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It has been advocated that placenta accreta/percreta should be managed conservatively to avoid massive pelvic bleeding and preserve fertility. Diagnosis of this condition with high-resolution imaging investigations performed during the antenatal period facilitates discussion of management plans with other clinical disciplines (eg interventional radiologists), the patient, and her family. Three cases of placenta praevia with accreta are presented. The three cases were managed by leaving the placenta in-utero after caesarean section, using uterine arterial embolisation to control postpartum haemorrhage only when needed. In all these cases, we succeeded in conserving the uterus without major complications. With improved imaging techniques, accurate antenatal diagnosis of placenta praevia with accreta is now possible. This new approach to conservative management can be considered in order to not only conserve the uterus but also to avoid uncontrolled pelvic haemorrhaging.

Objective: To review the results of vaginal hysterectomies in patients without uterine prolapse., Design: Retrospective chart review., Setting: University affiliated hospital, Hong Kong., Patients: Patients who had vaginal hysterectomies in the absence of uterine prolapse, from 1999 to 2005 inclusive., Main Outcome Measures: The number, indications, operative procedures, and complications of such hysterectomies., Results: A total of 94 patients who underwent vaginal hysterectomy fulfilled the inclusion criteria. They accounted for 4.3 to 8.2% of all hysterectomies performed annually for benign diseases in the department, over the inclusive period 2000 to 2004. The incidences of complications, except bladder injuries, were comparable to those reported in other studies. The incidence of vault haematoma decreased as each surgeon's experience increased and more attention was paid to 'bleeders' at the 'four and eight o'clock areas' and more cephalic regions of the vaginal incision. Increased size of the uterus was an important determinant of the risk of complications., Conclusions: Vaginal hysterectomy is an underutilised approach in Hong Kong. With more experience and better patient selection, complication rates can be further reduced. Further evaluation is suggested for the role of bleeders at 'four and eight o'clock regions' as potential causes of vault haematoma.

Objective: To review the use of episiotomy during vaginal delivery in Hong Kong public hospitals., Design: Prospective observational survey., Setting: Public hospitals, Hong Kong., Participants: Women who underwent normal vaginal delivery of a singleton foetus with cephalic presentation., Main Outcome Measures: Number of women having an episiotomy, severe-degree (third- or fourth-degree) tear, other types of tear, blood loss at delivery, postpartum haemorrhage, need for blood transfusion, puerperal pyrexia, wound infection, gaping wound that required suture removal, and drainage or resuturing of a perineal wound., Results: Between 1 January and 31 March 2003, there were 6222 singleton spontaneous normal vaginal deliveries in the public hospitals of Hong Kong. Of the 6167 women in whom the status of the perineum was known, episiotomy was performed in 5274 (85.5%). Primiparous women were more likely to undergo episiotomy at delivery than multiparous women (97.9% vs 71.4%). Women with episiotomy had significantly less perineal tearing of any kind than those without. The occurrence of any type of perineal tear and severe-degree (third- or fourth-degree) tear was significantly lower in primiparous women who had an episiotomy than those without (P<0.05). Women with episiotomy had increased mean blood loss at delivery but other complications were not significantly increased., Conclusions: In Hong Kong, episiotomy is routinely performed during normal vaginal delivery. It is associated with a significantly lower overall rate of perineal tearing. This study was observational, nonetheless the occurrence of other complications was likely to increase when episiotomy was performed. Firm evidence from several randomised controlled studies shows that routine episiotomy is unjustified and possibly harmful. Routine episiotomy should not be promoted in Hong Kong without further randomised controlled study.

A retrospective review was made of patients who underwent day surgery at a gynaecological day practice in Hong Kong from October 1993 to June 1994. The first three months of practice, which involved 326 patients, was analysed separately. During the initial period, 49.5% of patients who had gynaecological operations were managed as day patients. The rates for patients with prolonged hospital stay and cancelled operations were 15.6% and 3.0%, respectively. In the subsequent period, the incidence of prolonged hospital stay decreased to 7.4%, while the cancellation rate was similar, at 3.6%. Patients with a prolonged hospital stay were less likely to be Chinese, were more likely to have other medical problems, to be of American Society of Anesthesiologists Class II, and to have procedures that involved opening of the peritoneal cavity. Non-medical problems were an important reason for prolonged hospital stay (37.4%). The stay rate could be reduced by provision of a separate operating facility and by improved counselling and selection of patients.