Effects of method of uterine repair on surgical outcome of cesarean delivery

Objective

To compare the rates of intraoperative and postoperative complications of uterine repair when performed in situ or extra-abdominally following cesarean delivery.

Methods

In this prospective randomized study 4925 women who underwent cesarean delivery were randomly assigned to in situ (n = 2462) or extra-abdominal (n = 2463) uterine repair (group 1 and group 2, respectively). The study compares drop in hemoglobin concentration (as a measure of intraoperative blood loss). It also compares operating time, time to return of bowel sound, and duration of hospitalization as well as rates of uterine atony, blood transfusion, intraoperative complications, additional use postoperative analgesics, endometritis, and wound infection.

Results

Uterine atony developed in 96 women (3.8%) in group 1 and 226 women (9.1%) in group 2 (P = 0.001). Moreover, the operating time and the time to return of bowel sound were shorter and the rates of both additional use of postoperative analgesics and wound infection were lower in group 1 (P = 0.001, P = 0.002, P = 0.001, and P = 0.003, respectively).

Conclusion

Fewer cases of uterine atony, a shorter operating time, a faster return of bowel function, a lesser need for postoperative analgesics, and lower rates of additional use of postoperative analgesics and wound infections suggest that in-situ uterine repair ought to be preferred to extra-abdominal uterine repair following cesarean delivery.     

Prospective randomized,double-blinded,placebo-controlled trial of preoperative etoricoxib for pain relief in uterine fractional curettage under paracervical block

Objective

To evaluate the analgesic efficacy of preoperative etoricoxib combined with paracervical nerve block in patients who underwent uterine fractional curettage.

Study design

This double-blinded, randomized, placebo-controlled trial included 80 women who underwent uterine fractional curettage under paracervical block. Forty women were randomly assigned to etoricoxib 120 mg and 40 women to the placebo. The main outcome measure was the intensity of pain measured using the visual analog pain score during and after the procedure. Student's t-tests, Mann–Whitney U-test, and Chi-squared test were used for statistical analysis.

Results

The intensity of pain during operative procedure in the etoricoxib group was lower than in the placebo group (median visual analog pain scores (interquartile range) 48 (43–64) vs. 61 (51–72), P = 0.001) The amount of postoperative acetaminophen used in the etoricoxib group was also lower than in the placebo group (2.2 ± 1.7 vs. 3.2 ± 1.7 tablets, P = 0.011). We found no significant adverse effects in this study.

Conclusion

The preoperative administration of 120 mg oral etoricoxib can slightly reduce pain during fractional curettage under paracervical block. However, the degree of pain reduction by this treatment has no clinical importance.     

Preliminary uterine artery ligation versus pericervical mechanical tourniquet in reducing hemorrhage during abdominal myomectomy

Objective

To compare the effectiveness of preliminary uterine artery ligation versus pericervical mechanical tourniquet in reducing hemorrhage during myomectomy.

Methods

A total of 103 patients undergoing myomectomy were randomly allocated to undergo preliminary uterine artery ligation (52 patients) or pericervical tourniquet (51 patients). The primary outcome measure was estimated blood loss. Secondary outcomes included duration of the operation, duration of hospital stay, postoperative hemoglobin, and the need for postoperative analgesia.

Results

Operative blood loss was significantly less with uterine artery ligation compared with tourniquet (433.80 ± 285.21 vs 823.23 ± 237.33 mL, P < 0.001). The mean duration of the operation was lower in the uterine artery ligation group compared with the tourniquet group (50.5 ± 8.7 vs 76.3 ± 9.4 minutes, P < 0.001). Postoperative hospital stay was significantly shorter in the uterine artery ligation group compared with the tourniquet group (4.1 ± 0.1 vs 5.1 ± 0.2 days; P < 0.001). Postoperative hemoglobin concentrations and the need for postoperative analgesia were higher in the uterine artery ligation group (P = 0.012 and P < 0.001, respectively).

Conclusion

Uterine artery ligation was more effective than pericervical tourniquet as a preliminary step in reducing blood loss during abdominal myomectomy.     

Influence of gum chewing on postoperative bowel activity after complete staging surgery for gynecological malignancies: A randomized controlled trial

Objective

To investigate whether gum chewing affects the return of bowel function after complete staging surgery for gynecologic malignancies.

Methods

A total of 149 patients undergoing abdominal complete surgical staging for various gynecological cancers were randomized into a gum-chewing group (n = 74) or a control group (n = 75). The patients chewed sugarless gum three times from the first postoperative morning until the first passage of flatus. Each chewing session lasted 30 min. Total abdominal hysterectomy with systematic pelvic and para-aortic lymphadenectomy was performed on all patients as part of complete staging surgery. Groups were compared in terms of time to first bowel movement time, first flatus and feces pass time, postoperative analgesic and antiemetic drug requirement, postoperative oral intake tolerance, mild ileus symptoms and hospital stay.

Results

The mean time to flatus (34.0 ± 11.5 vs. 43.6 ± 14.0 h; p < 0.001), mean time to defecation (49.6 ± 18.7 vs. 62.5 ± 21.5 h; p < 0.001), mean time to bowel movement (41.5 ± 15.7 vs. 50.1 ± 15.9 h; p = 0.001), mean time to tolerate diet (4.0 ± 0.8 vs. 5.0 ± 0.9 days; p < 0.001), mean length of hospital stay (5.9 ± 1 vs. 7.0 ± 1.4 days; p < 0.001) were significantly reduced in patients that chewed gum compared with controls. Mild ileus symptoms were observed in 27 (36%) patients in the control group compared to 11(14.9%) patients in the gum-chewing group [relative risk, 2.4; 95% confidence interval, 1.2–4.5; p = 0.004]. Severe symptoms were observed in two patients (2.7%) in the control group.

Conclusions

Gum chewing early in the postoperative period following elective total abdominal hysterectomy and systematic retroperitoneal lymphadenectomy hastens time to bowel motility and ability to tolerate feedings. This inexpensive and well-tolerated treatment should be added as an adjunct in postoperative care of gynecologic oncology.     

The consequences of previous uterine scar dehiscence and cesarean delivery on subsequent births

Objective

To determine whether women with a previous uterine scar dehiscence are at increased risk of adverse perinatal outcomes in the following delivery.

Methods

A retrospective cohort study was conducted of all subsequent singleton cesarean deliveries performed at the Soroka University Medical Center, Beer-Sheva, Israel, between January 1, 1988, and December 31, 2011. Clinical and demographic characteristics, maternal obstetric complications, and fetal complications were evaluated among women with or without a previous documented uterine scar dehiscence.

Results

Of the 5635 pregnancies associated with at least two previous cesarean deliveries, 180 (3.2%) occurred among women with a previous uterine scar dehiscence. Women with this condition in a prior pregnancy were more likely than those without previous uterine scar dehiscence to experience subsequent preterm delivery (86 [47.8%] vs 1350 [24.7%]; P < 0.001), low birth weight (47 [26.1%] vs 861 [15.8%]; P < 0.001), and peripartum hysterectomy (5 [2.8%] vs 20 [0.4%]; P < 0.001). Nevertheless, previous uterine scar dehiscence did not increase the risk of uterine rupture, placenta accreta, or adverse perinatal outcomes, such as low Apgar scores at 5 minutes and perinatal mortality.

Conclusion

Uterine scar dehiscence in a previous pregnancy is a potential risk factor for preterm delivery, low birth weight, and peripartum hysterectomy in the following pregnancy.     

A randomized,controlled study comparing minilaparotomy versus isobaric gasless laparoscopic assisted minilaparotomy myomectomy for removal of large uterine myomas: Short-term outcomes

Objective

To compare the operative data and early postoperative outcomes for myomectomy performed by minilaparotomy (MLT) with isobaric laparoscopic assisted minilaparotomy myomectomy (LM) in a series of patients with large uterine myomas (≥5 cm) randomly assigned to each surgical technique.

Study design

80 patients were randomized blindly using a computer randomization list to MLT (n = 40) or LM (n = 40).

Results

The mean (±SD) operating time was significantly shorter after LM than after MLT (75.50 ± 25.70 vs 96.00 ± 26.20 min; p < 0.01). Intraoperative blood loss was less with LM (72.15 ± 44.00 vs 96.21 ± 38.50 ml; p < 0.05), and ΔHb was less with LM (1.21 ± 0.55 vs 1.64 ± 0.57; p < 0.05). No intraoperative complications occurred, and no case was returned to the theater in either group. No conversion to standard laparotomy was necessary. Hospitalization was shorter after LM than after MLT (4.30 ± 1.20 vs 6.90 ± 2.70 days; p < 0.01). Postoperative ileus was shorter after LM than after MLT (26.20 ± 4.20 vs 40.50 ± 4.90 h; p < 0.01). The mean VAS score at 12 h for abdominal pain was 5.5 ± 0.7 in the LM group and 5.2 ± 0.8 in MLT group (p < 0.05), whereas it was analogous in the two groups at 24 h, and at 48 h was 3.4 ± 1.1 in the LM group and 4.2 ± 1.1 in the MLT group (p < 0.05), and no difference between two groups was detected in the overall mean (at 12, 24 and 48 h).

Conclusions

Several surgical and immediate postoperative outcomes were significantly better in the LM group than in the MLT group.     

Advantages of recombinant follicle-stimulating hormone over human menopausal gonadotropin for ovarian stimulation in intrauterine insemination: a randomized clinical trial in unexplained infertility

Objective

To compare two different gonadotropin preparations, human menopausal gonadotropin (hMG) and recombinant follicle-stimulating hormone (rFSH), combined with clomiphene citrate (CC) in women with unexplained infertility undergoing intrauterine insemination (IUI).

Study design

In this prospective clinical trial, couples prepared for IUI cycles were randomly allocated to two groups either to receive CC and hMG (group A, n = 127) or CC and rFSH (group B, n = 132) for ovarian stimulation. Outcomes including rates of clinical pregnancy, miscarriage, OHSS, multiple pregnancy, cancelation, and live birth were compared between groups.

Results

Duration of gonadotropin therapy was significantly shorter in group B (5.1 ± 0.84 vs. 4.7 ± 0.8 days, CI = 95%, P < 0.001). The total dose of administered gonadotropin was also significantly lower in group B (386.9 ± 68.2 vs. 348.2 ± 56.3 IU, CI = 95%, P < 0.001). Dominant follicle number (>17 mm), mean follicular diameter, and endometrial thickness on the day of hCG injection were similar. Clinical pregnancy, multiple pregnancies, abortion, live birth, ovarian hyperstimulation syndrome (OHSS), and cancelation rates were not statistically different between the groups.

Conclusion

IUI cycles in which rFSH had been administered may require shorter duration and a lower total gonadotropin dose.     

Early-stage morphological observations of myoma and myometrium after laparoscopic uterine artery occlusion treatment

Objective

Myoma therapy by uterine artery occlusion using laparoscopic ligation (UAOL) has been performed for many years and has proven effective, but limited information is available on its therapeutic mechanism. To examine this issue, we conducted this study to investigate the morphological change and apoptosis occurring in myomal and adjacent myometrial tissues shortly after UAOL.

Study design

In total, 16 myomas and adjacent myometrium were obtained from 7 cases before and at various points after artery ligation. The tissues were stained using hematoxylin and eosin for morphological observation. To investigate the existence of apoptosis, in situ immunostaining of Caspase 3 and TUNEL assay were performed. Cytochrome C released from mitochondria was also detected by immunohistochemistry.

Results

Microscopic observation found that after UAOL, both myometrial and myomal tissues were edematous and apoptotic cells were widespread in both tissues. TUNEL assays showed that before UAOL, numbers of apoptotic cells in myomal and myometrial tissues had no significant differences (P = 0.866). After ischemia of (36.69 ± 18.53) min, apoptosis was significantly more elevated in myoma than in myometrium ((6.43 ± 4.38)/10 HPF vs. (2.74 ± 1.95)/10 HPF, P = 0.003). Caspase 3 stain shared similar features with the TUNEL assay. In both groups cytochrome C was released from mitochondria after UAOL, and more was detected in the myoma.

Conclusion

UAOL is an alternative method to treat symptomatic uterine myomas. Apoptosis via mitochondrial pathways may lead to reduction of the volume of myoma and myometrium and eventual relief of symptoms.     

A 5-year follow-up study comparing Burch colposuspension and transobturator tape for the surgical treatment of stress urinary incontinence

Objective

To compare the effectiveness of transobturator tape (TOT) and Burch colposuspension in the treatment of stress urinary incontinence (SUI).

Methods

The present retrospective study included 770 patients who underwent SUI surgery with Burch colposuspension (n = 498) or TOT (n = 272). Clinical follow-up occurred at 2 weeks, 3, 6, and 12 months, and annually thereafter. Objective and subjective cure rates and intra- and postoperative complications were assessed.

Results

Among patients who had SUI surgery without another concomitant procedure, the Burch group had a significantly longer mean operation time (41.48 ± 10.61 minutes versus 23.77 ± 10.49 minutes; P < 0.001) and a significantly longer length of hospital stay (3.11 ± 0.49 days versus 1.98 ± 0.40 days; P < 0.001), compared with the TOT group. The rates of unintended functional outcomes were lower among women undergoing TOT than among those undergoing the Burch procedure (long-term voiding dysfunction 0.7% versus 4.2%, P = 0.007; urinary retention 10.7% versus 26.9%, P < 0.001). The 5-year cure rates were similar in the 2 groups (objective cure rate, 73.9% versus 77.5%, P = 0.574; subjective cure rate, 76.8% versus 81.7%, P = 0.416).

Conclusion

In terms of efficacy, TOT appears equal to Burch colposuspension; however, TOT has fewer unintended functional outcomes than Burch colposuspension.     

Effect of a single preoperative dose of sublingual misoprostol on intraoperative blood loss during total abdominal hysterectomy

Objective

To investigate whether use of preoperative misoprostol can reduce blood loss during total abdominal hysterectomy (TAH).

Methods

In a randomized double-blind placebo-controlled trial at a tertiary care hospital in Kolkata, India, between March 2011 and April 2012, women (n = 132) undergoing TAH with or without bilateral salpingo-oophorectomy for symptomatic myomas were randomly allocated to receive either 400 μg of misoprostol or placebo 30 minutes before surgery. The primary outcome measure was intraoperative blood loss was. The secondary outcomes were postoperative drop in hemoglobin, need for blood transfusion, and incidence of adverse effects.

Results

The 2 groups were similar with regard to demographic and clinical characteristics. There was a significant reduction of blood loss during TAH after sublingual administration of misoprostol compared with placebo before surgery (356 mL vs 435 mL; P = 0.049). The mean postoperative hemoglobin concentration was higher (10.5 g/dL vs 9.5 g/dL; P < 0.001) and the postoperative drop in hemoglobin was smaller (1.1 g/dL vs 1.9 g/dL; P = 0.004) in the misoprostol group than in the placebo group. No significant adverse effects occurred in either group.

Conclusion

The results showed that a single dose of misoprostol administered before abdominal hysterectomy resulted in a significant reduction of blood loss with minimal adverse effects.Clinical Trial Registry India (www.ctri.nic.in): CTRI/2011/091/000216.     

Impact of a program of physiotherapy and health education on the outcome of obstetric fistula surgery

Objective

Surgery is the only successful treatment for most obstetric fistulae. The present study measured the impact of a structured program of pre- and postoperative physiotherapy and health education on the outcome of surgery for obstetric fistula.

Methods

We compared the postoperative outcomes of 2 consecutive groups of women with obstetric fistulae who were recruited and followed-up by 2 local nongovernmental organizations at a hospital in Tanguiéta, Benin. The first group of women (n = 99) had fistula repair using standardized techniques. The second group (n = 112) had a standardized surgical approach plus a structured program of pre- and postoperative health education and physiotherapy.

Results

The program had a significant positive impact on recovery in general and on urinary incontinence in particular. After physiotherapy, the odds of recovery were 2.72 times greater for women in the physiotherapy group than for control patients, and the probability of postoperative stress incontinence was considerably higher for patients in the control group than for those in the physiotherapy group (P < 0.001).

Conclusion

A structured program of health education and physiotherapy by experienced nurses and physiotherapists improves the likelihood of a successful outcome after surgical repair of obstetric fistula.     

Comparison of outcomes in early stage uterine carcinosarcoma and uterine serous carcinoma

Objective

To assess whether contemporary adjuvant management of early stage uterine carcinosarcoma (CS) produces equal outcomes as in uterine serous carcinoma (USC).

Methods

We reviewed 172 women treated from 2000 to 2011 for stage I–II USC (n = 112, 65%) or CS (n = 60, 35%). Adjuvant therapy was initiated in 154 (90%) patients, with 111 patients receiving intravaginal radiotherapy (IVRT)/chemotherapy. Median follow up was 4.6 years for surviving patients.

Results

Characteristics for USC vs. CS did not differ significantly by age ≥ 60, pelvic or para-aortic node sampling, stage, lymphovascular invasion, chemotherapy use, RT use or omission of adjuvant therapy. Outcomes were better for USC vs. CS in 5-year actuarial rates of recurrence [17% (C.I. 10–25%) vs. 45% (C.I. 31–59%), p < 0.001],disease-related mortality (DRM) [11% (5–17%) vs. 30% (16–44%), p = 0.016], and all-cause mortality [12% (C.I. 6–18%) vs. 34% (C.I. 20–48%), p = 0.007]. In multivariable analysis, CS histology remained a significant predictor of risk for recurrence [HR 3.1 (C.I. 1.7–5.7), p < 0.001], DRM [HR 2.4 (C.I. 1.1–5.1), p = 0.024], and all-cause mortality [HR 2.4 (C.I. 1.2–4.8), p = 0.012]. On sub-group analysis of 111 patients (77 USC, 34 CS) able to receive IVRT/chemotherapy, CS no longer was associated significantly with increased recurrence (29% vs. 15%, p = 0.18), DRM (22% vs. 10%, p = 0.39), or all-cause mortality (22% vs. 10%, p = 0.45).

Conclusions

CS was associated with worse outcomes than USC. However, that difference was not maintained in patients able to receive IVRT and chemotherapy. While intriguing, this result may be due in part to selection against rapid early relapsing CS patients in this group.     

Uterine artery embolization followed by dilation and curettage within 24 hours compared with systemic methotrexate for cesarean scar pregnancy

Objective

To assess the efficacy of uterine artery embolization (UAE) combined with dilation and curettage (D&C) within 24 hours for the treatment of a cesarean scar pregnancy (CSP), compared with methotrexate and D&C.

Methods

A retrospective cohort study of 119 women with CSP was conducted at two tertiary hospitals in Guangzhou and Shenzhen, China, during 2009–2012. Twenty-six women received systemic methotrexate followed by D&C, and 93 women were treated with UAE followed by D&C within 24 hours.

Results

Mean blood loss was 261.0 ± 357.4 mL in the methotrexate group versus 14.1 ± 40.6 mL in the UAE group (P < 0.001). The time to resolution of the level of β-human chorionic gonadotropin was 40.5 ± 17.2 days versus 15.4 ± 7.7 days (P < 0.001), respectively. The duration of hospitalization was 14.6 ± 9.2 days versus 6.2 ± 3.7 days (P < 0.001), respectively. An additional intervention was needed in 9 (35%) women in the methotrexate group and in 5 (5%) in the UAE group (P < 0.001).

Conclusion

UAE combined with D&C within 24 hours was an effective uterine preservation treatment for CSP, and was associated with less blood loss and a shorter hospital stay than administration of methotrexate followed by D&C.     

Sheathed versus standard speculum for visualization of the cervix

Objective

To determine whether modifying a plastic speculum with a flexible sheath would improve visualization and decrease pain during vaginal examination.

Methods

We conducted a prospective randomized controlled trial of 136 women undergoing vaginal speculum examination at an outpatient obstetrics and gynecology faculty practice. Patients underwent examination via a standardized technique with either a medium-sized plastic speculum (standard) or an identical speculum modified with a flexible polypropylene sheath (sheathed). Investigators recorded the percentage of the cervix visualized. After speculum insertion, patients recorded pain using a 10-cm visual analog scale.

Results

There were no substantial demographic differences between the standard (n = 67) and the sheathed (n = 68) groups. Investigators were able to visualize a significantly greater percentage of the cervix using the sheathed speculum compared with the standard speculum (95.1% ± 8.2% vs 78.2% ± 18.4%; P < 0.001), representing a 21.6% improvement in visualization, and were able to visualize the entire cervix in 42 (61.8%) patients when using the sheathed speculum compared with 11 (16.4%) patients undergoing standard speculum examination (P < 0.001). Patients undergoing examination with the sheathed speculum reported a nonsignificant decrease in pain scores (1.0 vs 1.2; P = 0.087).

Conclusion

A sheathed speculum significantly improves visualization of the cervix, without compromising patient comfort.ClinicalTrials.gov:NCT01670630     

Randomized study of bipolar vessel sealing system versus conventional suture ligature for vaginal hysterectomy

Objective

This study was undertaken to compare the use of bipolar vessel sealing system (BVSS) with conventional suture ligature in vaginal hysterectomy (VH) on a non-prolapsed uterus.

Study design

Women referred for VH for uterine myoma were randomized to BVSS (n = 45) or conventional suture ligature VH (n = 45). Exclusion criteria were uterine prolapse and indication associated surgical procedures. Main outcome measures were operative time, blood loss, hospital stay, pain status, peri and post-operative complications. Data of patients were collected prospectively. Statistical analysis was performed using chi-square and Student's t-test as appropriate.

Results

There were no differences in patients’ mean age, parity and uterine size between groups. Patients in the BVSS group had a significantly reduced operating time (29.2 ± 2.1 min vs. 75.2 ± 5 min; p < 0.001), operative blood loss (84 ± 5.9 mL vs. 136.4 ± 89.1 mL; p = 0.001), requirement of surgical sutures (1.2 ± 0.6 units vs. 7.4 ± 0.3 units; p < 0.001), pain status (1.6 ± 0.4 vs. 3.6 ± 0.4; p < 0.001) and hospital stay (25.6 ± 0.9 h vs. 33.2 ± 1.7 h; p < 0.001) compared to the control group. The overall complication rate in the study was 7.8% (7/90), and did not differ between patients of the BVSS and control group.

Conclusion

Bipolar vessel sealing for vaginal hysterectomy appears to be an effective and safe haemostatic control method, with reduced operating time, peri-operative blood losses, post-operative pain and hospital stay.     

Maintenance tocolysis with oral micronized progesterone for prevention of preterm birth after arrested preterm labor

Objective

To evaluate the efficacy of maintenance therapy with oral micronized progesterone (OMP) for prolongation of pregnancy in cases of arrested preterm labor.

Methods

Ninety women at 24–34 weeks of singleton pregnancy with intact membranes and arrested preterm labor were randomly allocated to receive OMP (n = 45) or placebo (n = 45) daily until 37 weeks or delivery, whichever was earlier. Outcome parameters were compared using Student t test, χ² test, Fisher exact test, and log-rank χ² test.

Results

OMP significantly prolonged the latency period (33.29 ± 22.16 vs 23.07 ± 15.42 days; P = 0.013). Log-rank analysis revealed a significant difference in mean time to delivery between the 2 groups (P = 0.014). There were significantly fewer preterm births (33% vs 58%; P = 0.034) and low birth weight neonates (37% vs 64%; P = 0.017), and significantly higher mean birth weight (2.44 ± 0.58 vs 2.14 ± 0.47 kg; P = 0.009) in the OMP group. Perinatal outcomes and adverse effects were similar in the 2 groups.

Conclusion

Maintenance tocolysis with OMP significantly prolonged pregnancy and decreased the number of preterm births.Clinical Trial Registry of India: CTRI/2011/10/002043.     

Reducing blood loss at abdominal myomectomy with preoperative use of dinoprostone intravaginal suppository: a randomized placebo-controlled pilot study

Objective

To determine the effect of a single preoperative intravaginal prostaglandin E₂ (PGE₂; dinoprostone) suppository on reducing intraoperative blood loss and the need for subsequent blood transfusion at abdominal myomectomy for symptomatic leiomyomas.

Study design

In a prospective randomized double-blind placebo-controlled pilot study, 108 women who had abdominal myomectomy for symptomatic leiomyomas were enrolled. Patients were randomly assigned to receive a single dose of intravaginal 20 mg dinoprostone (n = 54) or placebo (n = 54) 60 min before the operation. The primary outcome was the operative blood loss. The secondary outcomes were the need for blood transfusion, change in hemoglobin (Hb) level 24 h after operation, and the prevalence of side effects.

Results

Blood loss and transfusion rate were significantly greater in the group without PGE₂ suppository (group B) than in the group with PGE₂ (group A): they were respectively 485.7 ± 361.3 mL vs 364.1 ± 279.4 mL (P = .02; relative risk [RR] 0.95; 95% confidence interval [CI], 0.63–1.45) and 18.5% vs 3.7% (P = .04; RR 1.32; 95% CI, 3.7–18.5). Group B had a significant decrease in Hb level 24 h after operation compared with group A (P < .05). There was no difference in the patient demographics, intraoperative characteristics, postoperative stay, complications, and the side effects between the two groups.

Conclusion

A single pre-operative dose of dinoprostone administered intravaginally could be a safe and reliable method to help decrease blood loss during abdominal myomectomy. Further larger prospective studies are required to support this conclusion.     

Changes in sexual function and quality of life after single-incision mid-urethral sling for treatment of female stress urinary incontinence

Objectives

To evaluate the effectiveness and assess the changes in sexual function and quality of life after placement of a single-incision sling for the treatment of female stress urinary incontinence.

Study design

A prospective study of women diagnosed with stress urinary incontinence. The single-incision sling was implanted and patients were followed postoperatively for 6 months. The postoperative rate of continence, complications, changes in sexual function, and patient-reported quality of life were evaluated. Female Sexual Function in sexually active patients was evaluated before and after the single-incision sling procedure using the Female Sexual Function Index. From January 2009 to November 2011, 73 patients were enrolled and underwent the procedure to implant the MiniArc^® or Ajust^® single-incision sling.

Results

Overall, 93.2% of the patients who successfully received a single-incision sling demonstrated total restoration of continence (83.6%) or improved continence (9.6%) at the 6-month postoperative visit. Improvements were seen in the quality of life scores related to global bladder feeling (87.7%) and the Female Sexual Function Index (preoperative score 23.86 ± 5.67 vs postoperative score 27.25 ± 4.66 [P < 0.0001]).

Conclusion

Single-incision sling treatment for stress urinary incontinence led to improvements in continence and sexual function at 6 months of postoperative follow-up.     

Doppler study of uterine hemodynamics in women with unexplained infertility

Objective

To evaluate uterine artery blood flow using pulsed Doppler, and endometrial and subendometrial microvascularization using three-dimensional (3D) power Doppler, in women with unexplained infertility.

Study design

In a prospective clinical trial at a university teaching hospital, 40 women with unexplained infertility were compared to 40 fertile parous controls. In the mid-luteal (peri-implantation) phase, the endometrial thickness and volume, uterine artery pulsatility index (PI) and resistance index (RI), endometrial and subendometrial 3D power Doppler vascularization index (VI), flow index (FI), and vascularization flow index (VFI), and serum estradiol and progesterone levels were measured in both groups.

Results

The uterine artery PI (P = 0.003) and RI (P = 0.007) were significantly increased and the endometrial VI (P = 0.029), FI (P = 0.031), and VFI (P = 0.001) and subendometrial VI (P = 0.032), FI (P = 0.040), and VFI (P = 0.005) were significantly decreased in the unexplained infertility group. The endometrial thickness and volume and serum estradiol and progesterone levels, however, were not significantly different between the two groups.

Conclusion

Peri-implantation endometrial perfusion is impaired in women with unexplained infertility: Doppler study of uterine hemodynamics should therefore be considered in infertility work-up.     

Clinical evaluation of peripartum outcomes of mediolateral versus lateral episiotomy

Objective

To evaluate the incidence and extent of vaginal and perineal trauma among primiparous women after mediolateral and lateral episiotomy.

Methods

In a prospective randomized study at University Hospital Pilsen, Czech Republic, 790 consecutive primiparous women were enrolled between April 2010 and April 2012. Mediolateral episiotomy (MLE) followed an angle of at least 60° from the midline. Lateral episiotomy (LE) started 1–2 cm laterally from the midline and was directed toward the ischial tuberosity. A rectal examination was performed before episiotomy repair.

Results

MLE was performed for 390 women, and LE for 400. The groups did not differ in maternal or neonatal characteristics. No difference was found in incidence or extent of vaginal and perineal trauma; or in additional perineal (1.8% vs 1.5%, P = 0.6) or vaginal (8.5% vs 10.6%, P = 0.2) trauma continuing along the episiotomy incision. The incidence of anal sphincter injury did not differ between MLE and LE (1.5% vs 1.3%, P = 0.7). MLE was associated with shorter repair times (P < 0.05), less suturing material (P < 0.05), and shorter distances from the anus (P < 0.001).

Conclusion

Risk of additional vaginal and perineal trauma, and anal sphincter injury after adequately performed mediolateral episiotomy is relatively low and corresponds to that of lateral episiotomy.