Laparoscopic hysterectomy in the presence of previous caesarean section: a review of one hundred forty-one cases in the Sydney West Advanced Pelvic Surgery Unit.

OBJECTIVE: To examine whether laparoscopic hysterectomy is safe in the presence of previous caesarean section (CS). DESIGN: Canadian Task Force Classification II-2. SETTING: Laparoscopic hysterectomies performed for nonmalignant conditions by 7 gynecologic surgeons in public and private hospitals in Western Sydney. PATIENTS: Data were collected from January 2001 through December 2007, involving 574 patients, of which 141 patients had 1 or more previous CS. INTERVENTION: Laparoscopic hysterectomy. MEASUREMENTS: Conversions to laparotomy and major intraoperative and postoperative complications (within 6 weeks of surgery) were recorded and compared between cohorts of patients with and without previous caesarean sections. MAIN RESULTS: Of the 574 laparoscopic hysterectomies identified, 141 (24.6%) patients had at least 1 previous CS. Most women with previous CS had only 1 CS (51.8%), whereas 13.5% had 3 or more CS. The overall major complication rate among patients undergoing laparoscopic hysterectomy was 10.1%. The most common complication was hemorrhage (7.3% of patients) and inadvertent cystotomy (2.1%). The rate of major complications varied between the CS and non-CS groups. Among the non-CS group, the complication rate was 8.8%, whereas the complication rate among the CS group was 14.2%. The rate of inadvertent cystotomy in the group with no previous CS was 5 in 433 patients (1.2%). The rate of bladder complications showed an increase with the number of previous CS: 2.5% of patients with 1 or 2 previous CS and 21.1% of patients with 3 or more previous CS. The rate of inadvertent cystotomy in patients with 3 or more CS was 18 times that of patients with no CS (95% CI 5.1, 66.0). Twenty-four (5.5%) patients without previous CS and 15 (10.6%) patients with previous CS required conversion to laparotomy because of dense bladder or bowel adhesions. CONCLUSION: Laparoscopic hysterectomy in the setting of previous CS is recommended because long-term sequelae are rare. There are higher rates of major complications in patients undergoing laparoscopic hysterectomy with previous CS; the higher the number of previous CS, the higher the rate of complications. The most significant increase is seen in patients with more than 2 previous CS.

Normal and abnormal antenatal ultrasonic cardiographic patterns.

Data is presented from 1019 antenatal ultrasonic cardiographs performed on 391 patients; uterine contractions were not monitored concurrently with the fetal heart rate (FHR). No fetal deaths in utero or preterminal FHR patterns were seen within 24 hours of a normal trace. A comprehensive classification of FHR patterns is presented.

Proliferating ovarian "epithelial" tumours: a clinico-pathological analysis of 144 cases.

In a 25-year period, 144 patients with proliferating epithelial ovarian tumours were treated at the King George V Memorial Hospital. These tumours were classified according to the World Health Organisation (WHO) Histological Classification of Ovarian Tumours and subsequently divided into 4 grades of proliferation, again on histological criteria. The tumours were staged at laparotomy in accord with the recommendations of the International Federation of Gynecology and Obstetrics (FIGO). Follow-up data, analysed by a life-table method, were correlated against histological type of tumour, histological grade of proliferation, clinical/laparotomy stage, and mode of surgical therapy. Stage 1 proliferating tumours may be treated by surgery alone, including unilateral salpingo-oophorectomy in selected cases. Stage 2 and Stage 3 tumours should be treated similarly to invasive ovarian carcinomas of the same stage, despite their overall favourable prognosis.

Papillomavirus infection of the female genital tract before and after treatment: a cytological, colposcopic and histological study.

Papillomavirus infection (HPV) of the female genital tract is now recognized as a major risk factor for the development of neoplasia. With the combined investigative modalities of cytology, colposcopy and histopathology, it is clear that precancerous changes and HPV are closely associated. The differentiation of innocent HPV infection from progressive premalignant disease is not clear-cut in all situations. Despite various treatment modalities, close follow-up of these patients by cytology, colposcopy and histology reveals the presence of persistent genital tract infection by HPV.