RESUMO
OBJECTIVE: To compare efficacy of sterilization reversals by laparotomy versus laparoscopy. DESIGN: Meta-analysis. SEARCH STRATEGY: Electronic searches were carried out for randomized controlled trials and retrospective and prospective clinical studies. Search engines such as PubMed, Science Direct, Medline and the Cochrane database were made use of. Our restrictions were English human studies published from 1989 to January 2010. INTERVENTIONS: Microsurgical tubal reanastomosis performed comparing laparoscopy with laparotomy using a microsurgical technique. OUTCOME MEASURES: Primary: overall pregnancy rates, including positive clinical pregnancy, intrauterine and ectopic pregnancy rates. Secondary: surgery time. RESULTS: Three retrospective comparative studies were retrieved from international data that investigated laparotomy versus laparoscopy. A total number of 184 patients were included, 88 and 96 respectively undergoing laparoscopy and laparotomy. Pregnancy rates achieved by laparoscopy ranged from 65 to 80.5% (mean 74.43%) and by laparotomy from 70 to 80% (mean 71.33%). A subanalysis of two of the three comparative studies show that laparoscopy reversal surgery requires a statistically significant longer operative time than does laparotomy (p < 0.00001). CONCLUSIONS: There is no difference between the laparoscopy and laparotomy approach to tubal reanastomosis when regarding overall pregnancy rates, intrauterine and ectopic pregnancy rates.
Assuntos
Laparoscopia/métodos , Laparotomia/métodos , Reversão da Esterilização/métodos , Ensaios Clínicos como Assunto , Feminino , Humanos , Duração da Cirurgia , Gravidez , Taxa de Gravidez , Gravidez Ectópica/epidemiologia , Ensaios Clínicos Controlados Aleatórios como AssuntoAssuntos
Descolamento Prematuro da Placenta/diagnóstico , Descolamento Prematuro da Placenta/epidemiologia , Morte Fetal/epidemiologia , Resultado da Gravidez , Descolamento Prematuro da Placenta/terapia , Adolescente , Adulto , Fatores Etários , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Parto Obstétrico/métodos , Países em Desenvolvimento , Feminino , Idade Gestacional , Humanos , Incidência , Idade Materna , Paridade , Gravidez , Probabilidade , Prognóstico , Recidiva , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , África do Sul/epidemiologiaRESUMO
Audit of the quality of gynaecological care is essential so that errors due to medical interventions can be reduced to the bare minimum. The aim of this study was to determine the incidence and nature of adverse gynaecological events. The clinical records of all women admitted with gynaecological conditions over 9 months were assessed for adverse events, defined as an injury caused by medical management rather than the underlying disease. Adverse events occurred in 11.7% of admissions and 52% were avoidable. The majority of adverse events were minor (disability lasting less than 6 months). Mortality accounted for 17.7% of adverse events and 2.1% of all admissions. The death rate was higher in the elective admissions. The frequency of adverse events increased with age, the presence of co-existing illnesses, and severity of the illness on admission. Therapeutic mishaps (n = 67; 8%) were the most common type of adverse event. Lessons learnt from audit should reduce adverse events considerably.
