Laparoscopically-assisted vaginal hysterectomy for enlarged uterus: operative outcomes and the learning curve

Objectives: The aim of the study was to compare the effects of uterine size and surgeon experience on the surgical out­comes of laparoscopically-assisted vaginal hysterectomy (LAVH) for benign gynecological conditions. Material and methods: This was a retrospective analysis of 184 LAVH cases. All hysterectomies were performed by the same surgeon and divided into two groups, with uterine weight of < 280 g (group 1) and uterine weight of > 280 g (group 2). The groups were compared in terms of the effects of the uterine size and surgeon experience vs. the operative outcomes (operative time, change in hemoglobin levels, hospital stay, and perioperative complications). Results: No significant differences in mean age, parity, history of chronic systemic diseases and previous surgery history were observed between the two groups. However, operative time was significantly greater in group 2 as compared to group 1 (132.1 ± 42.7 minutes vs. 111.5 ± 30.4 minutes, p < 0.05). There were no differences in the hospital stay and perioperative complications between the two groups. One case of bladder injury occurred in each group and one patient underwent a second laparoscopic surgery for postoperative bleeding in group 2. Greater surgeon experience was demonstrated to be associated with decreased operative bleeding and, consequently, smaller differences between preoperative and postop­erative hemoglobin levels. Operative time was also reduced as the surgeon was getting more experienced but the effect did not reach statistical significance. Conclusions: Our study supports the thesis that LAVH is a safe and effective procedure for managing benign gynecologi­cal conditions. Despite increased operative time, LAVH can be safely performed for enlarged uterus in conjunction with increased surgeon experience

Makrozomik fetuslar 38. gebelik haftasında doğurtulabilir mi?

Objective: Numerous articles have been written on macrosomic fetuses, including the American College of Obstetricians and Gynecologists practice bulletin. However, there is no clear consensus about the time of birth. The aim of this study was to compare the maternal and fetal outcomes of women giving birth at 38+0-38+6 weeks and those with deliveries at ≥39 weeks in pregnancies complicated by fetal macrosomia, and to determine the effect on morbidity and mortality of delivery in the 38th gestational week.Material and Methods: Data of women and their infants born in Kayseri Training and Research Hospital between 01 May 2018 and 31 March 2020 were analyzed retrospectively. The patients included were those with a singleton pregnancy delivered at ≥38 weeks with a birthweight of ≥4000 gr. Demographic data and medical history and birth outcomes of the patients were recorded from the hospital data system. Multiple pregnancies, those with fetal anomalies and births <38 weeks were excluded from the study. The patients were separated into two groups as those who gave birth at 38+0-38+6 gestational weeks (Group 1) and those who gave birth at ≥39 weeks (Group 2).Results: Maternal and/or fetal trauma was found to be statistically significantly higher in nulliparous women with vaginal delivery ≥39 weeks compared to those with vaginal delivery at 38+0-38+6 weeks (p=0.017). No significant difference was observed between the groups in respect of fetal morbidity and mortality.Conclusion: When fetal macrosomia is determined antenatally, rates of fetal and/or maternal trauma can be reduced with delivery planned for the 38th week without increasing fetal morbidity and mortality.Amaç: Makrozomik fetüsler hakkında, Amerikan Obstetrik ve Jinekoloji Derneğinin bültenleri de dahil olmak üzere çok sayıda makale yazılmıştır. Ancak doğum zamanı konusunda net bir fikir birliği yoktur. Bu çalışmanın amacı fetal makrozomi ile komplike gebeliklerde 38+0-38+6 hafta arasında doğum yapan kadınlar ile ≥39 hafta sonrasında doğum yapan kadınların maternal ve fetal sonuçlarını karşılaştırmak ve doğum haftasının 38. haftaya çekilmesinin yenidoğanın morbidite ve mortalitesini etkileme düzeyini belirlemektir.Gereç ve Yöntemler: Bu retrospektif çalışmada, 01 Mayıs 2018-31 Mart 2020 tarihleri arasında Kayseri Eğitim ve Araştırma Hastanesinde doğum yapan kadınların ve bebeklerinin verileri geriye dönük olarak tarandı. Doğum ağırlığı ≥4000 gram, tekil, ≥38 hafta üzerinde doğum yapan hastalar çalışmaya dâhil edildi. Hastaların demografik ve medikal öyküleri ve doğum sonuçları hastane veri sisteminden kayıt edildi. Çoğul gebelikler, fetal anomaliler ve <38 gebelik haftasındaki doğumlar çalışma haricinde tutuldu. Hastalar 38+0- 38+6 hafta arasında doğum yapanlar (Grup 1) ve ≥39 haftada doğum yapanlar (Grup 2) olarak iki gruba ayrıldı.Bulgular: ≥39 haftadan sonra vajinal doğum yapan (grup 2) nullipar kadınlarda maternal veya fetal travma 38+0 - 38+6 (grup 1) hafta arasında vajinal doğum yapan nullipar kadınlara oranla istatistiksel anlamlı olarak yüksek bulundu (p=0.017). İki grup arasında fetal morbidite ve mortalite incelendiğinde gruplar arasında anlamlı farklılık izlenmedi.Sonuç: Doğum öncesi değerlendirmede fetal makrozomi saptanan gebelerde fetal ve/veya maternal travma oranları, fetal morbidite ve mortalite arttırılmadan 38. haftada planlanacak bir doğum ile azaltılabilir

Comparison of different methods in sonographic estimation of fetal weight in diabetic pregnant women on insulin therapy

Objectives: The aim of the study to compare the accuracy ofdifferent ultrasonographic weight estimating equations forpredicting the fetal weight in pregnant patients on insulintherapy.Design: Prospective clinical studySetting: Erciyes University Obstetric Clinic PerinatologyUnit, TurkeySubjects: One hundred and eleven diabetic pregnant womenusing insulinIntervention(s): The fetal weight estimations were calculatedoff-line using the two previously investigated methods(Hadlock 1 and Shepard) and abdominal circumference(AC).Main outcome measure(s): The accuracy of different weightestimating equations for predicting fetal weight in pregnantpatients on insulin therapyResults: Hadlock 1 and Shepard methods had estimated fetalweight values close to the actual birth weight whereas AChad not. The success rates and the sensitivity of the methodsfor detecting macrosomic fetuses weighing over 4000 g ininsulin using diabetic women were low and the rates were0.65 (95% CI: 0.40-0.84), 0.13 (95% CI: 0.01-0.40) and 0.55 (95%CI: 0.31-0.76), for the Hadlock 1, AC and Shepard formulaerespectively (P&lt;.05).Conclusion(s): The study showed that Hadlock 1 and Shepardmethods were significantly better for estimating fetal weightthan AC. The success rates of the methods for detectingmacrosomic fetuses weighing over 4000 g were similar, butthe methods did not have high sensitivity.</p