Comparison of "push" and "pull" methods for impacted fetal head extraction during cesarean delivery

ObjectiveTo compare maternal and neonatal outcomes associated with the “push” and “pull” methods for impacted fetal head extraction during cesarean delivery.MethodsA prospective study was conducted at Imam Reza Hospital, Kermanshah, Iran, from April 2006 to March 2008. After failed vacuum extraction, women with obstructed labor caused by impacted fetal head were randomly assigned to deliver via the push method (n = 35) or the pull method (n = 37). The outcomes investigated included operation time, operative blood loss, incidence of extension of the uterine incision, and postpartum fever. Data were analyzed using χ² and Student t tests.ResultsMean operative time and incidence of extension of the uterine incision were significantly increased in the group that delivered via the push method (P < 0.001). There were no significant differences in the other maternal and neonatal morbidities between the groups, although there was 1 case of neonatal femoral fracture in the pull group.ConclusionAlthough the pull method may lead to some neonatal complications, it is associated with lower maternal morbidity than the push method when used for impacted fetal head extraction during cesarean delivery.     

Influence of introducing a maneuverable vacuum extractor cup on maternal hospital stay after instrumental birth. Retrospective cohort study

ObjectivesThe aim of our study is to evaluate the impact of the introduction of a maneuverable vacuum extractor cup on the length of hospital stay after assisted vaginal birth in nulliparous women in a hospital where no vacuum devices were used.MethodsThis single center retrospective analytical study included two groups of nulliparous women who had undergone an assisted vaginal birth. The 2 groups differ according to the availability or not of a maneuverable vacuum extractor cup. The first group includes the last 54 instrumental births until May 2017, when only obstetric forceps and Thierry's spatulas were available in our center; the second group includes the first 54 instrumental births since May 2018 in our center, when obstetric forceps, Thierry's spatulas and maneuverable vacuum extractor cup were available. Maneuverable vacuum extractor cups had been available for 12 months in the second group.ResultsIn the no vacuum cup group, Kjelland forceps and Thierry's spatulas were used in 29 (53.7%) and 25 (46.3%) of the 54 assisted vaginal births, respectively. In the vacuum available group, a vacuum cup was chosen in 30 (55.6%), Kjelland forceps were used in 18 (33.3%) and Thierry's spatulas in 6 (11.1%) of the assisted vaginal births. 22 women (40.7%) had a postpartum hospital stay longer than 3 days in the group with no maneuverable vacuum extractor cup availability, versus 3 women (5.6%) in the group with availability of a maneuverable vacuum extractor cup, p < 0.001. Average postpartum hospital stay length was 3.17 ± 0.803 days versus 2.81 ± 0.585, p < 0.001. There was also a significant reduction in the number of episiotomies.ConclusionThe introduction of a maneuverable vacuum extractor cup in a center where only forceps and Thierry's spatulas had been used resulted in a decrease in postpartum hospital stay in nulliparous women.     

Maturation cervicale à terme par utilisation répétée du dispositif intravaginal de dinoprostone

ObjectivesTo evaluate efficacy and safety of cervical ripening with repeated administration of dinoprostone slow release vaginal pessary (Propess^®) in current practice.Patients and methodsAn observational study of 111 women who underwent cervical ripening with two Propess^® during the study period from 1st July 2007 to 31st October 2011. Modes of delivery, success of cervical ripening, failure of labor induction, maternal and neonatal morbidity were reported.ResultsThe nulliparous rate was 75,7%. The main indications for induction of labor were post-term pregnancy in 34,3% (38/111) and premature rupture of membranes in 25,2% (28/111). The rate of vaginal delivery was 53,1% (59/111). Cesarean sections were performed for failure of labor induction in 27/52 (51,9%) and an abnormal fetal heart rate in 17/52 (32.7%). Indication for induction of labor, nulliparous patients (44 [84.6%] versus 40 [67.8%]; P = 0.04), initial Bishop score (2.2 ± 1.2 versus 2.9 ± 1.2; P = 0.04) before the cervical ripening and Bishop score before administration of second Propess^® (3.3 ± 1.4 versus 4.0 ± 1.2; P = 0.05) were significant risk factors of cesarean delivery.Discussion and conclusionIn more than half of the cases, the cervical ripening by two Propess^® is efficient and allows a vaginal delivery. This practice does not appear to increase the maternal or neonatal morbidity.     

Median levels of serum biomarkers of fetal Down syndrome detected during the first trimester among pregnant Thai women

ObjectiveTo develop Thai-specific medians of serum pregnancy-associated plasma protein A (PAPP-A) and free β-human chorionic gonadotropin (hCG) levels during the first trimester of pregnancy and to compare these values to a Caucasian-specific model for the detection of fetal Down syndrome.MethodsSerum concentrations of PAPP-A and free β-hCG were measured during the first trimester in a group of 2339 Thai women undergoing normal singleton pregnancies.ResultsThai reference ranges of PAPP-A and free β-hCG were established by gestational age (70–98 days). The equation of best fit for PAPP-A was: predicted median PAPP-A level = 28.767 – 0.781 × (gestational age in days) + 0.006 × (gestational age in days)²; r = 0.986. The equation of best fit for free β-hCG was: predicted median free β-hCG level = 465.332 × 10^{(–0.024 × gestational age in days)}; r = 0.881. Weight-corrected models were also derived for each biomarker. The Thai-specific reference ranges gave higher positive screening rates than the Caucasian-specific model, even after weight correction (5.1% versus 4.0%). The Thai-specific models were validated in an independent group of 302 pregnant women.ConclusionEthnic group-specific medians for PAPP-A and free β-hCG should be incorporated during first-trimester screening for fetal Down syndrome.     

Laparoscopic hysterectomy versus abdominal hysterectomy for severe pelvic endometriosis

ObjectiveTo compare the surgical outcomes of laparoscopic hysterectomy (LH) versus abdominal hysterectomy (AH) in patients with severe pelvic endometriosis.MethodsA retrospective review of patients undergoing hysterectomy for endometriosis was conducted between January 2002 and December 2007. A total of 503 patients had severe pelvic endometriosis; of these, 115 patients underwent LH and 388 patients underwent AH. Surgical outcomes—including operative time, blood loss, length of hospital stay, and need for blood transfusion—were analyzed and compared between the 2 treatment groups.ResultsOperative time was significantly longer for LH than for AH (185.1 ± 48.7 minutes and 139.9 ± 52.4 minutes, respectively; P < 0.001). However, estimated volume of blood loss, length of hospital stay, and complication rates were significantly less for patients in the LH group than for those in the AH group (302.6 ± 255.1 mL versus 760.9 ± 633.2 mL [P < 0.001]; 3.5 ± 1.1 days versus 6.4 ± 3.0 days [P < 0.001]; and 18.3% versus 49.0% [P < 0.001], respectively).ConclusionCompared with AH, LH was associated with fewer complications. LH should, therefore, be the preferred surgical option for women with severe pelvic endometriosis who require a hysterectomy.     

The association of maternal and fetal glucose homeostasis with fetal adiposity and birthweight

ObjectiveTo examine the association between maternal and fetal glucose levels and fetal adiposity and infant birthweight.Study designThis is a prospective study of 479 healthy, non-diabetic mother and infant pairs attending the National Maternity Hospital in Ireland. Fasting glucose was measured in early pregnancy (11.8 ± 2.3 weeks). At 28 weeks gestation a repeat fasting glucose was measured and 1 h glucose challenge testing (1 h GCT) was performed. At 34 weeks’ gestation (33 + 5–34 + 5 weeks) fetal growth and fetal anterior abdominal wall width, a marker of fetal adiposity, were measured. At delivery cord glucose was measured and neonatal anthropometry recorded.ResultsThere was a positive correlation between fasting glucose concentration during pregnancy and both infant birthweight and fetal anterior abdominal wall width at 34 weeks gestation. The incidence of macrosomia (birthweight > 4.5 kg) was significantly greater for maternal and cord blood glucose levels in the highest quartile compared to the lowest quartile (20.7% vs. 11.7%, p < 0.05 in the first trimester, 21.3% vs. 7.2%, p < 0.05, at 28 weeks, and 33.3% vs. 10%, p < 0.05, in cord blood). Maternal glucose concentrations at each time point, though not cord glucose, were related to early pregnancy maternal body mass index (r = 0.19, p < 0.001 in first trimester, r = 0.25, p < 0.001 at 28 weeks, r = 0.15, p < 0.01 with 1 h GCT).ConclusionMaternal glucose homeostasis is an important determinant of fetal size. We have shown that even small variations in fasting glucose concentrations can influence fetal growth and adiposity. This effect is seen from the first trimester and maintained until delivery.     

Robotically assisted laparoscopic hysterectomy versus total abdominal hysterectomy and lymphadenectomy for endometrial cancer

ObjectiveTo compare surgical morbidity and clinical–pathologic factors for patients with endometrial cancer (EC) undergoing robotic-assisted laparoscopic hysterectomy (RALH) versus total abdominal hysterectomy (TAH) with aortic and/or pelvic lymphadenectomy (LA).MethodsDuring the first 14 months of a robotics surgical program, 56 patients with EC were scheduled to undergo RALH with LA. Cases were analyzed for operative (op) time, estimated blood loss (EBL), transfusion, intra- and post-op complications, surgical–pathologic data, patient demographics and length of stay (LOS). Data was compared to 106 serially treated patients with EC who underwent TAH with LA immediately prior to initiation of our robotics program.ResultsThree robotic cases (5.4%) were converted to TAH secondary to intra-op factors. FIGO stages for RALH vs. TAH were: stage I (82 vs. 69%), stage II (7 vs. 7.5%) and stage III (11 vs. 21.5%). Patients' mean age was 59 ± 10 vs. 63 ± 11 years (p = 0.05) and body mass index (BMI) was 29 ± 6.5 vs. 34 ± 9 kg/m² (p = 0.0001) for the robotic and open groups, respectively. Severe medical co-morbidities affected 5.4% of robotic patients compared to 8.5% of open cases (p > 0.05). Comparing RALH and TAH, mean op time was 177 ± 55 vs.79 ± 17 min (p = 0.0001), EBL was 105 ± 77 vs. 241 ± 115 ml (p < 0.0001), transfusion was 0 vs. 8.5% (p = 0.005), and LOS was 1.0 ± 0.5 vs. 3.2 ± 1.0 days (p < 0.0001). Robotic patients incurred a 3.6% major peri-operative complication rate while women undergoing open procedures had an incidence of 20.8% (p = 0.007). Total lymph node count was 19 ± 13 nodes for robotic cases vs. 18 ± 10 nodes obtained from open hysterectomy patients.ConclusionsPatients with EC who underwent RALH with LA during the first year of our robotics program were younger, thinner and had less cardio-pulmonary illness than patients previously treated with TAH and LA. LOS, EBL and peri-op complication rates were significantly lower for the robotic cohort.     

L’utilisation du TachoSil permet-elle de réduire la morbidité du curage axillaire ?

The lymphocele is the most frequently encountered complication after axillary dissection performed for breast cancer (15–81%). This study compares the efficacy of a lympho-hemostatic combipatch TachoSil^® versus conventional implementation of a suction drain on the incidence and severity of lymphoceles. This is a case (group TachoSil^® n = 20) control (drainage group) n = 40 study. In our study, we demonstrated an increased rate of postoperative complications (< 3 weeks) in the group TachoSil^® (P = 0.0265) explained by a lymphocele rate significantly higher (P = 0.0194). However, no significant difference was demonstrated on the severity of these lymphoceles. Beyond 3 weeks postoperatively, the two groups were comparable in terms of postoperative complications. The TachoSil^® does not prevent the formation of seroma but their severity is not increased. In addition, it reduces of more than 48 hours the duration of hospitalization stay (P = 0.002).     

Outcome and efficacy of a transobturator polypropylene mesh kit in the treatment of anterior pelvic organ prolapse

ObjectiveTo report the efficacy and complications of anterior pelvic organ prolapse (POP) repair with mesh placed through the transobturator route (Perigee system; AMS, Minnetonka, MN, USA).MethodsIn total, 198 women with anterior POP grade II or higher according to the POP Quantification (POP-Q) system were treated with the Perigee procedure. The primary outcome was defined as anterior POP grade I or lower at 12 months’ follow-up. The secondary outcomes included the incidences of perioperative, mesh-related, short-term, and long-term postoperative complications.ResultsThe cure rate was 92.9% overall and 90.6% among women who had previously undergone a hysterectomy or a traditional anterior colporrhaphy. The mean POP-Q Aa and Ba values were significantly improved after the procedure (Aa 2.2 cm [0.0 to 3.0 cm] versus ? 2.1 cm [? 3.0 to ? 1.2 cm]; Ba ? 2.5 cm [? 1.0 to 4.2 cm] versus ? 2.2 cm [? 5.5 to ? 1.0 cm]; P < 0.001). Vaginal or bladder erosions were observed in 3 patients. Other short- and long-term complications were infrequent and not statistically significant.ConclusionThe Perigee procedure is effective in the treatment of anterior POP and does not have serious complications even among women with previous hysterectomy or traditional anterior colporrhaphy.     

Outcome of embryo vitrification compared to slow freezing process at early cleavage stages. Report of the first French birth

ObjectivesSince the end of 2010, France by “l’Agence de Biomédecine” has validated the embryo vitrification procedure as an improvement of the slow freezing method. We presented here data concerning biological and clinical outcomes from a prospective observational study where early cleavage stage good quality embryos were vitrified and warmed. We compared these results to those of a retrospective series where embryos were thawed after a slow freezing procedure (SF). We report also the first French live birth following embryo vitrification.Patients and methodsIn all, 58 cycles of frozen-thawed embryo transfers (FET) following vitrification were prospectively included and compared with 189 FET from SF method. Primary end points were the (i) survival rate (SR) (% of embryos with ≥50% post-thaw intact blastomeres), (ii) intact survival rate (ISR) (% of embryos with 100% post-thaw intact blastomeres) and (iii) survival blastomeres index (SBI) (% of post thaw intact blastomeres per survival embryo). Secondary end point was the clinical pregnancy rate (CPR) defined as the presence of an intra-uterine gestational sac with positive foetal heart beat. We report here the first French live birth following embryo vitrification.ResultsIn all, 87 and 412 embryos have been thawed following vitrification and SF, respectively. We observed a highly significant increase of SR, ISR et SBI respectively when thawing concerned vitrified embryos rather than those from SF method (98.3 ± 13.1% vs. 77.3 ± 32.0%, P < 10^?4; 88.2 ± 28.3% vs. 47.7 ± 41.4%, P < 10^?4; 97.7 ± 6.1% vs. 87.3 ± 14.4%, P < 10^?4). Furthermore, CPR were of 32.7% (19/58) and of 18.5% (35/189) following FET performed after vitrification or SF and thawing (P = 0.03), respectively. The live birth of two healthy girls occurred following a caesarean section after 38 weeks of amenorrhea the 8th of August 2011.Discussion and conclusionWe experienced in our study that the post-thaw survival of vitrified embryos was significantly better than those of embryos resulting from SF. Then, a better CPR per thawed embryo cycle was observed following vitrification.     

Comparison of intrapartum outcome among immigrant women from Ethiopia and the general obstetric population in Israel

ObjectiveTo compare intrapartum outcome between ethnic Ethiopian women and the general obstetric population in Israel.MethodsIn a retrospective study, computerized data from all Ethiopian women who delivered between January 2004 and August 2011 at a university teaching hospital in Afula, Israel, were assessed. The control group comprised non-Ethiopian Israeli women, who were matched at a ratio of 1:2 on the basis of deliveries that took place immediately before and after delivery by an Ethiopian woman. The primary outcome was incidence of operative delivery.ResultsDuring the study period, 576 Ethiopian women delivered along with 1152 matched control women. Ethiopian women had a higher incidence of pre-eclampsia (6.8% versus 4.0%, P = 0.01) and early postpartum hemorrhage (4.3% versus 1.6%, P = 0.003) than control women. After adjustment for potential confounders, the incidence of vacuum or cesarean delivery was significantly higher among Ethiopian than among control women (odds ratio, 1.68; 95% confidence interval, 1.28–2.20; P = 0.002). The incidence of composite major perinatal morbidity, including Erb palsy and cord pH less than 7.1, tended to be higher among Ethiopian women than among control women (2.3% versus 1.1%; P = 0.053).ConclusionAlthough prepartum and intrapartum care are standardized, Ethiopian women had a less favorable intrapartum outcome.     

Sublingual misoprostol versus intramuscular oxytocin for prevention of postpartum hemorrhage in low-risk women

ObjectiveTo compare sublingual misoprostol with intramuscular oxytocin for prevention of postpartum hemorrhage (PPH) in low-risk vaginal birth.MethodsIn a prospective, randomized, double-blind trial, 530 women without risk of PPH were randomly allocated to receive either 400 μg of misoprostol sublingually or 10 units of oxytocin intramuscularly within 1 minute of delivery. The outcome measures were incidence of PPH, postpartum blood loss, drop in hemoglobin level in 24 hours, need for additional uterotonic drug, incidence of adverse effects, and need for blood transfusion. Student t, χ², Mann–Whitney U, and Fisher exact tests were used for comparison.ResultsIncidence of postpartum hemorrhage (≥ 500 mL) and postpartum blood loss in the misoprostol group were similar to those in the oxytocin group (6% versus 5.7%, P = 0.85; 153 mL versus 146 mL, P = 0.36). Shivering and pyrexia were encountered more often in the misoprostol than in the oxytocin group (shivering: 19% versus 0.8%, P < 0.001, relative risk [RR] 0.86, 95% confidence interval [CI] 0.82–0.90; pyrexia: 2.3% versus 0%, P = 0.03, RR 0.97, 95% CI 0.95–0.99).ConclusionThe efficacy of 400 μg of misoprostol administered sublingually was equivalent to that of 10 units of oxytocin given intramuscularly for prevention of PPH in low-risk vaginal delivery.     

Comparison of double- and single-dose methotrexate protocols for treatment of ectopic pregnancy

ObjectiveTo compare efficacy between double-dose methotrexate and single-dose methotrexate for treatment of tubal ectopic pregnancy (EP).MethodsBetween March 2008 and February 2011,157 patients who had tubal EP diagnosed by a non-laparoscopic approach and were hemodynamically stable were enrolled in a prospective study in Qassim, Saudi Arabia. The participants were randomized to receive either double-dose (50 mg/m² intramuscularly on days 0 and 4; group 1) or single-dose (50 mg/m² intramuscularly on day 0; group 2) methotrexate. Serum human chorionic gonadotropin (β-hCG) levels were followed until negative.ResultsThe overall success rate was comparable between groups 1 and 2 (88.6% versus 82.0%, P = 0.1). The duration of follow up until negative β-hCG was shorter in group 1 (P = 0.001). Receiver operative characteristics showed that higher cut-off levels of β-hCG and gestational mass diameter were associated with successful outcome in group 1. Among participants with initial β-hCG of 3600–5500 mIU/mL, the success rate was higher in group 1 (P = 0.03). There was no significant difference between groups in adverse effects.ConclusionFor treatment of EP, double-dose methotrexate had efficacy and safety comparable to that of single-dose methotrexate; it had better success among patients with moderately high β-hCG and led to a shorter follow up.     

Intérêt d’un combipatch de thrombine et de fibrinogène dans la prévention des lymphocèles après curage axillaire

ObjectiveTo evaluate the effect of combipatch TachoSil^® in the prevention of seromas after axillary dissection in local breast cancer.Patients et méthodesA retrospective, case-control study conducted between January 2007 and December 2009, in two departments of Obstetrics and Gynecology of the AP–HP. Sixty-six patients (45 in the control group and 22 in the group TachoSil^®) who have undergone an axillary dissection alone, with establishment of a redon or with lumpectomy, were included. The total amount of lymph drained during the stay, the number of days of drainage, duration of hospitalization, the number of lymphoceles and the number of retrievals performed at the waning of hospitalization were collected.ResultsThe population was similar in age, body mass index (BMI), clinical and pathological data. There was no significant difference in terms of total volume of lymph drained (268.2 ± 220.7 mL without TachoSil^® and 228.6 ± 128.8 mL with TachoSil^®, P = 0.89) and the number of days of drainage (3.9 ± 1.6 days without TachoSil^® and 3.1 ± 0.9 days with TachoSil^®, P = 0.10). The duration of hospitalization was significantly higher in the group TachoSil^® (5 ± 1.6 days with TachoSil^® and 3.8 ± 1.1 days without TachoSil^®, P = 0.006).ConclusionThis study shows no benefit of combipatch (TachoSil^®) in prevention of seromas after axillary lymph node dissection. A randomized study with large effective is necessary.     

Uterine artery embolization immediately preceding laparoscopic myomectomy

ObjectiveTo determine whether performing uterine artery embolization (UAE) immediately before laparoscopic myomectomy can facilitate a minimally invasive surgical approach for larger uterine fibroids.MethodsIn a retrospective case–control study, laparoscopic myomectomy with and without preoperative UAE was examined. Data were analyzed from 26 laparoscopic myomectomies performed by a single surgeon at Northwestern University Feinberg School of Medicine between 2004 and 2010. Controls were matched for age, calendar year, surgeon, and number of fibroids removed. Surgical outcomes included preoperative clinical uterine size, operative time, operative blood loss, and postoperative myoma specimen weight. Data were analyzed via 2-tailed Student t test.ResultsTwelve women underwent laparoscopic myomectomy within 169 ± 16 minutes (mean ± SEM) of preoperative UAE. Fourteen control patients underwent laparoscopic myomectomy alone. The UAE group had a greater mean preoperative clinical uterine size (19.7 versus 12.4 weeks, P < 0.001) and a greater mean myoma specimen weight measured postoperatively (595.3 versus 153.6 grams, P < 0.05). There were no significant differences in operative time or blood loss, and there were no intra-operative complications.ConclusionUAE performed immediately before laparoscopic myomectomy facilitated minimally invasive surgery for larger uteri and larger uterine myomas, with no differences in operative time or blood loss.     

Étude prospective multicentrique randomisée évaluant l’intérêt de l’électrostimulation intravaginale à domicile après rééducation périnéale pour incontinence urinaire

ObjectivesIn order to maintain the benefits of perineal reeducation, patients with stress urinary incontinence need to perform self-retraining exercises of the perineal muscles at home. The aim of this randomized prospective multicentric study is to assess the effectiveness of GYNEFFIK^®, a perineal electrostimulator, during this home-care phase.Patients and methodsTwo parallel groups of women with stress urinary incontinence (UI) or with mixed UI (composed predominantly of stress UI), improved by physiotherapy, have followed a self-reeducation program, either with electrostimulation sessions (GYNEFFIK^® or home perineal electrostimulation [HPES] arm) or with usual care (UC) only, without electrostimulation. The comparison of the two groups was based on the rate of women in which the benefit of the initial perineal reeducation was maintained (defined as the ICIQ and Ditrovie scales’ score not worsening) at 2, 4 and 6 months.ResultsA total of 161 patients were analyzed (76 in the HPES arm and 85 in the UC arm). The therapeutic benefit of the initial perineal reeducation at the last available measure (6 months for a wide majority of patients) was maintained in 81.6% in the HPES arm versus 62.4% in the UC arm (P = 0.007). This significant difference reflects a significant improvement both in clinical symptomatology and in quality of life. ICIQ score was improved in 44% of patients of HPES arm while it was improved in 14% of patients of UC arm (P < 0.001) and daily number of urine leakage decreased of 1.2 leakage in the HPES arm versus 0.1 leakage in UC arm (P < 0.05). Likewise, improvement of quality of life was superior in the HPES arm (48% improvement of Ditrovie score versus 19% in the UC group ; P < 0.05).Discussion and conclusionInvestigator global impression was more favorable in the HPES arm (clinical improvement in 83% of patients versus 68% in the UC arm). At the last measure (i.e. endpoint), the benefit of initial physiotherapy was considered maintained or improved in all patients of the HPES arm while it was reported as worsened in 16.5% of the UC group. Using GYNEFFIK^® favorably impacts quality of life, particularly physical activity and vitality and decreases emotional consequences of UI (i.e. anxiety and depression score as assessed by HAD scale).     

Comparison of the efficacy and safety of titrated oral misoprostol and a conventional oral regimen for cervical ripening and labor induction

ObjectiveTo compare the efficacy and safety of titrated oral misoprostol and a conventional oral regimen for cervical ripening and labor induction.MethodsA randomized double-blind trial of women with term singleton pregnancies with indications for labor induction. Participants were allocated to receive 20 mL of misoprostol solution (1 μg/mL) orally every 1 hour for 4 doses then titrated to 40 μg every 1 hour (titrated group) or 50 μg of misoprostol orally every 4 hours up to 12 hours (conventional group). Primary outcomes were success rate of cervical ripening within 12 hours, interval from first dose until more favorable cervix or active labor occurred, and total dose of misoprostol.ResultsSixty-four participants were included. Mean total dose of misoprostol and incidence of tachysystole were significantly higher in the titrated compared with the conventional group (236.2 ± 110.1 μg vs 103.1 ± 35.7 μg; P = 0.001 and 25.0% vs 6.3%; P = 0.03), whereas success rate, interval from drug administration to more favorable cervix and delivery, proportion of patients delivered vaginally within 12 hours and 24 hours, need for oxytocin augmentation, cesarean delivery rate, maternal adverse effects and complications, and neonatal outcome were not significantly different (P > 0.05).ConclusionConventional oral misoprostol is as effective as titrated misoprostol for cervical ripening and labor induction, but has a lower incidence of tachysystole and a lower total dose of misoprostol is required. ClinicalTrial.gov: NCT00886860.     

The influence of pre-eclampsia on fetal lung maturity

ObjectiveTo investigate clinical characteristics of usual-type vulvar intraepithelial neoplasia (uVIN) in China.MethodsA retrospective review of the records of 64 patients with uVIN was performed at 3 academic hospitals between 2004 and 2010. Patients were assigned to a younger (≤ 40 years) or an older (> 40 years) group. Clinical characteristics of lesions were described and analyzed.ResultsMean patient age was 40.6 years. There was a high proportion of incidental findings (34%), multifocal lesions (64%), variegated lesions (59%), and multiple neoplastic lesions in the lower genital tract (20%). As patient age increased, so did numbers of patients reporting pain (P < 0.05). Longer time between symptom onset and uVIN diagnosis, and more multifocal lesions were noted in the older group (P < 0.05). Whereas younger patients often presented with cervical intraepithelial neoplasia and uVIN, older patients often presented with intraepithelial neoplasia at uncommon locations (e.g. vagina, anus, and periurethral region) (P < 0.05). No differences between the groups were found regarding gross appearance or anatomic location of uVIN lesions (P > 0.05).ConclusionAge-specific differences were noted in location of neoplastic lesions in the lower genital tract and time to diagnosis of uVIN. However, the clinical features of uVIN lesions were heterogeneous and non-age specific.     

Quality of life and psychological distress in locally advanced cervical cancer patients administered pre-operative chemoradiotherapy

ObjectiveThe aim of the study was to analyze the Quality of life (QoL) scores in a single institution series of locally advanced cervical cancer patients (LACC) administered preoperative chemoradiation, compared to early stage disease (ECC) patients undergoing radical surgery.MethodsThe following criteria were required in order to enroll patients: age between 18 and 65years at initial diagnosis, at least 12months from the end of treatment, no evidence of recurrence/second malignancy. The SF-36 questionnaire on general health, and the HADS questionnaire on mental distress were utilized.Results93 subjects were available for the analysis. At time of analysis, median follow-up was 30months (range 12–120). LACC patients showed QoL scores comparable to ECC patients with the exception of physical functioning (mean ± SD = 69.0 ± 13.1 versus mean ± SD = 85.4 ± 16.2, p value = 0.0007). In the group of LACC patients, the presence of co-morbidities was significantly associated with the impairment of almost all subscales of QoL. A low education level and the status of unemployment were documented to negatively impact on the vast majority of SF-36 subscale scores. In the multivariate analysis, the presence of co-morbidities, low educational level, age> 50years, and unemployment maintained their independent negative association with poor QoL scores. The percentage of cases with high levels HADS-anxiety was higher in LACC than ECC patients (27.6% versus 8.6%, p value = 0.034).ConclusionsLACC patients administered preoperative chemoradiation showed QoL scores comparable to EEC patients, and a higher proportion of anxiety disorders; low educational level and unemployment status were mainly associated with poor QoL scores.     

La pratique française de la pose des implants de stérilisation tubaire Essure®

ObjectivesLaw no. 2001-588 of 4 July 2001 liberalised the practice of tubal sterilisation in France, at the same time as a new hysteroscopic method of female sterilization appeared. The growth of this method has been spurred by the reduced need for analgesia, absence of incision and scar, reduced duration of hospitalization and diminution of costs. The aim of this study was to analyse the use of the Essure^® procedure in France.Patients and methodsThis multicentre study covered seven French facilities from January 2004 through June 2006. This study included 1061 attempted placements of the Essure^® micro-insert, marketed by Conceptus™ SAS (France).ResultsThe first placement attempt was successful in 992 cases (94.4%). The success rate for second attempts was 59% (n = 23). Mean VAS was 3,23 ± 0.19. Ninety-three percent of patients undergoing Essure^® placement were satisfied or very satisfied.Discussion and conclusionTubal sterilisation with Essure^® micro-inserts is a reliable and reproducible method that requires a short period of training. In the future, the hysteroscopic pathway will replace the laparoscopic route.