{"title":"Mini Commentary on ‘Pregnancy and Birth Complications and Maternal Mental Health—The Case is Clear’","authors":"Nicole Votruba","doi":"10.1111/1471-0528.17990","DOIUrl":"10.1111/1471-0528.17990","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 2","pages":"143-144"},"PeriodicalIF":4.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Insights on Stillbirths in Africa Using the Robson Classification System: Mini Commentary","authors":"Adeline A. Boatin","doi":"10.1111/1471-0528.17993","DOIUrl":"10.1111/1471-0528.17993","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 2","pages":"222-223"},"PeriodicalIF":4.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julie Cormier, Lola Mirouse, Janine Barbot, François Goffinet, Camille Le Ray
Objective
To assess the association between the decrease in the use of episiotomy and the incidence of obstetric anal sphincter injuries (OASIS) over a 10-year period and understand their reasons by interviewing obstetricians and midwives.
Design
Mixed-methods study.
Setting
A tertiary university public maternity hospital, Paris, France.
Population
All patients who delivered vaginally between January 2012 and December 2021 in the maternity hospital and 20 interviews with obstetrician-gynaecologists and midwives.
Methods
Quantitative data analysis using a multivariate logistic regression model, stratifying on the mode of delivery. Semi-structured interview with 20 obstetricians and midwives, with an interview guide.
Main Outcome Measures
Obstetric anal sphincter injuries.
Results
The quantitative study of 37 942 women (16.1% of whom had an episiotomy and 1.4% OASIS) shows that, the incidence of episiotomy decreased from 25% to 7.6% over this 10-year period. Allow on the known risk factors for OASIS, we demonstrate that its incidence rose (adjusted odds ratio 1.35, 95% confidence interval 1.09–1.67) for the years in which the episiotomy incidence fell below 10% for the overall population. The interviews showed professionals' apparent awareness that the decreased incidence in episiotomy (achieved by changes in departmental policy, redefining its benefit/risk balance and acquiring new skills to manage the expulsion phase) could lead to an increased incidence of OASIS.
Conclusions
Decreasing the episiotomy incidence appears to be associated with a rising incidence of OASIS. The optimal incidence of episiotomy remains controversial in the literature and among professionals.
{"title":"Evolution of Episiotomy Incidence and Obstetric Anal Sphincter Injury Over 10 Years: A Mixed-Methods Study","authors":"Julie Cormier, Lola Mirouse, Janine Barbot, François Goffinet, Camille Le Ray","doi":"10.1111/1471-0528.17999","DOIUrl":"10.1111/1471-0528.17999","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the association between the decrease in the use of episiotomy and the incidence of obstetric anal sphincter injuries (OASIS) over a 10-year period and understand their reasons by interviewing obstetricians and midwives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Mixed-methods study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>A tertiary university public maternity hospital, Paris, France.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>All patients who delivered vaginally between January 2012 and December 2021 in the maternity hospital and 20 interviews with obstetrician-gynaecologists and midwives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Quantitative data analysis using a multivariate logistic regression model, stratifying on the mode of delivery. Semi-structured interview with 20 obstetricians and midwives, with an interview guide.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Obstetric anal sphincter injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The quantitative study of 37 942 women (16.1% of whom had an episiotomy and 1.4% OASIS) shows that, the incidence of episiotomy decreased from 25% to 7.6% over this 10-year period. Allow on the known risk factors for OASIS, we demonstrate that its incidence rose (adjusted odds ratio 1.35, 95% confidence interval 1.09–1.67) for the years in which the episiotomy incidence fell below 10% for the overall population. The interviews showed professionals' apparent awareness that the decreased incidence in episiotomy (achieved by changes in departmental policy, redefining its benefit/risk balance and acquiring new skills to manage the expulsion phase) could lead to an increased incidence of OASIS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Decreasing the episiotomy incidence appears to be associated with a rising incidence of OASIS. The optimal incidence of episiotomy remains controversial in the literature and among professionals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 4","pages":"454-463"},"PeriodicalIF":4.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17999","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katherine C. Whitehouse, Patricia A. Lohr, John Reynolds-Wright, Jonathan Lord, Stephen Robson, Tracey Masters, Yvonne Neubauer, Lydia Kingsley, Sharon Cameron
{"title":"Optimising Anti-D Use: Revisiting Guidelines for First Trimester Abortions","authors":"Katherine C. Whitehouse, Patricia A. Lohr, John Reynolds-Wright, Jonathan Lord, Stephen Robson, Tracey Masters, Yvonne Neubauer, Lydia Kingsley, Sharon Cameron","doi":"10.1111/1471-0528.17996","DOIUrl":"10.1111/1471-0528.17996","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 4","pages":"426-428"},"PeriodicalIF":4.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carol Bedwell, Wendy Taylor, Caroline Cunningham, Andrew D. Weeks, Dame Tina Lavender
Objective
To understand the experiences of women, birth partners and health professionals of verbal followed by retrospective written consent in a prospective cohort study of a device to manage postpartum haemorrhage (PPH).
Design
Grounded Theory.
Setting
Tertiary facility in North-West England, UK.
Sample
We used purposive and theoretical sampling to recruit 51 participants; 12 women, 12 birth partners, 16 obstetricians and 11 midwives.
Methods
Semi-structured interviews were conducted, using a topic guide for focus, until data saturation was achieved. Data were analysed using framework analysis technique.
Results
Most women wanted sufficient information to make a decision at the time of the event, rather than in advance, and preferred not to be overwhelmed with detail. A key factor in making the decision to participate was a positive and trusting relationship with the attending obstetrician. Obtaining consent for research in emergencies was viewed by obstetricians as requiring a different approach and more challenging than consent for standard procedures in an emergency.
Conclusions
This is one of the first studies to explore verbal followed by retrospective written consent processes with women, clinicians and observers. This was acceptable to all, however information needs to be appropriate, and those discussing consent require adequate training (199/200).
{"title":"Emergency Verbal Consent for Intrapartum Research: A Grounded Theory Study","authors":"Carol Bedwell, Wendy Taylor, Caroline Cunningham, Andrew D. Weeks, Dame Tina Lavender","doi":"10.1111/1471-0528.17997","DOIUrl":"10.1111/1471-0528.17997","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To understand the experiences of women, birth partners and health professionals of verbal followed by retrospective written consent in a prospective cohort study of a device to manage postpartum haemorrhage (PPH).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Grounded Theory.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Tertiary facility in North-West England, UK.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Sample</h3>\u0000 \u0000 <p>We used purposive and theoretical sampling to recruit 51 participants; 12 women, 12 birth partners, 16 obstetricians and 11 midwives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Semi-structured interviews were conducted, using a topic guide for focus, until data saturation was achieved. Data were analysed using framework analysis technique.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most women wanted sufficient information to make a decision at the time of the event, rather than in advance, and preferred not to be overwhelmed with detail. A key factor in making the decision to participate was a positive and trusting relationship with the attending obstetrician. Obtaining consent for research in emergencies was viewed by obstetricians as requiring a different approach and more challenging than consent for standard procedures in an emergency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This is one of the first studies to explore verbal followed by retrospective written consent processes with women, clinicians and observers. This was acceptable to all, however information needs to be appropriate, and those discussing consent require adequate training (199/200).</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 4","pages":"446-453"},"PeriodicalIF":4.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17997","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142596800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Simrit Nijjar, Simarjit Sandhar, Ilan E. Timor-Tritsch, Andrea Kaelin Agten, Jin Li, Krystle Y. Chong, Munira Oza, Rosanna Acklom, Francesco D'Antonio, Lan N. Vuong, Ben Mol, Cecilia Bottomley, Davor Jurkovic, the International Collaboration COSCAR
Background
Caesarean scar ectopic pregnancy (CSEP) is associated with significant maternal and foetal morbidity. However, the optimal treatment remains unknown.
Objectives
The aim of this study was to review outcomes reported in studies on CSEP treatment and outcome reporting quality.
Search Strategy
We reviewed 1270 articles identified through searching PubMed, MEDLINE and Google Scholar from 2014 to 2024 using the search terms ‘caesarean scar ectopic pregnancy and caesarean scar pregnancy’.
Selection Criteria
We included all study types evaluating any form of CSEP treatment, with a sample size of ≥ 50, where diagnosis was described, and the article was in English.
Data Collection and Analysis
Two authors independently reviewed studies and assessed outcome reporting and methodological quality. The relationship between outcome reporting quality and publication year and journal type was assessed with univariate and bivariate models.
Main Results
A total of 108 studies, including 17 941 women, were included. 83% of all studies originated from China. Studies reported on 326 outcomes; blood loss (86%), need for additional intervention (77%) and time for serum hCG to normalise post treatment (69%) were the most common outcomes. A primary outcome was clearly defined in 11 (10%) studies. The median quality of outcome reporting was 3 (IQR 3–4). No relationship was demonstrated between outcome reporting quality and publication year (p = 0.116) or journal type (p = 0.503).
Conclusions
This review demonstrates that there is a wide variation in outcomes reported in studies on CSEP treatment. Development and implementation of a core outcome set by international stakeholders which includes patients is urgently needed to enable high-quality research that is both useful and relevant to patients.
{"title":"Outcome Reporting in Studies Investigating Treatment for Caesarean Scar Ectopic Pregnancy: A Systematic Review","authors":"Simrit Nijjar, Simarjit Sandhar, Ilan E. Timor-Tritsch, Andrea Kaelin Agten, Jin Li, Krystle Y. Chong, Munira Oza, Rosanna Acklom, Francesco D'Antonio, Lan N. Vuong, Ben Mol, Cecilia Bottomley, Davor Jurkovic, the International Collaboration COSCAR","doi":"10.1111/1471-0528.17989","DOIUrl":"10.1111/1471-0528.17989","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Caesarean scar ectopic pregnancy (CSEP) is associated with significant maternal and foetal morbidity. However, the optimal treatment remains unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The aim of this study was to review outcomes reported in studies on CSEP treatment and outcome reporting quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>We reviewed 1270 articles identified through searching PubMed, MEDLINE and Google Scholar from 2014 to 2024 using the search terms ‘caesarean scar ectopic pregnancy and caesarean scar pregnancy’.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection Criteria</h3>\u0000 \u0000 <p>We included all study types evaluating any form of CSEP treatment, with a sample size of ≥ 50, where diagnosis was described, and the article was in English.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection and Analysis</h3>\u0000 \u0000 <p>Two authors independently reviewed studies and assessed outcome reporting and methodological quality. The relationship between outcome reporting quality and publication year and journal type was assessed with univariate and bivariate models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>A total of 108 studies, including 17 941 women, were included. 83% of all studies originated from China. Studies reported on 326 outcomes; blood loss (86%), need for additional intervention (77%) and time for serum hCG to normalise post treatment (69%) were the most common outcomes. A primary outcome was clearly defined in 11 (10%) studies. The median quality of outcome reporting was 3 (IQR 3–4). No relationship was demonstrated between outcome reporting quality and publication year (<i>p</i> = 0.116) or journal type (<i>p</i> = 0.503).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This review demonstrates that there is a wide variation in outcomes reported in studies on CSEP treatment. Development and implementation of a core outcome set by international stakeholders which includes patients is urgently needed to enable high-quality research that is both useful and relevant to patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 3","pages":"278-287"},"PeriodicalIF":4.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Linked article: This is a mini commentary on Tancred et al., pp. 433–443 in this issue. To view this article visit https://doi.org/10.1111/1471-0528.17953.
利益冲突作者声明没有利益冲突。
{"title":"Postpartum Haemorrhage Care in Ghana and Uganda: Grounds for Hope and Concern","authors":"Emily Maclean","doi":"10.1111/1471-0528.17998","DOIUrl":"10.1111/1471-0528.17998","url":null,"abstract":"<p><b>Linked article:</b> This is a mini commentary on Tancred et al., pp. 433–443 in this issue. To view this article visit https://doi.org/10.1111/1471-0528.17953.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 4","pages":"444-445"},"PeriodicalIF":4.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142596801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Studying Prevention of Postpartum Venous Thromboembolism With Low-Molecular-Weight Heparin.","authors":"Ishwa Shakir, Maryam Tariq","doi":"10.1111/1471-0528.17995","DOIUrl":"https://doi.org/10.1111/1471-0528.17995","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Linked article: This is a mini commentary on Hunt et al., pp. 231–240 in this issue. To view this article visit https://doi.org/10.1111/1471-0528.17948.
{"title":"BJOG Mini Commentary on Systematic Review of Clinical Prediction Models for the Risk of Emergency Caesarean Births","authors":"Hala Eldamanhoury","doi":"10.1111/1471-0528.17992","DOIUrl":"10.1111/1471-0528.17992","url":null,"abstract":"<p><b>Linked article</b>: This is a mini commentary on Hunt et al., pp. 231–240 in this issue. To view this article visit https://doi.org/10.1111/1471-0528.17948.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 3","pages":"241-242"},"PeriodicalIF":4.7,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>I like to highlight the improved knowledge from findings of research reports on gynaecological surgery in this issue of BJOG.</p><p>The length of post-operative stay following a hysterectomy has reduced considerably over the last 4 decades following the introduction of the minimally access surgical approach. Many of us may not remember patients used to routinely stay for 5–7 days post-operatively following this procedure when it was performed either via a laparotomy or vaginally. Since then, the use of the laparoscopic approach has reduced this duration to 2 days routinely with a significant reduction in the number of hospital beds required to deliver this service. Dedden and colleagues conducted a randomised controlled trial to compare the physical function of patients at 7 days post-operatively when patients were either discharge home within the same day or the next day follow a total laparoscopic hysterectomy for benign gynaecological indications (pages 1762–1770). The study concluded that this outcome was non-inferior between same and next day discharge from hospital. The study also reported that the post-operative complication rate at 6 weeks post-operatively, re-admission rate and the number of post-operative patient reviews at both hospital and primary care were not statistically significantly different between both study groups. The data also showed that the level of physical function 6 weeks after surgery is still below that measured pre-operatively, suggesting that full recovery from this type of surgery requires a longer time period. Hence, patients undergoing an unremarkable laparoscopic and possibly robotic assisted hysterectomy can be feasibly discharged on the same day after surgery, especially when early mobilisation and other aspects of enhanced surgical recovery are also implemented.</p><p>There remains uncertainty with the effectiveness of surgical excision to cure the pelvic pain from endometriosis. Currently there is an ongoing randomised clinical trial comparing pelvic pain following surgical excision versus placebo for patients with superficial peritoneal disease<span><sup>1</sup></span>. On pages 1793–1804, Lewin and colleagues analysed data from an international database on the effectiveness of surgical excision alone versus excision plus hysterectomy with or without bilateral oophorectomy for improving pelvic pain and quality of life in women with deep recto-vaginal endometriosis. When compared to women who undergone excision alone, non-cyclical pain, dyspareunia, back pain and quality of life scores at 24 months post-operatively were significantly improved in those women who had the endometriosis excised plus hysterectomy without oophorectomy. Those women who had surgical excision together with hysterectomy and bilateral oophorectomies also had significant improvement in these outcomes compared to those with excision alone. Women who had the removal of both ovaries during a hysterectomy at the time of the surgical ex
{"title":"Gynaecological surgery","authors":"Patrick Chien","doi":"10.1111/1471-0528.17988","DOIUrl":"10.1111/1471-0528.17988","url":null,"abstract":"<p>I like to highlight the improved knowledge from findings of research reports on gynaecological surgery in this issue of BJOG.</p><p>The length of post-operative stay following a hysterectomy has reduced considerably over the last 4 decades following the introduction of the minimally access surgical approach. Many of us may not remember patients used to routinely stay for 5–7 days post-operatively following this procedure when it was performed either via a laparotomy or vaginally. Since then, the use of the laparoscopic approach has reduced this duration to 2 days routinely with a significant reduction in the number of hospital beds required to deliver this service. Dedden and colleagues conducted a randomised controlled trial to compare the physical function of patients at 7 days post-operatively when patients were either discharge home within the same day or the next day follow a total laparoscopic hysterectomy for benign gynaecological indications (pages 1762–1770). The study concluded that this outcome was non-inferior between same and next day discharge from hospital. The study also reported that the post-operative complication rate at 6 weeks post-operatively, re-admission rate and the number of post-operative patient reviews at both hospital and primary care were not statistically significantly different between both study groups. The data also showed that the level of physical function 6 weeks after surgery is still below that measured pre-operatively, suggesting that full recovery from this type of surgery requires a longer time period. Hence, patients undergoing an unremarkable laparoscopic and possibly robotic assisted hysterectomy can be feasibly discharged on the same day after surgery, especially when early mobilisation and other aspects of enhanced surgical recovery are also implemented.</p><p>There remains uncertainty with the effectiveness of surgical excision to cure the pelvic pain from endometriosis. Currently there is an ongoing randomised clinical trial comparing pelvic pain following surgical excision versus placebo for patients with superficial peritoneal disease<span><sup>1</sup></span>. On pages 1793–1804, Lewin and colleagues analysed data from an international database on the effectiveness of surgical excision alone versus excision plus hysterectomy with or without bilateral oophorectomy for improving pelvic pain and quality of life in women with deep recto-vaginal endometriosis. When compared to women who undergone excision alone, non-cyclical pain, dyspareunia, back pain and quality of life scores at 24 months post-operatively were significantly improved in those women who had the endometriosis excised plus hysterectomy without oophorectomy. Those women who had surgical excision together with hysterectomy and bilateral oophorectomies also had significant improvement in these outcomes compared to those with excision alone. Women who had the removal of both ovaries during a hysterectomy at the time of the surgical ex","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 13","pages":"1737-1738"},"PeriodicalIF":4.7,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17988","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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