Conservative surgical management for postpartum hemorrhage (PPH), such as balloon tamponade, uterine compression suture, and uterine artery ligation, has the benefit of preserving reproductive function.
To assess the efficacy and subsequent pregnancy outcome of conservative surgical management for patients with immediate PPH.
Medical records of patients who had PPH between January 2011 and December 2016 were reviewed. Conservative surgical management included B-Lynch uterine compression suture, Bakri balloon tamponade, and uterine artery ligation. The treatments were considered successful if patients did not require subsequent hysterectomy. Perioperative complications and subsequent pregnancy outcomes were recorded.
Of 30,271 deliveries, 669 patients experienced PPH or 2.2% of total deliveries. Sixty-one patients (9.1%) did not respond to medical treatment with various uterotonic agents. Hysterectomy was selected initially in 30 patients. Conservative surgical management was performed in 31 patients: 15 Bakri balloon tamponade, 13 uterine compression suture, and 3 uterine artery ligation. There were 3 patients who failed Bakri balloon tamponade and proceeded to perform uterine compression suture with successful outcome. The success rates for conservative surgical treatment were 66.7%, 75%, and 66.7%, respectively. All patients who had successful conservative surgical management resumed normal menstruation. Three out of 11 patients (27.3%) who desired subsequent pregnancy were able to conceive and carry out a viable pregnancy.
Conservative surgical management has acceptable success rates for controlling intractable immediate PPH. Implementation of such procedures should be done to preserve fertility and decrease maternal morbidity and mortality.
Asama Vanichtantikul, Patou Tantbirojn and Tarinee Manchana
Survival for patients with early stage cervical cancer without any high-risk factors treated with radical hysterectomy is excellent. However, there are few data on the survival outcomes for low-risk and intermediate-risk early stage cervical cancer patients.
To determine survival outcomes and prognostic factors of low-risk and intermediate-risk stage IB1 cervical cancer patients.
Stage IB1 cervical cancer patients with radical hysterectomy and pelvic lymphadenectomy were retrospectively reviewed. Patients with positive pelvic nodes, parametrial involvement, and positive margin who are classified as high-risk patients were excluded. Patients with squamous cell carcinoma or grade 1–2 adenocarcinoma, tumor size less than 2 cm, no lymphovascular space invasion (LVSI), and depth of stromal invasion (DSI) less than 10 mm were defined as low-risk patients. Survival was evaluated using the Kaplan–Meier method and compared by the log-rank test. Multivariate analysis was performed using Cox proportional-hazards regression.
There were 82 (42.3%) low-risk patients and 112 (57.7%) intermediate-risk patients. More patients in intermediate risk received adjuvant treatment (3.6% and 14.3%, P = 0.07). Three (3.6%) low-risk patients and 18 (16.1%) intermediate-risk patients had recurrent disease (P = 0.004). At median follow-up of 86 months, 1.2% of low-risk patients and 8.9% of intermediate-risk had cancer-related deaths (P = 0.02). Low-risk patients had significantly better 5-year disease-free survival (98.2% vs 91.1%, P = 0.01) and estimated 5-year overall survival (98.5% vs 91.1%, P = 0.01). DSI more than 10 mm and presence of LVSI were significantly associated with recurrence. However, LVSI was an independent prognostic factor.
Stage IB1 cervical cancer patients had excellent survival. Low-risk patients had significantly better survival. Presence of LVSI was an independent prognostic factor.
Backgrounds: Uterine sarcoma was staged previously according to the 1988 FIGO staging system for endometrial adenocarcinoma. However, in 2009 a new staging system for uterine sarcoma has been developed.
Objectives: The purpose of this study was to compare the survival between traditional and new FIGO staging system.
Materials and methods: The medical records of uterine sarcoma patients who received primary treatment at King Chulalongkorn Memorial Hospital, Thailand between 1999 and 2008 were reviewed. The survival curves were generated by Kaplan-Meier method. A comparison of survival between groups was assessed by the log-rank test.
Results: Thirty-three patients were included. The incidence of uterine sarcoma was 0.8% and 4.4% of all gynecologic cancers and uterine cancer, respectively. A comparison between these two staging systems showed that four patients (12.1%) were down-staged and none was up-staged. The 5-year disease-free survival (DFS) and overall survival (OS) were 40.4% and 56.0%, respectively. Age, parity, histology, tumor size, lymph node dissection, and adjuvant treatments were not significant prognostic factors. Patients with early stage had significantly longer survival than those with advanced stage. Mean DFS in early stage according to 1988 and 2009 FIGO staging system were 80 and 77 months, respectively. Mean OS were 97 months and 91 months, respectively. Mean DFS in advanced stage were 34 months and 15 months, respectively. Median OS were 12 months and 10 months, respectively. There was no difference in survival between these two staging systems.
Conclusions: Stage is the only independent prognostic factor. There was no difference in survival between these two staging systems.