Thesis (MPH) -- University of Limpopo, 2011.

Thesis (doctoral)--University of Turku.

In North America, hysterectomy is the most common major surgery for benign non-obstetric reasons (e.g., uterine fibroids, endometriosis, abnormal bleeding) in premenopausal women. Many of these conditions may result in pelvic pain, sexual and psychological difficulties. However, the capacity of hysterectomy to relieve these problems has not been adequately evaluated. Recently, there has been controversy as to whether less invasive surgeries such as subtotal hysterectomy, in which the uterus is removed and the cervix is left intact, are less detrimental than total hysterectomy, in which both the uterus and the cervix are excised. / The first part of this thesis consists of a comprehensive review of the literature on the psychosocial outcomes of hysterectomy published within the past 30 years. Controversial theories, empirical studies, and review articles are discussed with regard to sexual, pain, and psychological outcomes. Findings suggest that while hysterectomy results in reduced pain, there are no strong effects on sexual or psychological functioning. Nevertheless, many studies reported adverse psychosocial outcomes in a subgroup of 10-20% of women post-hysterectomy. / The second part of this thesis presents findings from a randomized controlled trial investigating the psychosocial outcomes of total versus subtotal hysterectomy. Premenopausal patients with benign gynecological conditions were randomly assigned to either total hysterectomy, i.e., laparoscopic assisted vaginal hysterectomy (N=32), or subtotal hysterectomy, i.e., supra-cervical laparoscopic hysterectomy (N=31). In addition, two control groups of premenopausal women undergoing minor gynecological surgery (N=30) and healthy women undergoing no surgery (N=40) were recruited. For the two hysterectomy groups, abdominal pain was significantly reduced post-surgery. There was some evidence for positive effects of hysterectomy on sexual functioning, while psychological functioning did not significantly change. The study indicated that total and subtotal hysterectomy produced equally beneficial outcomes. Although 3-16% of women reported various adverse effects in psychosocial functioning post-hysterectomy, similar percentages of the two control groups reported such changes.

No description available.

Thesis (M.Med.(Obstetrics and Gynaecology)--University of the Witwatersrand, Faculty of Health Sciences, 2012 / Objective The study aimed to identify the profiles and outcomes of women undergoing hysterectomy for primary postpartum haemorrhage (PPH). Methods This was a retrospective descriptive study of maternal records of all women that underwent hysterectomy for primary postpartum haemorrhage (PPH) from January 2008 to December 2008. Results Twenty-seven women underwent hysterectomies for primary postpartum haemorrhage (PPH). Eighty nine percent of the women were booked, with a mean of 4.8 antenatal visits. Previous caesarean section and retained placenta were the main risk factors associated with hysterectomy for PPH, with retained placentae being the principle etiological factor (37% of cases). Forty percent of patients had one or more previous caesarean section. Atony was the leading cause of emergency hysterectomy (63%). Subtotal hysterectomy appeared to be the procedure of choice (70% of cases). Conservative management was not attempted in most cases. After hysterectomy, 18(29%) of women were admitted to the multidisciplinary intensive care unit. Two women died (7%). Conclusion Postpartum haemorrhage requiring hysterectomy appears to be an unpredictable emergency with no specific risk profile for peripartum hysterectomy. Conservative management could have been attempted more frequently. The findings have implications for peripheral hospitals that manage obstetric patients who have no specific risk factors for PPH. The possibility of emergency hysterectomies exists for all births and health workers need to be able to recognize and manage this emergency appropriately. Peripartum hysterectomy (PH) may be a lifesaving procedure and every obstetric doctor needs to be proficient in performing a subtotal hysterectomy at the very least.

In this qualitative study, I explore the impact of national culture on the gender identity of Serbian women with hysterectomies, with special emphasis on traditional motherhood discourse and its implications for women who cannot bear children. More specifically, I investigate how women who have undergone hysterectomy (surgical removal of part or all of the uterus) perceive themselves after the surgery and how that perception influences their sense of self, gender identity, and sexuality. Finally, I examine how these women communicate their gender identity to the people surrounding them, especially current and potential romantic partners, and how communication with their relational partners and others in their respective communities can help improve or diminish their emotional status after hysterectomy. In this report, I identify and analyze the following themes which emerged from the data gathered through my in-depth interviews: Serbian culture of imperative motherhood; the role of relational partners; Serbian women’s health beliefs and practices; spirituality and religion in relation to hysterectomy experience; the role of social networking in the lives of Serbian women, and stigmatization and stigma potential. These six prominent themes are all embedded in the fabric of Serbian culture and represent the summary of most common reactions, fears, anxieties, problems, ivattitudes, and beliefs Serbian women with hysterectomies may experience before or following the hysterectomy procedure. This study identifies ethnicity and nationality related issues influencing women’s hysterectomy experience and the experience of their partners, i.e., takes important cultural factors into account, analyzes them, and identifies social, historical, and cultural reasons for their existence. Furthermore, the current study identifies and provides explanation about the role of the social community, especially the roles other females play in influencing the attitudes of women with the lived experience of hysterectomy and the impact other women’s attitudes may have on their gender identity. Finally, the current study recognizes the necessity for improvement of health services offered to Serbian women with hysterectomy experience and especially the importance of establishing support and self-help groups to help women deal with hysterectomy related issues, such as fears, anxieties, insecurities, communication problems, and impaired gender identity and gender identity shifts.

In this qualitative study, I explore the impact of national culture on the gender identity of Serbian women with hysterectomies, with special emphasis on traditional motherhood discourse and its implications for women who cannot bear children. More specifically, I investigate how women who have undergone hysterectomy (surgical removal of part or all of the uterus) perceive themselves after the surgery and how that perception influences their sense of self, gender identity, and sexuality. Finally, I examine how these women communicate their gender identity to the people surrounding them, especially current and potential romantic partners, and how communication with their relational partners and others in their respective communities can help improve or diminish their emotional status after hysterectomy. In this report, I identify and analyze the following themes which emerged from the data gathered through my in-depth interviews: Serbian culture of imperative motherhood; the role of relational partners; Serbian women’s health beliefs and practices; spirituality and religion in relation to hysterectomy experience; the role of social networking in the lives of Serbian women, and stigmatization and stigma potential. These six prominent themes are all embedded in the fabric of Serbian culture and represent the summary of most common reactions, fears, anxieties, problems, ivattitudes, and beliefs Serbian women with hysterectomies may experience before or following the hysterectomy procedure. This study identifies ethnicity and nationality related issues influencing women’s hysterectomy experience and the experience of their partners, i.e., takes important cultural factors into account, analyzes them, and identifies social, historical, and cultural reasons for their existence. Furthermore, the current study identifies and provides explanation about the role of the social community, especially the roles other females play in influencing the attitudes of women with the lived experience of hysterectomy and the impact other women’s attitudes may have on their gender identity. Finally, the current study recognizes the necessity for improvement of health services offered to Serbian women with hysterectomy experience and especially the importance of establishing support and self-help groups to help women deal with hysterectomy related issues, such as fears, anxieties, insecurities, communication problems, and impaired gender identity and gender identity shifts.

No description available.

Hysterectomy is the second highest frequency of gynecologic surgery. With limited medical resources, understanding of qualities and expenses of different types of surgery can be used as a reference for patients and hospital administrators in making related decisions. Therefore, the purpose of this study is to compare the outcomes between ¡§Total Abdominal Hysterectomy¡¨ and ¡§Laparoscopic Hysterectomy¡¨. Data sources are the health insurance report data files and charts of a regional teaching hospital. There were 114 cases between January 2006 and June 2010 at the sample hospital. Operating time, length of stay, and intra-operative blood loss between both types of hysterectomy are analyzed and compared by using t-test. Linear regression analysis is then used to examine the predictive factors that impact the outcomes of both types of surgery. The results indicate that, in terms of clinical results, laparoscopic hysterectomy takes 120.45 minutes on average, and total abdominal hysterectomy 104.35 minutes; laparoscopic hysterectomy requires an average of 4.73 days of hospital stay, and total abdominal hysterectomy 5.54 days; and finally, laparoscopic hysterectomy causes an average of intra-operative blood loss of 249.70cc, and total abdominal hysterectomy 290.21cc, laparoscopic hysterectomy costs an average of NT$69,268.85, and total abdominal hysterectomy NT$46,634.88. In regard to hospitalization costs, laparoscopic hysterectomy costs an average of NT$49,732.50, and total abdominal hysterectomy costs NT$42,066.27. Based on findings of this study, the following suggestions are proposed: (1) Laparoscopic hysterectomy can be safely and effectively used for patients with large uterine myoma or multiple myoma. (2)Hospitals should develop standardized medical treatment procedures; therefore, cost control would not be at the expense of the quality of care. Furthermore, standardization of medical treatment can be used to pinpoint whether there is any waste in the medical treatment process. Keywords: uterine myoma, hysterectomy, total abdominal hysterectomy, laparoscopic hysterectomy, outcome.

MMed, Faculty of Health Sciences, University of the Witwatersrand / Postoperative pain is prevalent and not optimally managed in most patients. Pain can lead to adverse emotional and systemic consequences. Numerous device orientated studies have been done in other countries looking at the effect of infusions of local anaesthetic at the wound site postoperatively via an elastomeric pump. There have however been no similar studies done in South Africa. The aims of this study was to assess whether the use of an incisional wound catheter and 0.39% bupivacaine infusion in patients post total abdominal hysterectomy for a 30 hour period will decrease opioid requirements compared to a control group having only systemic analgesia. Pain intensities were also documented at set observation periods. The opioid requirements between the 2 groups were comparable however the participants who had the bupivacaine infusion in their incisional site had less pain intensity scores until 6 hours post operation and had less pain intensity on movement at 30 hours post operation. A bupivacaine infusion in the incisional site decreases pain intensity in the above mentioned parameters but does not reduce opioid requirements.