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Rufin KGA, do Valle HA, McAlpine JN, Elwood C, Hanley GE. Complications after opportunistic salpingectomy compared with tubal ligation at cesarean section: a retrospective cohort study. Fertil Steril 2024; 121:531-539. [PMID: 38043843 DOI: 10.1016/j.fertnstert.2023.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To compare perioperative and postoperative complications in patients who underwent opportunistic salpingectomy (OS) (removal of the fallopian tubes for ovarian cancer risk reduction during another surgery) at the time of cesarean section (C-section) with those in patients who underwent tubal ligation. DESIGN A population-based, retrospective cohort study. SETTING British Columbia, Canada. PATIENT(S) A total of 18,184 patients were included in this study, of whom 8,440 and 9,744 underwent OS and tubal ligation, respectively. INTERVENTION(S) Patients who underwent OS during a C-section were compared with those who underwent tubal ligation during a C-section. MAIN OUTCOME MEASURE(S) We examined the perioperative outcomes, including operating room time, length of hospital stay, surgical complications such as infections, anemia, incision complications, injury to a pelvic organ, or operating room return; postoperative complications, including physician visits for a postoperative infection or visits that resulted in ultrasound or laboratory examinations and hospital readmissions in the 6 weeks after discharge; and likelihood to fill a prescription for antibiotics or analgesics. RESULT(S) The OS group had decreased odds of perioperative complications compared with the tubal ligation group (adjusted odds ratio [aOR], 0.77; 95% confidence interval [CI], 0.61-0.99). Patients who underwent OS did not have increased risks of physician visits for surgical complications, such as infection, or hospital readmissions in the 6 weeks after hospital discharge. In addition, these patients had 18% and 23% increased odds of filling prescriptions for nonsteroidal anti-inflammatory drugs (aOR, 1.18; 95% CI, 1.07-1.28) and opioids (aOR, 1.23%; 95% CI, 1.12-1.35), respectively. CONCLUSION(S) In this population-based, real-world study of OS at C-section, we report decreased perioperative complications and no difference in postoperative complications between patients who underwent OS and those who underwent tubal ligation. Patients who underwent OS had an increased likelihood of filling a prescription for nonsteroidal anti-inflammatory drugs and opioids in the 6 weeks after hospital discharge. This result should be interpreted with caution because we did not have data on over-the-counter medication use and, thus, not all prescription analgesics were captured in our data. Our data suggest that OS after C-section is a safe way to provide effective contraception and ovarian cancer risk reduction.
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Affiliation(s)
- Khaye Gerazel A Rufin
- Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Helena Abreu do Valle
- Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica N McAlpine
- Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chelsea Elwood
- Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gillian E Hanley
- Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, British Columbia, Canada.
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Noori N, Edwards L, Anpalagan A, Athavale R, Burling M, Herbst U, Brand A, Kapurubandara S. Bilateral salpingectomy as an option of permanent contraception at time of caesarean section: A survey of practice. Aust N Z J Obstet Gynaecol 2024; 64:72-76. [PMID: 37674327 DOI: 10.1111/ajo.13748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/15/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Opportunistic bilateral salpingectomy during benign gynaecologic surgery is advocated as a risk-reducing strategy due to the inverse association of epithelial ovarian cancers observed in epidemiological studies in a low-risk setting. Currently, no formal guidance exists for permanent surgical contraception at time of caesarean section in Australia. AIMS Our aim was to survey Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) regarding bilateral salpingectomy compared to other procedures offered for permanent contraception at the time of caesarean section. MATERIALS AND METHODS An online survey was utilised to collect clinician demographics, opinions, barriers, and justifications in regard to options of permanent surgical contraception at time of caesarean section. RESULTS Bilateral salpingectomy was identified as the most effective method of permanent contraception at time of caesarean section. However, only 62% of respondents offer the procedure as a method of permanent contraception. The two most common reasons for clinicians to offer bilateral salpingectomy at time of caesarean section were evidence suggesting a link between the fallopian tube and gynaecological cancer (80%) and efficacy as a permanent form of contraception (16%). The primary barrier identified by 51% of respondents was perceived increased risk of surgical complications, followed by reasoning that it would not allow the possibility of future tubal reversal. CONCLUSION This study identifies diverse opinions on surgical approach to permanent contraception at time of caesarean section and offered by clinicians of RANZCOG. Further research is required to establish safety profiles and short- and long-term risks of bilateral salpingectomy.
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Affiliation(s)
- Nargis Noori
- Obstetrics and Gynaecology Department, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney West Advanced Pelvic Surgery Unit, Sydney, New South Wales, Australia
| | - Laura Edwards
- Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Apputhurai Anpalagan
- Obstetrics and Gynaecology Department, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney West Advanced Pelvic Surgery Unit, Sydney, New South Wales, Australia
| | - Ramanand Athavale
- Gynaecological Oncology Department, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Michael Burling
- University of Sydney, Sydney, New South Wales, Australia
- Gynaecological Oncology Department, Westmead Hospital, Sydney, New South Wales, Australia
| | - Unine Herbst
- Gynaecological Oncology Department, Westmead Hospital, Sydney, New South Wales, Australia
| | - Alison Brand
- University of Sydney, Sydney, New South Wales, Australia
- Gynaecological Oncology Department, Westmead Hospital, Sydney, New South Wales, Australia
| | - Supuni Kapurubandara
- Obstetrics and Gynaecology Department, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney West Advanced Pelvic Surgery Unit, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
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3
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McCarley CB, Boitano TK, Dilley SE, Subramaniam A. Complete Compared With Partial Salpingectomy for Postpartum Sterilization. Obstet Gynecol 2023; 142:1347-1356. [PMID: 37884007 DOI: 10.1097/aog.0000000000005416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/24/2023] [Indexed: 10/28/2023]
Abstract
In this narrative review, we describe evidence regarding the associated risks, benefits, and cost effectiveness of postpartum complete salpingectomy compared with partial salpingectomy. Permanent contraception can be performed via several methods, but complete salpingectomy is becoming more common secondary to its coincident benefit of ovarian cancer risk reduction. Small prospective studies and larger retrospective cohort studies have demonstrated the feasibility and safety of complete salpingectomy in the postpartum period. Additionally, multiple cost-effectiveness analyses have demonstrated the cost effectiveness of this method secondary to ovarian cancer reduction over the life span. Although future larger cohort studies will allow for more precise estimates of the effect of complete salpingectomy on ovarian cancer risk and incidence of rare complications, current data suggest that complete salpingectomy should be offered to patients as a method of permanent contraception in the postpartum period.
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Affiliation(s)
- Charlotte B McCarley
- Division of Maternal Fetal Medicine and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and the Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama; and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
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4
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Marchand GJ, Masoud AT, King AK, Brazil GM, Ulibarri HM, Parise JE, Arroyo AL, Coriell CL, Goetz SP, Moir CJ, Govindan ML. Salpingectomy, tubal ligation and hysteroscopic occlusion for sterilization. Minerva Obstet Gynecol 2022; 74:452-461. [PMID: 35912465 DOI: 10.23736/s2724-606x.22.05134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Sterilization of females is considered one of the most prevalent contraceptive techniques among women in the United States. There are many surgical sterilization procedures including salpingectomy, tubal ligation, and hysteroscopic occlusion of the fallopian tubes. We provide an overview of these methods from the clinical data and latest studies available on this topic. EVIDENCE ACQUISITION In order to review the latest literature on the topic, we searched electronic databases including PubMed, Web of Science, Scopus, and Cochrane library for all eligible studies from May 1st 2018 until May 1st 2022 using the following strategy: ("fallopian tube removal" OR Salpingectomy OR "fallopian tube excision" OR "tubal sterilization") AND ("tubal ligation" OR "bipolar coagulation" OR "tubal clip" OR "tubal ring" OR fimbriectomy). We reviewed every study that met our criteria and subjectively considered their results and methodology into this narrative review. EVIDENCE SYNTHESIS In addition to reviewing major guidelines in the United States, 19 recent studies met our eligibility criteria and were included in this review. We grouped the findings under the following headings: anatomical and physiological considerations, sterilization, salpingectomy, tubal ligation, and hysteroscopic tubal occlusion. CONCLUSIONS Bilateral salpingectomy and techniques of tubal ligation or occlusion continue to be effective procedures with good safety profiles. All techniques have similar surgical outcomes and long-term success rates. As salpingectomy has the advantage of reducing the risk of occurrence of ovarian cancer, this is preferential when feasible. Hysteroscopic occlusion techniques may be more minimally invasive but have the disadvantages of delayed efficacy, the need for a second invasive diagnostic procedure, and limited availability.
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Affiliation(s)
- Greg J Marchand
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA -
| | - Ahmed T Masoud
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
- Faculty of Medicine, University of Fayoum, Fayoum, Egypt
| | - Alexa K King
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Giovanna M Brazil
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Hollie M Ulibarri
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Julia E Parise
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Amanda L Arroyo
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Catherine L Coriell
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Sydnee P Goetz
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Carmen J Moir
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Malini L Govindan
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
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Benefits and Risks of Bilateral Salpingectomy Compared With Standard Tubal Ligation During Cesarean Delivery for Permanent Postpartum Contraception. Obstet Gynecol Surv 2022; 77:167-173. [PMID: 35275215 DOI: 10.1097/ogx.0000000000000995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Ovarian cancer is the second most common gynecologic malignancy, but the most deadly female reproductive cancer in the United States. Epithelial ovarian cancer makes up approximately 90% of all cases and is responsible for more than 90% of ovarian cancer deaths. Elective salpingectomy has been shown to reduce ovarian cancer risk when performed at the time of a benign hysterectomy. Data regarding the risks and benefits of opportunistic bilateral salpingectomy performed at the time of cesarean delivery are limited. Objective We aim to review the current evidence regarding safety and benefits of opportunistic bilateral salpingectomy at the time of cesarean delivery compared with bilateral tubal ligation. Evidence Acquisition Original research articles, review articles, and guidelines on contraception were reviewed. Conclusions and Relevance Opportunistic bilateral salpingectomy at the time of cesarean delivery is feasible and safe. Operative time may be increased up to 15 minutes for salpingectomy performed by suture ligation compared with standard tubal ligation. Women with a history of 3 or more cesarean deliveries are more likely to require an alternative procedure. It is important to counsel women that although opportunistic bilateral salpingectomy may significantly decrease the risk of ovarian cancer, it does not eliminate the risk entirely.
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Ferrari FA, Garzon S, Raffaelli R, Cromi A, Casarin J, Ghezzi F, Uccella S, Franchi M. Tranexamic acid for the prevention and the treatment of primary postpartum haemorrhage: a systematic review. J OBSTET GYNAECOL 2022; 42:734-746. [PMID: 34996342 DOI: 10.1080/01443615.2021.2013784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Tranexamic acid (TA) has been proposed for preventing or treating primary postpartum haemorrhage (PPH), which is the leading cause of maternal morbidity and mortality worldwide. We conducted a systematic literature search to the TA role in managing PPH in vaginal and caesarean delivery. Twenty-seven randomised controlled trials (RCTs) (33,302 women) were identified. Three RCTs investigated TA for preventing PPH after vaginal delivery and 22 after caesarean section. None demonstrated a preventive effect on secondary clinical outcomes related to blood loss. Two trials evaluated TA for treating PPH after vaginal and caesarean delivery. Only the WOMAN trial showed that 1 g of TA is effective. In conclusion, TA is considered useful and is recommended or advised for treating PPH. Conversely, available evidence on the prophylactic role is still limited, and this use is not supported. Further investigation is recommended. In this regard, stronger and more reliable outcomes than blood loss should be considered.
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Affiliation(s)
| | - Simone Garzon
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Ricciarda Raffaelli
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
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Magarakis L, Idahl A, Särnqvist C, Strandell A. Efficacy and safety of sterilisation procedures to reduce the risk of epithelial ovarian cancer: a systematic review comparing salpingectomy with tubal ligation. EUR J CONTRACEP REPR 2021; 27:230-239. [PMID: 34870544 DOI: 10.1080/13625187.2021.2010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The objective of this systematic review is to evaluate current literature comparing salpingectomy for sterilisation with tubal ligation, regarding the effectiveness and safety, and assess the certainty of evidence. MATERIALS AND METHODS PubMed, Cochrane, and Embase databases were searched. Randomised (RCT) and observational studies were included. Articles were quality assessed and data extracted by two independent authors. Certainty of evidence was assessed using GRADE. RESULTS Of 2020 articles, 17 were included. No study investigated the risk of EOC. No difference in anti-Müllerian hormone was reported in one RCT at caesarean section (CS). Two cohort studies evaluated ovarian function with surrogate measures and found no difference at caesarean section. Complications did not differ but were inconsistently reported. Laparoscopic tubal ligation was 7 min faster (95% CI 3.8-10.5). Operative time at caesarean section was dependent on the use of surgical devices. Certainty of evidence was low or very low for all estimates, indicating knowledge gaps. Reliable safety data on salpingectomy for sterilisation is lacking, and there is no effectiveness data. Presently, women cannot be properly counselled regarding salpingectomy for sterilisation.
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Affiliation(s)
- Leonidas Magarakis
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Goteborg, Sweden
| | - Annika Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Charlotte Särnqvist
- School of Medicine Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Annika Strandell
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Goteborg, Sweden
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Paradigm shift from tubal ligation to opportunistic salpingectomy at cesarean delivery in the United States. Am J Obstet Gynecol 2021; 225:399.e1-399.e32. [PMID: 34181896 DOI: 10.1016/j.ajog.2021.06.074] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/13/2021] [Accepted: 06/14/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Opportunistic salpingectomy is now recommended at the time of routine gynecologic surgery to reduce the risk of future ovarian cancer, and performance of opportunistic salpingectomy has increased markedly at the time of benign hysterectomy. Salpingectomy has also been suggested to be feasible at the time of cesarean delivery in women desiring sterilization; however, uptake has not been previously studied on a national level. OBJECTIVE This study aimed to examine recent population trends in the utilization and characteristics of salpingectomy at the time of cesarean delivery in the United States. STUDY DESIGN This is a population-based retrospective observational study querying the National Inpatient Sample between October 2015 and December 2018. The primary outcome measure was the temporal trend of bilateral salpingectomy at cesarean delivery, assessed with linear segmented regression with log transformation utilizing 3-month time increments. The secondary outcome measures included patient characteristics associated with bilateral salpingectomy, assessed with a multinomial regression model, and surgical outcome (hemorrhage, blood transfusion, hysterectomy, and oophorectomy) at the time of bilateral salpingectomy vs bilateral tubal ligation, assessed with generalized estimating equation in a propensity score-matched model. RESULTS There were 3,813,823 women at the age of 15 to 49 years who had cesarean deliveries included, of whom 397,260 (10.4%) had bilateral salpingectomy and 203,400 (5.3%) had bilateral tubal ligation overall. During the time period studied, performance of bilateral salpingectomy among women undergoing cesarean delivery significantly increased from 4.6% to 13.2% (odds ratio for the fourth quarter of 2018 vs the fourth quarter of 2015, 2.69; 95% confidence interval, 2.63-2.75; Figure panel). In contrast, performance of bilateral tubal ligation among women undergoing cesarean delivery significantly decreased from 11.3% to 2.4% (odds ratio, 0.20; 95% confidence interval, 0.19-0.21). By the third quarter of 2016, the number of women who had bilateral salpingectomy exceeded those who had bilateral tubal ligation at cesarean delivery (8.6% vs 7.3%). Increasing the utilization of bilateral salpingectomy did not vary across age groups; the salpingectomy rate increased from 7.5% to 21.1% among women at the age of ≥35 years and from 3.8% to 10.7% among women at the age of <35 years (both, P<.001). In a propensity score matched model, women in the bilateral salpingectomy group were more likely to have hemorrhage (3.8% vs 3.1%; odds ratio, 1.24; 95% confidence interval, 1.15-1.33), blood product transfusion (2.1% vs 1.8%; odds ratio, 1.16; 95% confidence interval, 1.04-1.30), hysterectomy (0.8% vs 0.4%; odds ratio, 2.28; 95% confidence interval, 1.84-2.82), and oophorectomy (0.3% vs 0.2%; odds ratio, 2.02; 95% confidence interval, 1.47-2.79) than those in the bilateral tubal ligation group. When restricted to the nonhysterectomy cases, the bilateral salpingectomy group had a higher rate of hemorrhage (3.4% vs 3.0%; odds ratio, 1.16; 95% confidence interval, 1.06-1.26) and oophorectomy (0.3% vs 0.1%; odds ratio, 1.75; 95% confidence interval, 1.22-2.50) than the bilateral tubal ligation group. CONCLUSION In the United States, the utilization of bilateral salpingectomy at the time of cesarean delivery increased rapidly between 2015 and 2018, replacing tubal ligation as the most common type of sterilization performed with cesarean delivery. The higher surgical morbidity in the bilateral salpingectomy group than the bilateral tubal ligation group observed in this study warrants further investigation.
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9
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Ferrari F, Ferrari FA, Negri B, Forte S, Franceschetti L, Sartori E, Odicino F. Uterine torsion and intrauterine growth restriction: Case report and systematic literature review. J Obstet Gynaecol Res 2021; 47:4224-4231. [PMID: 34569124 DOI: 10.1111/jog.15038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 08/26/2021] [Accepted: 09/12/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Uterine torsion (UT) in pregnancy is a rare condition in obstetric practice. It is defined as a rotation of the uterus of more than 45° around its long axis. Presentations are varied and, most of the time, this condition is recognized at laparotomy or cesarean section (CS). The aim of this study is to summarize the latest evidence about UT in pregnancy. METHODS A systematic research of the literature was conducted fetching all papers published from March 2006 to June 2020. We collected data regarding clinical features, treatment, and feto-maternal outcomes. Finally, we reported data of a case of UT associated with intrauterine growth restriction (IUGR) diagnosed and treated at our institution. RESULTS According to our search strategy, 38 articles were included. In 66% of the cases, acute symptomatology was present at the onset, most frequently abdominal pain was reported. In one-third of the cases, UT was diagnosed during CS without clinical suspicion. Only in two cases, including our case, IUGR was reported. Most (66%) of the cases presented a 180° torsion. In the majority of the cases, a CS was performed also with a deliberate or accidental posterior hysterotomy. One and six cases of maternal and fetal death were, respectively, reported. CONCLUSION UT is an infrequent obstetric condition but should be considered in case of abdominal pain, vomiting, or shock presentation during pregnancy. It could lead to a reduction in uterine blood flow contributing to poor placental perfusion, even though more evidence is needed to clarify this link.
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Affiliation(s)
- Federico Ferrari
- Department of Obstetrics and Gynecology, Spedali Civili Brescia, Brescia, Italy
| | | | - Beatrice Negri
- Department of Obstetrics and Gynecology, Spedali Civili Brescia, Brescia, Italy
| | - Sara Forte
- Department of Obstetrics and Gynecology, Spedali Civili Brescia, Brescia, Italy
| | - Laura Franceschetti
- Department of Obstetrics and Gynecology, Spedali Civili Brescia, Brescia, Italy
| | - Enrico Sartori
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Franco Odicino
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Desravines N, Brenner T, Venkatesh K, Stuart G. Frequency and characteristics associated with opportunistic salpingectomy at cesarean delivery: A retrospective chart review. Contraception 2020; 103:203-207. [PMID: 33345975 DOI: 10.1016/j.contraception.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 11/29/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To identify the frequency and characteristics associated with total salpingectomy (TS) versus occlusion or partial salpingectomy (PS) at the time of cesarean delivery. STUDY DESIGN We performed a retrospective chart review of cesarean deliveries with a concurrent permanent contraception procedure, from July 1, 2014 to June 30, 2019 at 2 hospitals (community hospital and tertiary care academic center) within a single healthcare system. We assessed the proportion of TS versus PS at cesarean, and secondarily compared operative times between the 2 procedures. RESULTS We identified 2110 procedures during the 5-year period. Surgeons performed TS in 302 (14%, 95% confidence interval [CI] 13%-16%) cases, and the annual rate varied from 14% to 18% over the study period (p = 0.14). Factors associated with increased likelihood of TS rather than PS included public insurance/self-pay (adjusted odds ratio, aOR 2.8, 95% CI 2.0-4.1), delivery at the community hospital (aOR 4.8, 95% CI 3.0-7.7), parity of 5 or more (aOR 2.2, 95% CI 1.1-4.4), and presence of an obstetrician/gynecologist for cesarean delivery (aOR 2.9, 95% CI 1.6-5.4). The total operative time for TS and PS differed at the academic center (90 vs 68 minutes, p < 0.001) but not at the community hospital (55 vs 54 minutes, p = 0.5). CONCLUSIONS This study highlights provider and institutional characteristics associated with TS compared to PS at the time of cesarean delivery, which may inform future programs aimed at increasing utilization of TS at cesarean delivery. IMPLICATIONS Access to TS at the time of cesarean delivery may provide pregnant women with a very effective permanent contraception method at a convenient time of concurrent cesarean. This study identifies patient factors that may influence access to TS as part of obstetrical care.
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Affiliation(s)
- Nerlyne Desravines
- University of North Carolina, Department of Obstetrics and Gynecology, Division of General Obstetrics and Gynecology, Chapel Hill, NC, United States.
| | - Tara Brenner
- University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, NC, United States
| | - Kartik Venkatesh
- University of North Carolina, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Chapel Hill, NC, United States
| | - Gretchen Stuart
- University of North Carolina, Department of Obstetrics and Gynecology, Division of Family Planning, Chapel Hill, NC, United States.
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Ferrari F, Ficarelli S, Forte S, Valenti G, Ardighieri L, Sartori E, Odicino F. Extra-abdominal ovarian cancer presenting with breast metastases at diagnosis: Case report and literature review. Eur J Obstet Gynecol Reprod Biol 2020; 255:211-221. [PMID: 33152565 DOI: 10.1016/j.ejogrb.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/17/2020] [Accepted: 10/08/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Malignant ovarian tumours are diagnosed at an advanced stage in the majority of cases. However, only a small percentage present as extra-abdominal, non-lymph-node solid metastases, as in the breast, and they are usually cases of relapse. The discovery of mono- or bilateral breast lesions with peritoneal carcinosis and/or abdomino-pelvic lesions can be cumbersome in the differential diagnosis of primary tumours. This article aims to summarize current evidence on the detection of breast metastases at diagnosis of ovarian cancer. STUDY DESIGN A systematic review of the literature in Scopus, PubMed/MEDLINE, ScienceDirect and the Cochrane Library, including case reports and case series, was undertaken. Data regarding study features; population characteristics; clinical, radiological and histological assessment of the disease; treatment and follow-up were collected. In addition, a case report of a patient managed at the authors' centre is provided. RESULTS According to the search strategy, 16 articles (18 patients) were included in this review. Serous ovarian, fallopian tube or primary peritoneal cancer was detected in 61% of cases, while another type or a non-specified type of epithelial ovarian cancer was detected in 27.7% of cases; there was one case with granulosa cell tumour of the ovary and one case with mucinous ovarian tumour of low malignant potential. Breast metastases were mainly monolateral (66.6%), with other extra-abdominal sites of disease in the majority of the cases. A minority of patients (16.6%) received treatment for primary breast cancer with a subsequent diagnosis of ovarian cancer. Concomitant breast and abdominal surgery can be an option. PAX8, WT1 and CA125 immunohistochemical staining can aid in differential diagnosis. CONCLUSION Breast metastases of malignant ovarian tumours must be promptly recognized to ensure proper treatment. Specific immunohistochemical analysis can be a decisive assessment in uncertain cases.
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Affiliation(s)
- Federico Ferrari
- Department of Obstetrics and Gynaecology, ASST Spedali Civili Brescia, Brescia, Italy.
| | - Silvia Ficarelli
- Department of Obstetrics and Gynaecology, ASST Spedali Civili Brescia, Brescia, Italy
| | - Sara Forte
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
| | - Gaetano Valenti
- Unit of Gynaecology and Obstetrics, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | | | - Enrico Sartori
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
| | - Franco Odicino
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
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Roeckner JT, Sawangkum P, Sanchez-Ramos L, Duncan JR. Salpingectomy at the Time of Cesarean Delivery: A Systematic Review and Meta-analysis. Obstet Gynecol 2020; 135:550-557. [PMID: 32080033 DOI: 10.1097/aog.0000000000003673] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare the differences in operative time and surgical outcomes between salpingectomy and standard tubal interruption at the time of cesarean delivery. DATA SOURCES PubMed, Medline, Google Scholar, Cochrane, and ClinicalTrials.gov were searched from inception until July 2019 for articles reporting outcomes for women undergoing salpingectomy during cesarean delivery compared with women undergoing standard sterilization methods. METHODS OF STUDY SELECTION Studies were selected if they included the main outcome of operative time or additional outcomes, which included infection, transfusion, readmission, change in hematocrit, and estimated blood loss. The Newcastle-Ottawa Quality Assessment scale or Cochrane Handbook were used to assess quality of cohort and randomized controlled trials (RCTs), respectively. A random-effects model was employed to calculate pooled relative risk or weighted mean difference for each outcome with their 95% CI. Heterogeneity was assessed using the I statistic, and L'Abbé plots were inspected visually to assess for homogeneity. TABULATION, INTEGRATION, AND RESULTS We identified 11 studies comprising 320,443 women undergoing total salpingectomy or standard sterilization methods at the time of cesarean delivery. Three RCTs and eight retrospective cohort studies were investigated separately by meta-analysis. When compared with standard sterilization methods, total operative time for patients receiving salpingectomy was significantly longer (6.3 minutes, 95% CI 3.5-9.1, seven studies, 7,303 patients) for cohort studies. With the three RCTs of 163 patients, total operative time was not significantly increased in women receiving salpingectomy (8.1 minutes, 95% CI -4.4 to 20.7). The salpingectomy group did not have an increased risk of wound infection, transfusion, readmission, reoperation, internal organ damage, blood loss, change in hemoglobin, or length of stay when compared with standard sterilization methods. CONCLUSION Salpingectomy at the time of cesarean delivery was associated with a small increase in operative time; however, it was not associated with an increased rate of surgical complications. This option should be considered for patients desiring sterilization during cesarean delivery. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42019145247.
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Affiliation(s)
- Jared T Roeckner
- Departments of Obstetrics and Gynecology, Divisions of Maternal Fetal Medicine, University of South Florida, Morsani College of Medicine, Tampa, and University of Florida College of Medicine, Jacksonville, Jacksonville, Florida
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Yassa M, Pulatoğlu Ç. Patients' perceptions toward and the driving factors of decision-making for opportunistic bilateral salpingectomy at the time of cesarean section. Turk J Obstet Gynecol 2020; 17:115-122. [PMID: 32850186 PMCID: PMC7406902 DOI: 10.4274/tjod.galenos.2020.12129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/10/2020] [Indexed: 01/19/2023] Open
Abstract
Objective: Enough data can be found in the literature regarding the protective effect of tubal ligation on gynecological cancers. In addition, a large body of evidence revealed that prophylactic bilateral salpingectomy had no significant negative effect on the ovarian function, quality of life, sexuality, surgery duration, and cost-effectivity. This study was aimed at exploring the underlying factors that motivate women for either opportunistic bilateral salpingectomy (OBS) or tubal ligation, particularly focusing on their preferences, knowledge, and beliefs toward female sterilization, satisfaction from counseling, and body image following the salpingectomy. Materials and Methods: A total of 54 patients who had undergone surgical sterilization with either OBS or tubal ligation were included in this prospective cohort study. The acceptance rate of the OBS at the time of cesarean section among pregnant women seeking surgical sterilization was calculated. The underlying reasons for women’s acceptance or refusal for salpingectomy were assessed by a non-validated data collection tool that had 14 open-ended questions focusing on the women’s preferences, knowledge, beliefs toward female sterilization, satisfaction from counseling, and body image following the salpingectomy. Results: The acceptance rate of OBS at the time of cesarean section among pregnant women and electively among non-pregnant women were 93.5% (n=43/46) and 75% (6/8), respectively. The main driving factors influencing the decision of preferring OBS over tubal ligation were the risk-reducing effect for ovarian cancer and superior pregnancy prevention. Conclusion: The acceptance rate of OBS at the time of cesarean section was found to be very high, and it should therefore be offered at the time of cesarean section to women who desire permanent contraception.
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Affiliation(s)
- Murat Yassa
- Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Çiğdem Pulatoğlu
- İstinye University, Medical Park Gaziosmanpaşa Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
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Duncan JR, Roeckner JT, Sanchez-Ramos L. A low-cost approach for salpingectomy during cesarean delivery. Am J Obstet Gynecol 2020; 223:305-306. [PMID: 32247838 DOI: 10.1016/j.ajog.2020.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/24/2020] [Indexed: 11/25/2022]
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