Uterine Sutures Research Articles

Uterine preservation with Alcides-Pereira’s compressive sutures for postpartum uterine atony

IntroductionPostpartum hemorrhage (PPH) is mostly caused by uterine atony and is the leading cause of maternal death. Hysterectomy may be necessary in severe cases, but uterine compressive sutures are an uterine-sparing alternative. In 2005, Alcides Pereira proposed a technique with serial superficial stiches around the uterus. To date, there were no further reports on its clinical use. ObjectiveTo evaluate a tertiary center’s experience with Alcides-Pereira’s compressive uterine sutures for severe PPH due to uterine atony, reviewing its efficacy, morbidity, and impact on reproductive outcomes. Study DesignAn 11-year retrospective cohort study of Alcides-Pereira’s sutures for PPH at a single tertiary hospital. Demographic and obstetric data were collected. Details of subsequent pregnancies and fertility plans were collected through a telephonic interview. Comparison between women in which the sutures were effective and ineffective to prevent hysterectomy was made. ResultsAlcides-Pereira’s sutures were applied in 23 patients with PPH due to uterine atony. The technique was successful in controlling the hemorrhage and avoiding hysterectomy in 20 patients (87%). When successful, the sutures avoided the need for any blood therapy in 55% (RR 0.45, 95% CI 0.28–0.73) of patients, intensive care unit admission in 80% (RR 0.2, 95% CI 0.08–0.48) and significantly shortened the length of hospital stay. All patients with preserved uterus resumed their usual menstrual pattern. One had a subsequent term vaginal delivery; one had three first trimester miscarriages. All other patients did not try to conceive. ConclusionAlcides-Pereira’s sutures are a feasible, uterine-sparing technique, providing an effective and safe option for PPH.

Transumbilical single-site laparoscopic parallel mattress suturing prevents bleeding and chronic pelvic pain in myomectomy: a retrospective cohort study of 124 cases with intramural fibroids

BackgroundThe most common complications of myomectomy are intraoperative hemorrhage and postoperative adhesion. The key point to overcome this problem is to improve suture quality. However, to date, there is still no consensus on the optimal method of uterine repair. In this study, we explored the effectiveness and feasibility of single-site laparoscopic parallel mattress sutures to reduce intraoperative bleeding and postoperative adhesion.MethodsA retrospective cohort analysis was performed, according to the STROBE guidelines, on 124 patients with intramural fibroids admitted between May 2020 and April 2021. The cases were divided into two groups based on the description of the uterine incision suture in the surgical records, including 68 cases in the parallel mattress suture (PMS) group and 56 cases in the simple continuous suture (SCS) group. Operation-related indicators, bleeding indicators, surgical complications, scar reduction index 1 month after surgery, and the incidence of chronic pelvic pain 6 months after the surgery were observed. Independent sample t-tests and Mann–Whitney U tests were performed for the measurement data, and Pearson Chi-square tests were performed for count data. Statistical significance was set at P < 0.05.ResultsThere was no significant difference in the baseline characteristics between the two groups. All operations were performed under transumbilical single-site laparoscopy without conversion. Compared to the SCS group, the PMS group had earlier postoperative anal exhaust (14.3 ± 6.7 h vs. 19.2 ± 9.6 h, P = 0.002), fewer postoperative hemoglobin drops (7.6 ± 3.7 g/L vs. 11.6 ± 4.3 g/L, P = 0.000), smaller uterine scars (3.7 ± 1.9 cm vs. 5.2 ± 1.8 cm, P = 0.000), and a larger uterine scar reduction index (50.2% vs. 31.0%, P = 0.000) one month after surgery and less chronic pelvic pain 6 months after surgery (2.9% vs. 12.5%, P = 0.016). No difference was found in auxiliary trocar usage, transfusion rate, operation time, hospital stay, or perioperative complications between the two groups.ConclusionSeromuscular parallel mattress sutures during myomectomy can prevent pinhole errhysis of the uterine incision, achieve complete serosal and aesthetic incisions, and reduce postoperative chronic pelvic pain. It is effective and feasible to complete a parallel mattress suture during myomectomy via single-site laparoscopy. Further prospective studies are required to determine its efficacy as well as pregnancy outcomes.

Comparative analysis of classical primary continuous and novel technique uterine suturing methods on uterine scar formation after caesarian section: a prospective clinical study.

The study investigated isthmocele rate, residual myometrium thickness, blood loss, and closure lengths through comparing the classical primary continuous suturing (CPCS) and novel technique uterine suturing (NTUS) after caesarian section. A total of 402 C/S patients were included in this single-center prospective clinical study. All patients were divided into two groups according to suture technique. Classical primary continuous suturing (CPCS) was applied to the patients in Group 1, while the novel technique uterine suturing (NTUS) was applied in Group 2 as Z suture on both corners and 8 sutures in the remaining middle part incision closure. Patients in the NTUS group bled less than in the CPCS groups (p < 0.0001). Incision length after closure was longer in the CPCS than in the NTUS (p < 0.0001). Similarly, the number of sutures we applied was higher in the CPCS (p < 0.0001). In comparison of residual myometrium thickness, the mean values measured 197 ± 50 mm in the NTUS and 146 ± 39 mm in the CPCS (p < 0.0001). Residual myometrium thickness showed a negative strong correlation with incision length after closure (r = -0.436; p < 0.0001), how many times the needles have been passed (r = -0.423; p < 0.0001) and time for suturing (r = -0.237; p < 0.0001). NTUS and CPCS groups were similar in comparison to isthmocele. The NTUS, termed as Erkayiran's suture, showed a successful reflection in our surgical cesarean section application compared to the classical suture. Although the occurrence of isthmocele in patients was similar, results were quite successful operationally in terms of both minimal blood loss and increased residual myometrium thickness.

Double-layered purse string uterine suture compared with single-layer continuous uterine suture: A randomized Controlled trial

BackgroundWith the aim of preventing cesarean scar defects, we introduced a new technique involving a purse string uterine suture. To date, this uterine suture technique has not been formally evaluated. The objective of the study was to test the hypothesis that compared to single layer continuous uterine suture (SLCUS), a double layered purse string uterine suture (PSUS) significantly reduces cesarean scar defect (CSD) rates, without increasing the perioperative maternal morbidity. MethodsA prospective randomized study. Primary outcome was the rate of CSD. 100 patients were enrolled in 2 groups according to the uterine suture technique. A hysterosonography was performed by the same senior obstetrician blinded to the uterine suture technique 6 months after surgery .Operative time and calculated blood loss (CBL) were used for the short time analysis. Uterine and CSD measurements were used for the mid time analysis. ResultsDespite a longer operative time with PSUS (7.17 ± 2.31 min Vs. 6.31 ± 3.04 min, p = 0.028; p <10‾³); there was no significant difference in terms of CBL (520 ± 58 with PSUS vs. 536 ± 50 ml, p = 0.724). There was a significant decrease in the rate of CSD with PSUS: 6.66% Vs.40% with SLUCS; p<0.001. Moreover, SLUCS was the leading risk factor for CSD: adjusted OR=6; 95% CI [0–1], p<10‾³). ConclusionCompared to single layer continuous suture, double layered purse stringuterine suture significantly reduces cesarean scar defect rates, without increasing the perioperative maternal morbidity.

Ultrasound and magnetic resonance imaging in the diagnosis of clinically significant placenta accreta spectrum disorders

We aimed to assess the performance of ultrasound (US) and magnetic resonance imaging (MRI) signs for antenatal detection of placenta accreta spectrum (PAS) disorders in women with placenta previa (placental edge≤2cm from the internal uterine orifice,≥260/7 weeks' gestation) with and without a history of previous Caesarean section. Single center prospective observational study. US suspicion of PAS was raised in the presence of obliteration of the hypoechoic space between uterus and placenta, interruption of the hyperechoic uterine-bladder interface and/or turbulent placental lacunae on color Doppler. All MRI studies were blindly evaluated by a single operator. PAS was defined as clinically significant when histopathological diagnosis was associated with at least one of: intrauterine balloon placement, compressive uterine sutures, peripartum hysterectomy, uterine or hypogastric artery ligature, uterine artery embolization. A total of 39 women were included: 7/39 had clinically significant PAS. There were 6/18 cases of PAS with anterior placenta: hypoechoic space interruption and placental lacunae were the most sensitive sonographic signs (83%), while abnormal hyperechoic interface was the most specific (83%). On MRI, focal myometrial interruption and T2 intraplacental dark bands showed the best sensitivity (83%), bladder tenting had the best specificity (100%). 1/21 women with posterior placenta had PAS. There was substantial agreement between US and MRI in patients with anterior placenta (κ=0.78). US and MRI agreement in antenatal diagnosis of clinically significant PAS was maximal in high-risk women. Placental lacunae on ultrasound scan and T2 intraplacental hypointense bands on MRI should trigger the suspicion of PAS.

Use of compressive sutures in the control of obstetric hemorrhage as a conservative measure of the uterus, in naval medical center, from june 2017 to December 2020

Objective: To describe the results obtained in the use of compression sutures in the control of obstetric hemorrhage as an alternative measure that conserves the uterus. Materials and methods: Observational, cross-sectional, descriptive, and retrospective, carried out at the Naval Medical Center in Mexico City, from June 2017 to December 2020. Patients with a diagnosis of postpartum obstetric hemorrhage were included. In which advanced surgical techniques were applied, such as compression sutures with the Hayman and B-Lynch technique. The variables of 1) Amount of bleeding before and after applying the compression suture, 2) Procedure time, 3) Hemoglobin concentration on admission to the care unit, 1 hour after the bleeding and 24 hours after the procedure were analyzed. surgical intervention, 4) outcome of the techniques, 5) complications. SPSS version 22 was used for data analysis. Results: 72 patients were registered: 46 patients with application of the Hayman technique and 26 patients with the B Lynch technique. Blood loss after the application of the techniques was lower (p&lt;0.001). The surgical time in the application of compression sutures was 85.8±17.6 minutes. The concentration at hospital admission and 1 hour after bleeding was significantly lower (p&lt;0.01) versus 24 hours later (p&lt;0.05). Among the causes of obstetric hemorrhage, we found uterine atony with 59 patients (81.94%), bleeding at the placental insertion site 8 (11.11%) and placenta previa 5 (6.94%). No maternal deaths associated with suturing techniques were reported. Conclusion: Uterine suture techniques represent a useful, fast and uncomplicated procedure for the control of obstetric hemorrhage and a uterine- conserving measure.

Study on the application of King\u2019s combined uterine suture for hemostasis during cesarean section

IntroductionPostpartum hemorrhage is a serious complication of childbirth and is still the leading cause of maternal death worldwide. Lower uterine segment hemorrhage during cesarean section is an important cause of postpartum hemorrhage. Our objective is to expore the efficacy and safety of King’s combined uterine suture for hemostasis during cesarean section.MethodsWe examined 48 cases: 16 cases of pernicious placenta previa (including one case of twins), 11 cases of central placenta previa (including one case of twins), 18 cases of uterine scarring (including two cases of twins), as well as one case of twin pregnancy, two cases of breech presentation, and one case of pulmonary hypertension. The “King’s combined uterine suture” method for hemostasis was used in patients with lower uterine segment hemorrhage during cesarean section.ResultsThe results showed that all patients had successful hemostasis during surgery, and there were no cases of hysterectomy.ConclusionWe have concluded that King’s combined uterine suture is a fast and safe hemostasis method for cesarean section that can effectively reduce blood loss and restore the normal shape of the lower uterine segment. Furthermore, this suture method can reduce postpartum hemorrhage and hysterectomy rate, as well as improve maternal prognosis.

Laparoscopic Myomectomy Assisted by Hysteroscopy: A Case Report

Study Objective To demonstrate the benefits of laparoscopic myomectomy assisted by hysteroscopy to minimize endometrium damage, therefore providing a better fertility outcome. Design Case report for surgical technique and description of the procedure using video. Setting Tertiary hospital. Patients or Participants A 30-year-old nulliparous woman presents with abnormal uterine bleeding and pelvic pain for a year and a half. She previously tried clinical treatment with Tranexamic Acid and Oral Progesterone without symptoms remission. In the physical examination there weren't any irregular findings. The MRI evidenced multiple nodular formations: a 2 cm submucous fibroid on the fundus with cavity distortion and 8mm of myometrial free margin and others intramural and subserous fibroids measuring up to 1.7cm. Interventions We performed a diagnostic hysteroscopy to locate the submucous fibroid and used the hysteroscope's pressure and light to guide de surgeon on the laparoscopy towards that fibroid. We did a vertical incision and proceeded to enucleate the fibroid. We also excised other subserous and intramural nodules along the surgery. Uterine suture was done with a 2-0 barbed suture in two layers. We finished the procedure with another diagnostic hysteroscopy to evaluate endometrium damage. Measurements and Main Results In the final hysteroscopy we could see little endometrium damage. The patient was discharged on the first postoperative day without significant pain. Conclusion We were able to achieve minimal endometrium damage in a Type 2 FIGO staging fibroid, which would not be possible if we had performed a hysteroscopic myomectomy. On the other hand, if we had done only a laparoscopic procedure, we would have had a significant higher degree of difficulty at finding the fibroid due to its deep placement. Therefore, we reached a favorable outcome regarding the surgical approach in resecting a submucous fibroid in a patient with intention of childbearing. To demonstrate the benefits of laparoscopic myomectomy assisted by hysteroscopy to minimize endometrium damage, therefore providing a better fertility outcome. Case report for surgical technique and description of the procedure using video. Tertiary hospital. A 30-year-old nulliparous woman presents with abnormal uterine bleeding and pelvic pain for a year and a half. She previously tried clinical treatment with Tranexamic Acid and Oral Progesterone without symptoms remission. In the physical examination there weren't any irregular findings. The MRI evidenced multiple nodular formations: a 2 cm submucous fibroid on the fundus with cavity distortion and 8mm of myometrial free margin and others intramural and subserous fibroids measuring up to 1.7cm. We performed a diagnostic hysteroscopy to locate the submucous fibroid and used the hysteroscope's pressure and light to guide de surgeon on the laparoscopy towards that fibroid. We did a vertical incision and proceeded to enucleate the fibroid. We also excised other subserous and intramural nodules along the surgery. Uterine suture was done with a 2-0 barbed suture in two layers. We finished the procedure with another diagnostic hysteroscopy to evaluate endometrium damage. In the final hysteroscopy we could see little endometrium damage. The patient was discharged on the first postoperative day without significant pain. We were able to achieve minimal endometrium damage in a Type 2 FIGO staging fibroid, which would not be possible if we had performed a hysteroscopic myomectomy. On the other hand, if we had done only a laparoscopic procedure, we would have had a significant higher degree of difficulty at finding the fibroid due to its deep placement. Therefore, we reached a favorable outcome regarding the surgical approach in resecting a submucous fibroid in a patient with intention of childbearing.

VP45.03: Double‐layered purse string uterine suture after a Caesarean section technique: an ultrasound randomised trial

VP45.03: Double‐layered purse string uterine suture after a Caesarean section technique: an ultrasound randomised trial

Беременность после повторного оперативного родоразрешения у женщины, имевшей в анамнезе реконструктивно-пластическую операцию по поводу несостоятельности швов на матке на восьмые сутки после операции кесарева сечения

Беременность после повторного оперативного родоразрешения у женщины, имевшей в анамнезе реконструктивно-пластическую операцию по поводу несостоятельности швов на матке на восьмые сутки после операции кесарева сечения

The Spiral Trial: A multicenter, randomized, controlled trial of Spiral thread sutures versus conventional thread sutures to prevent thinning of uterine scars following elective cesarean section

BackgroundThe aim of this randomized controlled trial (RCT) is to investigate whether Spiral-thread sutures are superior to conventional sutures (0-Vicryl) for preventing uterine scar thinning following elective cesarean section. MethodsThis multicenter, parallel-group RCT will be conducted in four hospitals across three medical regions in Japan to assess 200 women (≥20 years old) with singleton pregnancies who are scheduled to undergo cesarean sections. Eligible women will be randomly assigned (1:1 ratio) to receive either the conventional uterine suture continuous absorption thread, which is most commonly used in Japan, or the Spiral thread. The primary endpoint is the degree of scar thinning, measured by transvaginal ultrasonography 6–7 months postoperatively, to evaluate the position of the uterus (anterior or posterior tilt) and myometrial wound thickness. The degree of thinning will be compared between the groups, and four measurements (mm) of the thinning area, including caudal distance, depth of the depression, remaining thickness of the myometrium on the serous side of the most depressed area, and width of the depression, will be recorded in the sagittal view on transvaginal ultrasound. Secondary endpoints will include total operative time, suture application time (from birth to the end of uterine suturing), operative blood loss, number of additional Z-sutures or continuous sutures required to stop bleeding, maternal abnormality frequency (surgical complications and postoperative infections), surgeon's years of experience, and clinical interpretation of individual subscale scores. DiscussionThis study shall provide important evidence on the optimal suture for preventing hysterotomy wound thinning after the first cesarean section. Trial registrationNational Institute of Public Health, Japan: jRCT1062200001 (May 7, 2020; https://rctportal.niph.go.jp/en/detail?trial_id=jRCT1062200001) and Okayama University Certified Review Board: CRB6180001 (April 9, 2020, version 3.0).

The impact of previous cesarean section on the outcome of patients with non-adherent placenta previa

ObjectiveTo evaluate the impact of previous lower segment cesarean section on maternal and fetal outcomes of patients with non-adherent placenta previaMethodsThis is a retrospective study of all patients who delivered at a tertiary referral university hospital by lower uterine cesarean section with non-adherent placenta previa, over a 10-year period. Data were obtained through hospital registry and medical records. The differences in demographic, obstetric characteristics, peripartum complications, and fetal outcome between patients with no previous cesarean and those with previous cesarean section were analyzed.ResultsNinety patients with non-adherent placenta previa were included, 54 patients with no previous cesarean and 36 patients with previous cesarean section. Patients with previous cesarean section were significantly more likely to incur inadvertent organ injury, transfusion of 4 or more units of packed red blood cells, transfusion of fresh frozen plasma, uterine brace compressive sutures, uterine artery ligation, and peripartum hysterectomy.ConclusionThere is a significant increase in the incidence of inadvertent neighboring viscus injury, transfusion of 4 units or more of packed red blood cells, transfusion of fresh frozen plasma, uterine brace compressive sutures, uterine artery ligation, and peripartum hysterectomy in patients with non-adherent placenta previa and previous cesarean section, compared to those with non-adherent placenta previa and no previous history of cesarean section, with no difference in perinatal outcome.

The value of the portable fibrinogen measuring device\u2014a case report of severe postpartum hemorrhage with obstetric disseminated intravascular coagulation

BackgroundFibrinogen concentration is an important indicator of the treatment for obstetric disseminated intravascular coagulation (DIC). We present how using the fibrinogen measuring device could solve problems in the treatment of postpartum hemorrhage with complicated DIC.Case presentationA 32-year-old woman with monochorionic diamniotic twins at 22 weeks of pregnancy was diagnosed with placental abruption and underwent emergent cesarean section. The estimated blood loss was 8375 g. She was transferred to our hospital for further treatment. Compressive uterine sutures and balloon tamponade were performed. We transfused fibrinogen and fresh frozen plasma actively during the operation to maintain plasma fibrinogen above 200 mg/dL by using a point-of-care fibrinogen measuring device. In spite of massive hemorrhage exceeding 10 L, she was extubated at the end of the operation and discharged on the 7th day after the operation.ConclusionThe portable fibrinogen measuring device was useful for point-of-care assessment of obstetric DIC.

421 Hysteroscopic evaluation of the uterine cavity after conservative surgical management of placenta previa

To assess the consequences of different conservative surgical techniques used for management of intraoperative hemorrhage due to placenta previa through hysteroscopic evaluation of the uterine cavity. A cross sectional study encompassing all women managed by conservative surgical techniques during cesarean section after intraoperative hemorrhage due to placenta previa. The The study conducted in tertiary university between January 2017 and December 2018. All women were counseled for inclusion in the study before delivery during the preoperative counseling about the consequences of placenta previa. Patients who were managed by conservative surgical techniques were followed up till hospital discharge then they were contacted by phone calls for scheduled follow-up after 3 months. Office hysteroscopy for uterine cavity evaluation was done by expert gynecologist in the proliferative phase of the menstrual cycle if menses were resumed. Forty-seven women were included in the study; 14 (29.8%) were managed by compression uterine sutures, 7 (14.9%) were managed by bilateral uterine ligation only and 26 (55.3%) were managed by both of them. Regarding menses resumption, 22 (46.8%) still had amenorrhea, 13 (27.7%) had regular menses, and 12 (25.5%) had irregular menses. Hysteroscopic evaluation of the uterine cavity revealed normal cervical canal and uterine cavity with no adhesions in all cases Conservative surgical techniques for management of placenta previa had no late consequences on the uterine cavity and subsequent fertility.

Miomektomija tokom carskog reza

Myomas (fibroids, leiomyomas) are the most common benign tumors of genital organs in women of reproductive age and represent a significant problem in women's health care. The frequency of cesarean section is higher in women with uterine fibroids. Absolute indications for myomectomy during caesarean section are: fibroids that prevent hysterotomy during caesarean section, impede uterine incision suture, hamper safe fetal extraction and cause uterine torsion. Relative indications for myomectomy during caesarean section are: subserous and pedunculated fibroids, anterior uterine wall fibroids, fibroids that can cause immediate perioperative, and puerperal complications, the patient's desire, fibroids that can cause complications in subsequent pregnancies, and fibroids that can be enucleated without additional hysterotomy. Myomectomy during caesarean section is a complex surgical procedure, associated with the possibility of considerable complications, and defining their actual frequency and risk factors for their occurrence requires further research. Myomectomy during caesarean section is associated with an increased risk of perioperative bleeding. Other perioperative complications of myomectomy during cesarean section are: disseminated intravascular coagulation, paralytic ileus, surgical site infections, sepsis, postoperative febrile morbidity, increased incidence of blood transfusions, and prolonged hospitalization.

Hydrosonographic Assessment of the Effect of Two Different Suture Materials on Healing of the Uterine Scar after Cesarean Delivery: A Prospective Randomized Controlled Trial.

This study aimed to compare the effects of two different suture materials, monofilament synthetic absorbable sutures versus multifilament synthetic absorbable sutures, on healing the uterine scar after a cesarean delivery. A total of 95 women between the ages of 18 and 40 who had undergone a primary cesarean section (CS) after the 38th week of gestation. In Group I (n=48), continuous double-layer unlocked closure of the low transverse uterine incision was performed using monofilament synthetic absorbable sutures. In Group II (n=47), continuous double-layer unlocked closure of the low transverse uterine incision was performed using multifilament synthetic absorbable sutures. Six months after the operation, the integrity of the cesarean scar at the uterine incision site was assessed using hydrosonography. The healing ratio and the thickness of the residual myometrium covering the defect were calculated as markers of uterine scar healing. No statistically significant differences were observed between the groups with regard to the preoperative hemoglobin concentrations, the change in the hemoglobin concentrations, operating time, and the number of intraoperative additional hemostatic uterine sutures. Mean thickness of the residual myometrium covering the defect was thicker in the monofilament suture group in comparison to the multifilament suture group (7.76±2.11 vs. 5.96±1.69, respectively; p<0.01). The mean healing ratio was significantly higher in the monofilament suture group in comparison to the multifilament suture group (0.76±0.13 vs. 0.60±0.12, respectively; p<0.01) CONCLUSION: Continuous double-layer unlocked closure of the uterine incision at cesarean delivery using monofilament synthetic absorbable sutures decreases the risk of CS scar defect.

The niche in the uterine cesarean scar: a new problem of women’s reproductive health

Hypothesis/aims of study. In the recent decades, the quality of uterine suture repair after a cesarean section is widely discussed, as local thinning of the myometrium forming uterine scar defects, or the so-called scar niche, are relatively common after the operation. The aim of this study was to identify the causes of local thinning of the uterine scar after cesarean section, to determine the effectiveness of existing methods for assessing the uterine scar in non-pregnant women, and to develop a method for surgical correction of this pathology.&#x0D; Study design, materials and methods. Over 4 years, 175 non-pregnant women with a uterine scar were examined. The 50 of them were diagnosed with the uterine scar niche, with a laparoscopic metroplasty performed in these patients. The effectiveness of the operation was evaluated in the long-term postoperative period.&#x0D; Results. Performing cesarean section because of weakness of labor activity and a complicated course of the postpartum period are significant factors in the formation of a uterine scar niche (p 0.05). Ultrasound examination and magnetic resonance imaging of the pelvic organs can be used to detect local thinning of the myometrium with a sensitivity of 82% and 96%, and a specificity of 85% and 90%, respectively.&#x0D; Conclusion. Metroplasty for patients with a diagnosed scar niche can significantly increase the thickness of the myometrium (p 0.05) and reduce the frequency of complaints of such menstrual irregularities as postmenstrual vaginal bleeding, dysmenorrhea, and hypermenorrhea (p 0.05).

The objective: to optimize the treatment of children with the combined course of chronic gastroduodenitis (CGD) and primary arterial hypertension (PH) against the backdrop of hypomagnesemia by including the combined preparation of magnesium and vitamin В6 in the treatment regimen. Materials and methods. We examined 20 children aged 10 to 17 years with a combined course of CGD and PH

Uterine fibroids are the most common benign tumors of the female genital tract and are associated with numerous clinical problems. Laparoscopic myomectomy is an absolute altermative to standard open surgical technique with comparable long-term results. Due to the wide use and improvement of operational techniques with laparoscopic access, the pressing issue is possibility of its use in women, who have leiomyomas of the uterus and reрroductive intentions. The attitude to the quality of endoscopic suturing of the uterus after the enucliation of the knot and capability of suture during the next pregnancy is controversial. The technical aspects of suture of uterine incisions and also experience and skill of a surgeon during myomectomy deserves special attention. Uterine ruptures during the pregnancy and delivery are connected with violation of suture techniques – one-row uterine suture is compared with layering, and it’s extremely important for the full recreation of uterine-wall integrity after the removal of leiomyoma; wide use of electrocoagulation, which can lead to burns of myometrium with the further worsening of tissue regeneration.Given the need for an individual approach to each patient with uterine fibroids and reproductive intentions, surgical technique, access, choice of energy and suture are determined by each surgeon depending on the size, localization of uterine fibroids and clinical course to obtain the most effective postoperative result. The article is dedicated to peculiarities of the laparoscopic myomectomy in women of reproductive age. Laparoscopic myomectomy, when performed by an experienced surgeon, can be considered a safe technique with good results in terms of pregnancy outcome. Key words: uterine fibroids, fibroid, myomectomy, laparoscopy, surgical technique.

THE COMPARISON OF OUTCOMES AFTER LAPAROSCOPIC MYOMECTOMY WITH THE USE OF DIFFERENT UTERINE SUTURE TECHNIQUES

Purpose: to improve the outcomes and speed up the recovery after laparoscopic myomectomy in females with uterine leiomyoma, based on the comprehensive study and comparison of different uterine suturing techniques.&#x0D; Material and methods. The study enrolled 130 patients, including 100 females underwent laparoscopic myomectomy. Based on the simple randomization, the sample of 100 surgically treated females was subdivided into two subsamples depending on the applied uterine suturing technique: group I – extracorporeal knotting (n=50); and group II – intracorporeal continuous suturing (n=50). The control group included 30 apparently healthy females (group III). The clinical examination was performed before surgery in the outpatient setting, and in the hospital – after procedure and at the discharge (day 2). We assessed the parameters of myometrium tissue perfusion and the severity of inflammation in the surgical alteration area 1 month before and 1 month following the procedure. The ultrasound signs of myometrium regeneration completeness in the uterine scar area were determine 3 months after surgery. The late outcomes after myomectomy and catamnesis of reproductive function were evaluated at 6-month and 1-year follow-up.&#x0D; Results and discussion. We established that the use of intracorporeal continuous suturing technique in patients underwent laparoscopic myomectomy was favorable for preservation of microcirculatory bed in myometrium, related to a more uniform distribution of suture tension in the tissue and a more even distribution of pressure exerted on the wound edges, as compared to extracorporeal knotting technique. These advantages of intracorporeal continuous suturing technique over the extracorporeal knotting one are useful for the significant reduce of tissue hypoxia and myometrium ischemia in the alteration area. Additionally, this technique is in favor of the physiological programmed suture absorption and the cell-mediated immunity, and associated with the lower risk of necrotic areas formation. In contrast to the intracorporeal continuous suturing technique, the tight and non-uniform extracorporeal knotting is associated with the suppression of staged elimination of blood microclots and other factors of aseptic inflammation in the surgical alteration area.&#x0D; Conclusions. The use of extracorporeal knotting technique had no advantages over the intracorporeal continuous suturing, and, in the majority of cases, was associated with longer duration of procedure, inappropriate blood loss, as well as excessive consumption of suture material. The intracorporeal continuous suturing is the most optimal technique for uterine wound edges approximation, and associated with the positive outcomes regarding the reproductive function (the reproductive function could be realized in 3 months after the use of intracorporeal continuous suturing technique, in contrast to 6 months – after the extracorporeal knotting one), the minimal frequency of complications and favorable economic profile. The laparoscopic myomectomy in case of myoma sized 10 cm and more is associated with the risk of significant uterine wall defect and excessive blood loss, indicating the need for the intracorporeal continuous suturing technique for closing tissue defects in the area of surgical alteration of myometrium.

Less Blood Loss by Earlier Oxytocin Infusion in Cesarean Sections? A Randomized Controlled Trial.

The aim of our study was to evaluate the positive effect of starting an IV oxytocin infusion early before uterine incision on intraoperative blood loss. A total of 101 women between 18-40 years who underwent a primary elective cesarean section (CS) were included in this randomized controlled trial. The patients were divided into two groups. In Group I (n=51), oxytocin infusion was administered immediately after incision of the visceral peritoneum during CS. In Group II (n=50), infusion was administered immediately after clamping the umbilical cord. The primary outcome was the mean volume of blood loss during CS. The secondary outcomes included the mean reduction in hemoglobin and hematocrit levels, need for additional uterotonics and hemostatic uterine sutures, blood transfusion, post-operative pain score, and additional surgical procedures. There were statistical significant differences either in the change of the hemoglobin concentration (1.27±0.75 vs.1.74±0.81; p<0.01) or in the change of hematocrit concentration (3.89±2.24 vs. 5.41±2.93; p<0.01). Intraoperative blood loss was significantly lower in Group I when compared to Group II (475.86±150.11 vs. 605.1±203.2; p<0.01). Our findings suggest that the starting IV oxytocin infusion early before uterine incision reduces intraoperative blood loss. This could be effective to replace starting IV oxytocin infusion late after umbilical cord clamping or delivery of the placenta. Das Ziel unserer Studie war es. die positive Wirkung der beginnenden IV Oxytocin-Infusion früh vor der Uterusinzision auf den intraoperativen Blutverlust zu bewerten. In diese randomisierte kontrollierte Studie wurden insgesamt 101 Frauen zwischen 18 und 40 Jahren eingeschlossen, die sich einem primären elektiven Kaiserschnitt unterzogen hatten. Die Patienten wurden in 2 Gruppen eingeteilt. Gruppe I (n=51); Die Oxytocin-Infusion wurde unmittelbar nach der Inzision des viszeralen Peritoneums während der CS verabreicht. Gruppe II (n=50); Die Infusion wurde unmittelbar nach dem Klemmen der Nabelschnur verabreicht. Das primäre Ergebnis war das mittlere Blutverlustvolumen während der CS. Zu den sekundären Ergebnissen gehörte die mittlere Verringerung der Hämoglobin- und Hämatokritwerte, Bedarf an zusätzlichen Uterotonika und hämostatischen Uterusnähten, Bluttransfusion, postoperativer Schmerzscore und zusätzliche chirurgische Eingriffe. Es gab statistisch signifikante Unterschiede zwischen der Änderung der Hämoglobinkonzentration 1,27±0,75 vs.1,74±0,81; p<0,01) oder der Änderung der Hämatokritkonzentration(3,89±2,24 vs. 5,41±2,93; p<0,01). Der intraoperative Blutverlust war in Gruppe I im Vergleich zu Gruppe II signifikant geringer (475,86±150,11 vs. 605,1±203,2; p<0,01). Unsere Ergebnisse legen nahe, dass die beginnende intravenöse Oxytocin-Infusion früh vor der Uterusinzision den intraoperativen Blutverlust verringert. Dies könnte wirksam sein, um eine beginnende intravenöse Oxytocin-Infusion zu einem späten Zeitpunkt nach dem Klemmen der Nabelschnur oder der Abgabe der Plazenta zu ersetzen.