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Introduction

Introduction. 600,000 hysterectomies per year Modes of hysterectomy include trans-abdominal, trans-vaginal, laparoscopic assisted, and total laparoscopic. Modes of assessment. Bimanual exam Ultrasound.

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Introduction

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  1. Introduction • 600,000 hysterectomies per year • Modes of hysterectomy include trans-abdominal, trans-vaginal, laparoscopic assisted, and total laparoscopic

  2. Modes of assessment • Bimanual exam • Ultrasound

  3. Objectives: to determine how accurate both bimanual exams and ultrasound exams are in determining estimated uterine weight • Study Design: retrospective chart review performed at Texas Tech University Health Sciences Center and the affiliated hospital, University Medical Center

  4. Materials and Methods • Chart review from the year 2003- 2007 • Information retrieved • Estimated uterine size by physical exam • Pelvic ultrasound measurements • Actual uterine weight from pathology reports • Height and weight to calculate BMI • Statistics used: linear regression analysis

  5. 388 hysterectomies that met the inclusion criteria 6 charts with no documented pathology weight 366 charts reviewed 22 charts not accessible 185 charts with documented bimanual estimation of uterine size 129 charts with pelvic ultrasound performed no more than three month prior to surgery

  6. Texas Tech Chart

  7. Preoperative clinical uterine size along with mean uterine weights of specimens • nongravid ut size(wk) mean ut weight(g) stand deviation(g) 6 113 +/-48 8 141 +/-66 10 172 +/-82 12 233 +/-113 14 321 +/-160 16 465 +/-209 18 747 +/-311 20 1046 +/-464 22 1246 +/-588 24 1459 +/-479 26 1730 +/-713 *Harb and Adam

  8. Clinical exam compared to actual weights

  9. Ultrasound compared to actual weights

  10. Results by Linear Regression Analysis • Statistical analysis indicated R squared of 0.9773 when comparing the bimanual method to the pathological weight and R squared of 0.8033 when comparing the Ultrasound method to the pathological weight • The statistical analysis indicated R squared of 0.9032 when comparing obese subjects and R squared of 0.7833 in the non-obese subjects

  11. Conclusion • Bimanual exam was more accurate at predicting uterine weights compared to pelvic ultrasound, although this was not statistically significant • BMI did not influence the accuracy in estimating uterine size on bimanual exams • The objectives were met as shown by the above stated results. For purposes of estimating uterine size prior to hysterectomy bimanual examination highly correlates with actual uterine size. These results do not support pelvic ultrasound as a preferred method for purposes of estimating uterine size

  12. References • Cantuaria GH, Angioli R, Forst L, Duncan R, Penalver MA. Comparison of bimanual examination with ultrasound examination before hysterectomy for uterine leiomyoma. Obstet Gynecol 1998;92:109-12. • Flikinger L, D’Ablaing GD, Mishell, DR. Size and weight determinations of nongravid enlarged uteri. Obstet Gynecol 1986;68: 855-8. • Harb T, Adam R. Predicting uterine weight before hysterectomy: Ultrasound measurements versus clinical assessment. Am J Obstet Gynecol 2005;193: 2122-5. • Kung FT, Chang SY. The relationship between ultrasonic volume and actual weight of pathologic uterus. Gynecol Obstet Invest 1998;42: 35-8.

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