Seven percent of patients undergoing laparotomy for gynecologic malignancy developed SSI. Surgical site infection is associated with longer hospital stay and more than 5-fold increased risk of reoperation. In this study, we identified several risk factors for developing SSI among gynecologic cancer patients. These findings may contribute toward identification of patients at risk for SSI and the development of strategies to reduce SSI rate and potentially reduce the cost of care in gynecologic cancer surgery.

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Patients treated with upfront TXA and cryoprecipitate during CRS required less RBC transfusion than those treated with the standard protocol of early FFP.

SummaryWe report a patient, 33 weeks pregnant with twins, who sustained a ruptured splenic artery aneurysm. This presented with left sided chest pain, breathlessness, low oxygen saturations and electrocardiogram (ECG) changes supportive of a diagnosis of massive pulmonary embolus. The diagnosis of splenic artery rupture was made at emergency Caesarean section performed for fetal distress. Ruptured splenic artery aneurysm in pregnancy is a rare but well described condition, which carries a high mortality risk for mother and child. Among the visceral aneurysms, splenic artery aneurysms are relatively common, and the risk of rupture is increased by pregnancy, parity and portal hypertension. The incidence is between 0.16% and 0.78%, and half of all ruptures occur in pregnancy, with fetal and maternal mortality rates of 95% and 68.7-75%, respectively [1]. The majority are asymptomatic until rupture, when they may present with cardiovascular collapse in association with upper abdominal, flank, or left shoulder tip pain. Case reportAn 18-year-old woman with a 33-week twin pregnancy presented for obstetric review with intermittent lower abdominal pain, suggesting the possibility of preterm labour. On arrival at the delivery suite, the pain had settled and she was admitted to the prenatal ward for observation. She was in good health with no previous medical conditions and no disorders arising from pregnancy. Specifically, she had no history of liver disease or drug abuse and no family history of connective tissue diseases.During the night, she rang for assistance and reported to the midwife who attended her that she had severe shortness of breath, left-sided chest and shoulder tip pain. She then lost consciousness. Initial assessment revealed a patent airway, tachypnoea with use of accessory muscles of respiration, and central cyanosis. Pulse oximetry consistently gave oxygen saturations of 60-70%. Pulse was 140 beats.min )1 and blood pressure was unrecordable. There was no blood loss on vaginal examination. Glasgow coma score was 9. High-flow oxygen was administered, intravenous access obtained and 1 l of gelofusine infused rapidly. Her level of consciousness subsequently improved dramatically and she was able to indicate that she had severe breathlessness and substernal chest pain. She denied any abdominal pain. Oxygen saturations remained at 60-70%. Her ECG showed a sinus tachycardia of 150 beats.minwith a normal axis, non-significant Q waves in leads III and aVF, and T wave inversion in lead III (Fig. 1).The history, examination and ECG were felt to be consistent with a diagnosis of massive pulmonary embolus. In view of persistently low oxygen saturations, anaesthesia was induced and ventilation of the lungs with oxygen (F i O 2 > 0.9) commenced. Oxygen saturations improved to 99%.Ultrasound examination revealed severe fetal bradycardia, and emergency lower segment Caesarean section was performed in the room in an attempt to save the twins. On incising the peritoneum, a large quantity of blood was

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