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Aider les médecins qui pratiquent la chirurgie gynécologique dans leur processus décisionnel relatif aux indications bénignes de l'hystérectomie.Médecins, y compris gynécologues, obstétriciens, médecins de famille, chirurgiens généralistes, urgentologues; infirmières, y compris les infirmières autorisées et les infirmières praticiennes; apprentis en médecine, y compris étudiants de médecine, résidents, stagiaires (fellows); et autres fournisseurs de soins de santé.Femmes adultes (18 ans et plus) qui devront subir une hystérectomie pour une indication gynécologie bénigne.La présente directive clinique examine les différentes voies d'abord de l'hystérectomie et l'utilité des interventions chirurgicales concomitantes. DONNéES PROBANTES: Pour la présente directive clinique, des recherches ont été effectuées dans les bases de données PubMed, Medline et Cochrane Library pour trouver des études pertinentes. Les recherches ont été effectuées parmi les publications des cinq dernières années (2012-2017) au moyen des termes de recherche MeSH suivants ainsi que leurs variations : vaginal hysterectomy, laparoscopic hysterectomy, robotic hysterectomy, laparoscopically assisted vaginal hysterectomy, total laparoscopic hysterectomy, standard vaginal hysterectomy et total vaginal hysterectomy. MéTHODES DE VALIDATION: Le contenu et les recommandations ont été rédigés et acceptés par les auteurs principaux et membres du comité de pratique clinique - gynécologie. Le conseil d'administration de la Société des obstétriciens et gynécologues du Canada a approuvé la version définitive aux fins de publication. La qualité des données probantes utilisées dans le présent document a été évaluée au moyen des critères du cadre méthodologique GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) (tableau 1, tableau 2). Le résumé des conclusions est disponible sur demande. AVANTAGES, PRéJUDICES ET COûTS: Bien que l'hystérectomie soit commune, la pratique chirurgicale varie grandement chez les médecins spécialisés en gynécologie. La présente directive expose les facteurs pré- et périopératoires à prendre en compte pour améliorer la qualité des soins prodigués aux femmes qui doivent subir une chirurgie pour une affection gynécologique bénigne. MISE à JOUR DE LA DIRECTIVE CLINIQUE: La présente directive clinique de la Société des obstétriciens et gynécologues du Canada sera automatiquement passée en revue cinq ans après sa publication. Les auteurs peuvent toutefois proposer une autre date de réévaluation s'ils croient qu'une période de cinq ans est trop courte ou trop longue en fonction de leurs connaissances du sujet à titre d'experts en la matière.La présente directive clinique a été élaborée au moyen de ressources financées par la Société des obstétriciens et gynécologues du Canada. DéCLARATIONS CONDENSéES: RECOMMANDATIONS.

Objectives An isthmocele is a cesarean section scar defect with a depth of >2mm, and can cause both obstetric and gynecologic complications. To date, no study has determined the impact of a locked versus unlocked double-layer uterine closure technique on isthmocele prevention. The primary objective of this study is to evaluate protocol feasibility amongst our own patients and physicians, with the ultimate goal of a larger-scale randomized controlled trial (RCT). Secondary objectives include determining: (a) isthmocele incidence; (b) isthmocele measurements on postoperative transvaginal ultrasound; and (c) adverse surgical outcomes related to suture technique. Methods This is a single-centre parallel-group pilot RCT enrolling 50 participants (25 per arm) including all term singleton pregnant women >18 years old undergoing primary cesarean section. Exclusion criteria include previous uterine hysterotomy, known uterine anomalies, active labour, known bleeding disorders, and maternal connective tissue disorders. Subjects are randomized to locked versus unlocked first layer uterine closure, followed by an unlocked second layer. Women will undergo transvaginal ultrasound to evaluate isthmocele formation six months postoperatively. Results At time of submission 31 subjects have been recruited. Data will be analyzed on an intention-to-treat basis. Demographic data will be reported using descriptive statistics. Rates of isthmocele will be compared between groups using chi-square analysis; subgroup analysis of the variable suture material will be performed. Other outcomes will be assessed using a t test (continuous variables) or chi-square test (categorical variables) as appropriate. Conclusions This study design appears feasible at this time. Further outcome data will be reported once the study is complete.

Video abstract summary The background, clinical presentation and relevant pre-operative planning regarding complete uterine septums are reviewed. This is followed by an illustration of the surgical steps taken to correct such anomalies, preserving the cervical component of the septum. This is done with vaginal surgery followed by hysteroscopy with laparoscopic guidance. The technique demonstrated uses a Foley catheter balloon in one of the uterine cavities to delineate the septum, aiding in the resection of the septum in the ideal location. Technical tips are provided for additional surgical guidance. Finally, the post-operative considerations and long-term outcomes following surgical correction are discussed.

With typical use, unintended pregnancy rates in the first year after insertion are 0.8% for the copper-containing intrauterine device (IUD) and 0.2% for the levonorgestrel-releasing intrauterine system.[2][1] A systematic review in 2012 found increased rates of spontaneous abortion (48%–77%) and

Background There have been contradictory reports on the risks of persistent pulmonary hypertension (PPHN) in infants exposed to SSRIs in utero. However, there has been no assessment of fetal pulmonary arterial dynamics in such pregnancies. Aims and subjects To measure fetal right pulmonary artery (RPA) variables using Doppler ultrasound at 36 weeks gestation in fetuses of mothers taking SSRI antidepressants (n = 23) and in a control, normal pregnancy group (n = 35). Outcome measures At 36 weeks gestation, Doppler ultrasound estimates of Pulsatility Index (PI), Resistance Index (RI), vessel diameter, peak systolic velocity, mean velocity and volume flow were obtained from the fetal right pulmonary artery in a morning session (~ 0830), before the SSRI mothers took their daily drug dose and in an afternoon session (~ 1300). Venous blood was drawn at 5 time points across the day (~ 08:30 AM, ~ 10:30 AM, ~ 13:00 PM, ~ 13:45 PM, and ~ 15:00 PM) from the SSRI treated mothers for measurement of plasma SSRI concentration using high performance liquid chromatography tandem mass spectrometry. Results There were no differences in the RPA Doppler measures between the control and SSRI-exposed fetuses. However 8 of the 23 latter fetuses experience transient respiratory difficulties at birth and, in these RPA flow was significantly higher than in the SSR-exposed fetuses without respiratory problems. There were, however, no differences in RPA PI and RI between the 2 groups. Conclusions In SSRI-exposed infants with transient postnatal respiratory difficulties, fetal RPA flow in increased, likely due to partial constriction of the ductus arteriosus. However, this was not associated with PPHN.

Prenatal selective serotonin reuptake inhibitor (SSRI) exposure increases the risk for adverse neonatal behavioral outcomes; although it is unknown whether altered brain function is present before birth. We investigated fetal vascular and heart rate changes at 36-wk gestation in SSRI-treated women with mood disorders (n = 29) [exposed (EXP)] and controls (n = 45) [non-EXP (NEXP)]. Fetal middle cerebral artery (MCA) flow parameters and heart rate characteristics were obtained during pre-SSRI dose morning and postdose afternoon sessions. Maternal mood and cord Hb and hematocrit were measured. Basal fetal heart rate (fHR) did not differ between groups or across the day. The fHR short- and long-term variations, accelerations, and duration of high variability episodes remained lower and did not change across the day in EXP, whereas all increased significantly in NEXP. In both groups, MCA flow velocity and volume flow increased significantly across the day. EXP MCA pulsatility index was significantly lower, as was MCA cross-sectional area. EXP cord Hb and hematocrit were significantly increased. Prenatal SSRI exposure reduced fetal MCA flow resistance and fHR variability, before and after an SSRI dose, controlling for maternal mood. These changes and the SSRI-related increased red cell indices suggest possible fetal hypoxia.