Clinical obstetrics and gynecology
-
Clin Obstet Gynecol · Jun 2001
ReviewTraditional surgical approaches to uterine fibroids: abdominal myomectomy and hysterectomy.
Abdominal myomectomy and hysterectomy remain the traditional treatment of large symptomatic uterine myomas. The preoperative indications for abdominal myomectomy or hysterectomy must be clearly evaluated and delineated avoid unnecessary intervention. There appears to be an increasing trend toward expectant management for asymptomatic uterine myomas. ⋯ The rapid development and use of minimally invasive innovations and adjunctive medical therapies has provided clinicians with a wealth of alternatives. A practical and cost-effective approach based on the data currently available have been presented; however, there remains a paucity of prospective randomized data to evaluate and compare the effectiveness and safety of these alternative treatments to abdominal myomectomy and hysterectomy. Future studies should help define the optimal candidates for traditional surgical treatment with abdominal myomectomy and hysterectomy.
-
In general, tocolytic agents are effective in stopping uterine contractions and in temporarily delaying delivery. The benefit of stopping uterine contractions is dependent on the fetal status and gestational age. The rationale for stopping preterm labor is to improve neonatal outcome. ⋯ The most appropriate way to end preterm delivery would be to prevent the causes that initiate the cascade that ends in preterm labor. Authors' Note: Literally hundreds of papers have been written in the last 30 years on tocoloysis. For the purposes of space, when studies are summarized in peer-reviewed articles, we have referenced the reviews instead of the individual studies.