Placenta previa: distance to internal os and mode of delivery.

OBJECTIVE: The purpose of this study was to relate the mode of delivery and outcomes in a cohort of cases of placenta previa that had the last transvaginal ultrasonographic scan <28 days before delivery. STUDY DESIGN: Cases in which the placental edge overlapped the internal cervical (n = 42) underwent cesarean section delivery. Labor was allowed in those with placental edge to internal os distance of 1-10 mm (group 1, 24 women) and those with a distance of 11-20 mm (group 2, 29 women). RESULTS: Rates of cesarean section delivery (75% vs 31%; odds ratio, 6.7; 95% confidence interval [CI], 2-22) and of bleeding before labor (29% vs 3%; odds ratio, 11.5; 95% CI, 1.6-76.7) were higher in group 1 than in group 2. Blood loss at delivery (662 +/- 466 mL vs 510 +/- 547 mL) and rate of severe postpartum hemorrhage (21% vs 10%; odds ratio, 2.3; 95% CI, 0.5-9.7) were similar in the 2 groups. CONCLUSION: More than two-thirds of women with a placental edge to cervical os distance of >10 mm deliver vaginally without increased risk of hemorrhage.

Feasibility and morbidity of total laparoscopic radical hysterectomy with or without pelvic limphadenectomy in obese women with stage I endometrial cancer.

OBJECTIVE: The aim of this study was to describe the feasibility and morbidity rates associated with total laparoscopic radical hysterectomy (TLRH) with or without pelvic lymphadenectomy for stage I endometrial cancer in obese women. PATIENTS AND METHODS: Obese patients with stage I endometrial cancer who underwent total laparoscopic radical surgery at the Department of Obstetrics and Gynecology of San Gerardo Hospital were compared to nonobese patients. The same group of obese patients was compared with patients who underwent radical laparotomic surgery. Obesity was defined as a body mass index more than 30 kg/m(2). RESULTS: Between September 2003 and September 2007, 75 women underwent TLRH. Median age was 54 years and median body mass index was 28 kg/m(2). Thirty-seven women were obese. There were no differences between nonobese and obese women in operative, time length of parametria and pelvic nodes removed and operative or late complications. Blood loss was significantly higher in obese patients. Comparing retrospectively laparoscopy and laparotomy in obese women treated in our center, laparotomy was associated with decreased operative time, but also with increased blood loss, transfusion rate, duration of hospitalization and frequency of post surgical complications. CONCLUSIONS: Total laparoscopic radical hysterectomy (with pelvic lymphadenectomy) is a safe option in patients with endometrial cancer. Obesity is not a contraindication to perform a TRLH with no differences in surgical parameters between obese and nonobese population. TLRH show a significant decrease of complications compared to laparotomic radical surgery in obese women.