Inappropriate use of new technology: impact on women's health.

While medical technology is very useful we need to be aware of its inappropriate use. Examples are given, such as: continuous vs. intermittent electronic fetal monitoring; widespread use of magnetic resonance image technology where simple methods could be as effective; laparoscopically assisted vaginal hysterectomies replacing simple vaginal hysterectomies and increasing the cost; ultrasound to provide the first pictures of the baby or to detect female fetuses for female feticide; use of technology for defensive medicine rather than using it for the patient's welfare, and pecuniary indications. Woe betide the doctor who does not make enough money--he may find that his contract is not renewed. We need to empower patients with information, so that they can judge the technology and its appropriateness as it relates to them. Opinion programs have helped to curb the misuse of unnecessary surgery, and audit and peer review programs also provide a check on the misuse of technology. The provision of consensus statements, e.g. by the National Institutes of Health, USA, have helped to clarify issues and to guide doctors as to the appropriateness of the newer technologies, and practice guidelines formulated by experts are also very helpful. We need to teach medical students and residents how to be critical, how to evaluate claims and study the literature, so that they are not hoodwinked by 'authority' or misled by manufacturer's claims.

Vaginal hysterectomy following previous cesarean section.

OBJECTIVE: To determine whether hysterectomy by the vaginal route is safe and feasible in patients with previous cesarean section. METHODS: A retrospective study of the records of private and public hospital patients who underwent vaginal hysterectomy performed by the senior author. Two hundred twenty patients who had had previous cesarean sections were compared with a control group of 200 patients who had not had previous pelvic surgery, with special reference to operative difficulties, intraoperative complications, surgical time and length of hospital stay. RESULTS: It was possible to perform vaginal hysterectomy safety in patients with previous cesarean sections. Three of 200 (1.5%) patients had inadvertent intraoperative urological trauma because of dense adhesions. CONCLUSIONS: The vaginal route is the route of choice for performing a hysterectomy in patients with previous cesarean section.