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Objective: To describe (1) procedure‐related complications, and (2) gestational age (GA) at delivery in patients who received their final intrauterine transfusion (IUT) at ≥ 34 weeks 0 days versus at < 34 weeks 0 days. Methods: This was a retrospective study of pregnancies treated with IUT. Procedure‐related complications were defined as any of the following within 48 h of IUT: (1) rupture of membranes or preterm delivery, (2) intrauterine infection, (3) fetal death, (4) fetal compromise resulting in emergency cesarean, or (5) neonatal death. Patient and procedural characteristics were described among patients with final IUT at ≥ 34 weeks 0 days and at < 34 weeks 0 days. Results: We studied 94 pregnancies with 237 IUTs; 35 (37.2%) had their last IUT at ≥ 34 weeks 0 days and 59 (62.8%) had their last IUT at < 34 weeks 0 days. Three procedure‐related complications occurred (1.3% of procedures, 3.2% of pregnancies). All resulted in emergency cesarean section; 1 case performed at < 34 weeks 0 days resulted in neonatal death. The remaining 2 occurred during IUT at ≥ 34 weeks 0 days. Pregnancies with the last IUT at ≥ 34 weeks 0 days delivered at a median GA of 37.1 weeks. Conclusions: Complications were rare. IUT performed at ≥ 34 weeks 0 days appeared safe. [ABSTRACT FROM AUTHOR]

Objective: To examine characteristics and outcomes of cesarean delivery (CD) in women with a history of vertical hysterotomy. Method: This is a comparative study that retrospectively queried the National Inpatient Sample from October 2016 to December 2018. Pregnancy characteristics and surgical outcomes of CD among 18 575 women with prior vertical uterine incision were compared to 1 072 949 women with prior low‐transverse incision, assessed by multivariable generalized estimating equation model and propensity score weighting. Results: In a multivariable analysis, women who had prior vertical uterine incision were more likely to have placenta percreta (odds ratio [OR] 3.41, 95% confidence interval [CI] 1.87–6.20), pre‐labor uterine rupture (OR 2.70, 95% CI 1.52–4.80), in‐labor uterine rupture (OR 2.33, 95% CI 1.55–3.51), and extreme preterm delivery <28 weeks (OR 17.8, 95% CI 15.2–20.7) in the current pregnancy, compared to those who had prior low‐transverse uterine incision. In a weighted model, prior vertical hysterotomy was associated with increased surgical morbidity in current CD compared to prior low‐transverse hysterotomy (10.6% vs. 4.8%, OR 2.02, 95% CI 1.81–2.26), including hemorrhage (OR 1.99, 95% CI 1.74–2.27) and hysterectomy (OR 3.67, 95% CI 2.97–4.53). Conclusion: Prior vertical uterine incision at CD was associated with increased risk of placenta percreta, uterine rupture, particularly before labor, and adverse outcomes in the subsequent pregnancy. [ABSTRACT FROM AUTHOR]

The Laparoscopic Approach to Cervical Cancer (LACC) trial demonstrated that minimally invasive radical hysterectomy was inferior to the open approach [1]; this unexpected result could be attributed to the spillage of cancer cells [2]. Following the LACC trial, laparoscopic radical hysterectomy without an intrauterine manipulator upon completion of a vaginal cuff closure became the new standard treatment method [3]. However, the lack of intrauterine manipulator results in poor visualization and inadequate paracervical tissue resection. This study describes the no-look no-touch technique to address this difficulty. The core procedures in our no-look, no-touch laparoscopic radical hysterectomy are: (Step 1) Creation and closure of a vaginal cuff; (Step 2) Manipulation of the uterus without an intra-uterine manipulator; and (Step 3) Exposure of the paracervical tissues by the suspension technique. The patient eligibility for our procedure is as follows: 1) previously untreated cervical cancer (those who underwent diagnostic conization could be included); 2) clinical stage IA2, IB1, IB2, and IIA1 based on the 2018 International Federation of Gynecology and Obstetrics staging system; 3) histologically confirmed cervical cancer, including squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma. The important indication for this procedure is in cases where the tumor is less than 4 cm in diameter. We previously reported that our no-look no-touch technique enables smooth performance of laparoscopic radical hysterectomy without worsening oncologic outcomes [4]. According to a recent systematic review and meta-analysis [5], minimally invasive radical hysterectomy with vaginal cuff closure is a safe treatment option; however, it involves a steep learning curve, which has impeded its increased application. This video will hopefully make minimally invasive radical hysterectomy with protective maneuvers against cancer cell spillage more accessible. Based on our experiences, we propose that our transvaginal cervical tumor-concealing no-look notouch technique will mitigate the risk of surgical spill of tumor cells during minimally invasive radical hysterectomy. The informed consent for use of this video was taken from the patient. [ABSTRACT FROM AUTHOR]