Applicability of the modified ACOG/SGO referral criteria for adnexal mass within a limited-resource setting.

OBJECTIVE: To evaluate the performance of the modified American Congress of Obstetricians and Gynecologists (ACOG)/Society of Gynecologic Oncology (SGO) referral guidelines in a high-risk limited-resource setting. METHODS: In a retrospective study, data were assessed for all women who underwent surgery for an adnexal mass at John H. Stroger Jr Hospital, Chicago, IL, USA, between July 2006 and July 2011. Sensitivity, specificity, and positive and negative predictive values were calculated both for actual practice referral patterns and for the modified ACOG/SGO guidelines. RESULTS: Among 542 study women, 176 (32.5%) were diagnosed with ovarian malignancy. The ACOG/SGO guidelines showed 81.3% sensitivity and 71.9% specificity for the prediction of malignancy at time of surgery, with positive and negative predictive values of 58.1% and 88.9%, respectively. Actual practice patterns demonstrated lower sensitivity (68.2%; P<0.001) but higher specificity (84.2%; P<0.001). CONCLUSION: As compared with practice patterns, the modified ACOG/SGO guidelines lacked sufficient specificity for referral and might not be applicable in high-risk, low-resource settings. For this population, screening should be based on stratifying patients into low-, intermediate-, and high-risk categories to allow limited resources to be focused on women at highest risk.

Blood Loss as a Function of Body Surface Area: Redefining Parameters of Obstetric Blood Loss.

OBJECTIVE: To identify average blood loss in vaginal and cesarean deliveries in a cohort of women based on body surface area and compare this with the standard definitions. METHODS: In this descriptive study, we analyzed data from 459 deliveries. We identified the median estimated blood loss across the sample. Using body surface area, we calculated the total blood volume for each woman and represented estimated blood loss as a percentage of total blood volume. For each quintile of body surface area, we determined the median estimated blood loss at delivery, the median total blood volume, and the volumes of blood loss that represent 5%, 10% and 15% of total blood volume, respectively. RESULTS: A total of 459 women met inclusion criteria. Median body surface area was 1.9 m and median total blood volume was 5,046 mL. Median estimated blood loss was 300 mL and represented 5.9% of total blood volume. For each body surface area quintile, median estimated blood loss and percent total blood volume were: quintile 1, 250 mL, 5.7% total blood volume; quintile 2, 400 mL, 8.5% total blood volume; quintile 3, 300 mL, 5.9% total blood volume, quintile 4, 300 mL, 5.6% total blood volume, and quintile 5, 400 mL, 6.7% total blood volume. CONCLUSION: Redefining obstetric blood loss as a percentage of total blood volume rather than one universal value may help appropriate targeting of interventions.