Reflexed Compression Suture for the Management of Atonic Postpartum Hemorrhage with an Abnormally Adherent Placenta.

BACKGROUND/AIMS: Postpartum hemorrhage (PPH) is a life-threatening condition with a worldwide occurrence. The purpose of this study is to evaluate the efficacy and safety of a reflexed compression suture in controlling severe atonic PPH with placenta accreta. METHODS: Eleven women with severe PPH due to uterine inertia or placenta accreta were administered the reflexed compression suture. The procedure was to reflex the fundus onto the anterior wall of the uterus for compressing hemostasis and to form a 'belt-like' binding suture to reinforce the effectiveness of pressing the myometrium. RESULTS: Ten of the 11 women (90.9%) were successfully treated with the suture, and the uterus was preserved. None of these patients developed complications related to this method. Only in 1 patient with placenta increta could the bleeding not be stanched, and a peripartum hysterectomy was performed. Two women had pregnancies after the suture. CONCLUSION: The reflexed compression suture is a simple, swift, safe and effective technique of controlling uterine atonic bleeding, particularly in patients with an abnormally adherent placenta. The advantage of not having to conduct a hysterotomy also lies in reducing the duration of anesthesia and blood loss.

[Expression of cyclin D1 and p16 protein in vulvar white lesion].

OBJECTIVE: To investigate the relationship between cell cycle protein (cyclin D1 and p16) expression and vulvar white lesion. METHODS: Biopsies from 34 cases with vulvar white lesion, including 12 cases with lichen sclerosus (LS), 18 with squamous hyperplasia (SH) and 4 SH accompanied with LS, were examined for protein expression of cyclin D1 and p16 using immunohistochemical techniques. Normal vulvar tissues from 11 patients with other benign gynecologic diseases were used as control. RESULTS: Fifty-six percent of patients with vulvar white lesion were immunopositive for cyclin D1 protein, which was significantly higher than that of control group (9%, P < 0.05); but there was no significant difference between LS (58%) and SH patients (50%, P > 0.05) in expression of cyclin D1 protein. Immunopositive expression of p16 protein in patients was 6%, with no significant difference from the control group (0, P > 0.05). CONCLUSIONS: Cyclin D1 and p16 are important factors modulating cell cycle. The interrupt of balance between these two factors derived from abnormal expression of cyclin D1 may be one of the causes of vulvar white lesion.

[Meta-analysis of uterine arterial embolization and myomectomy in treatment of uterine myoma].

OBJECTIVE: To evaluate the effectiveness and safety of uterine arterial embolization (UAE) in the management of symptomatic uterine myomas compared with myomectomy. METHODS: All clinical trials on UAE treating symptomatic uterine myomas indexed in PubMed and Chinese National Knowledge Infrastructure (CNKI) were reviewed using meta-analysis by Revman 4.1 software. The patients were classified into two groups, i.e., UAE trial group and control group. Intervention method in control group was surgery of uterine myomectomy. There were no differences between two groups in age, general physical status, and manifestation of uterine myoma. RESULTS: Six hundred and eighty patients with symptomatic uterine myoma in eight trials were included into this study according to selection criteria of Cochrane collaboration. Meta-analysis indicated that weight of every trial contributing to the study was related to its number of patients in direct ratio, but not related to quality scale of the trial. There were no statistical differences between these trials in evaluation criteria (P > 0.05). Relative risk (RR) between UAE patients and control group was 0.95, and 95% CI was 0.92 - 0.99. The success rate (92.3%) of UAE group was 95% of control group (96.7%), with a significant difference between them (P < 0.05). CONCLUSIONS: Surgical procedures to treat uterine myomas have more effective outcomes than UAE. Patients who select UAE procedure may have 95% opportunity to improve clinical symptoms and avoid some surgical risks, and also have a higher life quality in future, although this has to be testified by long term follow-up.