 patients was collected using purposive sampling technique. Data was collected from Memorial Christian Hospital Sialkot. Patients with multiple miscarriages due to uterine abnormalities were included in the current study. Patients with less than two miscarriages, self-induced miscarriages and miscarriages due to foetal anomalies were excluded. Data was analysed using SPSS version 20.0. Results: The study showed that the mean age of affected women experiencing miscarriage is 28.72. The highest rate of miscarriage was found in 38 (54.3%) of females and least in 4 (5.7%). The common cause of miscarriage was fibroids. Out of 70 females, 34 (48.6%) had fibroids, 14 (20%) had cervical incompetence, 9 (12.9%) had uterine adhesions, 6 (8.6%) had abnormal uterine size, 4 (5.7%) had uterine polyp and remaining 3 (4.3%) had congenital anomalies. Conclusion: The study concluded that miscarriages and uterine factors are closely linked. Uterine fibroids have shown the highest percentage of patients that had undergone miscarriage.

VAN WYK GRUMBACH SYNDROME: CASE REPORT

BACKGROUND: Children with primary hypothyroidism usually presents with delay in linear growth and pubertal development, but in rare instances they can present with precocious puberty. In 1960, presentation of primary hypothyroidism with precocious puberty was first reported and labelled as Van Wyk Grumbach syndrome (VWGS). We report a case of VWGS in a six years old girl. CASE DESCRIPTION: A six years old girl presented with precocious puberty accompanied by short stature and delayed bone age due to untreated hypothyroidism. On examination she had Tanner’s stage B3 (breast development) and P2 (pubic hair). She had normal external genitalia. On workup her Thyroid Stimulating Hormone was 100 mIU/ml, Free-T4 0.7 was ηg/dl, Follicle Stimulating Hormone 8.1 mIU/ml, Luteinizing Hormone 0.12 mIU/ml, estradiol 58 ρg/ml and prolactin 177 ηg/ml. Pelvic ultrasound revealed a uterine size of 5.4 × 3.2 × 3.6 cm and enlarged ovaries with multi cystic appearance. She was started on 50 µg of Levo-thyroxine per day and then was reassessed after 9 weeks of treatment which showed improvement in her Tanner’s Stage and hormonal profile. CONCLUSION: The girl was diagnosed as VWGS and responded to the treatment which was evident by improvement in her physical and biochemical assessment.

Pro-Sexual Effects of Aqueous and Methanol Extracts of Phyllanthus muellerianus (Kuntze) Exell (Phyllanthaceae) on a Model of Low Sexual Desire Disorder in Female Rats

Low sexual desire disorder is a recurrent deficiency in desire for sexual activity which impairs lifestyle. It is a frequent problem in women with limited therapeutic options. Phyllanthus muellerianus (Kuntze) Exell is a plant used by traditional healers to boost libido in women. This study aimed at evaluating the aphrodisiac properties of root barks extracts of this plant on a model of Low Sexual Desire Disorder (LSDD) in female rats. Low sexual desire was induced by ovariectomy plus low steroid hormones supplementations. Thirty ovariectomized rats were treated for 21 days with either distilled water, aqueous or methanol extracts (60 or 372 mg/kg) of P. muellerianus. All animals were supplemented with a low dose of 17β-estradiol and progesterone prior to sexual behavior test. Sexual behavior test was performed each week by pairing each female rat with a sexually experienced male. Sexual motivation (approach, ear wiggling, hops and darts, anogenital presentation and aggressive behavior frequency) and sexual receptivity parameters (lordosis frequency and quotient) were recorded. At the end of treatments, animals were sacrificed, uteri and vagina collected, weighed and conserved for total uterine proteins assay and histology. LSDD was characterized by significant inhibition of sexual motivation parameters and lordosis frequency compared to a normal control. Moreover, poor reproductive tissues growth characterized by low total uterine proteins, uterine wet weight and uterine epithelia size was noted in LSDD group compared to normal control. Interestingly, plant extracts significantly improved sexual motivation parameters (p < 0.05-0.001) compared to LSDD group. In addition, moderate reproductive tissues growth was noted in plant treated groups as confirmed by amelioration of uterine cell integrity. Present results show that P. muellerianus exhibits pro-sexual effects through amelioration of sexual motivation and reproductive tissues growth on a model of LSDD.

Learning curve analysis of transvaginal natural orifice transluminal endoscopic hysterectomy combined under the standard operating procedure.

To investigate the learning curve of transvaginal natural orifice transluminal endoscopic hysterectomy (tVNOTEH) when using a standard operating procedure (SOP). Seventy-nine patients were treated with tVNOTEH by a single surgeon. The SOP for tVNOTEH was created after the first eight cases. Patients' perioperative data were retrospectively reviewed. Operative time (OT) was regarded as a replaceable marker for surgical competency. The learning curve was drawn using the cumulative sum method. All patients completed surgeries without switching to other surgical paths. The overall mean OT was 90.23 ± 29.85 min. Four unique phases of the learning curve were identified: phase I (the exploring stage over eight cases), phase II (after adopting the SOP, acquirement of competence over 20 cases), phase III (post-learning of 19 cases, in which more difficult cases were introduced), phase IV (more adept at tVNOTEH), with OT 113.75 ± 43.07 min, 82.50 ± 25.88 min, 101.05 ± 27.83 min, 82.75 ± 25.53 min, respectively. No significant differences were found apart from OT, uterine size, and disease types. Our data demonstrated four distinct phases of the learning curve of tVNOTEH. For an experienced surgeon, surgical competence in tVNOTEH can be grasped after eight cases. With SOP, surgical competence could be rapidly acquired.

Invasive epithelial ovarian carcinoma (EOC) at a young age: role of fertility-sparing

Objective: Improving knowledge to manage an invasive epithelial ovarian cancer at a young age who expect to preserve their reproductive function 
 Method: a Case report
 Result : A 26 years old, nulliparity, Indonesian woman with chief complaint abdominal enlargement simultaneous with dyspnoea condition. Physical examination revealed an enlarged abdomen until processus xhypoideus with positive shifting dullness. Gynecology examination found normal uterine size, palpable cystic mass originated from adnexa until navel, mobile. CT whole abdomen showed a cystic solid mass in the pelvic area up to mid abdominal size 17,8 x 10,7 x 18,8 cm accompanied by lymphadenopathy in paraaortic and bilateral inguinal. Ascites and pleural fluid cytology examination results were both positive for malignant cells (metastatic adenocarcinoma). The patient was assessed as advanced staged ovarian cancer and procced for Interval Debulking Surgery (IDS) after 3 cycles of Neoadjuvant Chemotherapy (NACT). Postoperative histopathology examination result was high-grade clear cell ovarian carcinoma 
 Conclusion: Fertility-sparing surgery for invasive epithelial ovarian carcinoma could be chosen for selective young age patients who fulfilled the criteria. Education and informed consent is a must regarding the risk of recurrence and prognosis. 
 Keywords: Invasive EOC, fertility sparing, selection criteria, recurrence, prognosis

Comparative Plasma Levels of Angiotensin II in Women with or without Uterine Fibroid in Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria

Background: Uterine fibroid is the most common tumour in women reproductive age group Recently uterine fibroids have been noticed to be more common in patients with hypertension, another disease with a predilection for the black race. The study compares the serum levels of angiotensin II in women with uterine fibroids and women without uterine fibroids. Methods/Designs: The study was a prospective case-controlled study involving ninety consecutive women with a confirmed diagnosis of uterine fibroids and ninety consecutive women with intact uterus with no sonological diagnosis of uterine fibroids matched for age, parity and body mass index. A structured interviewer-administered questionnaire was completed for each subject, who also had their blood pressure checked in the clinic and 5ml of venous blood drawn for angiotensin 2 assay. The uterine size was measured in pregnancy weeks. The data obtained were processed and analyzed using Statistical Package for Social Sciences, (SPSS) version 20. Results: The mean serum level of angiotensin II in women with uterine fibroids was significantly higher than that in women without uterine fibroids, (0.71±0.07ng/ml vs. 0.23±0.07ng/ml), p <0.001. The mean systolic blood pressure was significantly higher in respondents with uterine fibroids (122.99±16.01 vs. 112.92±13.22mmhg), p<0.001. Women with uterine fibroids were about six times more likely to have hypertension than women without fibroids, p= 0.01. Conclusion: Uterine fibroids and hypertension are associated with higher levels of angiotensin II, suggesting a possible important aetiological role in both by angiotensin II.

The Effectiveness of Hot Herbal Compress in Accelerate Uterine Involution and Recovery of Afterpains on the Postpartum Mothers

About 55% of postpartum mothers in Banyumanik and Ungaran districts in October 2019 experienced uterine subinvolution, and 75% of them experienced afterpains. Hot Herbal Compress could stimulate myometrium contraction required for uterine involution and analgesic effect. This study aimed to prove the effectiveness of hot herbal compress in accelerating uterine involution and afterpain recovery on postpartum mothers. This research used a quasi-experimental design—the investigation from 13 December 2019 until 26 January 2020 in Semarang. The authors grouped 42 postpartum mothers equally into experimental and control groups with random cluster sampling. The experimental group received a hot herbal compress for 20 minutes. The control group received uterus massage for 10 minutes and breathing exercises for 15 minutes. Both groups received the therapy 1x/day from the 2nd-10th day of the postpartum period. The observation of uterine fundal height by metlin, lochia volume by gravimetric, and afterpains intensity by visual analogue scale before and after the intervention every day. The analysis used Repeated Measure Anova. The experimental group's uterine fundal height, lochia volume, and afterpains intensity were consistently lower than the control group. There were significant differences between the experimental and control groups on a uterine fundal height on days 1-5 and 6-8, on lochia volume on days 5-6, and on the intensity of afterpains on days 1-4 (p < 0.05). The hot herbal compress effectively decreased the uterine fundal height on a uterine fundal size on days 1-5 and 6-8, reduced lochia volume on days 5-6 and effectively decreased afterpains intensity on days 1-4 on of postpartum mothers. This study recommends that midwives provide hot herbal compress therapy for the postpartum mother to accelerate uterine involution and recovery of afterpains.

Relation between vitamin D and uterine fibroid

Background; Uterine fibroids (UFs) are benign tumors that develop from the uterus' smooth muscle cells and are mostly found in the pelvic. Aim of the work; we aimed to compare serum vitamin D level between patients, have uterine fibroids and those without. Subjects and methods; our current study included 90 females and was conducted as a case control study; 50 were diagnosed with uterine fibroid and 40 were healthy volunteers (control) during the period from July 2019 to July 2020. they were recruited from Al Zahra’a University Hospital. Serum vitamin D level was measured by ELISA. Results; Vitamin D serum concentrations were significantly lower in the studied females with UFs compared to healthy controls (mean 19.24 ±16.0 vs. 33.83 ±17.5) ng/mL in cases and controls, respectively, with a statistically significant p-value <0.001. Serum vitamin D levels have a significant, linear, negative, moderate association with uterine fibroids size. Conclusion; in our study group, reduced serum vitamin D levels were found to be inversely related to UF burden. A lack of vitamin D may be a risk factor for the incidence of uterine fibroids.

Monitoring Influence of PGF2 , Estrogen and Oxytocin on α Postpartum Uterine Involution by Ultrasonography in Ewes

The goal of this study was designed to investigate the effect of estrogen, oxytocin and PGFα on uterine involution post-partum (p.p). In addition, the times for ewes to go through involution by ultrasonographical rectal examination lead to assess the best time for insemination that ensure the highest fertilization rate to avoid endometrit is post-partum. This study carried out at sheep and goat's improvement station, state board of agricultural research in Agargof, during November 15,2020 to April 15, 2021 This study involved 30 ewes of 2-4 years old and . 50-65kg body weight. Blood was collected to estimate progesterone concentration and the role of ovarian activity. Results showed a gradual decrease in uterine lumen and uterine diameter. The uterine horn diameter, at different weeks of post-partum in groups treated PGF2 was α40.63 mm at first week and decrease14.22 mm The uterine involution in ewes treated with PGF2 on post-partum, facilitate uterine involution . α process in ewes and lead to remove uterine fluid (lochia) and decrease uterine size, and uterine lumen. The study proves progesterone concentration as indicator to detect Ewes' post-partum ovarian activity. The current study reveals that the ultra-sonographic approach is a viable option for uterine involution management.

"Iavazzo score", a preoperative score to predict duration of robotic-assisted gynaecological surgeries.

Long operation time remains a disadvantage of robotic-assisted gynaecological procedures. A score that predicts the duration of such surgeries could be useful. A retrospective analysis of robotic-assisted gynaecological surgeries in our institution were conducted. We assessed preoperative values such as body mass index, uterine size, previous abdominal surgeries, way of previous deliveries and pathology that led patients to the theatre and we created a preoperative predictive score, the 'Iavazzo score'. Thereafter, we correlated this score with duration of surgery. 57 patients were included. Mean 'Iavazzo' score was 7.96, while mean surgery and overall time were 140 and 208.8min, respectively. Correlation between Iavazzo score and operation time was statistically significant (p<0.001). Using median operation time, we found an area under curve of 0.86 and a cut-off value of 7.5 for Iavazzo score. 'Iavazzo' score can be a useful predictive score that evaluates duration of robotic-assisted gynaecological surgeries.

Comparative Analysis of Peri-Operative Outcomes Following Total Laparoscopic Hysterectomy with Conventional Bipolar-Electrosurgery versus High-Pressure Pulsed LigaSure Use.

Objectives:Quick and effective hemostasis is essential for a successful laparoscopic surgery. Hence, it is of utmost importance for laparoscopic surgeons to understand the various available and emerging energy sources to tailor their use according to their properties and surgical requirement. The aim of this study was to compare LigaSure, an advanced bipolar versus conventional bipolar in total laparoscopic hysterectomy, with respect to operating time, mean blood loss, mean reduction in hemoglobin, intraoperative, and postoperative complications, and duration of prospective hospital stay.Materials and Methods:It was a randomized controlled study. One hundred and twenty patients scheduled for elective hysterectomy for any benign indication were randomly allocated to two groups namely, conventional bipolar group and LigaSure group. Patients with a history of ≥3 laparotomies, uterine size >20 weeks were excluded. Total laparoscopic hysterectomy with bilateral salpingectomy/salpingo oophorectomy was done in all the patients and endpoints were evaluated.Results:All the recruited participants (n = 120) achieved study endpoints. There was statistically significant difference in the meantime to dissect adnexal ligaments, primary and total operating time (for adnexal ligaments: Conventional bipolar-9.44 min vs. LigaSure-7.05 min; P = 0.000) (Primary: Conventional bipolar-97.03 min vs. LigaSure 74.39 min; P = 0.000) (Total: 142.5 min vs. 136.37 min P = 0.002). Mean blood loss (145 ml vs. 141.67 ml; P = 0.846), mean reduction in hemoglobin (0.802 versus 0.752; P = 0.484) and duration of postoperative stay (2.54 days vs. 2.32 days; P = 0.128) were comparable (P > 0.05). None of the participants suffered from any major complication during the surgery or in the postoperative recovery period.Conclusion:With an ability to effectively reduce operating time, LigaSure is a safe and efficient instrument for laparoscopic hysterectomy.

Effects of Estrogen Replacement Therapy on Uterine Size in Girls with Turner Syndrome

Background: More than 95% of girls with Turner Syndrome (TS) will eventually experience premature ovarian insufficiency, and many will require early hormone replacement therapy (HRT) to initiate puberty, develop secondary sex characteristics, and optimize uterine size. However, limited data exist on the effects of estrogen replacement on achieving mature uterine size, which is important in improving obstetric and gynecologic care for this population. The objectives of the current study are to evaluate the effects of HRT on uterine size in girls with TS.

Oral Versus Transdermal Estrogen for Uterine Maturation in Girls with Turner Syndrome

Background: Turner syndrome (TS) is a genetic disorder caused by the absence of a part or whole X-chromosome with an estimated prevalence of 25-50/100,000 females. The predominant gynecologic manifestation of TS is primary ovarian insufficiency (POI) and inadequate development of secondary sexual characteristics and uterine size. Although uterine growth to allow for future spontaneous pregnancy or embryo transfer is an important goal of care for girls with TS, the optimal method of estrogen delivery and dosing for uterine maturation is unknown.

Evaluation of the efficiency of treatment in girls with central precocious puberty/rapidly progressive puberty via ultrasonography

Introduction: Central precocious puberty (CPP) is defined as the development of secondary sexual characteristics in girls before the age of 8 years due to the activation of the hypothalamus-pituitary-gonadal (HPG) axis, and long-acting GnRH analogues (GnRHa) are used in its standard treatment. The gold standard method for evaluating the efficiency of treatment is to demonstrate the suppression of the LH response with the GnRH stimulation test. Pelvic ultrasonography (US) is an easily accessible, safe, free of ionizing radiation and non-invasive imaging method, which is used for the evaluation of internal genital organs, monitoring of sexual development, and excluding ovarian mass. This study aimed to evaluate the effect of GnRHa treatment on internal genital organs and to determine the role of pelvic ultrasonography in treatment follow-up. &#x0D; Material and Method: Between January 2017 and May 2021, 50 girls who were started on GnRHa treatment due to the diagnosis of CPP or rapidly progressing puberty were followed up, and who underwent pelvic US imaging at the beginning of treatment and in the 1st year of treatment were included in the study. The clinical and sonographic findings were compared before and after the treatment.&#x0D; Results: Of the 50 patients in the study, 52% (n=26) were being followed up with CPP, and 48% (n=24) with rapidly progressive puberty. In the first year of GnRHa treatment, while the suppression of the HPG axis was detected in 82% (n=41) of the cases with the GnRHa test, there was no suppression in 18% (n=9). A decrease in ovarian volume was observed in 73.2% (n=30) of 41 patients with suppression of the HPG axis, a decrease in uterine volume in 65.9% (n=27), and a decrease in uterine anterior-posterior size in 61% (n=25). While endometrial thickness could be measured in 64% (n=32) of the cases before treatment, measurable endometrial thickness was detected in only 6% (n=3) of the cases in the 1st year of treatment. &#x0D; Conclusion: We detected in this study that GnRHa treatment in girls with a diagnosis of CPP/rapid puberty caused a significant regression in ovarian and uterus dimensions and endometrial echo selectability. Our results, in line with the literature, support that pelvic ultrasonography is an appropriate modality for monitoring the suppression of the HPG axis during CPP treatment and may reduce the need for repeated GnRH stimulation tests.

SONOGRAPHIC MEASUREMENT OF NORMAL UTERINE DIMENSION IN NULLIPAROUS ADULTS

Background: Normal uterine size determination of nulliparous women is very important for the diagnosis of the various uterine pathology. There are different pathologies of uterus but before describing the pathological aspects normal dimension has to be defined. Ultrasound is the first tool for scanning female pelvis pathology. The objective of the study is determining the normal uterine dimension in the nulliparous adults and correlate with the age, height, weight and BMI. Methods: The study was conducted in Department of Radiology and Imaging College of medical sciences, Bharatpur. Patient presenting with any other symptoms than pelvic cause are included in study with age group (15-25years). All ultrasound examinations were performed using Toshiba Aplio 500. A cross-sectional study is conducted among the 49 patients in College of Medical Sciences, Bharatpur, over the period of one year (November 2020 to October 2021). Results: Present study showed the mean length, AP diameter, width and volume of the uterus in nulliparous women between the ages of 15-25years. The mean length is 6.88±0.75cm, mean AP diameter is 3.89±0.44cm, mean width is 4.2±0.50 and mean volume is 61.41±16.96 cc. The present study showed the strong correlation between the weight of the patient and uterine dimension, however there is no significant correlation could be established between the age, height and body mass index of the patients with volume uterine dimension. Conclusions: Normal uterine dimension in Nepalese population is similar to the Nigerian, Scandinavian and Iranian population however the dimensions are smaller than the European population which may be due to the body habitus and genetic factors. There is significant correlation between the weight of patient and volume of the uterus.

Total laparoscopic hysterectomy in patients with deep endometriosis: Different technical and postoperative considerations, in comparison with a procedure performed for other benign indications

ObjectiveTotal laparoscopic hysterectomy (TLH) may be indicated in patients with deep infiltrative endometriosis (DIE) to treat severe chronic pelvic pain symptoms, recurrences, or co-existing uterine disease. This study discusses the challenges and specific operative and postoperative considerations in patients submitted to TLH and excision of DIE, in comparison with those undergoing a procedure for other benign indications. Materials and methodsPatients undergoing TLH and excision of DIE were included (N = 18, group 1). These were matched with cases, treated with TLH for other benign indications during the same period (2010–2019), at a 2:1 ratio (N = 36, group 2). The two groups were compared with regards to their characteristics, and intraoperative and postoperative data, including operative time, estimated blood loss (EBL), hospital stays, and rates of complications. ResultsIn group 1, median DIE nodule size was 2.5 cm (range: 1.3–4.2). Simple hysterectomy was performed in 10, and a more extended procedure in 8 cases. All nodules were removed from the bowel wall using the shaving technique. Average EBL was significantly higher (p = .027), and duration of surgery and hospital stays longer (p = .003, and p = .0001, respectively), in group 1 vs. group 2. The rates of long-term (L-T) complications were higher in group 1 but not to a significant level (p = .087). Analysis within the DIE group showed that operative time was significantly related to nodule size, type of hysterectomy (p = .021), presence of adenomyosis (p = .041), uterine size ≥12weeks (p = .039), and the occurrence of L-T complications (p = .016). Increasing nodule size and an extended procedure (p = .005) increased significantly the EBL, which had also a significant effect on the risk of L-T complications (p = .006). ConclusionsTLH in DIE patients is a different, complex and potentially more dangerous procedure compared with TLH for other benign indications. Thorough knowledge of retroperitoneal anatomy, a clear operative plan, and excellent laparoscopic skills are necessary for concomitant radical excision of lesions, with low rates of adverse events.

Abdominal hysterectomy versus total laparoscopic hysterectomy in cases of enlarged uterine size

Background: Total laparoscopic hysterectomy (TLH) is a feasible, efficient way to manage benign uterine pathology, and is better than standard abdominal hysterectomy as it offers less postoperative discomfort, shorter hospitalization, rapid recovery, and early return to daily living activities.Methods: A retrospective comparative cohort study was done on patients with abnormal uterine bleeding due to large myomas in the Department of Obstetrics and Gynecology, Tanta University Hospital, Tanta, Egypt, and Institute of Obstetrics and Gynecology, Cagliari University, Cagliari, Italy. Participants were classified into two groups. Group I (Laparoscopy group) included 20 patients for whom TLH was done. Group II (Laparotomy group) included 20 patients for whom open hysterectomy (OH) was done.Results: Our result revealed that statistically significant differences were observed between the studied groups in post-operative Hb value, postoperative return of bowel sounds, and amount of blood loss however, prolonged duration of surgery was noticed in laparoscopic group than laparotomy group.Conclusions: TLH is an accessible technique and an alternative to laparotomy when it was done by experienced surgeons for large uteri regardless of the site, size.

The risk of venous thromboembolism in patients with and without leiomyomas undergoing hysterectomy

Leiomyomas occur in 80% of women and can require hysterectomy for management. The risk for venous thromboembolism (VTE) is 0.7% for any hysterectomy. However, it has been theorized that large uterine size due to fibroids increases VTE risk due to pelvic vasculature compression. The objective of this study is to evaluate if the risk of VTE of women undergoing surgeries for fibroid-related indications is different compared to women undergoing hysterectomy for non-fibroid-related indications. We also aimed to determine the preexisting incidence of VTE between the groups and identify risk factors for VTE. Patients who underwent hysterectomy by any route at an academic center between January 2019-December 2019 were included. Demographic, pathology, and VTE diagnosis data were assessed. Preoperative VTE occurred prior to surgery. Perioperative VTE occurred within 6 weeks of surgery. Patients with malignancy and known thrombophilias were excluded. A total of 1,029 patients were included, of which 687 patients had fibroids and 342 had none. Patients with fibroids were likely to be older, have higher BMI, larger uterine size, and greater EBL (p<0.05). Of the total cohort, 22 patients (2.1%) had VTE, of which 19 (1.8%) were preexisting, and 3 (0.2%) occurred peri-operatively. Ten of the 22 patients (45%) with preexisting VTE had fibroids; none of whom developed perioperative VTE. The presence of fibroids did not increase the odds of perioperative VTE (OR 0.2, CI [0.02-2.7]). Those with preexisting VTE were more likely to have increased BMI, Charlson Comorbidity Index (CCI), postoperative length of stay, and ASA risk score (P<0.05). In both univariate analysis and logistic model, both fibroids and total uterine size were not associated with preexisting VTE (univariate p= 0.18, p=0.50; logistic model p=0.08, p=0.17 respectively). Higher BMI and ASA score of 3-4 are associated with higher odds of preexisting VTE (1 unit increase of BMI OR 1.06, CI [1.0-1.1]; OR 3.6 [1.4-9.3]). However, specifically in patients with fibroids, only ASA score of 3-4 is associated with higher odds of preexisting VTE (OR 4.2, CI 1.2-15.1). Patients undergoing hysterectomy for fibroid-related indications are not at increased risk for VTE compared to patients undergoing surgery for non-fibroid-related indications. Preexisting VTE in patients with fibroids did not increase the risk for perioperative VTE. Overall, for patients with fibroids, higher ASA scores are associated with VTE event.

The Role of FIGO PALM-COEIN Classification of the Underlying Causes of Abnormal Uterine Bleeding and Clinicopathological Correlation of Patients Undergoing Hysterectomy in a Tertiary Care Referral Center of Western Rajasthan.

The International Federation of Gynaecology and Obstetrics working group on menstrual disorders has developed a classification system (PALM-COEIN) for causes of the AUB in non-gravid women. The present study was conducted with the aim to study the two components of this system in clinical practice in general and establish a clinicopathological correlation of AUB with the context of the PALM component in particular. The data of 158 patients who underwent hysterectomy for abnormal uterine bleeding in 1 year at the tertiary care Centre of western Rajasthan was collected from old case records and analysed. The patients were initially worked up in the outpatient department with the history and clinical examination, followed by transabdominal or transvaginal ultrasonography depending on the uterine size and the pathology. The patients requiring more detailed pictures were advised computed tomography (CT) scan. All the patients were screened for common medical disorders like thyroid disorders, prolactin levels, and blood sugar levels. Thereafter an endometrial biopsy and liquid-based cytology were done for all the patients to rule out malignancy. The relative contribution of various causes of PALM (structural) and COEIN (functional) components and clinicopathological correlation was analysed. PALM and COEIN components contributed almost equally for AUB when assessed clinically. On the other hand, the histological examination revealed significantly more cases of PALM (structural or anatomical) component of AUB, i.e., 17.2% versus 82.8 %. AUB-L was the commonest (41.1 %) aetiology overall. The PALM-COEIN classification system should consider both the clinical and histopathological diagnoses in women having AUB. It is concluded that the most common cause of AUB is leiomyoma and the most common age group undergoing hysterectomy is the 4th decade. Although the medical treatment options are there, patients of premenopausal age require hysterectomy who do not benefit from medical regimens.