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Objective: The objective of this article is to determine the safety and effectiveness of transvaginal sacrospinous ligament fixation as part of the management of pelvic support defects in a residency program. Study Design: A retrospective chart review of patients undergoing sacrospinous ligament fixation at the Division of Gynecology, Jackson Memorial Hospital, University of Miami School of Medicine, between July 1990 and December 1995, was performed. Patients with vaginal vault prolapse and uterine prolapse with documented preoperative evaluation were included in this study. Data were obtained using a detailed predetermined flow sheet. Results: A total of 160 patients was included in the study. All patients underwent right sacrospinous ligament fixation, anterior and posterior colporrhaphy, and perineorrhaphy. In addition, 31 (19%) underwent enterocele repair, 5 (3%) underwent trachelectomy, and 9 (6%) underwent Burch procedure. Complications included fever 13 (8.1%), urinary tract infection 16 (10%), blood loss requiring transfusion 7 (4.3%), sciatic neuralgia 2 (1.2%), and rectovaginal fistula 2 (1.2%). The mean follow-up was 40 months (range 18 to 78 months). The success of the operation was gauged by recurrence. Ninety-four percent of the patients had no evidence of vaginal vault prolapse on follow-up, and 85% had no recurrence of any pelvic support defect. Eleven of the 24 patients with recurrence underwent repeat surgery, whereas 13 opted for conservative management with pessaries. Conclusion: Transvaginal unilateral sacrospinous ligament fixation is a safe and successful operation for the treatment of pelvic support defect and should be an essential component in the training of gynecologic residents.

Objective: The deleterious effect of abdominal pregnancy on the mother and fetus is in part related to the morbidity of the surgical interventions utilized in its treatment. The purpose of this study is to review outcome in abdominal pregnancy after surgical intervention. Study Design: Charts of patients diagnosed with abdominal pregnancy at our institution between 1984 and 1997 were reviewed. The identified cases were categorized as group I, placenta removed at surgery (n = 10), and group II, placenta left in situ (n = 4). Gestational age, maternal death, duration of hospital stay, blood transfusions, organ excisions, and postoperative readmissions were recorded. Student t test was used for statistical analysis with a P < .05 being significant. Results: Fourteen cases were identified ranging from 7 to 36 weeks of gestation. The diagnosis was made before laparotomy in 6 patients by imaging studies. There were no maternal deaths. Among the 9 in whom placenta was removed, 2 had salpingo-oophorectomy (S-O), 4 had total abdominal hysterectomy and bilateral S-O, and 5 received blood transfusions. One developed DIC requiring massive transfusion after a 7-week placenta was excised from the mesentery. This patient was hospitalized postoperatively for 5 months. In contrast, the 4 patients in whom the placenta was left in situ had neither blood transfusions nor removal of pelvic organs. Their hospital stay was shorter, group II, mean 9 ± 6 days versus group I, 34 ± 64 days, P = .0007. This difference was accounted for by the one prolonged hospitalization in group I. No patients in either group were readmitted. Conclusion: The diagnosis of abdominal pregnancy is often not made until laparotomy. Regardless of gestational age, placental excision can cause hemorrhage. Leaving the placenta in situ is potentially less costly and less morbid, and appears to shorten operative time and hospital stay while lowering risk of blood transfusion and of surgical menopause.