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A 40yrs old woman is suffering from severe menorrhagia due to multiple fibroids. Her uterus is irregularly enlarged to 16 weeks pregnancy size. She has three living children. Which one of the following would be best suited for her ?

a) Total abdominal hysterectomy with bilateral salpingo oophorectomy
b) Total abdominal hysterectomy
c) Vaginal hysterectomy
d) Total abdominal hysterectomy with unilateral salpingo oophorectomy


b ? ( or is vaginal associated with less complications confused...i really need to review gynaec)








b rather than c b'cos the uterus is enlarged to 16 wks size. would be a problem for vh


B is correct.


Seri Can u please tell me till what size vaginal hysterectomy can be done.


hey docprash vh isnt done for bulky uterus, i cant get more specific than that. may be yasmeen would be able to help you out with this q


Table 1. Factors that affect choice of surgical route for hysterectomy

Uterine size
Weight >280 g versus <280 g

Uterine attachments
History or presence of:

* Endometriosis
* Adnexal disease
* Chronic pelvic pain
* Adhesions
* Previous pelvic surgery
* Chronic pelvic inflammatory disease

Anatomic accessibility
Bituberous diameter <9 cm
Pubic arch <90°
Narrow vagina (less than two fingerbreadths, especially at the apex) or an undescended uterus

Uterine size
An enlarged uterus has commonly been considered a contraindication to vaginal hysterectomy. How large is "large"? Unless uterine reduction techniques have been used, ACOG and various researchers have specified that abdominal hysterectomy is indicated for a uterus that is 12 weeks' gestational size (280 g) or larger (7,8,11,14). However, 85% to 90% of all uteri removed for various indications do not exceed 280 g. Surgeons appear to have varying comfort levels regarding transvaginal removal of a uterus larger than normal (70 g), which may reflect their practice style and experience rather than adherence to ACOG guidelines.

The uterus can be measured in vivo by using simple transvaginal ultrasound techniques and algebraic data to determine the size expressed in weights and measurements. The weight data provide a more precise preoperative measure of uterine size, thus giving a more objective method for selecting the most appropriate surgical approach to hysterectomy .


thanks babli



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