To Alfred Deakin

BACKGROUND: The Board of the Nordic Federation of Societies of Obstetrics and Gynecology established a Quality Group for Gynecological Surgery connected with benign diseases with one member from each of the Nordic countries. The aim was to suggest guidelines for the quality assessment of such surgery. METHODS: A questionnaire study was carried out in all Nordic gynecological departments concerning quality assessment and the elaboration of guidelines. RESULTS: Most of the departments (80.4%) want to participate in establishing and maintaining a quality register. The majority of responders strongly agree that registers detect areas of satisfactory as well as unsatisfactory quality, and are necessary for comparison of treatment results among departments. Several departments are hesitant about joining a register if it will incur financial costs (59.5%) and/or extra work (47.6%). Most departments (71.4-94.6%) consider that all major gynecological surgery should be monitored. The departments agree that pre-, per-, and post hospital patient events should be included in any register. These results are incorporated into common general guidelines for quality assessment of gynecological surgery in the Nordic countries. CONCLUSION: The gynecological departments in the Nordic countries agree on the necessity for and the main content of registers for quality assessment, but the interest drops when extra work is needed, and if the departments have to pay to participate, which emphasize the need for simple and low-cost registers. In accordance with the results of the Nordic questionnaire, common general quality guidelines for gynecological surgery are suggested

Uterine Healing after Therapeutic Intrauterine Administration of TachoSil (Hemostatic Fleece) in Cesarean Section with Postpartum Hemorrhage Caused by Placenta Previa

Background. Application of hemostatic fleece (TachoSil) directly onto the bleeding surfaces of the lower uterine segment has been used to obtain hemostasis during cesarean section caused by placenta previa. Methods. Eleven of 15 patients treated with TachoSil for excessive postpartum haemorrhage due to placenta previa were enrolled. An evaluation of the cesarean section scar by transvaginal ultrasound, the uterine cavity and endometrium by hysteroscopy, and the endometrium by biopsy were made. The main outcome measures were intrauterine adhesions, recovery of endometrium at the site of TachoSil application, visible remnants of TachoSil, and scar healing. Results. Eight patients had small remnants of TachoSil in the uterine cavity together with signs of resorption. All had a normal endometrial mucosa, and none had adhesions in the uterine cavity. All cesarean section scars were healed without defects. Conclusion. TachoSil did not seem to impair healing of the endometrium or scar formation in the uterus after intrauterine application. Resorption of TachoSil seems to progress individually. Intrauterine treatment with TachoSil is a valuable supplement to the traditional treatment of post partum haemorrhage and may help retain reproductive capability. This is a small study, and it will require more studies to confirm the reproducibility