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Increasingly we are using a combination of surgery, chemotherapy and radiotherapy for treatment of gynaecological malignancies. Most studies in literature are concentrated on the concept of survival. There is minimal data examining the impact of these treatments on quality of life. Survival being a surrogate marker is an arbitrary end point and is of arguable significance if quality of life is not maintained. Long-term side effects of radiotherapy are debilitating and severely affect quality of life. Pelvic insufficiency fractures (PIF) are a known long-term side effect of radiotherapy. Intensity-modulated radiotherapy (IMRT) is being routinely used in the treatment of prostate and head and neck cancer. We postulated that use of IMRT in gynaecological cancers reduces the incidence of PIF.
Patients and methods
We retrospectively reviewed 10 cases of PIF treated on standard treatment. We recalculated dose volume histograms based on IMRT protocols for patients with PIF.
We found that none of the patients received any radiation at the fracture site and the total radiation received to the sacrum was lower compared with the standard treatment protocols.
We conclude that the feasibility of IMRT in gynaecological cancers should be further evaluated and might be an useful tool in reducing the number of PIF.
This chapter describes the types, key implications and management strategies of massive obstetric haemorrhage. Antepartum haemorrhage due to placental abruption and intrapartum haemorrhage due to uterine rupture are associated with increased perinatal mortality. Visible blood loss greater than 2 litres, ongoing bleeding are some key pointers of massive obstetric haemorrhage. Immediate management involves active resuscitation to ensure a patient airway, breathing and maintaining circulation with intravenous fluids, blood and blood products as well as correction of coagulopathy. In women who are not acutely compromised or bleeding severely, interventional radiology can be considered. If the bleeding is predominantly from the lower segment, a total abdominal hysterectomy is warranted. Women with massive obstetric haemorrhage often need multi-organ support. Hence, transfer to an intensive care unit or high dependency unit should be considered for monitoring. Thromboprophylaxis should be considered once the coagulation parameters return to normal.