Active management of the third stage of labor: A brief overview of key issues

WOS: 000443619200011PubMed ID: 30202630Postpartum hemorrhage is a potentially life-threatening, albeit preventable, condition that persists as a leading cause of maternal death. It occurs mostly during the third stage of labor, and active management of the third stage of labor (AMTSL) can prevent its occurrence. AMTSL is a recommended series of steps, including the provision of uterotonic drugs immediately upon fetal delivery, controlled cord traction, and massage of the uterine fundus, as developed by the World Health Organization. Here, we present current opinion and protocols for AMTSL

Effects of coffee consumption on gut recovery after surgery of gynecological cancer patients: a randomized controlled trial

BACKGROUND: Paralytic ileus that develops after elective surgery is a common and uncomfortable complication and is considered inevitable after an intraperitoneal operation

The role of changes in systemic inflammatory response markers during neoadjuvant chemotherapy in predicting suboptimal surgery in ovarian cancer

Aim: The aim of this study was to investigate the possibility of using the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and platelet count and their dynamic changes during chemotherapy to predict suboptimal interval debulking surgery (IDS) in stage IIIC-IVA serous ovarian cancer (OC)

Postoperative nomogram for the prediction of disease-free survival in lymph node-negative stage I?IIA cervical cancer patients treated with radical hysterectomy

The purpose of this study was to develop and validate a nomogram for individual prediction of recurrence and disease-free survival (DFS) among lymph node (LN)-negative early-stage (I?IIA) cervical cancer (CC) patients treated with Type B or Type C2 hysterectomy. Data were collected from patients diagnosed with CC between 1995 and 2017 at the Gynecological Oncology Department, Tepecik Training and Research Hospital. A total of 194 cases with stage IA2?IIA CC were evaluated retrospectively. Patients with stage IA2?IIA CC who underwent radical (Type C2) or modified radical (Type B) hysterectomy and pelvic???paraaortic LN dissection with LN negativity were included in the study. The relationships between prognostic factors such as stage, tumour size, parametrial involvement, vaginal cuff margin, endomyometrial infiltration, and lymphovascular space invasion status and DFS were compared using a univariable Cox regression model. When the nomogram was prepared, the scores of the risk factors were collected, and we observed that scores were at least 0 to a maximum of 414 points. The concordance-index for the nomogram was 0.895 (95% confidence interval, 0.79?0.99). The nomogram based on the indicated prognostic factors yielded excellent results in predicting recurrence in early-stage CC patients without LN metastasis who underwent radical hysterectomy.Impact statement What is already known on this subject? Pathology of radical hysterectomy specimens in patients with early-stage cervical cancer provides information that has predictive prognostic potential. In addition to FIGO stage, other important prognostic factors are lymph node status, tumour size, parametrial involvement, vaginal cuff margin status, endomyometrial infiltration, histological type, patient age, lymphovascular space invasion, histological grade, and depth of cervical stromal invasion. What do the results of this study add? In this study, patients with early-stage cervical cancer who underwent radical and modified radical hysterectomy without retroperitoneal lymph node involvement were evaluated, and recurrence development and factors affecting disease-free survival were investigated. A nomogram consisting of factors influencing disease-free survival was constructed. The total score was determined according to the status of all risk factors. This allowed clear definition of the risk for each patient. A nomogram predicting recurrence in patients with stages IA2?IIA cervical cancer with radical hysterectomy without lymph node involvement has not previously been published

Do estrogen, progesterone, P53 and Ki67 receptor ratios determined from curettage materials in endometrioid-type endometrial carcinoma predict lymph node metastasis?

Aim: Estrogen receptor (ER), progesterone receptor (PR), and Ki-67 and P53 receptor levels in endometrial curettage material were investigated for their ability to predict lymph node (LN) involvement in patients with endometrioid-type endometrial cancer (EEC)

Is the measurement of the size of uterine lesions with positron emission tomography consistent in pre- and postmenopausal periods in endometrioid-type endometrial cancer?

Objective: We aimed to investigate the correlation of the size and volume of uterine tumors obtained using positron emission tomography/computed tomography (PET/CT) and pathology specimens in patients with endometrioid-type endometrial cancer (EEC) in the premenopausal period, and to compare the results with those of postmenopausal women. In the premenopausal period, the endometrium uses more glucose than in the postmenopausal period. Therefore, the measurement of uterine tumor size using PET/CT in the premenopausal period may normally be different

What Are the Risk Factors for Lymphocyst Formation Apart From Lymphnode Dissection and Lymphnode Count in Gynecologic Malignancy?

Aim: Lymphocyst is one of the most common complications of lymphadenectomy and generally encountered during uro-gynecological oncology surgeries. We aimed to define the risk factors for formation of a lymphocyst in patients with various gynecological cancer types in whom a lymphadenectomy was performed. Methods: This retrospective study was performed on 206 patients. Of the 206 patients, 100 were diagnosed with a lymphocyst, and 106 were assigned to a control group. Laboratory findings and surgical characteristics of the patients were compared. Results: No differences were observed in age, pre-operative hemoglobin; platelet, white blood cell, and lymphocyte counts; or pre-operative albumin level (p=0.315, 0.500, 0.525, 0.683, 0.740, and 0.97, respectively). A significant effect of the heparin dose x heparin days interaction and lymphocyst formation was observed (p=0.002). Lymphocysts were most frequently detected in the ovarian cancer subgroup (49%). Significant differences were detected between the groups in the percentages of patients who underwent CT only and RT only treatments (p=0.001 and 0.002, respectively). The logistic regression analysis revealed a relationship between the LMWH dose x days interaction and formation of a lymphocyst (OR, 1.10; 95% CI, 1.0-1.13; p=0.01). Conclusion: The association between total LMWH dose administered and the formation of lymphocysts in patients with gynecological pelvic cancer was investigated for the first time. Significant relationship between heparin dose x days and lymphocyst formation was found. Although anticoagulation with LMWH is essential for preventing thromboembolism, it should be used appropriately to prevent other complications, such as bleeding and lymphocysts

Management of Isolated Vaginal Metastasis in Squamous Cell Cervical Cancer: 23 Years' Experience at a Single Center

Aim: The aim of this study was to investigate the treatment options and survival of cervical cancer (CC) patients who develop isolated vaginal metastasis (IVM), and to establish risk factors for IVM. Patients and Methods: A total of 21 cases with IVM were evaluated retrospectively. In addition, 42 control patients diagnosed with CC without recurrence were matched. Tumor size, depth of stromal invasion (DOI), lymphovascular space invasion (LVSI), and size of vaginal and lymph node metastases were analyzed in accordance with the pathology reports. Patients who had IVM were investigated in terms of treatment options (chemotherapy (CT), radiotherapy (RT), or chemoradiotherapy (CRT)) and survival. Results: After detection of IVM, the 1-, 3-, and 5-year survival rates were 57.1, 23.8, and 9.5%, respectively. The mean survival time after metastasis detection was 23.1 +/- 31.3 months. LVSI, DOI >= 1/2, hemoglobin = 4 cm were independent risk factors for IVM. The 5-year survival rates were 30.0% for patients receiving RT, 17.1% for patients receiving CRT, and 0% for patients receiving CT. Conclusion: IVM typically develops within the first 2 years after the diagnosis of CC, and survival is generally poor. RT was the most effective treatment in patients with IVM. (C) 2016 S. Karger GmbH, Freibur

MELF Pattern for Predicting Lymph Node Involvement and Survival in Grade I-II Endometrioid-type Endometrial Cancer

The aim of this study was to examine the associations between microcystic, elongated, and fragmented (MELF) pattern and other prognostic factors and lymph node involvement, disease-free survival, and overall survival (OS) using a case-control group consisting of grade I-II endometrioid endometrial carcinoma (EEC) patients with/without lymph node involvement. The files of the patients were searched electronically for all hysterectomy specimens with a diagnosis of grade I-II EEC of the uterine body from January 1, 2008 to July 31, 2014. Lymph node involvement was detected in 27 patients who were histologically diagnosed with grade I-II EEC, and these patients made up the case group. Using a dependent random sampling method, 28 grade I-II EEC patients without lymph node involvement were selected. According to multivariate regression analysis, lymphovascular space invasion [odds ratio, 23.5; 95% confidence interval (CI), 2.4-223.5] and MELF pattern (odds ratio, 13.3; 95% CI, 1.4-121.8) were significant predictors of lymph node involvement. There was recurrence in 15.8% of cases that showed a MELF pattern and in 19.4% of those that did not (P=0.738). According to Kaplan-Meier analysis, the MELF pattern revealed no significant differences in disease-free survival (hazard ratio, 1.0; 95% CI, 0.1-36.5), whereas the effect on OS was significant (hazard ratio, 2.2; 95% CI, 1.3-4.2). The presence of MELF pattern was a substantial risk factor for detecting lymph node involvement in patients with grade I-II EEC. The MELF pattern may be important for identifying which patients need staging surgery, in addition to its effect on the OS