Comparison of pelvic floor muscle strength between women undergoing vaginal delivery,cesarean section,and nulliparae using a perineometer and digital palpation

Objectives.?To compare pelvic floor muscle (PFM) strength between women undergoing vaginal delivery, cesarean section, and nulliparae, investigating the factors associated with PFM strength, and observing the correlation between vaginal digital palpation and use of a perineometer.

Methods. A cross-sectional study was conducted, including 31 women following vaginal delivery, 30 women following cesarean section, and 30 nulliparous women. PFM strength was measured by vaginal digital palpation and use of a perineometer. Multiple linear regression analysis with adjustment for covariables was used to compare the mean PFM strength and identify its associated factors.

Results.?The mean PFM strength of women undergoing vaginal delivery and cesarean section was 25.6?±?14.5 cmH₂O and 39.6?±?22.0 cmH₂O (p?<?0.01, adjusted for covariables), respectively. A correlation was observed between measurements of PFM strength obtained by vaginal digital palpation and use of a perineometer (tau?=?0.82; p?<?0.01). The non-white race/ethnicity was negatively associated with PFM strength (coefficient: ?10.2424; p?=?0.02).

Conclusions.?A lower PFM strength was observed in women with a history of vaginal delivery compared to those undergoing cesarean section. Non-white race/ethnicity negatively affected PFM strength. Our data suggest that vaginal digital palpation may be used in clinical practice because of its expressive correlation with use of a perineometer.     

Comparison of sVCAM-1 and sICAM-1 levels in maternal serum and vaginal secretion between pregnant women with preterm prelabour ruptures of membranes and healthy pregnant women

Objective: The study aims to evaluate the maternal serum and the vaginal fluid levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecular (sICAM-1) in pregnant women complicated by preterm prelabour ruptures of membranes (PPROM).

Materials and methods: The prospective case control study included 34 pregnant women with PPROM and 34 healthy pregnant women. Patients with additional diseases, a smoking habit and vaginal bleeding, as well as those using antibiotics, during the study period were not included in the study. Cervicovaginal fluid and serum samples were taken during the patients’ admission. The demographic data, maternal serum and vaginal fluid sVCAM-1 and sICAM-1, C reactive protein (CRP) and leukocyte counts were noted for all pregnant women included in the study. The sVCAM-1 and sICAM-1 levels were measured by enzyme-linked immunosorbent assay kits.

Results: In pregnant women with PPROM, the serum leukocyte (mean?±?SD =11.41?±?1.067 versus 9.18?±?1.56, p?p?p?=?.06), vaginal sVCAM-1 (median 208.00 versus 140.20?ng/ml, p?=?.014) and sICAM-1 (mean?±?SD 32.32?±?6.49?ng/ml versus 24.87?±?6.79?ng/ml, p?r?=?0.850; p?Conclusion: To the best of our knowledge, this is the first study evaluating the levels of sICAM-1 in maternal serum in pregnant women with PPROM. The maternal serum and vaginal fluid sVCAM-1 and sICAM-1 levels can be used as biochemical markers supporting the PPROM diagnosis because of the increase in both maternal serum and vaginal fluid sVCAM-1 and sICAM-1 levels in pregnant women with PPROM.     

Sexually Induced Orgasm to Improve Postpartum Pelvic Floor Muscle Strength and Sexual Function in Primiparous Women After Vaginal Delivery: A Prospective Randomized Two-Arm Study

BackgroundPostpartum pelvic floor dysfunction is known to affect the quality of life of women and the methods to treat it are more complex with majority requiring training under supervision.AimTo compare the efficacy of sexually induced orgasm along with Kegels exercises versus Kegels exercises alone as a treatment method to enhance postpartum pelvic floor muscle strength and sexual function in primiparous women undergoing uncomplicated vaginal deliveries.MethodsThe prospective randomized two-arm study was conducted on sexually active primiparous women who had undergone uncomplicated vaginal deliveries. Those with risk factors for female sexual dysfunction and pelvic floor muscle dysfunction were excluded. Participants in Group 1 were advised daily Kegel's exercises, whereas, those in Group 2 were advised to initiate self-initiated/partnered sexual activity-induced orgasms along with daily Kegel's exercises. Their pelvic floor muscle strength on voluntary contraction, ability to relax pelvic floor voluntarily, and sexual function (using FSFI-6) were assessed monthly for 6 months and the analysis was done using G* Power software (© 2021 Heinrich-Heine-Universität Düsseldorf, Germany).Main Outcome MeasurePostpartum pelvic floor strength and sexual function in 2 groups of women under study.ResultsThe study period was from January 2020 to December 2020. The Group 1 had 26 participants (mean age 29.69 ± 2.2 years) and Group 2 had 29 participants (mean age 30.07 ± 2.57 years). The sexual function as well as ability to relax pelvic floor were significantly better in Group 2 compared to Group 1 at each monthly intervals whereas strength of pelvic floor muscles during voluntary contraction was significantly higher in Group 2 compared to Group 1 at the end of 6 months and it was statistically significant at a P value of .05.Clinical ImplicationsNovel method of using naturally occurring sexually induced orgasms for postpartum pelvic floor rehabilitation can revolutionize postpartum pelvic floor training in women, as it can be practiced at home with ease, along with easily performable Kegel's exercises.Strengths and LimitationsUse of prospective randomization and minimization of confounding factors is the strength of the study. The small sample size is the limitation of the study.ConclusionsPostpartum pelvic floor muscle strength and sexual function in primiparous women who have undergone uncomplicated vaginal deliveries can be significantly improved with the addition of sexually induced orgasm as a therapeutic tool along with physical exercises such as Kegels exercises in these women.Bhat GS, Shastry A. Sexually Induced Orgasm to Improve Postpartum Pelvic Floor Muscle Strength and Sexual Function in Primiparous Women After Vaginal Delivery: A Prospective Randomized Two-Arm Study. J Sex Med 2022;19:1634–1643.     

Reference intervals of embryos/fetuses heart rate between 6 and 14 weeks of pregnancy

Abstract

Objective: To determine reference intervals for the embryos/fetuses heart rate (HR) between 6 and 14 weeks of pregnancy.

Methods: A retrospective cross-sectional study was carried in a single center with singleton pregnancies of embryos/fetuses with a crown-rump length (CRL) between 5 and 85?mm. The HR was assessed by real time M-mode or spectrum Doppler ultrasound. To evaluate the correlation between embryo/fetal HR and CRL, polynomial equations were calculated, with adjustment by the determination coefficient (R²).

Results: A total of 5867 pregnancies were assessed. The mean gestational age was 10.37?±?2.12 weeks. The mean maternal age was 26.41?±?6.78 years. The mean embryo/fetal HR (bpm) for the CRL (mm) intervals 5├15; 15├25; 25├35; 35├45; 45├55; 55├65; 65├75; 75├85 was 145.1?±?18.7; 167.2?±?10.1; 166.9?±?8.7; 165.5?±?6.9; 162.2?±?6.8; 159.2?±?6.4; 157.1?±?6.4; 154.9?±?7.3; respectively. The following third-order equation best represented the correlation between embryo/fetal HR and CRL: HR?=?119.25?+?3.596*CRL-0.07954*CRL^2?+?0.00051*CRL³ (R^2?=?0.36).

Conclusion: Reference intervals of HR in embryos/fetuses in a large sample were determined. These reference intervals can be used in high-risk early pregnancy losses.     

Measurement of the fetal occiput-spine angle during the first stage of labor as predictor of the progress and outcome of labor

Background: Fetal head attitude has a substantial impact on labor progress and outcome. Fetal head deflexion is basically diagnosed by digital vaginal examination during labor.

Objectives: To assess the effect of the fetal occiput-spine angle (OSA) measured through transabdominal ultrasound during the first stage of labor on the progress and outcome of labor.

Material and methods: A prospective cohort study conducted on 400 women with term uncomplicated singleton pregnancy with occipitoanterior position during active labor. The angle between two tangential lines to occipital bone and the vertebral body of the first cervical spine was measured during active labor. Follow up till delivery was done. The primary outcome parameter was the labor duration. Secondary outcomes included the mode of delivery, occurrence of maternal and fetal complications.

Results: There was a significant longer duration of both first and second stage of labor among women with OSA <126° when compared to those with OSA ≥126° (6.8?±?2.1 and1.89?±?0.85 versus 4.16?±?1.63 and 0.92?±?0.43, respectively). Women with OSA <126° had higher incidence of CS (46.3 versus 5.7%), perineal tears (10.4 versus 5.1%), vaginal tears (22.4 versus 6.3%), need for oxytocin augmentation (47.8 versus 21.3%) when compared to those with OSA ≥126. OSA at cutoff value of 126° had a sensitivity, specificity, and accuracy of 8264.6 and 78.4% and 93.79 and 92% in prediction of mode of delivery and overall complications, respectively.

Conclusions: There was a significantly longer duration of both first and second stages of labor with higher rates of CS and maternal and fetal complications in women with OSA <126.     

Women with Deep Infiltrating Endometriosis: Sexual Satisfaction,Desire, Orgasm,and Pelvic Problem Interference with Sex

IntroductionEndometriosis is a chronic and progressive condition of women of reproductive age. It is strongly associated with a significant reduction of quality of life (QOL) and sexual function.AimsThis study aims to objectively evaluate sexual function in women with deep infiltrating endometriosis (DIE) and to study the impact of endometriosis symptoms and type of lesion on patient's sexual function.MethodsThis is a cross‐sectional study in a tertiary care university hospital. It included 182 patients with preoperative clinical and ultrasound diagnosis of DIE who were referred to our center from 2008 to 2011.Main Outcome MeasuresA sexual activity questionnaire, the Sexual Health Outcomes in Women Questionnaire (SHOW‐Q) was used to collect data pertaining to satisfaction, orgasm, desire, and pelvic problem interference with sex. Short Form 36 (SF‐36) was used to evaluate QOL. Demographic and clinical characteristics were assessed: age, body mass index, parity, ethnicity, postsecondary education, employment, smoking, history of surgical treatment, and hormonal contraception. Patients were asked about pain symptoms (dysmenorrhea, dyspareunia, dyschezia, chronic pelvic pain, and dysuria) using a visual analog scale.ResultsThe mean values obtained on the different scales of the SHOW‐Q showed poor sexual function (mean SHOW‐Q total score 56.38 ± 22.74). Satisfaction was the dimension most affected (mean satisfaction score 55.66 ± 34.55), followed by orgasm (mean orgasm score 56.90 ± 33.77). We found a significant correlation between the SF‐36 scores and the SHOW‐Q scores (P < 0.0001). Sexual dysfunction and deterioration of QOL seem to be correlated. Analyzing the impact of symptoms and lesions on sexual function, we found that dyspareunia and vaginal DIE nodules significantly affect sexual activity (P < 0.05).ConclusionThe results of this study demonstrated that women with DIE have a sexual function impairment, correlated with the overall well‐being decrease. Moreover, the presence of dyspareunia and vaginal endometriotic lesions seems to be involved in sexual dysfunction.     

Weight gain,body image and sexual function in young patients treated with contraceptive vaginal ring. A prospective pilot study

Introduction: Oral contraceptives could induce mood changes. As far as our knowledge, there are no studies in literature that have examined the role of vaginal contraception in self-perceived body image.

Aim: To evaluate the effects of intravaginal contraception on weight gain and perceived body image in relation with the Beck’s Depression Inventory questionnaire (BDI) and the McCoy Female Sexuality Questionnaire (MFSQ).

Methods: Twenty-one adult (18–35?years old) eumenorrheic (menstrual cycle of 25–35?days), lean (body mass index – BMI – of 19–25?kg/m²) women who were referred for hormonal contraception were administered the Stunkard Figure Rating Scale (FRS), BDI and MFSQ. Subjects were studied in basal condition and after 6?months of therapy with vaginal contraception (NuvaRing®; Organon-Schering-Plough Italia, Milan, Italy).

Main outcome measures: BMI, FRS, MFSQ and BDI.

Results: After 6?months of therapy with NuvaRing®, both body weight (60.0?±?8.3; p?=?0.050) and BMI (22.1?±?3.1; p?=?0.028) slightly, but statistically, increased. FRS and BDI showed no differences after the vaginal contraception. Hormonal contraception was associated with a significant decrease in the two-factor Italian MFSQ score.

Conclusions: Vaginal ring seems a good alternative to other hormonal contraceptive not significantly altering the female sexuality and not influencing the FRS and BDI.     

Vaginal alpha-lipoic acid shows an anti-inflammatory effect on the cervix,preventing its shortening after primary tocolysis. A pilot,randomized, placebo-controlled study

Introduction: Inflammation might be an important underlying cause of preterm birth. Our aim is to explore whether vaginal administration α-lipoic acid reduces cervical inflammation and shortening after primary tocolysis.

Materials and methods: Singleton pregnancies between 24–30 weeks remaining undelivered after hospitalization for preterm labor were randomly allocated to placebo (20 women, 15 analyzed) or vaginal ALA 400?mg (active ingredient 10?mg) daily (20 women, 17 analyzed) for 30 days. A cervical swab to quantify pro-inflammatory (IL1, IL2, IL6, IL8, TNFα) and anti-inflammatory (IL4, IL10) cytokines as well as transvaginal ultrasound cervical length measurement (CL) were performed before and after treatment.

Results: The % changes of pro-inflammatory cytokines do not differ between treatment groups, while IL4 significantly increases by vaginal ALA in comparison to placebo (118.0?±?364.3% versus 29.9?±?103.5%, p?=?0.012). Combined anti-inflammatory cytokines show same trend (292.5?±?208.5% versus 64.5?±?107.4, p?=?0.03). CL remains similar in vaginal ALA group (from 23.1?±?6.6 to 20.80?±?7.9?mm), while it significantly decreased in placebo group (from 20.4?±?6.5 to 13.8?±?7.5?mm, p?p?=?0.003 versus vaginal ALA).

Conclusion: Vaginal ALA significantly stimulates anti-inflammatory ILs in the cervix of undelivered women after a preterm labor episode. This effect is associated with a stabilization of the CL.     

Outcomes of In-bag Transvaginal Extraction in a Series of 692 Laparoscopic Myomectomies: Results from a Large Retrospective Analysis

Study ObjectiveTransvaginal extraction is a feasible method to remove surgical specimen. In this study, we aim to report our experience with in-bag transvaginal specimen retrieval after laparoscopic myomectomy over the past 15 years.DesignSingle-center retrospective analysis.SettingAcademic hospital.PatientsWomen who underwent laparoscopic myomectomy from January 2005 to April 2021.InterventionPosterior colpotomy and in-bag transvaginal extraction of the surgical specimen.Measurements and Main ResultsWe collected and analyzed data about patients’ characteristics, main indication for surgery, and intra- and postoperative (within 30 days) complications.ResultsA total of 692 women underwent transvaginal specimen retrieval after laparoscopic myomectomy (mean largest myoma diameter: 6.64 ± 2.21 cm; mean specimen weight: 177 ± 140 g; mean operative time: 84.1 ± 37.1 minutes; mean blood loss: 195 ± 191 mL). Within 30-days, we reported the following colpotomy-related complications: a total of 4 cases (0.6%) of vaginal bleeding, 3 of which resolved spontaneously (1 case required readmission with new colporrhaphy under general anesthesia), and 2 cases (0.3%) of vaginal pain, with no underlying cause identified on physical examination and pelvic ultrasound. Specimen weight was positively correlated with longer operative time, intraoperative blood loss, and length of hospital stay.ConclusionPosterior colpotomy and in-bag transvaginal extraction can be considered a feasible option for retrieval of surgical specimens after laparoscopic myomectomy.     

Prediction of maternal near-miss in placenta previa: a retrospective analysis from a tertiary center in Ankara,Turkey

Aim: To determine risk factors for severe complications during and after cesarean delivery (CD) in placenta previa (PP).

Methods: We reviewed retrospectively collected data from women with PP who underwent CD during a 6-year study period. We identified the complicated group based on the modified WHO near-miss criteria. Complicated and noncomplicated groups were compared considering clinical, laboratory, and sonographic features.

Results: Thirty-seven of 256 cases classified as near miss consisting of 14 peripartum hysterectomies, 12 uterine balloon placements, 10 great artery ligations, and four B-lynch suture placement procedures without maternal mortality. Perioperative complications included surgical wound infections (n?=?5), bladder injury (n?=?4), pelvic abscess (n?=?1), and uterine rupture (n?=?1). Logistic regression analyses demonstrated following features to be associated with maternal near miss in PP: (1) coexistent abruption (aOR 13.2, 95% CI 5.8–75.3), (2) morbidly adherent placenta (aOR 11.92, 95% CI 3.24–43.82), (3) number of hospitalizations for vaginal bleeding (≥3) (aOR 8.88, 95% CI 3.32–26.69), and (4) transvaginal cervical length (CL) measurement?<10th percentile (aOR 5.5, 95% CI 2.1–15.4).

Conclusion: Short cervical length, recurrent vaginal bleeding, morbidly adherent placenta, and concurrent placental abruption are independent predictors for subsequent severe maternal morbidity in PP cases. Early identification of these risk factors during PP follow-up may improve maternal outcome.     

Benefits of vaginal misoprostol prior to IUD insertion in women with previous caesarean delivery: a randomised controlled trial

Objective: The aim of the study was to evaluate the value of vaginal misoprostol 6?h prior to intrauterine device (IUD) insertion in women with previous Caesarean delivery.

Methods: A double-blind randomised controlled trial was conducted in 120 women who were eligible for IUD insertion. Participants were randomly divided to receive either 600?μg vaginal misoprostol or placebo 6?h before IUD insertion. The primary outcome measure was the pain score during the procedure. Secondary outcome measures were failure of insertion, insertion difficulty score, complications of IUD insertion and side effects related to misoprostol.

Results: Pain and insertion difficulty scores were significantly lower in the misoprostol group compared with the placebo group (5.7?±?1.4 vs. 6.5?±?0.9 and 4.1?±?1.1 vs. 5.4?±?2.2, respectively; p?p?=?.06) and cramps (10 vs. 0; p?Conclusions: The use of misoprostol before IUD insertion is associated with less painful and easier placement.     

Second trimester abortion in women with and without previous uterine scar: Eleven years experience from a developing country

ABSTRACT

Objectives To study the safety of second trimester abortion in women with previous uterine scar.

Methods We screened the records of 518 women who underwent an abortion between 12 and 20 weeks’ gestation at the Postgraduate Institute of Medical Education and Research, Chandigarh, India, from January 2000 to December 2010. Methods used for abortion were: (i) vaginal misoprostol with or without pre-treatment with mifepristone, and (ii) intracervical dinoprostol gel or vaginal misoprostol ± extra-amniotic saline ± oxytocin infusion. Seventeen women, aborted by means of a hysterotomy, were excluded from further analysis.

Results Of the remaining 501 women, 44 had a uterine scar (Group 1) and 457 had none (Group 2). In Group 1, 40/44 (91%) and in Group 2, 452/457 (99%) women aborted successfully. The mean induction-abortion interval (IAI) was similar in the two groups (15.03 ± 10.69 hours and 12.52 ± 9.0 hours in Groups 1 and 2, respectively; p = 0.083). There were three uterine ruptures, 1/44 (2%) in group 1 and 2/457 (0.4%) in group 2 (p = 0.132, NS); all three women had received mifepristone followed by vaginal misoprostol.

Conclusion In women with a scarred uterus, midtrimester abortion may be successfully achieved using any of the aforementioned regimens.     

Correlation between clinical fetal head station and sonographic angle of progression during the second stage of labor

Purpose: To investigate the correlation between the angle of progression and the clinical fetal head station (FHS) during the second stage of labor, and to build reference range.

Materials and methods: A prospective, observational study was conducted. Women carrying singleton term pregnancies were enrolled during the second stage of labor. FHS was assessed manually by a senior obstetrician, while the angle of progression (AOP) was assessed by transperineal ultrasound (TPU). Both examiners were blinded to each others results. The correlation between the sonographic AOP and the clinical FHS was analyzed.

Results: Seventy patients comprised the study group. Clinical FHS demonstrated an excellent correlation with the sonographic measurement of AOP (Pearson’s Correlation 0.642, p?2?=?0.423, p?Conclusions: Our results demonstrate a significant correlation between the clinical FHS and the TPU measured AOP. These standardized sonographic values may serve the obstetrician as a reliable, objective auxiliary tool for the evaluation of the FHS during the second stage of labor.     

Expression of Aquaporin Proteins in Vagina of Diabetes Mellitus Rats

IntroductionAquaporins (AQPs) are membrane proteins that facilitate water movement across biological membranes. Vaginal lubrication may be mediated by blood flow and other potential mechanisms related to transudation of fluid. The most common female sexual dysfunction in diabetes is inadequate vaginal lubrication.AimTo investigate the expression of AQP1–3 in vaginal tissue of diabetes mellitus rats.MethodsFemale Sprague‐Dawley rats (N = 20) were randomly divided into group A (12‐week‐old nondiabetic control, N = 5), group B (16‐week‐old nondiabetes control, N = 5), group C (12‐week‐old diabetes mellitus rats, N = 5), and group D (16‐week‐old diabetes mellitus rats, N = 5). Vaginal fluid was measured by fluid weight absorbed by cotton swabs after pelvic nerve electrostimulation and anterior vaginal tissue was dissected for determining the expression of AQP1–3 by immunohistochemical study and Western blot.Main Outcome MeasuresThe expression of AQP1–3 was determined in the vagina of diabetes mellitus rats by Western blot.ResultsThere are no significant differences in serum estradiol concentrations of rats among these groups (P > 0.05). Vaginal fluid was significantly lower in group C (2.7 ± 0.67 mg) and group D (2.5 ± 1.03 mg) than in group A (5.74 ± 1.23 mg) and group B (5.5 ± 1.08 mg) (P < 0.05), respectively. The protein expressions of AQP1–3 were significantly lower in group C (43.40 ± 4.83, 60.60 ± 12.80, and 59.60 ± 6.95) and group D (20.81 ± 2.86, 47.80 ± 11.43, and 54.20 ± 5.26) than in group A (116.62 ± 3.21, 110.81 ± 8.044, and 108.80 ± 4.97) and group B (122.12 ± 14.54, 111.21 ± 15.07, and 106.40 ± 4.16) (P < 0.05), respectively.ConclusionsDecreased vaginal fluid in diabetes mellitus rats after electrostimulation may be partly due to estrogen‐independent decreases of AQP1–3 in vaginal tissue. Pei L, Jiang J, Jiang R, Ouyang F, Yang H, Cheng Y, and Fan Z. Expression of aquaporin proteins in vagina of diabetes mellitus rats. J Sex Med **;**:**–**.     

Linear association between maternal age and need of medical interventions at delivery in primiparae: a cohort of 21,235 singleton births

Objectives: We sought to investigate the potential association between maternal age and the need for active obstetrical intervention intrapartum in primiparas.

Study design: Observational study over 14 years (2001–2014) of all consecutive primiparous singleton births having delivered at the Centre Hospitalier Universitaire Hospitalier Sud Reunion’s maternity (French overseas department, Indian Ocean).

Results: Of the 21,235 singleton primiparous births, there were three significant linear associations between maternal age from 12 years of age to 42?+?(all χ² for linear trend, p?2), “heavy babies” (>3.5?kg), and ethnicity. Using maternal age remained significantly an independent risk factor (p?p?Conclusions: Increasing maternal age has a linear association with vaginal deliveries without any medical intervention, rate of cesarean sections, and rate of operative vaginal procedures. These associations are independent of maternal BMI and maternal height. We currently do not have a specific explanation why younger women appear to be protected from requiring intrapartum obstetric intervention. Nevertheless, these strong facts deserve acknowledgement and further research.     

Effects of metformin on the adrenal cortex of androgenized rats

Abstract

Objective: To evaluate the sex steroid profile and histomorphometry of the adrenal cortical zones of androgenized rats (wistar) with polycystic ovary syndrome treated with metformin.

Study design: Thirty animals were divided into three groups: GC (regular estrous cycle), GPE (permanent estrus), and GPEM (permanent estrus + metformin 28?mg/kg for 50 days). At the end of this period, blood was collected for hormone measurement. The width of the adrenal cortical zones and the nuclear volumes were analyzed by histomorphometry. The ANOVA test was used in the statistical analysis.

Results: The adrenal glands of the androgenized animals were larger and more intensely vascularized than those of the other groups. The concentration of androstenedione in GPE was higher than that in the other groups (0.4?±?0.1*>=?0.2?±?0.1?=?0.2?±?01, *p?<?0.05). The width of the zona glomerulosa and of the zona reticularis and their nuclear volumes were greater in GPE compared to those of the other groups (GPE*?>?GPEM?=?GC, *p?<?0.05).

Conclusion: Metformin treatment may decrease the serum levels of androstenedione as well as the width and the nuclear volumes of the zona glomerulosa and of the zona reticularis in androgenized animals.     

Reference range of fetal nasal bone length between 18 and 24 weeks of pregnancy in an unselected Brazilian population: experience from a single service

Abstract

Objective: To determine reference range of fetal nasal bone length (NBL) during the second trimester of pregnancy in a Brazilian population.

Methods: This was a retrospective cross-sectional study with 2681 normal singleton pregnancies between 18 and 24 weeks of gestation. The NBL was obtained in the mid-sagittal plane of the fetal face profile using the following landmarks: nasal bone, overlying skin and the tip of the nose. The NBL was measured by placing the calipers in the out-to-out position. To assess the correlation between NBL and gestational age (GA), polynomial equations were calculated, with adjustments by coefficient of determination (R²).

Results: The mean of NBL ranged from 5.72?±?0.87?mm at 18–18?+?6 weeks to 7.45?±?1.23?mm at 24–24+6 weeks of pregnancy. We observed a good correlation between NBL and GA, best represented by a linear equation: NBL?=?0.080+0.276*GA (R^2?=?0.16).

Conclusion: We established a reference range of fetal NBL in the second trimester of pregnancy in a Brazilian population.     

Vaginal Versus Robotic Hysterectomy and Concomitant Pelvic Support Surgery: A Comparison of Postoperative Vaginal Length and Sexual Function

Study ObjectiveTo compare the change from pre- to postoperative total vaginal length (TVL) in women who underwent either a total vaginal hysterectomy (TVH) with uterosacral ligament suspension (USLS) or a robotic hysterectomy (RH) with colpopexy (SCP). Secondary objectives included comparing sexual function, pelvic floor function, and prolapse recurrence between routes of surgery.DesignThis was a retrospective cohort study (Canadian Task Force classification II-2).SettingThis was conducted at 1 tertiary academic medical center over a 2-year period.PatientsWomen who underwent either TVH/USLS or RH/SCP.InterventionsBaseline and postoperative POP-Q Pelvic Organ Prolapse Quantification exams were recorded as well as postoperative validated questionnaires. Twenty-nine subjects were needed in each group to detect a 1.5-cm difference in TVL.Measurements and Main ResultsThere were 38 TVH/USLS and 46 RH/SCP participants. RHs were either total (28/46 [61%]) or supracervical (18/46 [39%]). The mean postoperative follow-up was 9.5 ± 3.1 months. For the primary outcome, women in the TVH/USLS group had a decrease in TVL, whereas women in the RH/SCP group had an increase in TVL (−0.6 ± 1.0 cm vs 0.5 ± 0.8 cm, p < .001). Among sexually active women (55/84, 65.5%), there was no difference in postoperative sexual function between groups based on Pelvic Organ Prolapse/Urinary incontinence Sexual Function Questionnaire short form scores, with good sexual function in both groups (32.6 ± 6.2 TVH/USLS vs 35.1 ± 7.3 RH/SCP, p = .22). Although both groups showed good postoperative apical support, the TVH/USLS group had a slightly lower mean C point compared with the RH/SCP group (−6.8 ± 1.2 vs −7.7 ± 1.8, p = .02). Both groups showed good postoperative pelvic floor function, with no difference in mean postoperative Pelvic Organ Prolapse Distress Inventory scores (42.2 ± 45.4 vs 52.7 ± 46.6, p = .44). Recurrent prolapse (defined as any prolapse at or beyond the hymen) was not different between groups (13.2% for TVH/USLS vs 6.5% for RH/SCP, p = .46).ConclusionVaginal length decreased after vaginal hysterectomy with pelvic support surgery compared with RH with pelvic support surgery, with no differences in postoperative sexual function or pelvic floor function between groups.     

Effect of vaginal pH on efficacy of the controlled-release dinoprostone vaginal insert for cervical ripening/labor induction

Objective: To evaluate whether vaginal pH alters the efficacy of the controlled-release dinoprostone vaginal insert (Cervidil^®) for cervical ripening/labor induction. Methods: Thirty-four women with an unfavorable cervix undergoing labor induction were enrolled in this prospective, double-blind investigation. Vaginal pH and Bishop score assessments were made by an independent examiner. All women received preinduction with the dinoprostone vaginal insert 10 mg intravaginally for 12 h. Twelve hours later, oxytocin induction initiated according to the standardized protocol and outcome data were collected. Results: Mean (± SD) initial vaginal pH was 4.9 ± 0.5 for the study cohort. No significant differences were noted between women with a high vaginal pH (> 4.5, n = 18) and those with a low vaginal pH (≤ 4.5, n = 16) with respect to maternal age, parity, gestational age, or initial Bishop score. Similarly, Bishop score change over the preinduction interval (3.2 vs. 3.3), time to active labor (28.6 vs. 24.6 h) and time to delivery (33.7 vs. 31.4 h) were not significantly different between the low and the high pH groups, respectively. Linear regression analysis revealed no significant association between vaginal pH and Bishop score change during the preinduction interval, time to active labor, time to complete dilatation, or time to delivery. Conclusion: Vaginal pH does not appear to influence the efficacy of the controlled-released dinoprostone vaginal insert for cervical ripening/labor induction.     

Glycated albumin level during late pregnancy as a predictive factor for neonatal outcomes of women with diabetes

Purpose: To investigate the association between glycated albumin (GA) in diabetic mothers and complications in their children, and to determine GA cutoff values for predicting complications in infants.

Materials and methods: This hospital-based case-control study involved 71 Japanese diabetic mothers and their children. Mean GA values were compared between mothers of infants with and without complications, and relationship with number of complications was analyzed by Pearson’s correlation. Receiver operating characteristic analysis determined GA cutoff values for complications in infants.

Results: GA was significantly higher in mothers of children with neonatal hypoglycemia (15.8?±?3.2 versus 12.6?±?1.2%, p?<.001), respiratory disorders (15.7?±?3.6 versus 12.9?±?1.9%, p?<.001), hypocalcemia (15.9?±?3.7 versus 13.1?±?1.8%, p?<.001), polycythemia (15.7?±?2.3 versus 13.8?±?2.1%, p?=.009), myocardial hypertrophy (16.1?±?3.7 versus 13.1?±?2.3%, p?<.001), and large-for-date status (15.8?±?2.4 versus 13.7?±?3.1%, p?=?.006), showing significant positive correlation with number of complications in infants (r?=?.704, 95%CI: 0.579–0.797, p?Conclusions: GA is useful for predicting pregnancy outcomes in mothers with diabetes and must be maintained at low levels to prevent complications in infants.