SASGOG's Pearls of Exxcellence

Management of Second Trimester Fetal Loss

Second trimester fetal loss complicates 1% to 2% of pregnancies and occurs between 14 and 27 weeks gestation and may encompass spontaneous abortion, stillbirth, and early preterm labor. Risk factors...

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Management of Fetal Demise caused by Abruption at Term

Placental abruption complicates 0.5 to 1% of pregnancies, but very rarely results in fetal demise. Fetuses that survive are at increased risk of significant morbidity. Management must address maternal...

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Evaluation and Management of Postmenopausal Bleeding in a Woman with a Stenotic Cervix

Postmenopausal bleeding (PMB), defined as any bleeding which occurs greater than 12 months after the final menstrual period, requires evaluation because of the 1-14% risk of endometrial cancer. More than...

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Management of Grade 1 Adenocarcinoma of the Endometrium

Surgery is the cornerstone of treatment for endometrial carcinoma except for select premenopausal patients desiring fertility and patients with significant medical comorbidities. In patients with known grade 1 adenocarcinoma,...

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Management of Dehiscence of the Vaginal Cuff

Vaginal cuff dehiscence, a rare complication of hysterectomy, is the full or partial separation of the edges of the vaginal cuff. Evisceration is dehiscence with prolapse of abdominal contents....

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Diagnosis and Management of Cervical Ectopic Pregnancy

Cervical ectopic pregnancy is the rare implantation of a pregnancy in the endocervical canal and accounts for less than 1% of all ectopic pregnancies. Patients usually present with vaginal bleeding,...

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Management of Broad Ligament Extension and Hematoma during a Cesarean Delivery

The broad ligaments consist of anterior and posterior leaflets of peritoneum which cover the lateral uterine corpus and upper cervix and extend from the lateral walls of the uterus to...

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Amniotic Fluid Embolism

Amniotic Fluid Embolism (AFE) is an uncommon, catastrophic obstetric emergency. The frequency of AFE is 2-7 cases per 100,000 births with a mortality rate as high as 60%. It is...

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Management of a Lost Pedicle At the Time of a Vaginal Hysterectomy

Clinically significant bleeding occurs in 1-2% of vaginal hysterectomies; subclinical hematomas, identified by sonography, may be seen in up to 15% of cases. Risk factors include an enlarged uterus, lack...

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Management of Atypical Glandular Cells

Though atypical glandular cells (AGC) are uncommon, occurring in approximately 3 per 1000 specimens, the associated risk of invasive malignancy is as high as 2-5%. All patients with...

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Management of Lateral Uterine Perforation at the Time of Hysteroscopy

Lateral uterine perforation at the time hysteroscopy is a rare, but potentially dangerous complication. The overall rate of hysteroscopic complications is low and diagnostic procedures have a lower rate than...

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Management of Ureteral Injuries

Ureteral injuries are relatively uncommon and may be more common with gynecologic than other types of abdominopelvic surgery. The incidence of ureteral injury ranges from < 0.1% to over 1%...

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Surgical Management of Endometriosis

Endometriosis may be strongly suspected based on clinical presentation however laparoscopy remains the gold standard for diagnosis. In patients with pain that is not improved with medical management, surgery affords...

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Management of Placenta Accreta Spectrum Diagnosed Antenatally

The degree of invasion of the myometrium by the chorionic villi defines placenta accreta (adherent to the myometrium), increta (invading the myometrium) and percreta (perforating through the myometrium). A...

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Postoperative Urinary Fistulae

Although it has been estimated that the risk of injury to the urinary tract is 0.3% during pelvic surgery, particularly hysterectomy, many of these injuries are occult. When routine cystoscopy...

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Complications of Gynecologic Laparoscopic Surgery

Complications of gynecologic laparoscopy occur in 3 to 6 per 1000 cases. Approximately one-third to one-half of complications occur during initial access. Evidence is insufficient to support the use...

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Trial of Labor after Cesarean (TOLAC)

Options following a cesarean delivery include elective repeat cesarean delivery and trial of labor after cesarean (TOLAC). Successful TOLAC results in vaginal birth after cesarean (VBAC), and is estimated...

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Postpartum Hemorrhage from Atony Unresponsive to First Line Uterotonics

Primary postpartum hemorrhage (PPH), a leading cause of severe maternal morbidity in the US, is defined as cumulative blood loss of ≥1000 ml and signs of hypovolemia during the 24...

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Lynch Syndrome

Lynch syndrome is an autosomal dominant hereditary cancer syndrome which commonly presents with colon cancer, endometrial cancer, or ovarian cancer. It is also associated with cancers of the stomach,...

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Management of Placenta Accreta at Delivery

Placenta accreta spectrum (PAS) describes the pathologic adherence of the placentaand includes placenta increta, percreta, and accreta. The PAS incidence has increased in parallel with increasing cesarean...

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The Management of Borderline Ovarian Tumors

Borderline ovarian tumors, previously known as low-malignant potential (LMP) tumors, make up nearly 20% of ovarian epithelial cancers and have an excellent prognosis regardless of stage at diagnosis. Borderline ovarian...

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Vaginal Squamous Intraepithelial Lesions

Vaginal intraepithelial neoplasia (VaIN) affects 0.2 per 100,000 women in the United States. VaIN, like cervical intraepithelial neoplasia (CIN), is caused by human papillomavirus (HPV). High-risk HPV (hrHPV)...

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Endometrial Ablation

Endometrial ablation can be performed by several different minimally invasive procedures which cause surgical destruction of the endometrium to treat abnormal uterine bleeding (AUB). First generation technique involves...

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Ovarian Conservation at the Time of Hysterectomy

With hysterectomy representing a common opportunity for removal of the ovaries, a general approach to conservation or removal should focus on risk stratification. Placing aside known pathology of the ovary...

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Persistent Postpartum Endometritis

When patients with postpartum endometritis do not respond to initial broad-spectrum antibiotic therapy and either demonstrate persistent temperatures over 38° Celsius after 48 hours or who are critically...

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Transgender Care

The terms transgender male or transgender man describe individuals who were sex-assigned female at birth who identify on the more masculine spectrum of gender identity. The transgender and gender-diverse experience...

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Management of Cesarean Scar Pregnancy

Cesarean scar pregnancy (CSP), also referred to as cesarean scar ectopic pregnancy, was first reported in 1978. CSP is rare, occurring in 1 in 1800 to 2656 pregnancies, and it...

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Diagnosis and Management of Molar Gestation

Molar gestation arises from villous trophoblasts in the setting of aberrant fertilization. Moles are at the benign end of the spectrum of gestational trophoblastic disease (GTD), which includes malignant tumors...

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