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Intraoperative Cervical Treatment Does Not Affect the Prevalence of Vaginal Bleeding 1 Year Postoperatively After Subtotal Hysterectomy: A Register Study From the Swedish National Register for Gynecological Surgery
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
2018 (English)In: Obstetrical and Gynecological Survey, ISSN 0029-7828, E-ISSN 1533-9866, Vol. 73, no 2, p. 88-89Article in journal (Refereed) Published
Abstract [en]

A subtotal hysterectomy implies retaining the cervix. Women who undergo this procedure are more likely to present with persistent vaginal bleeding (PVB) after surgery. To prevent subsequent vaginal bleeding, intraoperative cervical treatment (electrosurgical cauterization or resection) has been recommended. However, there is insufficient evidence demonstrating the efficacy of this treatment. The aims of this retrospective register study were to (1) establish the prevalence of PVB 1 year after subtotal hysterectomy, (2) analyze the effect of intraoperative cervical treatment during the subtotal hysterectomy on the occurrence of PVB, and (3) assess the impact of PVB on the patients self-reported assessment of her medical condition and satisfaction with the hysterectomy 1 year after surgery. Data were obtained fromthe SwedishNational Register for Gynecological Surgery for a cohort of women who underwent subtotal hysterectomy for benign conditions between January 2004 and June 2016. Preoperative and perioperative forms were collected to obtain demographic and clinical data. The 1-year inquiry form was used to collect data on occurrence of PVB, rating of medical condition, and satisfaction with surgical results. Multivariate logistic regression analyses were used to assess outcome measures. The prevalence of PVB following subtotal hysterectomy was 18.6%. Intraoperative treatment of the cervix at the time of the subtotal hysterectomy did not affect the frequency of PVB; the adjusted odds ratio (aOR) was 1.48, with a 95% confidence interval (CI) of 0.93 to 2.37. Althoughmore than 90% of women were satisfied or very satisfied with the surgical results, those experiencing bleeding episodes 1 year after the subtotal hysterectomy were significantly less content with the result of the surgery (aOR, 0.42; 95% CI, 0.26-0.67). There was no difference in self-perception of the medical condition 1 year after the surgery between women with and without PVB; the aOR was 1.16 with a 95% CI of 0.33 to 4.12. These data show that nearly 2 in 10 women may expect PVB following subtotal hysterectomy and that intraoperative cervical treatment does not affect the prevalence of bleeding. Although more than 90% of patients are satisfied with the results of surgery, women with PVB are less content. When choosing hysterectomy technique, information on the risk of PVB may be important. Subtotal hysterectomy may not be an option for women not willing to accept this risk.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS , 2018. Vol. 73, no 2, p. 88-89
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:liu:diva-145779DOI: 10.1097/OGX.0000000000000527ISI: 000426177600009OAI: oai:DiVA.org:liu-145779DiVA, id: diva2:1192443
Available from: 2018-03-22 Created: 2018-03-22 Last updated: 2019-04-09

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Borendal Wodlin, Ninnie
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Department of Clinical and Experimental MedicineFaculty of Medicine and Health SciencesDepartment of Gynaecology and Obstetrics in Linköping
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Obstetrical and Gynecological Survey
Obstetrics, Gynecology and Reproductive Medicine

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