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Rahman J, Qiu Y, Yuan X, Kassim SH, Ji T, Dai H. Pituitrin Injection before Hysteroscopic Curettage for Treating Type I Cesarean Scar Pregnancy in Comparison with Uterine Artery Embolization: A Retrospective Study. J Obstet Gynaecol India 2023; 73:229-234. [PMID: 37324364 PMCID: PMC10267048 DOI: 10.1007/s13224-022-01724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 10/23/2022] [Indexed: 12/23/2022] Open
Abstract
Background The effectiveness and safety of pituitrin injection coupled with hysteroscopy and suction curettage as treatment for type I cesarean scar pregnancy (CSP) have not been studied enough in the literature, by comparing it to uterine artery embolization (UAE) followed by suction curettage we aim to determine its efficacy. Materials and Methods Data of 53 patients (the PIT group) with type I CSP treated with pituitrin injection combined with hysteroscopic suction curettage and 137 patients (the UAE group) with type I CSP treated with UAE followed by suction curettage were collected in retrospect. The clinical data were analyzed statistically to compare the efficacy and safety between the two groups. Results The PIT group had a shorter duration of postoperative vaginal bleeding, postoperative hospitalization, and overall hospitalization length (P < 0.05). The PIT group had lower overall hospitalization costs and a lower rate of adverse events than the UAE group (P < 0.05). There was no significant difference between the two groups in terms of treatment success rate, the average length of operation, blood loss during the procedure, time when serum β-hCG returned to normal range, and menstrual recovery time after hospital release (P > 0.05). Conclusion UAE and pituitrin injection followed by hysteroscopic suction curettage are good choices for type I CSP treatment. However, pituitrin injection with hysteroscopic suction curettage outperforms UAE followed by suction curettage. Thus, pituitrin injection may be an option of high priority for type I CSP.
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Affiliation(s)
- Juveria Rahman
- Department of Gynecology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, 300 Guangzhoulu, Gulou District, Nanjing, Jiangsu 210029 China
| | - Yixuan Qiu
- Department of Gynecology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, 300 Guangzhoulu, Gulou District, Nanjing, Jiangsu 210029 China
| | - Xiong Yuan
- Department of Gynecology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, 300 Guangzhoulu, Gulou District, Nanjing, Jiangsu 210029 China
| | | | - Tonghui Ji
- Department of Gynecology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, 300 Guangzhoulu, Gulou District, Nanjing, Jiangsu 210029 China
| | - Huihua Dai
- Department of Gynecology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, 300 Guangzhoulu, Gulou District, Nanjing, Jiangsu 210029 China
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Pharmacologic Interventions to Minimize Fluid Absorption at the Time of Hysteroscopy: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 141:285-298. [PMID: 36649319 DOI: 10.1097/aog.0000000000005051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/20/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess which interventions are effective in reducing fluid absorption at the time of hysteroscopy. DATA SOURCE Ovid MEDLINE, Ovid EMBASE, PubMed (non-MEDLINE records only), EBM Reviews-Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov , and Web of Science were searched from inception to February 2022 without restriction on language or geographic origin. METHODS OF STUDY SELECTION Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, all English-language, full-text articles reporting fluid balance, with an intervention and comparator arm, were included. Title and abstract screening and full-text review were completed independently by two authors. Conflicts were resolved through discussion and consensus. Studies' risk of bias was assessed using the Cochrane Risk of Bias Tool for RCTs and the Newcastle-Ottawa Scale for observational studies. TABULATION, INTEGRATION, AND RESULTS The search identified 906 studies, 28 of which were eligible for inclusion, examining the following interventions: gonadotropin-releasing hormone (GnRH) agonist; ulipristal acetate; vasopressin; danazol; oxytocin; and local, general, and regional anesthesia. A significant reduction in mean fluid absorption was seen in patients preoperatively treated with danazol (-175.7 mL, 95% CI -325.4 to -26.0) and a GnRH agonist (-139.68 mL, 95% CI -203.2, -76.2) compared with patients in a control group. Ulipristal acetate and type of anesthesia showed no difference. Data on type of anesthesia and vasopressin use were not amenable to meta-analysis; however, four studies favored vasopressin over control regarding fluid absorption. Mean operative time was reduced after preoperative treatment with ulipristal acetate (-7.1 min, 95% CI -11.31 to -2.9), danazol (-7.5 min, 95% CI -8.7 to -6.3), and a GnRH agonist (-3.3 min, 95% CI -5.6 to -0.98). CONCLUSION Preoperative treatment with a GnRH agonist and danazol were both found to be effective in reducing fluid absorption and operative time across a range of hysteroscopic procedures. High-quality research aimed at evaluating other interventions, such as combined hormonal contraception, progestin therapy, and vasopressin, are still lacking in the literature. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021233804.
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Alomar O, Abu-Zaid A, Jamjoom MZ, Almubarki AAMA, Alsehaimi SO, Alabdrabalamir S, Baradwan S, Abuzaid M, Alshahrani MS, Khadawardi K, Badghish E, Bakhsh H, Baalharith MA, Bukhari IA, Baradwan A, Salem H, Al-Badawi IA. Prophylactic vasopressin to reduce intraoperative blood loss and associated morbidities during myomectomy: A systematic review and meta-analysis of 11 controlled trials. J Gynecol Obstet Hum Reprod 2022; 51:102485. [DOI: 10.1016/j.jogoh.2022.102485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/26/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022]
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Hafidh B, Latifah HM, Gari A, Alshahrani MS, AlSghan R, Alkhamis WH, Allam HS, AlRasheed MA, Bakhsh H, Abu-Zaid A, Baradwan S. Vasopressin to Control Blood Loss during Hysterectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Minim Invasive Gynecol 2021; 29:355-364.e2. [PMID: 34648933 DOI: 10.1016/j.jmig.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Minimizing intraoperative blood loss during hysterectomy is crucial to lessen associated perioperative morbidity. The aim of this investigation is to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that compared vasopressin versus normal saline in controlling intraoperative blood loss during hysterectomy. DATA SOURCES We screened 5 major databases (PubMed, Scopus, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials) from inception till July 18, 2021. We used the following query search in all databases: (vasopressin OR arginine vasopressin OR argipressin OR antidiuretic hormone) AND (hysterectomy) AND (saline OR placebo OR control OR no treatment) AND (randomized OR randomised OR randomly). There was no language restriction during database screening. METHODS OF STUDY SELECTION We considered all studies that met the following evidence-based criteria: (1) patients: individuals undergoing hysterectomy for any indication, (2) intervention: vasopressin, (3) comparator: normal saline, placebo, or no treatment, (4) outcomes: reliable extraction of any of our endpoints, and (5) study design: RCTs. We assessed risk of bias of included studies and pooled endpoints as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI). We performed statistical analysis using the Review Manager software, version 5.4.0. TABULATION, INTEGRATION, AND RESULTS Seven RCTs with an overall low risk of bias met the inclusion criteria. This meta-analysis included a total of 455 patients; 232 and 223 patients were allocated to vasopressin and control group, respectively. The majority of RCTs were vaginal hysterectomy (n = 5), few abdominal hysterectomy, (n = 2) and no laparoscopic hysterectomy. The mean estimated intraoperative blood loss was significantly lower in favor of the vasopressin group compared with the control group (n = 6 RCTs, MD = -119.85 mL, 95% CI [-177.55, -62.14], p <.001). However, there was no significant difference between both groups regarding mean operating time, mean change in postoperative hemoglobin, mean hospital stay, rate of febrile morbidity, rate of pelvic infection, rate of perioperative blood transfusion, and rate of perioperative complications. CONCLUSION Compared with normal saline, vasopressin significantly reduced the estimated blood loss during hysterectomy but did not change any clinically significant outcomes. In addition, vasopressin was safe and did not correlate with an increase in the rates of febrile morbidity or pelvic infection.
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Affiliation(s)
- Bandr Hafidh
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah (Drs. Hafidh, Latifah, Gari, and Baradwan)
| | - Hassan M Latifah
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah (Drs. Hafidh, Latifah, Gari, and Baradwan)
| | - Abdulrahim Gari
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah (Drs. Hafidh, Latifah, Gari, and Baradwan); Department of Obstetrics and Gynecology, College of Medicine, Umm Al-Qura University, Makkah (Dr. Gari)
| | - Majed Saeed Alshahrani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran (Dr. Alshahrani)
| | - Rayan AlSghan
- Department of Obstetrics and Gynecology, Maternity and Children Hospital, Alkharj (Dr. AlSghan)
| | - Waleed H Alkhamis
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, King Saud University Medical City, Riyadh (Dr. Alkhamis)
| | - Hassan Saleh Allam
- Department of Obstetrics and Gynecology, Prince Sultan Military Medical City, Riyadh (Dr. Allam); Department of Obstetrics and Gynecology, Faculty of Medicine at Rabigh, King Abdulaziz University, Rabigh (Dr. Allam)
| | - May A AlRasheed
- Department of Obstetrics and Gynecology, King Saud Hospital, Unayzah, Qassim (Dr. AlRasheed), Saudi Arabia
| | - Hanadi Bakhsh
- Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh (Dr. Bakhsh)
| | - Ahmed Abu-Zaid
- Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University (Dr. Abu-Zaid), Riyadh.
| | - Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah (Drs. Hafidh, Latifah, Gari, and Baradwan).
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Guo F, Jiao C, Xu K, Yang C, Huang X, Lu Y, Xu L, Chen X. Optimal Dose of Pituitrin in Laparoscopic Uterine Myomectomy: A Double-Blinded, Randomized Controlled Trial. J Minim Invasive Gynecol 2021; 28:2073-2079. [PMID: 34147692 DOI: 10.1016/j.jmig.2021.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE To determine the optimal effective dose of pituitrin in laparoscopic myomectomy for uterine leiomyoma. DESIGN Double-blinded, randomized controlled trial. SETTING Tertiary women's hospital in China. PATIENTS Total of 118 patients who underwent laparoscopic myomectomy. INTERVENTIONS Patients randomly received 0, 2, 4, or 6 units of pituitrin injected into the myometrium surrounding the myoma. MEASUREMENTS AND MAIN RESULTS Rate of satisfactory surgical condition, hemodynamic changes, total surgical time, and blood loss were recorded. The rates of satisfactory surgical conditions were 6.7%, 72.4%, 89.7%, and 93.3% in groups 0U, 2U, 4U, and 6U, respectively; they were higher in groups 2U, 4U, and 6U than those in group 0U, but there were no significant differences among the groups 2U, 4U, and 6U. The blood loss was higher in group 0U than that in groups 2U, 4U, and 6U (p < .01). Pituitrin was associated with a transient decrease in blood pressures and an increase in heart rate in a dose-dependent fashion, with more pronounced changes in groups 4U and 6U, and these groups also required a higher amount of vasoactive drug to correct hemodynamic changes (p < .05). CONCLUSION Two units of pituitrin could provide a satisfactory surgical field with minimal hemodynamic changes for laparoscopic uterine myomectomy.
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Affiliation(s)
- Feihe Guo
- Departments of Anesthesia (Drs. Guo, Jiao, L. Xu, and Xinzhong)
| | - Cuicui Jiao
- Departments of Anesthesia (Drs. Guo, Jiao, L. Xu, and Xinzhong)
| | - Kaihong Xu
- Gynecology (Drs. K. Xu, Yang, Huang, and Lu), Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunbo Yang
- Gynecology (Drs. K. Xu, Yang, Huang, and Lu), Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiadi Huang
- Gynecology (Drs. K. Xu, Yang, Huang, and Lu), Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yongchao Lu
- Gynecology (Drs. K. Xu, Yang, Huang, and Lu), Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lili Xu
- Departments of Anesthesia (Drs. Guo, Jiao, L. Xu, and Xinzhong)
| | - Xinzhong Chen
- Departments of Anesthesia (Drs. Guo, Jiao, L. Xu, and Xinzhong).
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Kim JW, Kim G, Kim TW, Han W, Kim MS, Jeong CY, Park DH. Hemodynamic changes following accidental infiltration of a high dose of vasopressin. J Int Med Res 2020; 48:300060520959494. [PMID: 32993389 PMCID: PMC7536500 DOI: 10.1177/0300060520959494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Vasopressin local infiltration is useful in gynecological surgery because it can reduce
hemorrhage. Depending on the activities of the sympathetic system and the
renin–angiotensin system, reactions to vasopressin may differ and predicting its systemic
effects is difficult. Because life-threatening complications can occur, infiltration with
vasopressin should be administered with caution. A 42-year-old female patient was
diagnosed with uterine leiomyomas. During a robot-assisted laparoscopic myomectomy, 50 U
of vasopressin, which is ten-times the recommended dose, was accidentally infiltrated.
Subsequently, bradycardia with a heart rate of 25 bpm occurred, which recovered within 3
minutes. Peripheral perfusion indices and the diameter of the radial and brachial arteries
also decreased markedly and recovered within 1 hour. The surgery was concluded without
additional events. The patient was discharged 2 days later with no abnormal findings.
Because vasopressin infiltration can cause life-threatening complications, it is necessary
to determine the extent of patient reactions to vasopressin using measures such as the
peripheral perfusion index or radial and brachial artery diameters. These measures may
also help to predict the occurrence of complications.
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Affiliation(s)
- Jae Won Kim
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Goo Kim
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Tae Woo Kim
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Woong Han
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Mo Se Kim
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Chang Young Jeong
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Dong Ho Park
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
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Nickol J, Berlit S, Lis S, Hornemann A, Tsagogiorgas C, Sütterlin M, Tuschy B. Hemodynamic effects of intramyometrial epinephrine injection for blood loss reduction in laparoscopic myomectomy. Arch Gynecol Obstet 2018; 298:933-938. [PMID: 30229298 DOI: 10.1007/s00404-018-4891-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate changes in hemodynamic effects of intramyometrial epinephrine injection for blood loss reduction in laparoscopic myomectomy. METHODS A total of 185 women with symptomatic uterine fibroids who underwent laparoscopic myomectomy were enrolled in this study. Eighty-six women (study collective) received an intramyometrial injection of epinephrine and were compared to ninety-nine women (control collective) who underwent laparoscopic myomectomy without an intramyometrial epinephrine injection. Demographic parameters, change of hemodynamic parameters during surgery as well as hemoglobin drop after surgery were analyzed. RESULTS In the study collective maximum systolic blood pressure (p < 0.001), maximum increase of the systolic blood pressure within 5 min (p = 0.003), duration of hypertension (p = 0.012), maximal (p < 0.001) and mean heart rate (p = 0.005), maximal increase of heart rate within 5 min (p = 0.003) and difference of mean to maximal heart rate (p < 0.001) were higher compared to the control collective. There was no difference in pre- and postoperative hemoglobin levels in both collectives and no intraoperative clinically relevant complication occurred due to intramyometrial epinephrine injection. CONCLUSION The intramyometrial application of epinephrine seems to be safe but leads to significant alterations of hemodynamic parameters without a significant change in postoperative hemoglobin levels.
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Affiliation(s)
- Jana Nickol
- Department of Obstetrics and Gynecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Sebastian Berlit
- Department of Obstetrics and Gynecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Stefanie Lis
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Amadeus Hornemann
- Department of Obstetrics and Gynecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Charalambos Tsagogiorgas
- Department of Anesthesiology and Critical Care Medicine, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Overdijk LE, Rademaker BMP, van Kesteren PJM, de Haan P, Riezebos RK, Haude OCH. The HYSTER study: the effect of intracervically administered terlipressin versus placebo on the number of gaseous emboli and fluid intravasation during hysteroscopic surgery: study protocol for a randomized controlled clinical trial. Trials 2018; 19:107. [PMID: 29444699 PMCID: PMC5813421 DOI: 10.1186/s13063-018-2442-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 01/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background Transcervical resection of myoma or endometrium is a safe, hysteroscopic, minimally invasive procedure. However, intravasation of distension fluid is a common phenomenon during these procedures. In a previous study we observed venous gas emboli in almost every patient. The severity of hysteroscopic-derived embolization has been shown to be correlated to the amount of intravasation. In addition, paradoxical gas embolism, which is potentially dangerous, was observed in several patients. Studies have shown a reduction of intravasation by using intracervically administered vasopressin during hysteroscopy. We think that its analog, terlipressin, should have the same effect. In our previous research we observed more gaseous emboli as intravasation increased. Whether or not the insertion of intracervically administered terlipressin leads to a lower incidence and severity of gas embolism is unknown. We hypothesize that intracervically administered terlipressin leads to a reduction of intravasation with a lower incidence and severity of gas embolism. Terlipressin may be of benefit during hysteroscopic surgery. Methods/design Forty-eight patients (ASA 1 or 2) scheduled for transcervical resection of large, types 1–2 myoma or extensive endometrium resection will be included. In a double-blind fashion patients will be randomized 1:1 according to surgical treatment using either intracervically administered terlipressin or placebo. Transesophageal echocardiography will be used to observe and record embolic events. A pre- and post-procedure venous blood sample will be taken to calculate intravasation based on hemodilution. Our primary endpoint will be how terlipressin influences the severity of embolic events. Secondary endpoints include the effect of terlipressin on the amount of intravasation and on hemodynamic parameters. Discussion If terlipressin does indeed reduce the number of gaseous emboli and intravasation occurring during hysteroscopic surgery, it would be a simple method to minimize potential adverse events. It also allows for prolonged operating time before the threshold of intravasation is reached, thereby reducing the need for a second operation. Trial registration Nederlands Trial Register (Dutch Trial Register), ID: NTR5577. Registered retrospectively on 18 December 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2442-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - Peter de Haan
- OLVG Hospital, Oosterparkstraat 9, 1091 AC, Amsterdam, Netherlands
| | | | - Oscar C H Haude
- University of Amsterdam/AMC Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
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Sirkeci RF, Belli AM, Manyonda IT. Treating symptomatic uterine fibroids with myomectomy: current practice and views of UK consultants. ACTA ACUST UNITED AC 2017; 14:11. [PMID: 28890674 PMCID: PMC5570799 DOI: 10.1186/s10397-017-1014-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 06/12/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND The demand for uterus-sparing treatments is increasing as more women postpone childbirth to their 30-40s, when fibroids are more symptomatic. With an increasing choice of treatment options and changing care-provider profiles, now is an opportune time to survey current practices and opinions. Using a 25-stem questionnaire, a web-based survey was used to capture the practices and opinions of UK consultant gynecologists on the treatment of symptomatic fibroids, including the types of procedure most frequently used, methods used to reduce blood loss, and awareness and acceptability of treatment options, and to assess the impact of gender and experience of the treating gynecologist. RESULTS The response rate was 22%. Laparascopic myomectomy is used least frequently, with 80% of the respondents using GnRHa preoperatively to minimize blood loss and correct anemia, while vasopressin is most frequently used to reduce intraoperative blood loss. Female consultants operate significantly less frequently than males. Those with more than 10 years consultant experience are more likely to perform an open myomectomy compared to those with less than 10 years experience. CONCLUSIONS Compared to a similar survey performed 10 years ago, surgical methods remain to be the most common treatments, but use of less invasive treatments such as UAE has increased. Consultants' attitudes appear to be responding to the patient demand for less radical treatments. However, it is yet to be seen if the changing consultant demographics will keep up with this demand. The low response rate warrants cautious interpretation of the results, but they provide an interesting snapshot of current views and practices.
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Affiliation(s)
| | - Anna Maria Belli
- Department of Radiology, St George's Healthcare NHS Foundation Trust, St George's, University of London, London, UK
| | - Isaac T Manyonda
- Department of Obstetrics and Gynecology, St George's Healthcare NHS Foundation Trust, St George's, University of London, Blackshaw Road, Tooting, SW17 0QT London, UK
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