Skip to main content Accessibility help
×
Hostname: page-component-5d59c44645-lfgmx Total loading time: 0 Render date: 2024-02-20T14:15:25.869Z Has data issue: false hasContentIssue false

Case 23 - A 35-Year-Old G3P3 Woman with a 12-Week Uterus and a Prior Cesarean Section Who Desires Vaginal Hysterectomy

Published online by Cambridge University Press:  19 November 2021

Todd R. Jenkins
Affiliation:
University of Alabama, Birmingham
Lisa Keder
Affiliation:
Ohio State University School of Medicine, Columbus
Abimola Famuyide
Affiliation:
Mayo Clinic, Rochester
Kimberly S. Gecsi
Affiliation:
Medical College of Wisconsin
David Chelmow
Affiliation:
Virginia Commonwealth University School of Medicine
Get access

Summary

A 35-year-old gravida 3, para 3 presents with complaints of heavy menstrual bleeding. Patient reports her menses have been getting progressively heavier over the last year. She has been on oral contraceptive pills for the last six months, and feels they are not helping. She is experiencing heavy flow requiring her to wear a pad and a tampon together for the first two days of her seven-day cycle. She had a cesarean section for her second child followed by a vaginal birth after cesarean (VBAC) of an 8 lb infant. She has no other surgical history and no medical history and has no known drug allergies. She denies any history of sexually transmitted infections (STIs). Her last cervical cytology six months ago was normal. She is currently taking desogestrol 0.15 mg, 0.03 mg ethinyl estradiol contraceptive pills but she has completed her family and desires definitive therapy. After discussing her treatment options, patient requests a hysterectomy.

Type
Chapter
Information
Surgical Gynecology
A Case-Based Approach
, pp. 64 - 66
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Committee Opinion No 701: Choosing the route of hysterectomy for benign disease. Obstet Gynecol 2017; 129: e155–9.Google Scholar
Aarts, JWM, Neiboer, TE, Johnson, N, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2015; 2015(8): CD003677.Google ScholarPubMed
AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL position statement: route of hysterectomy to treat benign uterine disease. J Minim Invasive Gynecol 2011; 18(1): 13.CrossRefGoogle Scholar
Harmanli, OH, Khilnani, R, Dandolu, V, Chatwani, AJ. Narrow pubic arch and increased risk of failure for vaginal hysterectomy. Obstet Gynecol 2004; 104: 697700.CrossRefGoogle ScholarPubMed
Kovac, SR, Barhan, S, Lister, M, et al. Guidelines for the selection of the route of hysterectomy: application in a resident clinic population. Am J Obstet Gynecol 2002; 187: 1521–7.CrossRefGoogle Scholar
Jeppson, PC, Balgobin, S, Rahn, DD, et al.; Society of Gynecologic Surgeons Systematic Review Group. Comparison of vaginal hysterectomy techniques and interventions for benign indications: a systematic review. Obstet Gynecol 2017; 129: 877–86.CrossRefGoogle ScholarPubMed
Antosh, DD, High, R, Brown, HW, et al. Feasibility of prophylactic salpingectomy during vaginal hysterectomy. Am J Obstet Gynecol 2017; 217: 605.e15.CrossRefGoogle ScholarPubMed
Schmitt, J, Baker, M, Occhino, J, et al. Prospective implementation and evaluation of a decision-tree algorithm for route of hysterectomy. Obstet Gynecol 2020; 135: 761–9.CrossRefGoogle ScholarPubMed
Unger, J, Meeks, GR. Vaginal hysterectomy in women with history of previous cesarean delivery. Am J Obstet Gynecol 1998; 179: 1473–8.CrossRefGoogle ScholarPubMed
Doucette, R, Sharp, H, Alder, S. Challenging generally accepted contraindications to vaginal hysterectomy. Am J Obstet Gynecol 2001; 184: 1386–91.CrossRefGoogle ScholarPubMed
Nazah, I, Robin, F, Jais, JP, et al. Comparison between bisection/morcellation and myometrial coring for reducing large uteri during vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy: results of a randomized prospective study. Acta Obstet Gynecol Scand 2003; 82: 1037–42.CrossRefGoogle ScholarPubMed
Lethaby, A, Puscasiu, L, Vollenhoven, B. Preoperative medical therapy before surgery for uterine fibroids. Cochrane Database Syst Rev 2017; 11(11): CD000547.Google ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×