Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Vaginal Hysterectomy & Perceived Contraindications

Female Pelvic Med Reconstr Surg; ePub 2017 Sep 13; Schmitt, et al

Vaginal hysterectomy can be safely performed with favorable outcomes, even in women with perceived contraindications, a recent study found. The retrospective cohort of benign hysterectomies took place between 2009 and 2013. Outcomes includes uterine debulking, transfusion, intraoperative complications, length of stay (LOS), and Accordion grade 2+ postoperative complications. Researchers found:

  • Among 692 vaginal hysterectomies, 11% had a uterine weight >280 g, 11.3% had no vaginal parity, 14.9% had a history of cesarean delivery, and 37.7% had a body mass index (BMI) of 30 kg/m2 or greater; 15.9% had ≥2 contraindications.
  • After adjustments, uterine weight >280 g and prior cesarean delivery were significantly associated with an increased likelihood of uterine debulking, which occurred in 146 (21.1%) women.
  • None of the contraindications were significantly associated with the need for a blood transfusion, presence of an intraoperative complication, LOS >2 days, or presence of an Accordion grade 2+ postoperative complication.

Citation:

Schmitt JJ, Occhino JA, Weaver AL, McGee ME, Gebhart JB. Outcomes of vaginal hysterectomy with and without perceived contraindications to vaginal surgery. [Published online ahead of print September 13, 2017]. Female Pelvic Med Reconstr Surg. doi:10.1097/SPV.0000000000000469.

This Week's Must Reads

Prophylactic Antibiotic Use in Labor & Delivery, Obstet Gynecol; 2018 Sep; Coleman, et al

USPSTF on Screening for Cervical Cancer, JAMA; 2018 Aug 21; US Preventive Services Task Force

Prevention of Obstetric Lacerations at Vaginal Delivery, Obstet Gynecol; 2018 Sep; Cichowski, et al

Effect of Menstrual Bleeding on IUD Discontinuation, Am J Obstet Gynecol; ePub 2018 Aug 28; Hobby, et al

Leukemia risk after maternal contraception use, Hargreave M et al. Lancet Oncol. 2018 Sep 6. doi: 10.1016/S1470-2045(18)30479-0

Must Reads in Gynecology

Uterine Weight & Complications After Hysterectomy, Am J Obstet Gynecol; ePub 2018 Jun 27; Louie, et al

New Persistent Opioid Use After Hysterectomy, Am J Obstet Gynecol; ePub 2018 Jun 18; Swenson, et al

Infection Prevention After Gynecologic Procedures, Obstet Gynecol; ePub 2018 Jun; Soper, Chelmow, et al

Treatment Update for Polycystic Ovary Syndrome, Obstet Gynecol; ePub 2018 Jun; Legro, et al

Hysterectomy Performed by Very Low-Volume Surgeons, Obstet Gynecol; ePub 2018 May 7; Ruiz, et al