Venous thromboembolism prophylaxis in gynecologic surgery: a systematic review.


OBJECTIVE:To comprehensively review and critically assess the available gynecologic surgery venous thromboembolism prophylaxis literature and provide clinical practice guidelines. DATA SOURCES:MEDLINE and Cochrane databases from inception to July 2010. We included randomized controlled trials in gynecologic surgery populations. Interventions and comparators included graduated compression stockings, intermittent pneumatic compression, unfractionated heparin, and low molecular weight heparin; placebo and routine postoperative care were allowed as comparators. METHODS OF STUDY SELECTION:One thousand two hundred sixty-six articles were screened, and 14 randomized controlled trials (five benign gynecologic, nine gynecologic oncology) met eligibility criteria. In addition, nine prospective or retrospective studies with at least 150 women were identified and provided data on venous thromboembolism risk stratification, gynecologic laparoscopy, and urogynecologic populations. TABULATION, INTEGRATION, AND RESULTS:Two reviewers independently screened articles with discrepancies adjudicated by a third. Eligible randomized controlled trials were extracted for these characteristics: study, participant, surgery, intervention, comparator, and outcomes data, including venous thromboembolism incidence and bleeding complications. Studies were individually and collectively assessed for methodologic quality and strength of evidence. Overall incidence of clinical venous thromboembolism was 0-2% in the benign gynecologic population. With use of intermittent pneumatic compression for benign major procedures, venous thromboembolism incidence was less than 1%. No venous thromboembolisms were identified in prospective studies of benign laparoscopic procedures. Overall quality of evidence in the benign gynecologic literature was poor. Gynecologic-oncology randomized controlled trials reported venous thromboembolism incidence (including "silent" venous thromboembolisms) of 0-14.8% with prophylaxis and up to 34.6% without prophylaxis. Fair quality of evidence supports that unfractionated heparin and intermittent pneumatic compression are both superior to placebo or no intervention but insufficient to determine whether heparins are superior to intermittent pneumatic compression for venous thromboembolism prevention. Combining two of three risks (aged 60 years or older, cancer, or personal venous thromboembolism history) substantially elevated the risk of venous thromboembolism. CONCLUSION:Intermittent pneumatic compression provides sufficient prophylaxis for the majority of gynecology patients undergoing benign surgery. Additional risk factors warrant the use of combined mechanical and pharmacologic prophylaxis.


Obstet Gynecol


Rahn DD,Mamik MM,Sanses TVD,Matteson KA,Aschkenazi SO,Washington BB,Steinberg AC,Harvie HS,Lukban JC,Uhlig K,Balk EM,Sung VW,Society of Gynecologic Surgeons Systematic Review Group.




Has Abstract


2011-11-01 00:00:00














  • Maternal mortality in developed countries: not just a concern of the past.

    abstract:OBJECTIVE:To review the activities in selected developed countries for strategies to identify maternal deaths, the impact of these strategies on underreporting, and the information needed to understand the events leading to death. DATA SOURCES:We reviewed the literature from the United States, Europe, and Australia fo...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,评审


    authors: Atrash HK,Alexander S,Berg CJ

    更新日期:1995-10-01 00:00:00

  • Letter from Africa.

    abstract::A day in obstetric-gynecologic practice in Kenya involves uterine rupture and other conditions resulting from inadequate care and facilities for labor, as well as infected abortions. Technology and equipment taken for granted in America either don't exist or don't work. Although practice is primitive in many ways, som...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Blumenthal PD

    更新日期:1990-07-01 00:00:00

  • ACOG Committee Opinion No. 647 Summary: Limitations of Perineal Lacerations as an Obstetric Quality Measure.

    abstract::Perineal lacerations are a common occurrence with vaginal delivery. Although perineal lacerations are tracked easily from coding data, there are a variety of problems with using rates of such tears as a quality measure. The rate of severe perineal lacerations should not be used as a measure of obstetric quality for th...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Committee on Obstetric Practice.

    更新日期:2015-11-01 00:00:00

  • Severe hydramnios and preterm delivery in association with transient maternal diabetes insipidus.

    abstract:BACKGROUND:Diabetes insipidus is rare in pregnancy. It is characterized by hypoosmolar polyuria and may be central, nephrogenic, or transient in etiology; the latter is presumably related to excess placental vasopresinase production. In theory, fetal effects of this endocrine condition may include hydramnios secondary ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Weinberg LE,Dinsmoor MJ,Silver RK

    更新日期:2010-08-01 00:00:00

  • Doppler fetal echocardiography in endocardial fibroelastosis.

    abstract:BACKGROUND:Endocardial fibroelastosis is a congenital heart disease known to cause congestive heart failure in early infancy. We report a case using new modalities for early prenatal diagnosis of endocardial fibroelastosis causing fetal heart failure. CASE:A multipara with two children, who died of endocardial fibroel...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Weiner Z,Shalev E

    更新日期:2001-11-01 00:00:00

  • Vascular endothelial growth factor serum concentrations in ovarian cancer.

    abstract:OBJECTIVE:To determine whether serum vascular endothelial growth factor is an independent prognostic factor in ovarian cancer patients. METHODS:We measured vascular endothelial growth factor in pretreatment serum samples of 60 women with International Federation of Gynecology and Obstetrics stages I to IV epithelial o...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Tempfer C,Obermair A,Hefler L,Haeusler G,Gitsch G,Kainz C

    更新日期:1998-09-01 00:00:00

  • Bilateral radial nerve palsies from use of the standard birthing bar.

    abstract:BACKGROUND:Serious injury can result from improper use of the birthing bar. CASE:A 31-year-old woman delivered a neonate using a birthing bar for her entire second stage of labor. Shortly after delivery, she experienced bilateral upper extremity weakness from compression of the radial nerve. She was treated with physi...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Roubal PJ,Chavinson AH,LaGrandeur RM

    更新日期:1996-05-01 00:00:00

  • Enterocele: is there a histologic defect?

    abstract:OBJECTIVE:To examine the histology of the vaginal wall in women with an enterocele confirmed by physical examination, cystoproctography, and intraoperative exploration. METHODS:Thirteen women with posthysterectomy apical and posterior wall prolapse were evaluated with a detailed physical examination, cystoproctography...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Tulikangas PK,Walters MD,Brainard JA,Weber AM

    更新日期:2001-10-01 00:00:00

  • Risk Calculator to Predict Cesarean Delivery Among Women Undergoing Induction of Labor.

    abstract:OBJECTIVE:To develop and validate a predictive risk calculator for cesarean delivery among women undergoing induction of labor. METHODS:We performed a population-based cohort study of all women who had singleton live births after undergoing induction of labor from 32 0/7 to 42 6/7 weeks of gestation in the United Stat...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Rossi RM,Requarth E,Warshak CR,Dufendach KR,Hall ES,DeFranco EA

    更新日期:2020-03-01 00:00:00

  • Cortical blindness in severe preeclampsia: computed tomography, magnetic resonance imaging, and single-photon-emission computed tomography findings.

    abstract:BACKGROUND:Cortical blindness is a complication of severe preeclampsia, but it is unclear whether it results from cerebral vasospasm and ischemic injury or vasogenic (hydrostatic) edema due to increased capillary permeability. CASE:Reversible cortical blindness in a 33-year-old gravida 2, para 1, with severe postpartu...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Apollon KM,Robinson JN,Schwartz RB,Norwitz ER

    更新日期:2000-06-01 00:00:00

  • ACOG Committee Opinion No. 771 Summary: Umbilical Cord Blood Banking.

    abstract::Since the first successful umbilical cord blood transplant in 1988, it has been estimated that more than 35,000 transplants have been performed in children and adults for the correction of inborn errors of metabolism, hematopoietic malignancies, and genetic disorders of the blood and immune system. Two types of banks ...

    journal_title:Obstetrics and gynecology

    pub_type: 评论,杂志文章



    更新日期:2019-03-01 00:00:00

  • Considerations to improve the evidence-based use of vaginal hysterectomy in benign gynecology.

    abstract::Vaginal hysterectomy fulfills the evidence-based requirements as the preferred route of hysterectomy for benign gynecologic disease. Despite proven safety and effectiveness, the vaginal approach for hysterectomy has been and remains underused in surgical practice. Factors associated with underuse of vaginal hysterecto...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Moen M,Walter A,Harmanli O,Cornella J,Nihira M,Gala R,Zimmerman C,Richter HE,Society of Gynecologic Surgeons Education Committee.

    更新日期:2014-09-01 00:00:00

  • Recurrence of group B streptococci colonization in subsequent pregnancy.

    abstract:OBJECTIVE:To estimate the prevalence of group B streptococci (GBS) colonization in a subsequent pregnancy in women with and without GBS colonization in an index pregnancy. METHODS:A retrospective cohort study of women who had two consecutive deliveries with the availability of GBS culture result at 35 to 37 weeks of g...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Turrentine MA,Ramirez MM

    更新日期:2008-08-01 00:00:00

  • Amenorrhea related to progestin excess in congenital adrenal hyperplasia.

    abstract::Studies of the cause of amenorrhea in a patient with congenital adrenal hyperplasia (CAH) whose androgen levels were easily controlled suggested that inhibition of menses in CAH is more closely related to overproduction of progestins than to overproduction of androgens. Supporting this concept was the observation in a...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Rosenfield RL,Bickel S,Razdan AK

    更新日期:1980-08-01 00:00:00

  • Bleomycin-adriamycin-cisplatin combination chemotherapy in the treatment of primary advanced and recurrent cervical carcinoma.

    abstract::A chemotherapeutic combination of bleomycin-adriamycin-cisplatin has been used to treat 21 consecutive patients with primary advanced or recurrent cervical carcinomas. Four complete (19.0%) and four partial remissions were recorded. The responding patients had significantly longer survival levels compared with the rem...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Sorbe B,Frankendal B

    更新日期:1984-02-01 00:00:00

  • Transurethral bladder eversion concurrent with uterovaginal prolapse.

    abstract:BACKGROUND:Transurethral bladder eversion is rare. A case of transurethral bladder eversion with concurrent uterovaginal prolapse is presented. CASE:The patient was postmenopausal, had a long history of uterovaginal prolapse, and developed bladder eversion. Examination under anesthesia revealed full-thickness transure...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Mastropietro MA,Clark MH,Hale DS

    更新日期:2002-05-01 00:00:00

  • Massive blood transfusion during hospitalization for delivery in New York State, 1998-2007.

    abstract:OBJECTIVE:To define the frequency, risk factors, and outcomes of massive transfusion in obstetrics. METHODS:The State Inpatient Dataset for New York (1998-2007) was used to identify all delivery hospitalizations for hospitals that reported at least one delivery-related transfusion per year. Multivariable logistic regr...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Mhyre JM,Shilkrut A,Kuklina EV,Callaghan WM,Creanga AA,Kaminsky S,Bateman BT

    更新日期:2013-12-01 00:00:00

  • Umbilical coiling index in normal and complicated pregnancies.

    abstract:OBJECTIVE:To estimate the relation between undercoiling and overcoiling of the umbilical cord and adverse pregnancy outcome. METHODS:Umbilical cords and hospital records of 885 patients were studied in a cross-sectional study design. The umbilical coiling index was determined as the number of complete coils divided by...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: de Laat MW,Franx A,Bots ML,Visser GH,Nikkels PG

    更新日期:2006-05-01 00:00:00

  • What is new in intrauterine devices? Best articles from the past year.

    abstract::This month, we focus on current research about intrauterine devices. Dr. Hurd discusses four recent publications, and each is concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in on this page, along with direct links to the abstracts. ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Hurd WW

    更新日期:2013-10-01 00:00:00

  • Adherence and acceptability of the contraceptive ring compared with the pill among students: a randomized controlled trial.

    abstract:OBJECTIVES:To compare satisfaction with and adherence to the contraceptive vaginal ring and a daily low-dose oral contraceptive pill (OCP) among college and graduate students using a novel method of electronic data collection. METHODS:We randomly assigned 273 women to the contraceptive vaginal ring (n=136) or OCP (n=1...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Gilliam ML,Neustadt A,Kozloski M,Mistretta S,Tilmon S,Godfrey E

    更新日期:2010-03-01 00:00:00

  • Recurrent vulvovaginal candidiasis associated with long-term tamoxifen treatment in postmenopausal women.

    abstract:BACKGROUND:Symptomatic vulvovaginal candidiasis is rare in postmenopausal subjects because of the estrogen-dependence of this infection. Tamoxifen, a breast-cancer cell estrogen-antagonist, has not previously been reported to predispose to vulvovaginal candidiasis. CASES:Three postmenopausal women, age range 60-81 yea...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Sobel JD,Chaim W,Leaman D

    更新日期:1996-10-01 00:00:00

  • Breast carcinoma in young women.

    abstract:OBJECTIVE:To estimate the incidence of breast carcinoma and survival in patients younger than 25 years old, and to describe presenting clinical signs and symptoms of breast cancer in this age group. METHODS:A population-based descriptive study and case review in Olmsted County, Minnesota, was conducted using the resou...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Simmons PS,Jayasinghe YL,Wold LE,Melton LJ 3rd

    更新日期:2011-09-01 00:00:00

  • Steroid hormone contraception and bone mineral density: a cross-sectional study in an international population. The WHO Study of Hormonal Contraception and Bone Health.

    abstract:OBJECTIVE:To evaluate relationships between bone mineral density and use of steroid hormonal contraceptives. METHODS:This was a multicenter cross-sectional study in seven centers in three regions of the developing world from April 1994 to June 1997. Women 30-34 years old attending family planning clinics, with at leas...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,多中心研究


    authors: Petitti DB,Piaggio G,Mehta S,Cravioto MC,Meirik O

    更新日期:2000-05-01 00:00:00

  • Interpreting the literature in obstetrics and gynecology: II. Logistic regression and related issues.

    abstract::The goal of epidemiology is accurate measure of the relationship between an exposure and a disease of interest. The control of covariates of the exposure-disease relationship is required to obtain a valid measure. Two types of covariates, confounders and effect modifiers, must be considered. Investigators can design s...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,评审


    authors: Peterson HB,Kleinbaum DG

    更新日期:1991-10-01 00:00:00

  • Delayed postpartum hemorrhage: a morphologic study of causes and their relation to other pregnancy disorders.

    abstract:OBJECTIVES:To ascertain the various causes of delayed postpartum hemorrhage and to test whether subinvolution of the placental bed is associated with other pregnancy disorders for which defective maternal-fetal interaction has been implicated pathogenetically. METHODS:In a group of women presenting with postpartum hem...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Khong TY,Khong TK

    更新日期:1993-07-01 00:00:00

  • Clinical and pathologic characteristics of women undergoing hysterectomy after tubal sterilization.

    abstract:OBJECTIVE:To examine differences in clinical and pathologic characteristics between women undergoing hysterectomy who had had prior tubal sterilization and those who had not. METHODS:One thousand eight hundred fifty-one women undergoing hysterectomy were enrolled as part of a multicenter, prospective cohort study. We ...

    journal_title:Obstetrics and gynecology

    pub_type: 临床试验,杂志文章,多中心研究


    authors: Hillis SD,Marchbanks PA,Peterson HB

    更新日期:1996-08-01 00:00:00

  • Pregnancy after successful vaginoplasty and cervical stenting for partial atresia of the cervix.

    abstract::We previously reported surgical correction of vaginal agenesis and partial cervical atresia in an 11-year-old girl with amenorrhea and a pelvic mass. This patient, the subject of this report, conceived 7 years later and delivered at term. An abdominal cerclage was placed at 12 weeks' gestation to protect the cervix, a...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Hampton HL,Meeks GR,Bates GW,Wiser WL

    更新日期:1990-11-01 00:00:00

  • Using videography to teach retropubic space anatomy and surgical technique.

    abstract::This report describes an innovative use of videography in teaching retropubic space anatomy and surgery. After the standard abdominal incision has been made, the second surgical assistant places a gynecologic laparoscope, fitted with an endoscopic camera, into the retropubic space and guides the laparoscope documentin...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Shull B

    更新日期:1991-04-01 00:00:00

  • Primary peritoneal cancer after bilateral salpingo-oophorectomy in two patients with Lynch syndrome.

    abstract:BACKGROUND:Women with Lynch syndrome or hereditary nonpolyposis colorectal carcinoma (HNPCC) have a 40-60% lifetime risk of endometrial cancer and a 7-12% lifetime risk of ovarian cancer. Risk-reducing surgery, including hysterectomy and bilateral salpingo-oophorectomy (BSO), is currently recommended once child bearing...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Schmeler KM,Daniels MS,Soliman PT,Broaddus RR,Deavers MT,Vu TM,Chang GJ,Lu KH

    更新日期:2010-02-01 00:00:00

  • Physiologic estradiol replacement therapy and cardiac structure and function in normal postmenopausal women: a randomized, double-blind, placebo-controlled, crossover trial.

    abstract:OBJECTIVE:To assess the effect of estradiol (E2) replacement therapy on cardiac structure and function in healthy postmenopausal women. METHODS:We conducted a randomized, double-blind, placebo-controlled, crossover study of 31 healthy postmenopausal female volunteer study subjects (55-65 years) using 12 weeks of micro...

    journal_title:Obstetrics and gynecology

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Snabes MC,Payne JP,Kopelen HA,Dunn JK,Young RL,Zoghbi WA

    更新日期:1997-03-01 00:00:00