CONSENT

ADVI
CES
SUMMARY
1.
DIAGNOSTI
CHYSTEROSCOPYUNDERGA
Ser
iousr
isks
i
ncl
ude:
 ●Theoveral
lri
skofser
iouscompl
icat
ionsfr
om di
agnost
ic
hy
ster
oscopyisappr
oxi
mat el
y2:
1000(uncommon)
 ●Damaget
otheut
erus(
uncommon)
 ●Damaget
obowel
,bl
adderormaj
orbl
oodv
essel
s(r
are)
 ●Fail
uretogainentr
ytouter
inecav
ityandcompl
ete
i
ntendedprocedur
e(uncommon)
 ●I
nfer
ti
li
ty(
rar
e)
 ●3-8:
100,
000under
goi
nghyster
oscopydieasar
esul
tof
compli
cat
ions(
ver
yrar
e).Fr
equentr
isks
 Fr
equentr
isksi
ncl
ude:
 ●i
nfect
ion
 ●bl
eedi
ng.

2.
DIAGNOSTI
CLAPAROSCOPY
Ser
iousr
isksi
ncl
ude:
  ●theoveral
lri
skofseri
ouscompli
cationsf
rom di
agnosti
c
l
aparoscopy
,approxi
matel
y2:1000(uncommon)(1:1000in
gt
g)
 ●damaget obowel,bl
adder,ut
erusormaj orbloodvessel
s
whichwouldrequi
reimmediaterepairbylapar
oscopyor
l
aparotomy(uncommon) .However,upto15%ofbowel
i
njuri
esmightnotbediagnosedatthet i
meofl apar
oscopy
 ●fail
uret
ogai nentr
ytoabdomi
nal
cav
ityandt
ocompl
ete
i
ntendedprocedure
 ●her
niaatsi
teofent
ry●death;3-
8:100,
000undergoing
l
apar
oscopydieasaresul
tofcomplicat
ions(
ver
yr ar
e).
Fr
equentr
isks
i
nclude:
●woundbruisi
ng●shoul
der
-t
ippai
n●wound
gaping●woundi
nfecti
on.

3.
ABDOMI
NALHYSTERECTOMYFORBENI
GNDI
SEASES

Ser
iousr
isksi
ncl
ude:
●theoveral
lri
skofser
iouscompli
cat
ionsf
rom abdomi
nal
hy
ster
ectomyisapproxi
mately4:
100(common)
●damaget ot
hebladderand/ort
heureter(
7:1000)and/
orl
ong-
t
erm di
stur
bancet
ot hebladderf
unct
ion(uncommon)
●damaget
othebowel
:4:
10,
000(
rar
e)
●haemor
rhager
equi
ri
ngbl
oodt
ransf
usi
on,
23:
1000(
common)
●ret
urntot
heatr
ebecauseofbl
eedi
ng/
wounddehi
scence,
and
soon:7:
1000(uncommon)
●pel
vi
cabscess/
inf
ect
ion:
2:1000(
uncommon)
●venoust
hrombosi
sorpul
monar
yembol
i
sm,
4:1000
(
uncommon)
●r
iskofdeat
hwi
thi
n6weeks,
32:
100000(
rar
e).
Themaincausesofdeat
har
epul
monar
yembol
i
sm andcar
diac
di
sease.
Fr
equentr
isksi
ncl
ude:
 ●woundinf
ecti
on,
pai
n,br
uisi
ng,
del
ayedwoundheal
i
ngor
kel
oidf
ormati
on
 ●numbness,
tingli
ngorbur ningsensat
ionaroundt
hescar
(
thewomanshoul dber eassuredthatt
hisi
susuall
ysel
f-
l
imi
ti
ngbutwar nedthatitcouldtakeweeksormonthsto
r
esol
ve)
 ●f
requencyofmi
ctur
it
ionandur
inar
ytr
acti
nfect
ion
 ●ov
ari
anf
ail
ure.

4.
VAGI
NALSURGERYFORPROLAPSE
Ser
iousr
isks
 ●damaget
obl
adder
/ur
inar
ytr
act
,2:
1000(
uncommon)
 ●damaget
obowel
,5:
1000(
uncommon)
 ●excessi
vebl
eedi
ngrequi
ri
ngt
ransf
usi
onorr
etur
nto
t
heatr
e,2:
100(common)
 ●neworcont
inui
ngbl
adderdy
sfunct
ion(
var
iabl
e–r
elat
ed
t
ounder
lyi
ngprobl
em)
 ●pel
vi
cabscess,
3:1000(
uncommon)
  ●fai
l
uret
oachi
evedesi
redr
esul
ts;
recur
renceofpr
olapse
(
common)
 ●alt
houghv enousthr
ombosi
s(common)andpulmonary
emboli
sm (uncommon)maycont r
ibut
etomort
ali
ty,t
he
over
all
riskofdeathwit
hin6weeksis37:
100000(rar
e).
Fr
equentr
isks
Fr
equentr
isksi
ncl
ude:
 ●ur
inar
yinf
ect
ion,
ret
ent
ionand/
orf
requency
 ●v
agi
nal
bleedi
ng
 ●postoper
ati
vepai
nanddi
ff
icul
tyand/
orpai
nwi
th
i
nter
course
 ●woundi
nfect
ion.

5.
CESAREANSECTI
ON
Ser
iousr
isks
i
ncl
ude:
Mat
ernal
:
 ●emer
gencyhy
ster
ect
omy
,7-
8:1000(
uncommon)
 ●needf
orfur
thersur
ger
yatal
aterdat
e,i
ncl
udi
ngcur
ett
age,
5:
1000(
uncommon)
 ●admissi
ontointensi
vecar
eunit(hi
ghlydependenton
r
easonforcaesar
eansecti
on),
9:1000(uncommon)
 ●t
hromboembol
i
cdi
sease,
4–16:
10000(
rar
e)
 ●bl
adderi
njur
y,1:
1000(
rar
e)
 ●ur
eter
ici
njur
y,3:
10000(
rar
e)
  ●deat
h,appr
oxi
mat
ely1:
12000(
ver
yrar
e).
Fut
urepr
egnanci
es:
 ●increasedriskofuter
inerupt
uredur
ingsubsequent
pregnancies/
deli
veri
es,2-
7womeni nevery1000
(uncommon)
 ●incr
easedri
skofant
epar
tum st
il
lbi
rt
h,1-
4womani
nev
ery
1000(uncommon)
 ●increasedr
iskinsubsequentpr
egnanci
esofpl
acent
a
praevi
aandplacentaaccret
a,4-
8womeni never
y1000
(uncommon).
 Fr
equentr
isksFr
equentr
isksi
ncl
ude:
Mat
ernal
:
 ●per
sist
entwoundandabdominaldi
scomf
orti
nthef
ir
st
f
ewmont hsaf
tersur
ger
y,9:100(common)
 ●increasedri
skofr
epeatcaesar
eansect
ionwhenv
agi
nal
del
iveryatt
emptedi
nsubsequentpr
egnanci
es,
onewoman
i
nev ery4(ver
ycommon)
 ●r
eadmi
ssi
ont
ohospi
tal
,5womeni
nev
ery100(
common)
 ●haemor
rhage,
5womani
nev
ery1000(
uncommon)
 ●i
nfect
ion,
6womeni
nev
ery100(
common)
.
Fet
al:
 ●l
acer
ati
ons,
1-2babi
esi
nev
ery100(
common)

6.
LAPAROSCOPI
CMANGEMNETOFTUBALECTOPI
C
Ser
iousr
isks
 ●damaget
obowel,bl
adder
, ut
erusormaj
orbloodvessel
s
whi
chwoul
drequi
reimmediaterepai
rbyl
apar
oscopyor
 l
aparotomy(uncommon);howev
er,
upt
o15%ofbowel
i
njur
iesmightnotbedi
agnosedatt
het
imeofl
apar
oscopy
 ●fail
uret
ogai nentr
yt oabdominalcavi
tyandcomplete
i
ntendedprocedurelaparoscopi
cal
l
y ,
requi
ri
nglapar
otomy
i
nstead
 ●theoveral
lri
skofser
iouscompli
cat
ionsf
rom di
agnost
ic
l
aparoscopyi
sapproxi
mately2:
1000
 ●3-8:
100000undergoi
nglapar
oscopydi
easar
esul
tof
compli
cat
ions(
ver
yr ar
e)
Fr
equentr
isks
 ●inabi
li
tyt
oident
if
yanobv
iouscausef
orpr
esent
ing
complai
nt
 ●brui
sing●shoul
der
-t
ippai
n●woundgapi
ng●wound
i
nfect
ion
 ●persi
stentt
rophobl
ast
ict
issue,
whensal
pingot
omy
per
formed(4–8in100)
 ●herni
aatsit
eofent
ry.Anyext
raprocedur
eswhi
chmay
becomenecessar
ydur
ingthepr
ocedure
 ●Lapar
otomy.●Salpi
ngectomy
.●Repairofdamaget
o
bowel
,bl
adder
,ut
erusorbloodvessel
s.
 ●Bl
oodt
ransf
usi
on

7.REPAI
ROF3RD&4RTHDEGREEPERI
NEALTEARS
Ser
iousr
isks
Someoft hesecompl icat
ionsarear esul
toft
het
earandnot
necessari
l
yt herepair
.Howev er
,thesecompli
cat
ionswi
ll
bemor
e
si
gnifi
cantiftherepai
risnotperformed.
Common:
●Incont
inenceofst
ool
sand/
orf
lat
us.
Uncommon: ●Del iv
erybycaesareansecti
oninf
ut ur
e
pregnanciesmayber ecommendedi fsy
mpt omsofinconti
nence
persistorinv
estigati
onssuggestabnormalanalsphi
ncter
structur
eorf uncti
on.
Rar
e:
 ●Haemat
oma.
 ●Consequencesoff ai
l
ureoftherepai
rrequi
ri
ngtheneed
f
orfurt
herint
ervent
ionsint
hef ut
uresuchassecondary
r
epairorsacr
alnervesti
mulat
ion.
Ver
yrar
e:
 ●Rect
ovagi
nal
fist
ula.
Fr
equentr
isks
i
ncl
ude:
 ●fear
,dif
fi
cul
tyanddiscomfor
tinpassi
ngst
ool
sint
he
i
mmedi at
epostnat
alperi
od
 ●mi
grat
ionofsut
uremat
eri
alr
equi
ri
ngr
emov
al
 ●gr
anul
ati
ont
issuef
ormat
ion
 ●f
aecal
urgency
,26/
100(
ver
ycommon)
 ●per
ineal
pai
nanddy
spar
euni
a,9/
100(
common)
 ●woundi
nfect
ion,
8/100(
common)
 ●ur
inar
yinf
ect
ion.

8.SURGI
CALEVACUATI
ONOFTHEUTERUSFOREARLY
PREGNANCYLOSS
Ser
iousr
isks
i
ncl
ude:
 ●ut
eri
neper
for
ati
on,
upt
o5:
1000women(
uncommon)
 ●si
gni
fi
cantt
raumat
othecer
vix(
rar
e)
 ●Ther
eisnosubstanti
atedev
idencei
nthel
i
ter
atur
eofany
i
mpactonfut
urefert
il
it
y.
Fr
equentr
isks
 ●bleedi
ngthatlast
sforupt
o2weeksisver
ycommonbut
bl
oodt r
ansf
usionisuncommon(
1–2in1000women)
 ●needf
orrepeatsur
gical
evacuat
ion,
upt
ofi
vei
n100
women(common)
 ●locali
sedpelvi
cinfect
ion,t
hreein100women
(common) .
Anyextraprocedureswhichmaybecome
necessarydur
ingtheprocedure
 ●Laparoscopyorlaparot
omytodiagnoseand/
orr
epai
r
or
ganinjuryorut
erineperf
orat
ion.
6.Whatthepr
ocedur
eisl
ikel
ytoi
nvolv
e,thebenef
it
sandri
sksof
anyavai
l
ableal
ter
nat
ivet
reat
ments,
incl
udingnotr
eatment
?
Thecervi
xmayneedtobedi l
atedtoall
owempt yi
ngoftheut
eri
ne
content
s.I
fti
ssuei
ssentforhist
ology
,thereasons(
toexcl
ude
ectopi
cormolarpr
egnancy)shoul
dbeexplained.
Theal
ter
nat
ivesar
e:
1.Medi
cal
management(
wit
hmi
fepr
ist
one,
prost
agl
andi
ns)
2.expect
antmanagement
,par
ti
cul
arl
yforwomenwi
thoutan
i
ntactsac.
 Non-
sur
gical
met
hodsar
eassoci
atedwi
thl
ongerand/
or
 heav i
erbleedi
nganda15–50%possi bil
it
yofeventual
l
y
needingsur gi
cal
evacuat
ionforcl
ini
calneedorthewoman’
s
preference.However
,nonsur
gicalmethodsar
eal so
associatedwithalowerri
skofinf
ecti
oncompar edwit
h
surgery.

9.
OPERATI
VEVAGI
NALDELI
VERY

Ser
iousandf
requent
lyoccur
ri
ngr
isks

Iti
srecommendedthatcl
ini
ci
ansmakeev er
yeffortt
oseparat
e
seri
ousfr
om fr
equentl
yoccurr
ingr
isks.
Higherratesoff
ail
ureand
seri
ousorfr
equentcompl
icat
ionsareassociat
edwi t
h:
 ●hi
ghermat
ernal
bodymassi
ndex
 ●ult
rasound-est
imat
edf
etal
wei
ghtgr
eat
ert
han4000gor
cl
i
nical
lylar
gebaby
 ●occi
pit
opost
eri
orposi
ti
on
 ●mi d-
cavi
tydel
i
ver
yorwhen1/
5fet
alheadpal
pabl
e
abdominal
ly.
Ser
iousr
isks
Ser
iousr
isksi
ncl
ude:
Mat
ernal
:
 ●thir
d-andfourth-
degreeper
ineal
tear
,1–4i
n100wit
h
vacuum-assi
steddeli
very(
common)and8–12in100wit
H
f
orcepsdeliv
ery(ver
ycommon)
 ●extensi
veorsi
gni
fi
cantv
aginal
/vul
val
tear
,1i
n10wi
th
vacuum 1andi
n5withfor
ceps.
Fet
al:

 ●subgal
eal
haemat
oma,
3–6i
n1000(
uncommon)
 ●i
ntr
acr
ani
alhaemor
rhage,
5–15i
n10000(
uncommon)
 ●f
aci
alner
vepal
sy(
rar
e).

Fr
equentr
isks
Fr
equentr
isksi
ncl
ude:
Mat
ernal
:
 ●post
par
tum haemor
rhage,
1–4i
n10(
ver
ycommon)
 ●v
agi
nal
tear
/abr
asi
on(
ver
ycommon)
 ●anal
sphi
nct
erdy
sfunct
ion/
voi
dingdy
sfunct
ion.
Fet
al:
 ●f
orcepsmar
ksonf
ace(
ver
ycommon)
 ●chignon/cupmarki
ngont
hescal
p(pr
act
ical
l
yal
lcasesof
vacuum-assist
eddel
i
ver
y)(
ver
ycommon)
 ●cephal
haemat
oma1–12i
n100(
common)
 ●f
aci
alorscal
placer
ati
ons,
1in10(
common)
 ●neonat
alj
aundi
ce/
hyper
bil
i
rubi
naemi
a,5–15i
n100
(
common)
 ●r
eti
nal
haemor
rhage17–38i
n100(
ver
ycommon)
.

10.C/
SECTI
ONFORPLACENTAPREVI
A
Ser
iousr
isks
Mat
ernal
I
nal
lwomenwi
thpl
acent
apr
aev
ia:
 ●emer
gencyhy
ster
ect
omy
,upt
o11i
n100women(
ver
y
common)
 ●needforfur
therl
apar
otomyduri
ngr
ecover
yfr
om t
he
caesar
ean,
75i n1000women(common)
 ●thr
omboembol
i
cdi
sease,
upt
othr
eei
n100women
(
common)
 ●bl
adderorur
eter
ici
njur
y,upt
osi
xin100women(
common)
 ●f
utur
epl
acent
apr
aev
ia,
23i
n1000women(
common)
 ●massi
veobst
etr
ichaemor
rhage,
21i
n100women(
ver
y
common).
Inwomenwi
thpl
acent
apr
aev
iaandpr
evi
ouscaesar
ean
sect
ion:
 ●emer
gencyhy
ster
ect
omy
,upt
o27i
n100women(
ver
y
common)
.
I
nwomenwi t
hanabnor
mal
l
yadher
entpl
acent
a(e.
g.
pl
acent
aaccr
eta)
:
 ●thewomanshoul
dbeadv
isedt
hathy
ster
ect
omyi
shi
ghl
y
l
ikel
y.
Iftheplacentaisfoundt obeabnor mal l
yadherenttothewall
oft heuter
us,itmaybesaf ertoleavetheplacentainsi
dethe
uterusortoper for
m apl annedcaesar eanhyster
ectomyt o
avoi dheavybleedi
ngt hantoat t
emptr emov al
.Excessiv
e
bleedingmayr equirebloodtransfusionandother
procedures,i
ncludingemer gencyhy sterect
omy ,
tocontroli
t.
 Admi
ssi
ont
oacr
it
ical
car
euni
tmayt
henbenecessar
y.

Fr
equentr
isks
Mat
ernal
 ●Admissi
ontoi
ntensi
vecar
e.●I
nfect
ion.●Bl
ood
t
ransf
usi
on.
 Fet
al
 ●Admi
ssi
ont
oneonat
ali
ntensi
vecar
e.
 5.Anyextr
aprocedureswhi
chmaybecomenecessar
y
duri
ngtheprocedur
e
 ●Repai
rofdamaget
obowel
,bl
adderorbl
oodv
essel
s.
 ●Specif
ical
ly,
wher eplacentapraevi
aaccret
aissuspected
owingtothecombi nat
ionofplacentapraevi
aandprevious
caesar
eansectionand/ ori
maginginformati
on,
discussion
concer
ningthefoll
owing( whereavai
labl
e)
shoul
dtakepl
ace:
◆Cellsalv
age:thi
sreducest hesmallri
skoft r
ansmi ssi
onof
i
nfect
ionandtransf
usionr eacti
onsassoci
atedwi ththeuseof
donat
edblood;however,thereisatheoret
icalri
skofmat er
nal
sensi
ti
sati
ontothebaby ’
sbl oodand,r
arel
y ,amnioti
cf l
uid
emboli
sm.Neitherofthesecompl i
cati
onshasy etbeenconf i
rmed
bypubli
shedresear
ch.
◆Inter
ventionalradiol
ogy:thi
soccl udest heuter
inebloodv essel
s
bycannul
at i
onoft hefemor alarteryunderX-rayscreening.Foam
pl
ugs,bal
loonsorcoi l
sarepassedt hroughthesecannul asto
bl
ockthev esselsandcont r
ol bleeding,ei
thertemporari
lyor
per
manent l
y .Therisksofthisinterventi
onshouldbedi scussed
wi
tht
hewomanbyt
her
adi
ologi
sti
nadv
ance.
6.Whattheprocedurei
sli
kel
ytoi
nv ol
veandt
hebenef
it
sand
ri
sksofanyavail
ableal
ter
nat
ivet
reatment
s,i
ncl
udi
ngno
tr
eatment….
.
Theprocedureislikelytoinvol
vedeli
veryofthebaby/babiesand
pl
acenta/pl
acentast hroughanopenappr oachusingan
abdominali
ncisionandani nci
sioni
ntotheuterus.Bothinci
sions
areusual
lytransverse.Ifeit
heramidli
neabdomi nali
ncisionora
cl
assicuter
ineincisionisbeingconsi
dered,the
womanmustbei nfor
medoft hereasonsandt headdedr isks.
Somet i
mesf orcepsareusedt odeli
verthehead, especiall
ywi th
breechpr esentati
ons.Thereasonf orthecaesareansect ionmust
becl ear l
ydiscussedanddocument ed,asmustt hegr eatriskt o
mot herandbabyofnotper for
mingt hecaesareansect ion.An
i
nformed, competentpregnantwomanmaychooset heno-
tr
eat mentopt i
on,i.
e.shemayr efusecaesareansect i
on, ev en
whent hiswoul dbedet r
imentalt
oherownheal t
hort hewel l
being
ofherf etus.I
nsuchasi tuati
onev eryatt
emptmustbet akent o
ensur et hewomanandherbi r
thpartnerreal
isethecriti
cal
i
mpor tanceoft hecaesareansectioninthisspecifi
csi t
uat i
on.

11.
AMNI
OCENTESI
S&CVS
Ser
iousr
isksi
ncl
ude:
f
ail
uret
oobt
ainasampl
eofamni
oti
cfl
uid.
Anexper
iencedoper
atori
sli
kel
ytoobt
ainsuccessatt
hef
ir
st
at
tempti
n94%ofpr ocedur
es.
Anexper i
encedoperatori
sli
kel
ytoobtai
nbl
oodstai
nedsampl
es
i
nappr oxi
mat el
y0.8%ofprocedur
esassumi
ngtheuseof
cont
inuousultrasoundgui
dance.
mi scar
ri
age.Ar
ateof1%ov
ert
henor
misusual
l
yquot
eddur
ing
counsell
ing.
Arat
elowerthan1%shoul
dbequot
edonl
yifi
tissuppor
tedby
r
obustl
ocaldata.
f
etal
inj
ury
.
Thi
sisr
areandhasbeendescr
ibedonl
yincaser
epor
ts.
Thiscompli
cati
onmaybemi nimi
sedbyt
henowst
andar
duseof
conti
nuousult
rasoundgui
dance.
mater
nalbowel i
njur
y.Thi
sisalsor
areand,
agai
n,t
heriski
s
mini
misedbytheuseofcont i
nuousul
tr
asoundgui
danceatthe
t
imeofneedleinsert
ion.
amniot
icfl
uidl
eakage–tempor
aryorpr
olongedandwi
tht
he
addedri
skofpret
erm del
i
ver
y
chorioamni oni
ti
s.Severesepsi
s,i
ncl
udi
ngmater
naldeat
h,has
beenr eport
edbutt heri
skofsever
esepsi
sisl
i
kelyt
obelessthan
1/1000pr ocedures.
St
andardsforcontr
olofi
nfecti
onshoul
dconf
ormt
othosef
orany
i
nvasi
vediagnosti
cradi
ologi
calpr
ocedur
e.
f
ail
ureofcel
lcul
tur
eint
hel
abor
ator
y.
Fr
equentr
isks
i
ncl
ude:
mil
ddi
scomf
ort

12.
MORCELLATI
ONOFMYOMECTOMY/
HYSTERECTOMY
Morcel
l
ati
onisaterm usedt
odescri
bethepr
ocessofcutt
ing
t
issuei
ntosmal
lerpi
ecestofaci
l
itat
eit
sremovalf
rom t
hebody.
Bef
oreconsi
der
ati
oni
sgi
vent
omor
cel
l
ati
onofaf
ibr
oidor
breachingofafibroi
dcapsul
e(vi
aanyroute)MRIorult
rasound
i
magi ngshouldhav ebeenper
for
medtodiagnoseafibroi
d.
NeitherUSSnorMRIar eablet
odefi
nit
ivel
yexcl
udesarcomat ous
changei nafi
broid.
Thereshoul
dbecaref
uldiscussi
onwit
hthei
ndi
vi
dual
,i
ncl
udi
ng
checksonthef
oll
owingredflagi
ndi
cator
s:
 Post
-MenopausalBl
eedi
ng(
PMB)orabnormalut
eri
ne
bl
eedi
ng(AUB)inwomenofrepr
oduct
iveage/
pr
emenopausal)
 Suspiciousfeatur
esoni maging-ther
eisal i
mitedev i
dence
base( soli
dmasseswi thinhomogeneousechogenicity,
i
rregularcysti
careas,f
anshapedshadowi ng,moder atelyor
verywel lv
ascular
isedonul t
rasound)
;absenceofthese
featur
esdoesnotexcl udesar coma1,
6•Rapidlyenlarging
fi
broidinpost-menopausal women1
Inpremenopausal
women: fi
broi
dst
hatdonotdecreasein
sizeaft
erGnRHagonistt
reat
ment(oest
rogendepr
ivati
on)
shouldrai
sesuspi
cion
 Fami
lyhist
oryofbr
east/ovari
ancarci
noma(orknown
BRCA1/2germli
nemutation)and/
orLynchSyndrome•Ri
sk
i
sstr
ati
fi
edbyage( per
iandpostmenopause)
 Hi
stor
yofTamoxi
fenuse
 Ethnici
tyshoul
dbeconsi
dered;
asthei
ncidenceoff
ibr
oids
i
shi gheri
nblackwomen,soisthei
nci
denceofUter
ine
Sarcoma
 Hi
stor
yofpel
vi
cir
radi
ati
on
RI
SKOFUNDI
AGNOSEDLEI
OMYOSARCOMA
 Pr
esumedf
ibr
oidsar
emor
eli
kel
ytobesar
comasi
nper
iand
 post
-menopausalwomen,i
ftheyar
erapi
dlygr
owi
ngand
sol
it
ary
,rat
herthanmult
ipl
e.
 Beforeconsi
derati
onisgiventomorcel
l
ati
onofaf i
broi
dor
breachi
ngofaf i
broidcapsul
e(vi
aanyroute)MRIor
ult
rasoundimagingshouldhavebeenperf
ormedt odiagnose
afibroi
d.Nei
therUSSnorMRIar eablet
odef i
nit
ivel
yexclude
sarcomatouschangeinaf i
broi
d.

PROCEDUREOFMORCELLATI
ON
 Morcel
lat
ioncanbeper
for
medl
apar
oscopi
cal
l
y,abdomi
nal
l
y,
orv
aginal
ly.
 Laparoscopi
call
y,i
tinvolvesthei nsert
ionofasur gical
i
nstrumentthroughapor tinci
siont oelectr
icall
yor
mechanicall
ycutaut erusorfibroidint
osmal l
erpiecesaf
ter
i
thasbeendet ached, t
hef r
agment sarethenremov ed
thr
ought hei
nstrument .
 Auter
usorfibr
oidcanal
sobecutint
osmall
erpi
ecesby
i
nsert
ingaspeci
all
ydesi
gnedkni
fethr
oughapor
tinci
sion.
 Morcellati
onofanenl argedut er
usorfi
broi
dcanbe
perf
ormedi nthev agi
na, [t
hroughaposteri
orcolpotomyifa
subtotalhyst
erectomyi sperformedorvaginal
l
ydur inga
tot
al l
aparoscopichysterectomy]ort
hroughapor tusing
 othercut
ti
ngi
nstr
umentsordevi
ces)
.Itcanal
sobe
perfor
medwit
hinanabdominal
inci
sion.
I
NTENDEDBENEFI
TS
Themai nbenef i
toftheuseofmor cel
lat
ioni
st hecompleti
onof
theenti
repr ocedur
elapar oscopi
call
yorvagi
nally
,whichis
associ
atedwi thsmallerincisi
ons,l
esspain,
reducedriskof
i
nfecti
on, r
educedriskoft hromboembolism,short
erhospit
alst
ay
andaqui ckerrecovery.
SERI
OUS& FREQUENTLYOCCURI
NG RI
SKS
1.
Uni
ntendedmor
cel
l
ati
onofaut
eri
nesar
coma
2.2Wor
seni
ngt
hepr
ognosi
sofanexi
sti
ngsar
coma
3.Disseminat
edfi
broi
ds(presenceofbeni
gnf
ibr
oidswi
thi
nthe
abdomi nal
andpel
viccav
ity
)
Therangeofr
iski
sconsi
der
edt
obe1i
n120(
uncommon)t
o1i
n
1200(r
are)
4.Damaget obowel,
bladder,ur
eter
sandbloodvessel
s.
Laparoscopi
cmy omectomy ,wi
thandwi
thoutmorcell
ati
onal
so
carr
iesariskoft
heseinjur
ies)
BENEFI
TSOFALTERNATI
VETRETMENTAT MORCELLATI
ON
1.Not
reat
ment
2.Openmy omectomyorhy st
erectomyThebenef iti
sthatan
unsuspectedsarcomawoul dnotbemor cel
lated,Theseare,an
i
ncr easedri
skofthr
omboembol i
sm,woundi nfect
ions,bl
ood
transfusi
onandinci
sional
hernias,wit
halongerhospi t
alstayand
recovery)
3.Cont
ainedr
etr
iev
aldur
ingmor
cel
l
ati
on.
4.Conser
vat
ivemeasur
esandut
eri
near
ter
yembol
i
zat
ion
ALLTHEVERYBESTEVERYONE
STUDYSMART
MAKEI
THAPPEN