Safety of salpingectomy at time of delivery.
| Autor: | Parikh P; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.; Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA., Kim S; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA., Hathcock M; Department of Biostatistics, Mayo Clinic, Rochester, MN, USA., Torbenson VE; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA., Raju R; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA. |
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| Jazyk: | angličtina |
| Zdroj: | The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians [J Matern Fetal Neonatal Med] 2021 Sep; Vol. 34 (17), pp. 2765-2770. Date of Electronic Publication: 2019 Oct 01. |
| DOI: | 10.1080/14767058.2019.1671328 |
| Abstrakt: | Objective: The most common methods of sterilization during cesarean delivery rely on excision of a mid-segment of the fallopian tube. Contemporary data suggest ovarian cancers may originate in the fimbriae of the fallopian tube; therefore, a strategy of prophylactic salpingectomy (SL) has been adopted during gynecologic surgery. The purpose of this study was to evaluate the safety of SL compared to traditional mid-segment excision at time of cesarean and after vaginal delivery through change in perioperative hemoglobin (Hgb). Study Design: We retrospectively evaluated patients undergoing sterilization concurrent with cesarean delivery or in the post-vaginal delivery period between 1 January 2015 and 31 December 2017 in the Mayo Clinic Health System; a community-based practice. In order to test for non-inferiority, 30 patients in each arm (tubal ligation (TL) and SL) were required to detect a pre- and post-operative Hgb difference of 0.5 mg/dL between groups with a power of 80%. Exclusion criteria included: age <18 years, BMI >50 kg/m 2 , endometriosis, other concurrent surgical procedures, bleeding disorders, postpartum hemorrhage due to atony, trial of labor after cesarean (TOLAC), and the presence of ovarian masses. Results: One hundred fifty-two patients met inclusion criteria. There was no evidence of inferiority in either the post-vaginal delivery or the cesarean groups with a mean difference in pre- and post-op Hgb of 0.18 mg/dL ( p = .99) post-cesarean and 0.04 mg/dL post-vaginal delivery with less reduction in Hgb from SL. The mean length of the procedure was 10.0 and 9.9 min ( p = .005) longer for SL procedures amongst cesarean and postpartum procedures, respectively. Subgroup analyses did not demonstrate differences in blood loss between different techniques. Clamp-cut-tie techniques took longer than all other procedures in both groups. Conclusion: This study provides evidence that the practice of salpingectomy at the time of cesarean and post-vaginal delivery may be safe and should form the basis of prospective trials. |
| Databáze: | MEDLINE |
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