Secondary Postpartum Hemorrhage due to Spontaneous Uterine Artery Rupture after Normal Vaginal Delivery Managed by Selective Arterial Embolization.

Secondary postpartum hemorrhage due to an intraperitoneal bleed following a vaginal delivery is extremely rare. We present a case of spontaneous rupture of the uterine artery following a normal vaginal delivery with a delayed presentation, which resulted in significant morbidity. This case discusses the presentation and management of this rare obstetrical emergency. The report also discusses the role of selective arterial embolization in management of secondary postpartum hemorrhage.

Stage IIA1 versus stage IIA2 cervical cancer: does the new staging criteria predict survival?

OBJECTIVE: (1) To determine the correlation of 2008 International Federation of Gynecology and Obstetrics staging system with survival in patients with stage IIA cervical cancer, (2) to elucidate the treatment patterns in stage IIA1 and stage IIA2 cervical cancer, and (3) to investigate whether radical hysterectomy or radiation influenced overall survival. METHODS: Data were extracted from the Surveillance, Epidemiology and End Results database between 1988 and 2005. Statistical analysis used χ test, Kaplan-Meier method, Cox regression, and logistic regression. RESULTS: Of the 560 women, 271 (48.4%) had stage IIA1, and 289 (51.6%) had stage IIA2 cervical cancer. Stage IIA2 patients were younger than stage IIA1 patients (mean age, 49 years vs 54 years; P = 0.01). Stage IIA1, compared with stage IIA2, differed significantly regarding the administration of primary radiation (47.2% vs 64.7%, P < 0.001) and adjuvant radiation (60.5% vs 77.5%, P = 0.006). The following variables were significantly associated with the performance of radical hysterectomy: patient age, 65 years or younger, tumor size, ≤ 2 cm or lesser, high tumor grade, and nonsquamous tumor histology. The incidence of adjuvant radiation after radical hysterectomy was high (48% [tumor size, ≤ 2 cm] to 86% [tumor size, >6 cm]). The 5-year overall survival was not significantly different between stages IIA1 and IIA2 (65.8% vs 59.5%, P = 0.2). Only patient age (P = 0.01), tumor size (P = 0.02), and lymph node status (P = 0.002) were independent predictors of survival. When controlled for other contributing factors, there was no significant difference in survival between patients treated by radical hysterectomy and primary radiation. CONCLUSIONS: The 2008 International Federation of Gynecology and Obstetrics staging criteria is not an independent predictor of survival in stage IIA cervical cancer. Given the equivalent efficacy of radical hysterectomy and radiation, attention should be paid to the high risk of adjuvant radiation in these patients.

Volume change of uterine myomas during pregnancy: do myomas really grow?

STUDY OBJECTIVE: To estimate changes in uterine myoma volume during pregnancy. DESIGN: Review of departmental electronic perinatal database and medical records. Canadian Task Force Classification II-3. SETTING: Obstetrical ultrasound unit in an academic tertiary care center. PATIENTS: One hundred-seven patients diagnosed with uterine myomas during pregnancy and who had two or more obstetrical ultrasounds in different periods of pregnancy. INTERVENTIONS: We analyzed the change in volume of uterine myomas between the first half of pregnancy (up until 19 weeks), third quarter (20-30 weeks), and last quarter (31 weeks to term). The volume of largest uterine myoma was calculated using the formula Volume (mm3)=Pi/6x(length mm)x(width mm)x(height mm). MEASUREMENTS AND MAIN RESULTS: The mean age of the population was 31+/-6 years. Between the first and the second study periods, the percentage of uterine myomas that decreased in size was 55.1% (95% CI: 43-66), with a mean decrease in volume of 35%+/-4%; while the percentage of uterine myomas that enlarged was 44.9% (95% CI: 34-56), with a mean increase in volume of 69%+/-11%. Between the second and the third study periods, 75% (95% CI: 56-87) became smaller, with a mean decrease in volume of 30%+/-3%; while 25% (95% CI: 13-43) enlarged, with a mean increase in volume of 102%+/-62%. CONCLUSION: Contrary to common belief, we found that uterine myomas commonly decrease in volume over the course of pregnancy.