Obstetrical Hysterectomy, cesarean delivery and abnormal placentation.

OBJECTIVE: To examine the incidence, risk factors, and complications associated with Obstetrical Hysterectomy at a single University Hospital. STUDY DESIGN: This was a retrospective study of all cases of Obstetrical Hysterectomy performed between January 1993 and December 2005 at Temple University Hospital, Philadelphia, Pennsylvania. The current procedural terminology (CPT) codes were used to identify patients, and chart review was used to collect demographics and indications. RESULTS: During the study years, 19 patients underwent Obsterical Hysterectomy. Of these, 14 (73.7%) had cesarean during their current delivery. Further, 9 (47.4%) of the 19 had previous cesarean deliveries (CDs), with 5 (56%) of the 9 having had two or more previous CDs. Only two women (10.5%) never had cesarean either in the current or previous pregnancy. Eighteen of the women had singleton pregnancies, while only one woman had a twin gestation. A total of 42.1% of the cases had abnormal placentation with 21% experiencing placenta accreta, 15.8% with placenta previa, and 5.3% with placental abruption. A variety of complications arose including fever (52.6%) and blood transfusion (84.2%). CONCLUSION: CD in the current pregnancy and history of CD were strong risk factors for Obstetrical Hysterectomy. There was also a high occurrence of Obstetrical Hysterectomy in patients who had abnormal placentation. This information should be used to counsel women regarding the increased risk of remote complications of CD while discussing the route of delivery.

Unusually large extraintestinal GIST presenting as an abdomino-pelvic tumor.

BACKGROUND: Gastrointestinal stromal tumor (GIST) is a rare visceral tumor that may mimic ovarian tumor. CASE: A 56-year-old woman presented with a large abdomino-pelvic mass and moderately elevated CA-125. A large tumor occupying the whole abdominal cavity and pelvis was noted on laparotomy. In addition, multiple tumor nodules were seen from the ligament of Treitz to the terminal ileum involving only the surface intestine. The ovaries appeared normal. The tumor demonstrated spindle and epithelioid components and was found to be morphologically and immunohistochemically consistent with GIST. CONCLUSION: Gynecologists need to be cognizant of extra-ovarian pathology in the atypical presentation of a pelvic mass. Correct diagnosis is essential for proper management since GISTs specifically respond to the c-kit selective tyrosine kinase inhibitor, Imatinib mesylate.