The effect of learning curve on the outcome of caesarean section.

OBJECTIVE: To evaluate the operative outcomes when trainees first perform caesarean sections independently. DESIGN: A retrospective study in a tertiary obstetric unit. POPULATION: Five hundred caesarean sections, which represented the first 50 caesarean sections performed independently by each of ten trainees, were studied. METHODS: The effect of learning curve on outcome was analysed. MAIN OUTCOME MEASURES: Total operative time, incision-to-delivery interval, operative blood loss, Apgar score, cord arterial pH, incidence of neonatal intensive care unit admission, postoperative complication rates and duration of hospitalisation. RESULTS: The mean operative time for the first five cases by trainees was 52.2 +/- 11.4 minutes. It progressively decreased and reached 39.6 +/- 8.4 minutes for the 46th to 50th cases. The operative time was significantly longer in the first 15 caesarean sections (P < 0.05). Moreover, the incision-to-delivery interval was also longer during the first five cases (P= 0.02). Besides the time of the operation, the trend for operative blood loss stabilised after the first ten caesarean sections (P < 0.05). Otherwise, there were no significant differences among other outcome variables. CONCLUSION: This study shows that trainees need to perform 10-15 caesarean sections before their skills become more proficient. Senior obstetricians may need to provide guidance to the trainees during their first independent 15 caesarean sections.

Evidence of circulating donor genetic material in bone allotransplantation.

Musculoskeletal allotransplantion is the most common form of human tissue transplantation. Unlike solid organ transplants, bone allotransplants undergo rigorous processing and are considered non-viable tissue. In this study, we propose that donor genetic material may exist in circulation after bone allotransplantation. Fifty-one female patients who received bone allotransplants from male donors were assessed. Blood plasma samples were analyzed using real-time quantitative polymerase chain reaction (PCR) with dual labeled fluorogenic probes for the presence of the SRY gene on the Y chromosome. Of the total 51 patients, the SRY sequence was detected in 6 patients. Five were positive at day 1 postoperatively and negative thereafter, with the remaining patient positive at 3 months post-transplantation. Our results document, for the first time, the presence of donor DNA in the circulation of recipients after bone allotransplantation. Our findings suggest a potential new investigative tool to assess the postoperative status of bone allotransplants.

Duplex ultrasound screening for deep vein thrombosis in Chinese after cesarean section.

BACKGROUND: To evaluate the incidence of asymptomatic deep vein thrombosis (DVT) in Chinese after cesarean section (CS). METHODS: This is a prospective observational study. Ethnic Chinese women who were asymptomatic for DVT and delivered by CS were included. Duplex ultrasound scan (US) of the lower limbs was carried out 3-7 days after CS. RESULTS: From July 2000 to March 2001, a total of 93 women were examined. The mean age was 32.1 years (SD 5.0). Forty-nine of 93 CSs were elective (52.7%). The median time from CS to US was 4 days (interquartile range, 4-5 days). No case of DVT was found in these 93 women. CONCLUSION: The incidence of asymptomatic DVT is low in Chinese women after CS. Routine screening for DVT after CS is not warranted.

Prospective self-controlled study on prevention of hysteroscopic dissemination in endometrial carcinoma.

Patients diagnosed to have endometrial carcinoma without prior hysteroscopic examination were recruited from March 2000 to August 2003. Normal saline was used to distend the uterine cavity during the hysteroscopic examination to look for endocervical spread before the definitive surgical treatment. We performed laparotomy, clamped both fallopian tubes, and collected peritoneal washing before the hysteroscopic examination was performed. Peritoneal washing was collected once more after the hysteroscopic examination. Hysteroscopic assessment was performed in 103 patients. Of them, 10 patients were excluded from the study due to previous history of tubal sterilization or blockage. The final analysis was confined to 93 patients. Positive peritoneal cytology was found in 10 (10.8%) patients and this finding was significantly related to the tumor grading (P = 0.023), adnexal involvement (P = 0.003), cervical invasion (P = 0.01), and the presence of peritoneal seedlings (P = 0.001). In five of the 10 patients with positive peritoneal cytology before the hysteroscopic examination, malignant cells could also be recovered in the peritoneal washing collected after the hysteroscopic examination. For patients with negative peritoneal cytology before hysteroscopy, none exhibited positive peritoneal cytology after the procedure. Our data suggested that complete occlusion of both fallopian tubes can effectively prevent the dissemination of endometrial malignant cells into the peritoneal cavity during hysteroscopy.