Changes in serum D-dimer level and effect of enoxaparin sodium after a cesarean section: a retrospective study.

BACKGROUND: Pregnancy increases the risk of venous thromboembolism (VTE). During pregnancy and a post-cesarean section, an increase in D-dimer levels can be observed. However, to date, the usefulness of the D-dimer level measurement for thrombosis in pregnant women has not been determined. OBJECTS: We aimed to evaluate the changes in D-dimer levels after a cesarean section, the risk factors of high D-dimer levels, and enoxaparin sodium's preventive effects on VTE. METHODS: This retrospective study enrolled 160 pregnant women who underwent a cesarean section. D-dimer levels were measured on postoperative day (POD)1 and POD6. If on POD1, the D-dimer levels were ≥10 µg/mL, enoxaparin sodium was administered until POD7. Regardless of enoxaparin administration, when the D-dimer levels on POD6 were ≥10 µg/mL, lower-limb venous ultrasonography was performed. After a cesarean section, patients were screened for the following: factors causing high D-dimer levels, incidence of deep vein thrombosis (DVT), and need for enoxaparin. RESULTS: The median D-dimer levels on POD1 and POD6 were 7.5 µg/mL (1.1-34.1) and 4.2 µg/mL (0.02-31.4), respectively. Enoxaparin sodium was administered to 56 patients (35%). The D-dimer levels on POD6 decreased more significantly than on POD1. The median D-dimer levels in the enoxaparin administration group significantly dropped from 14.3 (POD1) to 3.9 (POD6) (p<.001). The D-dimer levels on POD1 were higher in patients aged ≥35 years and with a hospitalization history of threatened preterm labor. In addition, on POD6, patients aged ≥35 years and with a high body mass index had high D-levels. Following a multivariate analysis, the elderly represent an independent factor for high D-levels. DVT was not observed. CONCLUSION: When the D-dimer levels on POD1 after a cesarean section are ≥10 µg/mL, enoxaparin reduces D-dimer levels six days after cesarean section. Moreover, patients aged ≥35 years represent an independent factor for high D-levels. These findings should be validated by further studies.

Comparison of Total Laparoscopic Hysterectomy with Abdominal Total Hysterectomy in Patients with Benign Disease: A Retrospective Cohort Study.

BACKGROUND: The present study aimed to determine whether total laparoscopic hysterectomy (TLH) is being implemented safely and appropriately compared with abdominal total hysterectomy (ATH) in our hospital. METHODS: We retrospectively reviewed clinical records of 102 patients who underwent total hysterectomy for benign gynecological disease at Japanese Red Cross Yamaguchi Hospital from January 2017 to August 2018. We examined periods of hospital stay, operation time, blood loss, weight of the uterus, frequency of perioperative complications, and the duration from the first visit to the date of surgery. P < 0.05 was considered to be statistically significant indicated statistical significance. RESULTS: TLH and ATH were performed in 55 (53%) and 47 (46%) cases, respectively. The TLH group had significantly longer total operation time [133 (82-205) min vs. 87 (57-155) min, P < 0.0001], lesser blood loss [5 (5-35) g vs. 100 (10-820) g, P < 0.0001], shorter hospital stay [7 (5-14) days vs. 10 (9-26) days, P < 0.0001], and lighter uterine weight [206 (27-658) g vs. 554 (79-2284) g, P < 0.0001] than the ATH group. The frequency of perioperative complications did not differ between the two groups (3.5% vs. 8.0%, P = 0.4103). CONCLUSION: TLH had a longer operation time and a lesser excised uterine weight, but it had less intraoperative blood loss, shorter hospital stay, and no difference in perioperative complication frequency when compared with ATH.

Training in the Departments of Urology and Surgery for Gynecologists in Japan.

BACKGROUND: The authors wanted to understand the current situation concerning Japanese obstetricians' and gynecologists' ideas for and against training in other departments. METHODS: We sent questionnaires to obstetrics and gynecology (Ob-Gyn) specialists via a social networking service (SNS) in Japan. They answered anonymously using Google Forms over the internet. RESULTS: The respondents comprised 120 Ob-Gyn specialists, and their age ranges of 28-29, 30-39, 40-49, and 50 or more, were 5.8%, 73.3%, 15.8%, and 5.0%, respectively. Only five Ob-Gyn specialists (4.2%) had experience in other departments, specifically gastrointestinal and urology. Ninety percent of them responded that they thought training in other departments was useful for developing clinical and surgical skills. In addition, 91.0% of respondents thought that surgical knowledge and skills were necessary in the clinical practice of gynecology, while 94% stated training in urology was also necessary. However, 49.2% of respondents answered that they may feel stress training in other departments where there were many issues, including a lack of personnel and difficulties securing cases. CONCLUSION: Many Ob-Gyn specialists think training in other departments is necessary, but potential problems include proper training implementation and stress management for residents. If additional training is enforced, greater flexibility in each facility will be required.

Re-evaluation of Urinary Trypsin Inhibitor on Pregnancy Course in Patients with Threatened Preterm Delivery: A Single-Center Retrospective Study.

BACKGROUND: We evaluated the necessity of urinary trypsin inhibitor for patients with threatened premature labor. METHODS: We enrolled 146 women with singleton pregnancies who were treated for threatened premature labor as inpatients. The uterine cervical length of each patient was ≤ 25 mm at 22-35 weeks of gestation on transvaginal ultrasonography. The patients were divided into two groups: the urinary trypsin inhibitor group (91 patients treated with urinary trypsin inhibitor daily) or non-urinary trypsin inhibitor group (55 patients not treated with urinary trypsin inhibitor). The childbirth outcomes were retrospectively assessed. RESULTS: The median cervical length measured on the day of admission was almost similar between the urinary trypsin inhibitor and non-urinary trypsin inhibitor groups. Depending on the symptoms of uterine contractions, we determined whether ritodrine hydrochloride and/or magnesium sulfate would be appropriate for treatment. The median gestational week at birth was 38 weeks in the urinary trypsin inhibitor group, and no obvious differences were observed when compared with the non-urinary trypsin inhibitor group. With regard to birth weight, no significant difference was found between the two groups (urinary trypsin inhibitor group, 2776 g; non-urinary trypsin inhibitor group, 2800 g). CONCLUSION: Our data showed no significant beneficial effects of urinary trypsin inhibitor in the maternal course and delivery outcomes.