Uterine Morcellation – Use of the Technique may be Too Risky under Any Circumstance

Some professional groups and medical institutions are stressing the importance of counseling patients about both the potential risks and benefits of morcellation of a fibroid or uterus

Evaluating the Risks of Electric Uterine Morcellation

Gynecologic surgeons, like many other surgical specialists, have embraced laparoscopic surgical techniques because they offer quicker recovery, less postoperative pain, and fewer wound complications than open procedures. The removal of large pieces of tissue through the small incisions of laparoscopy is difficult. However, this problem can be overcome by tissue morcellation, a technique of fragmenting tissue into smaller pieces that often prevents the need to enlarge established incisions. Surgeons have long used manual morcellation with a scalpel or scissors to remove masses abdominally and vaginally, but use of the technique has increased with wide adoption of laparoscopic approaches and with the introduction of laparoscopic electric morcellators in 1993.

Critics of Fibroid Removal Procedure Question Risks It May Pose for Women With Undetected Uterine Cancer

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Uterine Morcellation – Use of the Technique may be Too Risky under Any Circumstance

Use of a surgical technique that involves cutting fibroid or uterine tissue into small pieces for extraction during minimally invasive surgery has come under scrutiny recently—scrutiny prompted by concerns that the process may disperse fragments of undetected malignant tumors throughout the abdominal cavity and upstage otherwise contained cancers.

Because it’s not possible to reliably detect the presence of uterine sarcomas before surgery, some experts say that use of the technique—known as intracorporeal uterine morcellation, which can be performed with an electric morcellator or by hand with a knife—may be too risky under any circumstance. Others say more research on risks associated with the procedure is needed before banning it outright. In the meantime, some professional groups and medical institutions are stressing the importance of counseling patients about both the potential risks and benefits of morcellation of a fibroid or uterus.

Sources and Full Text
  • Evaluating the Risks of Electric Uterine Morcellation, The Journal of the American Medical Association, 1828692, 2014;311(9):905-906. doi:10.1001/jama.2014.1093.
  • Critics of Fibroid Removal Procedure Question Risks It May Pose for Women With Undetected Uterine Cancer, JAMA Network, 1828691, 2014;311(9):891-893. doi:10.1001/jama.2014.27.

The more Weight a Woman gains during Pregnancy, the higher the Risk to have a Child with Autism

The observed associations were particularly pronounced in male children

Abstract

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@JAMAPeds : editorial team of pediatricians and researchers passionate about child health research; part of the newly formed JAMA Network Pediatrics

Importance
One in 88 children in the United States is diagnosed as having autism spectrum disorder. Significant interest centers on understanding the environmental factors that may contribute to autism risk.

Objective
To examine whether induced (stimulating uterine contractions prior to the onset of spontaneous labor) and/or augmented (increasing the strength, duration, or frequency of uterine contractions with spontaneous onset of labor) births are associated with increased odds of autism.

Design, Setting, and Participants
We performed an epidemiological analysis using multivariable logistic regression modeling involving the North Carolina Detailed Birth Record and Education Research databases. The study featured 625 042 live births linked with school records, including more than 5500 children with a documented exceptionality designation for autism.

Exposures
Induced or augmented births.

Main Outcomes and Measures
Autism as assessed by exceptionality designations in child educational records.

Results
Compared with children born to mothers who received neither labor induction nor augmentation, children born to mothers who were induced and augmented, induced only, or augmented only experienced increased odds of autism after controlling for potential confounders related to socioeconomic status, maternal health, pregnancy-related events and conditions, and birth year. The observed associations between labor induction/augmentation were particularly pronounced in male children.

Conclusions and Relevance
Our work suggests that induction/augmentation during childbirth is associated with increased odds of autism diagnosis in childhood. While these results are interesting, further investigation is needed to differentiate among potential explanations of the association including underlying pregnancy conditions requiring the eventual need to induce/augment, the events of labor and delivery associated with induction/augmentation, and the specific treatments and dosing used to induce/augment labor (eg, exogenous oxytocin and prostaglandins).

Sources

Association of Autism With Induced or Augmented Childbirth in North Carolina Birth Record (1990-1998) and Education Research (1997-2007) Databases