600,000 hysterectomies per year

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Introduction

• 600,000 hysterectomies per year
• Modes of hysterectomy include trans-abdominal,
  trans-vaginal, laparoscopic assisted, and total
  laparoscopic

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Modes of assessment

• Bimanual exam
• Ultrasound

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• Objectives to determine how accurate both
  bimanual exams and ultrasound exams are in
  determining estimated uterine weight
• Study Design retrospective chart review
  performed at Texas Tech University Health
  Sciences Center and the affiliated hospital,
  University Medical Center

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Materials and Methods

• Chart review from the year 2003- 2007
• Information retrieved
• Estimated uterine size by physical exam
• Pelvic ultrasound measurements
• Actual uterine weight from pathology reports
• Height and weight to calculate BMI
• Statistics used linear regression analysis

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Texas Tech Chart
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Preoperative clinical uterine size along with
mean uterine weights of specimens

• nongravid ut size(wk) mean ut weight(g)
  stand deviation(g)
• 6 113 /-48
• 8 141
  /-66
• 10 172
  /-82
• 12 233
  /-113
• 14 321
  /-160
• 16 465
  /-209
• 18 747
  /-311
• 20 1046
  /-464
• 22 1246
  /-588
• 24 1459
  /-479
• 26 1730
  /-713
• Harb and Adam

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Clinical exam compared to actual weights
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Ultrasound compared to actual weights
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Results by Linear Regression Analysis

• Statistical analysis indicated R squared of
  0.9773 when comparing the bimanual method to the
  pathological weight and R squared of 0.8033 when
  comparing the Ultrasound method to the
  pathological weight
• The statistical analysis indicated R squared of
  0.9032 when comparing obese subjects and R
  squared of 0.7833 in the non-obese subjects

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Conclusion

• Bimanual exam was more accurate at predicting
  uterine weights compared to pelvic ultrasound,
  although this was not statistically significant
• BMI did not influence the accuracy in estimating
  uterine size on bimanual exams
• The objectives were met as shown by the above
  stated results. For purposes of estimating
  uterine size prior to hysterectomy bimanual
  examination highly correlates with actual uterine
  size. These results do not support pelvic
  ultrasound as a preferred method for purposes of
  estimating uterine size

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References

• Cantuaria GH, Angioli R, Forst L, Duncan R,
  Penalver MA. Comparison of bimanual examination
  with ultrasound examination before hysterectomy
  for uterine leiomyoma. Obstet Gynecol
  199892109-12.
• Flikinger L, DAblaing GD, Mishell, DR. Size and
  weight determinations of nongravid enlarged
  uteri. Obstet Gynecol 198668 855-8.
• Harb T, Adam R. Predicting uterine weight before
  hysterectomy Ultrasound measurements versus
  clinical assessment. Am J Obstet Gynecol
  2005193 2122-5.
• Kung FT, Chang SY. The relationship between
  ultrasonic volume and actual weight of pathologic
  uterus. Gynecol Obstet Invest 199842 35-8.