VIMS Journal: July 2017

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Adhesion barrier use after Myomectomy and hysterectomy: Rates and immediate postoperative complications
Tuland T, Closon F, Czuzoj-Dhulman N, Abenhaim H. Obstet Gynecol 2016;127:23-8.
Earlier small studies had suggested that the use of adhesion barriers following myomectomy and hysterectomy reduces the chance of adhesion formation. In this retrospective study, the investigators used the national database of 62,563 women who underwent myomectomy and 411,225 women who underwent hysterectomy for analyzing the short term complications following use of adhesion barriers. It was observed that the use of adhesion barrier following myomectomy was associated with higher incidence of postoperative fever and ileus and that following hysterectomy was associated with higher incidence of postoperative fever, ileus and bowel obstruction.

Human amniotic fluid : a source of stem cells for possible therapeutic use
Margaret Dziadosz, Ross S Basch, Bruce K Young, March 2016, ajog, volume 214, issue 3, pages 321-327
Stem cells are undifferentiated cells with the capacity for differentiation. Cells retrieved from amniotic fluid are now considered as a possible source of stem cells to be used for clinical purposes. Amniotic fluid cells of human origin proliferate rapidly and are multipotent with the potential for expansion in vitro to multiple cell lines. There are no ethical or sampling constraints for the use of amniocentesis as a standard clinical procedure for obtaining an abundant supply of amniotic fluid cells. Amniotic fluid cells may be of clinical benefit for fetal therapies, degenerative disease, and regenerative medicine applications. The authors presented a comprehensive review of the evolution of human amniotic fluid cells as a possible modality for therapeutic use.

Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial
de Bruijn AM, Ankum WM, Reekers JA, et al. Am J Obstet Gynecol 2016;215:745.e1-12.
Uterine artery embolisation is an effective treatment for symptomatic uterine fibroids. In this RCT, the majority of the patients (78% of the uterine artery embolization group vs 87% in the hysterectomy group) were (very) satisfied about the received treatment. Hysterectomy can be avoided in about two thirds of uterine artery embolization-treated patients. Health related quality of life 10 years after uterine artery embolization or hysterectomy remained comparably stable. The authors concluded that the Uterine artery embolization is a welldocumented and less invasive alternative to hysterectomy for symptomatic uterine fibroids and the eligible patients should be counseled accordingly.

Lifetime cancer risk and combined oral contraceptives: the Royal College of General Practitioner's Oral Contraception Study.
Iversen L, Sivasubramaniam S, Lee AJ, et al. Am J Obstet Gynecol 2017;216:580.e1-9.
The results suggest that users of oral contraceptives are protected from colorectal, endometrial, and ovarian cancer for many years after stopping, perhaps for >35 years for colorectal and ovarian cancer. An increased breast and cervical cancer risk that is seen in current and recent users appears to be lost within approximately 5 years of stopping oral contraception, with no evidence of either cancer recurring at increased risk in ever users with time. An increased risk of lung cancer was seen only in ever users who were smokers at recruitment. There was no evidence of new cancer risks appearing later in life among women who had used oral contraceptives. These results provide strong evidence that most women do not expose themselves to long-term cancer harm if they choose to use oral contraception; indeed, many are likely to be protected. Most women who choose to use oral contraceptives do not expose themselves to long-term cancer harms; instead, with some cancers, many women benefit from important reductions of risk that persist for many years after stopping.

Interpregnancy interval after termination of pregnancy and the risks of adverse outcomes in subsequent birth
Jaana M, Aini B, Marrit M, Mika G, Oskari H and Marrit N. Obstet Gynecol 2017;129:347-54
In this study 19,894 women, who underwent termination of pregnancy between 2000 and 2009 and whose subsequent pregnancy ended in live singleton delivery, were analysed to assess whether the interpregnancy interval affects the subsequent pregnancy outcome. Depending on the interpregnancy interval, the women were divided into five groups: < 6 months, 6 - < 12 months, 12 - < 18 months, 18 - < 24 months and = 24 months. There was a slight but significant increase in the rate of preterm birth in the group who had interpregnancy interval of < 6 months. This difference remained significant even after adjusting for 9 background factors: parity, prepregnancy BMI, cohabitation, type of residence, socioeconomic status, maternal age, smoking, type of termination of pregnancy and gestational age at termination. The data emphasizes the need for initiation of effective contraception and counseling the women for optimum subsequent pregnancy interval soon after termination of a pregnancy.

Antiplatelet agents and the prevention of spontaneous preterm birth ├▒ a systemic review and meta-analysis
Elvira O.G. van Vliet, Lisa A. Askie, Ben W.J. Mol and Martijn A Quidijk. Obstet Gynecol 2017;129:327-36
There are evidences to suggest that uteroplacental ischaemia plays an important role in the causation of spontaneous preterm birth. In this meta-analysis of 17 RCTs (28,797 women), women were randomized to low dose aspirindipyridamole or placebo no treatment as a primary preventive strategy for pre-eclampsia. Primary endpoints were spontaneous preterm birth at < 37 weeks, at < 34 weeks and at < 28 weeks. There is a reduced risk of spontaneous preterm birth at < 37 weeks (RR - 0.93) and at < 34 weeks (RR - 0.86) for women, who received antiplatelet agents as compared to placebo or no treatment. The authors concluded that antiplatelet agents reduce spontaneous preterm birth in women who are at risk for preeclampsia.

Risks and benefits of opportunistic salpingectomy during vaginal hysterectomy: A cost-effectiveness analysis
L. A. Cadish, J. P. Shepherd, E. L. Barber, B. Ridgeway
Fallopian tubes are commonly removed during laparoscopic and open hysterectomy to prevent ovarian and tubal cancer, but not routinely removed during vaginal hysterectomy due to assumed increased morbidity. Salpingectomy should routinely be performed with vaginal hysterectomy as it was the dominant and therefore cost effective strategy. Switching from a policy of vaginal hysterectomy alone to a policy of routine planned salpingectomy prevents 1 in 225 ovarian cancer cases, and 1 in 450 ovarian cancer deaths. Complications are minimally increased, but the trade-off with cancer prevention is highly favorable.

Prophylactic salpingectomy during vaginal hysterectomy: A feasibility study
D. Antosh, R. High, H. W. Brown, S. S. Oliphant, H. Abed, C. Grimes
The American Congress of Obstetricians and Gynecologists (ACOG) recommends that ├Čthe surgeon and patient should discuss the potential benefits of the removal of the fallopian tubes during a hysterectomy in women at population risk of ovarian cancer who are not having an oophorectomy, resulting in an increasing rate of salpingectomy at the time of hysterectomy. Rates of salpingectomy are highest for laparoscopic (>60%) and lowest for vaginal (< 20%) hysterectomy.

This is a multicentric, prospective, observational study of patients undergoing planned vaginal hysterectomy with bilateral salpingectomy. The objectives of this study were to determine whether bilateral salpingectomy is feasible in the majority of planned vaginal hysterectomies and to assess its impact on operating time, estimated blood loss (EBL), surgical complications, and menopausal symptoms. The primary indication for hysterectomy was prolapse (76%), heavy menstrual bleeding (18%), and other (6%). Vaginal salpingectomy is feasible in the majority of women undergoing planned vaginal hysterectomy and increases operating time by 11 minutes and estimated blood loss by 6 ml. Risk factors for unsuccessful removal could not be identified.

Courtesy by :
Dr. Sukanta Misra
Prof. & HOD,
Dept. of Obs and Gynae, RKMSP, VIMS

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