Vasopressin during abdominal hysterectomy: a randomized controlled trial.

OBJECTIVE: To investigate if the use of vasopressin during abdominal hysterectomy would decrease blood loss. METHODS: Fifty-one patients undergoing abdominal hysterectomy with the diagnosis of leiomyomatous uterus were randomized and received either vasopressin 10 units/10 mL of normal saline or 10 mL of normal saline, injected 5 mL bilaterally, 1 cm medial to the uterine vessels into the lower uterine segment. The sample size was determined assuming a one-third reduction in total blood loss would be clinically relevant. A power analysis determined that 25 patients would be required in each group to assure a power of 0.80, at the.05 significance level. RESULTS: Overall, the two groups were very similar with regard to their demographics, preoperative diagnosis, and relevant findings at the time of surgery. The mean total blood loss in the vasopressin and placebo groups was 445.41 mL and 748.42 mL, respectively. Total blood loss was significantly decreased by 40% in the vasopressin group compared with the placebo group (P <.001). There was no statistically significant difference between the two groups with respect to possible confounding variables or surgical complications. CONCLUSION: Injection of vasopressin into the uterus at the time of abdominal hysterectomy significantly reduces blood loss without increasing morbidity. We have shown that it is a useful adjunct during abdominal hysterectomy.

The CLIPED procedure: an attempt to improve perinatal outcome in hopeless situations.

The purpose of this study was to prevent delivery in women who at < 23 weeks' gestation were in premature labor with excessive cervical dilation and membranes prolapsed into the vagina. Six patients were seen at gestational ages of 17 to 22.5 weeks in premature labor with cervical dilatation of 2 to 8 cm and membranes prolapsed into the vagina. There were three singleton pregnancies, two sets of twins, and one set of triplets. Cerclage placement was successful in five of six patients and one patient had ruptured membranes at operation. One fetus died the day after successful cerclage. The average prolongation of gestation was 33 days in the remaining four patients. It is our opinion that the poor prognosis of a patient at < 23 weeks' gestation in premature labor with excessive cervical dilatation and membranes prolapsed into the vagina may be altered with cerclage placement. We suggest that patients at > or = 21 weeks' gestation with prolapsed membranes whose contractions have been stopped be considered for cerclage late in pregnancy with excessive dilation (CLIPED procedure). The average amount of time a gestation is prolonged may preclude the procedure before 21 weeks.