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Objective To investigate whether women who conceive after assisted reproductive technology (ART) are at higher risk for emergency peripartum hysterectomy. Design A case–control study using a prospectively maintained institutional database. Setting A tertiary referral university teaching maternity hospital. Patient(s) Thirty-one women who underwent peripartum hysterectomy for management of hemorrhage, and 19,902 control women. Intervention(s) None. Main Outcome Measure(s) Association between potential predictors and peripartum hysterectomy. Result(s) The incidence of peripartum hysterectomy was 1.7 cases per 1,000 births (95% confidence interval [CI] 1.2–2.4). After adjustment for maternal age and twin pregnancy, placenta previa (odds ratio [OR] 50.78, 95% CI 23.30–110.68), prior cesarean delivery (OR 6.72, 95% CI 2.99–15.09 for one cesarean; OR 6.80, 95% CI 1.45–31.90 for two or more cesareans), previous myomectomy (OR 24.59, 95% CI 6.70–90.19), and ART conception (OR 5.98, 95% CI 2.18–16.40) were all antenatal predictors for peripartum hysterectomy. In women having a peripartum hysterectomy, 13.4% of the risk is attributable to mode of conception. Conclusion(s) A history of ART increases the likelihood of needing a peripartum hysterectomy to control hemorrhage. Further investigation is needed to determine whether ART conception should be included in algorithms of risk stratification for emergency cesarean hysterectomy and plan of care be modified accordingly.

Objective To evaluate the impact of deep endometriosis (DE) on bladder function, focusing on detrusor pattern, in patients without preoperative urinary symptoms. Design Prospective study. Setting Academic research center. Patient(s) A total of 25 asymptomatic patients: 12 patients with DE (group 1) and 13 patients with ovarian endometriosis (group 2, control group). Intervention(s) Preoperative urodynamic evaluation. Main outcome measure(s) The impact of DE on urodynamic parameters. Result(s) For the first time, a urodynamic diagnosis of detrusor overactivity was correlated with the presence of deep infiltrating endometriosis (group 1, 91.7% [11/12] vs. group 2, 7.7% [1/13]). All involuntary detrusor contractions were detected only during the filling phase. All cystometry parameters were found to be altered in group 1 and statistically different between the two groups. No pressure/flow study parameter significantly differed between the two groups, besides maximal detrusor pressure (46 cmH2O [33-79] vs. 29 cmH2O [15-40]), which was significantly higher in group 1. Therefore, all detrusor-related parameters are statistically different between the two groups. Postvoid residual does not reach a statistically significant difference. Conclusion(s) DE could significantly impair detrusor functions. A preoperative urodynamic evaluation allows the attainment of important functional information, even in asymptomatic patients.

Sequential transdermal estrogen-progestin therapy induced a significant reduction in fasting serum homocysteine levels in postmenopausal women. The addition of folic acid supplementation for 6 months did not further lower the homocysteine concentrations.