Ultrasound Detection of Vault Hematoma Following Vaginal Hysterectomy and Their Relation to Morbidity / 대한산부인과학회잡지

OBJECTIVE: To assess whether ultrasound detection of vault hematoma can be used as a predictor of post-operative morbidity following vaginal hysterectomy. METHODS: Prospective observational study of 418 consecutive cases of vaginal hysterectomy was performed between December 2000 and May 2001. The transvaginal sonographic examination of vaginal vault in the first postoperative week (3rd or 4th day) after vaginal hysterectomy was done. Routine observation and clinical assessments were made by established management protocol: febrile morbidity, hemoglobin drop, need for transfusion, length of stay in hospital. RESULTS: Of the 418 scaned patients, 103 (24.6%) had a vault hematoma. This group was compared with the 315 patients without hematoma. Significant increases in febrile morbidity (22.3% vs 7.6%), postoperative hemoglobin drop (2.39 g/dL vs 1.58 g/dL), need for blood transfusion (10.7% vs 1.3%) and length of hospital stay (8.6 days vs 6.2 days) were seen in the hematoma group. CONCLUSION: Ultrasound detection of vault hematoma following vaginal hysterectomy is a common finding associated with increased febrile morbidity, hemoglobin drop, need for blood transfusion and longer hospital stay. Transvaginal sonography may facilitate the diagnosis of posthysterectomy vault hematoma, which are not readily detected by pelvic examination.

Clinical usefulness of transabdominal cervicoisthmic cerclage in IIOC patients for whom transvaginal cervicoisthmic cerclage is unsuitable / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to review the clinical use of transabdominal cervicoishmic cerclage to determine whether it is a valid alternative to transvaginal cerclage. Study design : A retrospective review was carried out of transabdominal cerclage patients at our hospital from Jan. 1999 to May. 2001. Analysis of the clinical use of transabdominal rather than the vaginal approach in some IIOC patients was performed and fetal outcomes was evaluated. RESULTS: Fifteen patients underwent transabdominal cerclages. The primary indication for transabdominal cervicoisthmic cerclage was failed transvaginal cerclage in 9 patients and anatomic unsuitability for transvaginal cerclage in 6 patients. Follow-up was conducted for all except one patient. All patients were successfully delivered of live babies by Cesarean section. Complications including blood loss requiring transfusion did not occur. However one baby died at postpartal 1 day because of congenital Tetralogy of Fallot. CONCLUSION: All patients had histories compatible with incompetent cervix requiring cerclage, and none were suitable candidates for vaginal cerclage. Our results and review of the literature confirm that Transabdominal cervicoisthmic cerclage has an important role to play for carefully selected patients.