Orientador: Anaglória Pontes / Resumo: Avaliar a função ovariana, em mulheres no menacme submetidas à histerectomia total abdominal (HTA), por meio de parâmetros clínicos, endocrinológicos e ultra-sonográficos. Pacientes e Métodos: Estudou-se, prospectivamente, 61 mulheres, idade ≤ 40 anos, divididas em: G1, composto por 31 pacientes submetidas à HTA e, G2, por 30 mulheres normais. Critérios de inclusão: eumenorreicas, ovulatórias, não obesas ou fumantes, sem cirurgias prévias, sem uso de medicações ou de endocrionopatias, com FSH basal < 15 mIU/ml (duas ocasiões). Realizou-se dosagens de FSH, LH, estradiol (E2) e inibina B nos momentos basal, aos 2, 6 e 12 meses. O volume ovariano na ultra-sonografia (US), o Índice de Pulsatilidade (IP) das artérias ovarianas pela dopplervelocimetria e o Valor de Maturação (VM) na colpocitologia foram mensurados inicialmente e aos 6 e 12 meses. Resultados: Na comparação estatística inicial, os grupos foram homogêneos. Nas pacientes submetidas à histerectomia, aos 6 e 12 meses, ocorreu aumento do E2 e redução da inibina B (p<0,05), sem alterar FSH e LH. Ao US, observou-se aumento do volume ovariano e diminuição do IP ao doppler (p<0,05), quando confrontadas ao controle. Aos 12 meses ocorreu redução do Valor de Maturação (p<0,05) no G1. Ao final do estudo, apenas entre as pacientes histerectomizadas, encontrou-se que 12,9% (4/31) apresentaram FSH > 40 mIU/ml, estradiol < 20 pg/ml e inibina B < 5 ng/ml, compatíveis com falência ovariana. No grupo controle não alterou nenhum desses parâmetros. Conclusão: Nas pacientes submetidas à HTA ocorreu redução significativa da inibina B, sem alterações de FSH e LH. Houve aumento do volume ovariano e redução do índice de pulsatilidade, ao doppler. Esses resultados sugerem que, a histerectomia total abdominal acelere o declínio da função ovariana em mulheres no menacme. / Abstract: To evaluate the ovarian function in women of reproductive age submitted to total abdominal hysterectomy, using endocrine and ultrasonographic parameters. Patients and Methods: A prospective study on 61 women, age ≤ 40 years, was distributed in two groups: G1, 31 patients submitted to hysterectomy and, G2, 30 normal women. Criteria of inclusion: women with normal ovarian function at baseline, without tobacco exposition, normal body weight, no history of medications use or hormonal diseases, with basal FSH <15mUI/ml. The dosages of FSH, LH, estradiol (E2) and inhibin B, and ultrasonography (US) measures of the ovarian volume, of the Pulsatility Index (PI) realized by the doppler of ovarian arteries and of the Maturation Value (MV) assessed by vaginal cytology were performed in 3 moments: baseline, 6 and 12 months. Results: At baseline the groups were homogeneous. In the patient hysterectomized group, with 6 and 12 months, it was observed increase of the E2, reduction of the inhibin B, increase of the volume of the ovaries and decrease of PI (p<0,05), without altering FSH and LH. And it was observed decrease of MV (p<0,05) in the G1. At the end of the study, among the patient hyterectomized, 12,9% (4/31) of them presented FSH > 40mUI/ml, estradiol < 20pg/ml e inhibin B < 5ng/ml, compatible with ovarian failure. While in the control group it was not observed alteration of any appraised parameter. Conclusion: The hysterectomized group of patients showed expressive reduction of the inhibin B, while changes of FSH and LH levels were not observed. Enlargement of the ovaries and decrease of PI ocurred also. These results evokes that total abdominal hysterectomy stimulate the deterioration of ovarian function in women of reproductive age. / Doutor

The thesis charts the rate of perioperative complications after removal of the uterus from non-malignant causes in two different medical facilities and compares them with the indicators in the DRG classification system to determine whether this is suitable for tool for the quality assesment of health care in health facilities.

Thesis (M.S.)--University of Michigan, 1971.

Thesis (M.S.)--University of Michigan, 1971.

M.A. (Clinical Psychology) / Please refer to full text to view abstract

Titel: Kvinnors upplevelser efter att ha genomgått hysterektomi. Bakgrund: Hysterektomi är ett kirurgiskt ingrepp där livmodern avlägsnas. I Sverige genomgår årligen cirka 10 000 kvinnor hysterektomi. Indikationer för hysterektomi kan vara onormala blödningar, postpartum blödning och myom. Syfte: Syftet med denna litteraturstudie var att belysa kvinnors upplevelser efter att ha genomgått hysterektomi. Metod: En litteraturstudie som grundas på åtta kvalitativa studier. Resultat: Resultatet har presenterats i tre huvudkategorier samt sex underkategorier. Anpassning till ett ”nytt liv” – nya möjligheter och att hantera situationen. Förlusten av det reproduktiva organet – infertilitet och kvinnlighet samt sexualitet och relationer. Emotionella påfrestningar – reaktioner och återupplevelser samt bemötande i sjukvården. Konklusion: Upplevelserna bland kvinnor som genomgått hysterektomi är individuella. Det är därför viktigt att sjuksköterskan aktivt lyssnar på kvinnans berättelse om sin situation. Det behövs mer kvalitativ forskning om hur kvinnor upplever bemötandet av sjukvårdspersonal i samband med hysterektomi för att sjuksköterskan ska kunna ge adekvat och personcentrerad omvårdnad. / Title: Women’s experiences after gone through hysterectomy. Background: Hysterectomy is a surgical procedure where the uterus is removed. In Sweden approximately 10 000 women undergo hysterectomy annually. Indications for hysterectomy can for example be abnormal bleedings, postpartum haemorrhage and uterine fibroids. Aim: The aim of this literature study was to illuminate experiences of women who had undergone hysterectomy. Methods: A literature study based on eight qualitative studies. Results: The results were presented in three main categories and six subcategories. Adaption to a ”new life” – new opportunities and to handle the situation. The loss of the reproductive organ – infertility and femininity and sexuality and relationships. Emotional strains – reactions and re-experiences and treatment in healthcare. Conclusion: The experiences of women who have undergone hysterectomy are individual. Therefore, it is of importance that nurses actively listen to the woman's story about her situation. There is a need for more qualitative research regarding women’s experiences of the hospitality from the healthcare providers during hysterectomy so nurses can provide adequate and person-centered care.

by Li Ho Cheung, William. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 82-88). / Abstracts in English and Chinese. / Abstract --- p.ii / Acknowledgements --- p.vi / Table of Contents --- p.vii / List of Tables --- p.viii / List of Appendices --- p.x / Chapter Chapter 1 : --- Introduction and Literature Review --- p.1 / Chapter Chapter 2 : --- Method --- p.31 / Chapter Chapter 3 : --- Results --- p.48 / Chapter Chapter 4 : --- Discussion --- p.60 / Reference --- p.82 / Appendices --- p.89

In elderly women, discharge after gynecologic surgery is often associated with increased morbidity. Little information exists about elderly women's discharge destination after gynecologic surgery and the outcome of early hospital readmission. The purpose of this study, conceptualized using the quality health outcomes model, was to examine whether post hysterectomy discharge destination is an independent predictor of 30-day hospital readmission in women age 65 and older. Examination of covariates included patient age, race, medical comorbidity and complications of care, as well as surgical anatomic approach and operative technique. This study involved use of a retrospective cohort design and data from 10,598 cases contained in the Healthcare Cost and Utilization Project 2010 and 2011 California State Inpatient Databases. Results of the bivariate analysis showed a statistically significant association between discharge destination after hysterectomy and 30-day hospital readmission. Additionally, the results of multivariate logistic regression revealed the odds of readmission after discharge with home care were 2.99, p < .001, 95% CI [2.29, 3.67] times greater when compared with discharge home for self-care and 5.99, p < .001, 95% CI [4.68, 7.43] times greater with discharge to continuing inpatient care versus home for self-care. This study may lead to positive social change for elderly women by informing health care providers about the odds of early hospital readmission associated with discharge destination after hysterectomy. Further, this information may stimulate development of interventions to improve health care practices for elderly women preparing for hospital discharge after hysterectomy.

Hysterektomi är ett av de vanligaste kirurgiska ingreppen kvinnor genomgår och det är vanligt att kvinnans sexualitet påverkas. Sexualiteten är svårdefinierad och inrymmer mer än bara sexuella handlingar, det är en del av att vara mänsklig. Hur kvinnor uttrycker sin sexualitet beror på många olika faktorer så som ålder, samhällsklass och/eller kulturella aspekter. Vårt syfte är att beskriva kvinnors sexualitet efter hysterektomi. En litteraturöversikt baserad på 14 vetenskapliga artiklar där resultaten behandlade hur en hysterektomi påverkade kvinnors sexualitet. Artiklarna var publicerade i olika världsdelar och alla kvinnor i studierna var i vuxen ålder och de hade genomgått ingreppet på grund av benigna anledningar. Den teoretiska referensram som har använts är Joyce Travelbee’s teori om mellanmänskliga relationer. Psykosexuella faktorer som påverkades var bland annat lubrikation, orgasm, sexuell åtrå samt smärta. Hur ingreppet påverkade sexualiteten hos kvinnan skiljer sig mellan individerna och det går inte att säga vilken faktor som drabbas mest. Dessutom så finns det psykologiska och sociala faktorer som har betydelse för kvinnans sexualitet. Hur hysterektomin påverkar kvinnors sexualitet är varierande och individuellt. Vad som inte tas hänsyn till i resultatet är hur kvinnans naturliga åldrande påverkar sexualiteten. Information och utbildning är en viktig del av sjuksköterskans omvårdnad när det kommer till kvinnans sexualitet. Partnern till kvinnan kan ha en avgörande stödjande roll och även de är i stort behov av kunskap. Det finns fortfarande stora brister inom omvårdnaden kring sexualitet och det är vanligt att sjuksköterskor använder tidsbrist som ett argument till varför sexualitet inte kommer på tal. / Hysterectomy is one of the most common surgical procedures women undergo and it is common that the woman’s sexuality is affected. Sexuality is difficult to define and includes more than just the sexual act; it is a part of being human. How women express their sexuality depends on many different factors such as age, social and/or cultural aspects. Our aim is to describe women’s sexuality after hysterectomy A literature review based on 14 scientific articles whose results showing how a hysterectomy affects women's sexuality. The articles were published in different continents and all the women in the studies were adult women who had undergone hysterectomy due to benign causes. The theoretical framework used is Joyce Travelbee´s theory of interpersonal relations. Psychosexual factors that were affected were for instance lubrication, orgasm, sexual desire and pain. How the procedure affected the women’s sexuality differed is individual and it is difficult to say which factor who is most affected by the procedure. Furthermore, social and psychological factors contribute to women's experience of her sexuality. How hysterectomy affects women's sexuality is varying and individual. Women’s natural ageing which affects women’s sexuality is something that is not taken in consideration. Information and education which is included in the task of nursing is according to the women in the study important for them. In addition, women’s partners have an important role in supporting the woman but they are in need of information and knowledge. There are major shortcomings within nursing regarding sexuality and it is common that nurses blame lack of time as a factor why sexuality is not spoken about.

RATIONALE OF THE STUDY. To carry out a retrospective chart review of all patients who had a peripartum hysterectomy in hospitals at different levels of health care in the Pietermaritzburg Hospital Complex to examine the incidence and indications for peripartum hysterectomy. METHODS. The charts of 120 cases of peripartum hysterectomy operations performed between January 2003 and January 2008 in the Pietermaritzburg hospital complex of University of KZN were analysed retrospectively. The total number of deliveries were 48 964. The traditional indications, risk factors and associated complications were revisited to determine if there have been changes in current obstetric practice. RESULTS. The overall incidence of peripartum hysterectomy at the Pietermaritzburg complex of hospital was 0.25/1000 deliveries (95% C1 0.2 – 2.9). Uterine atony, bleeding abruption placentae, placentae praevia, uterine rupture following induction and extension of uterine incision into the uterine arteries comprised 87.9% of the indications for peripartum hysterectomy. By far, the most common complications were wound infection and haemorrhage due to difficult haemostasis. Both comprised 61% of complications, others were bladder injury and renal failure. Coagulopathy occurred in 16.7% of cases of whom 2 died due to massive uncontrollable haemorrhage and 26.7% cases had relaparatomy. There were 13.3% of haemorrhagic shock and 5% developed septic shock. All the patients had blood transfusion, 13.3% of patients received platelets in addition to blood. The results showed that 55.8% had previous caesarean sections while 12.5% had VBAC. There were 75.8% live babies. CONCLUSION. The review noted that there has not been a significant change in the incidence and indications for peripartum hysterectomy. The incidence of peripartum hysterectomy in the study 0.25/1000 compared favourably with the findings from similar studies in different parts of the world. Worldwide the incidence of PH ranges from 0.2 to 5.09/1000 deliveries, in our study the incidence was 0.25/1000. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2012.