July 2010 - AOGD

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Dr Shakun Tyagi, Dr Neha Singh, Dr Ayesha Arif, Dr Seema Beniwal
WHAT MEASURED BLOOD LOSS TELLS US
ABOUT POSTPARTUM BLEEDING: A SYSTEMATIC
REVIEW. (BJOG 2010;117:788–800) ___________
Sloan NL, Durocher J, Aldrich T, Blum J, Winikoff B
Objectives: Systematic review of measured postpartum
blood loss with and without prophylactic uterotonics for
prevention of postpartum hemorrhage (PPH).
Methods: 29 studies with objective measurement of blood
loss after delivery were evaluated. Most of the studies
measured blood loss by placing a bedpan underneath the
parturient woman. The collected blood was poured into a jar
for volume measurement, and all soaked gauze pads were
counted and weighed. A few studies used the fairly new
blood collection sheet or delivery drape to calculate blood loss.
Results: The distribution of average blood loss is similar
with any prophylactic uterotonic, and is lower than without
prophylaxis. Compared with no uterotonic, oxytocin and
misoprostol have lower PPH (≥500 ml) and severe PPH
(≥1000 ml) rates. Oxytocin has lower PPH and severe PPH
rates than misoprostol.
Conclusion: Oxytocin is superior to misoprostol in
hospitals. Although oxytocin is superior, misoprostol
substantially lowers PPH and severe PPH. A sound
assessment of the relative merits of the two drugs is needed
in rural areas, where most PPH deaths occur.
RISK OF UTERINE RUPTURE ASSOCIATED WITH
AN INTERDELIVERY INTERVAL BETWEEN 18 AND
24 MONTHS (OBSTETRICS & GYNECOLOGY, MAY
2010;115,( 5): 1003-6) _______________________
Bujol E, Gauthier R
Objective: To estimate the association between interdelivery
interval and uterine rupture in women with a
previous cesarean delivery
Methods: Secondary analysis was performed in a
retrospective cohort study of women who underwent a trial
of labor after undergoing a previous cesarean delivery. Only
singleton pregnancies with a trial of labor at term were
included. The rates of uterine rupture were compared among
women with interdelivery intervals 24 months or longer
(controls), 18–24 months, and fewer than 18 months. The
student t test and multivariable logistic regression analysis
were conducted. A P value of less than .05 was considered
significant.
Results: Of the 1,768 women analyzed, 1,323 (74.8%)
had an interdelivery interval of 24 months or longer, 257
(14.5%) had an interval between 18 and 24 months, and 188
(10.6%) had an interval of less than 18 months. The rate of
successful VBAC (70%, 74%, and 73%, respectively; P=0.28)
not different across the three groups. After adjustment for
confounding variables, an interdelivery interval less than 18
months was associated with a significant increase of uterine
rupture (odds ratio [OR], 3.0; 95% confidence interval [CI],
1.3–7.2), whereas an interdelivery interval between 18 and
24 months was not (OR, 1.1; 95% CI, 0.4 –3.2)
Conclusion: The risk of uterine rupture was significantly
higher in women with an interdelivery interval less than 18
months than in women with an interval of 24 months or
longer, but not in women with an interval between 18 and
23 months. An interdelivery interval less than 18 months
was an independent and an important factor associated
with uterine scar defect, after adjustment for a uterine
scar thickness less than 2.3 mm and a previous single-layer
closure of the uterus.
PROGESTOGEN TREATMENT OPTIONS FOR
EARLY ENDOMETRIAL CANCER (BR J OBSTET
GYNAECOL 2010;117:879–84) ________________
Cade TJ, Quinn MA, Rome RM, Neeshama D
Objective: Analysis of cancer-free outcome and fertility
potential with progestogen therapy for early endometrial
cancer.
Methods: Sixteen patients receiving progestogen therapy
for stage-1 grade-1 endometrial cancer were retrospectively
reviewed and their response to treatment, duration of
response and fertility outcome in a specialist gynaecological
oncology unit at a tertiary hospital was evaluated.
Results: Of the 16 patients, four received an oral
progestogen, three received levonorgestrel-releasing
intrauterine system (Mirena), and nine received both forms
of treatment. Response to therapy was assessed by disease
regression on serial endometrial curettage. Ten patients
(63%) responded to treatment, with a median time to
response of 5.5 months. Six patients did not respond, but
they were either early in treatment or opted for surgical
management before the average time of response. No
patient who responded had a later recurrence. The mean
follow-up time was 27 months (range 3–134 months),
with no patient deaths. Three patients had successful
pregnancies.
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