C-reactive protein should accelerate the diagnosis of bowel injury after gynecologic surgery

STUDY OBJECTIVE: To search for a marker that could aid in earlier diagnosis of bowel injury after gynecologic surgery. DESIGN: Retrospective case study with prospective controls (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: Fourteen women with bowel injuries and 50 controls with no postoperative complications. MEASUREMENTS AND MAIN RESULTS: Bowel injury occurred in 14 (2.4/1000) of 5901 gynecologic procedures. Of these, eight were recognized intraoperatively and treated immediately. In six women C-reactive protein levels were markedly increased (>100 mg/L) relative to control patients (p <0.0001). CONCLUSION: Systematic postoperative assessment of C-reactive protein in patients at high risk for bowel injury may help identify this complication earlier in the postoperative period.     

The duration of the third stage of labor is subject to the location of placental implantation

We evaluated the association between placental location and length of the third stage of labor in normal term singleton pregnancies. Two hundred consecutive singleton term live vaginal deliveries following uncomplicated pregnancies were included in a retrospective study. The mean maternal age was 27.5 +/- 5.2 years, and the mean parity was 2.2 +/- 1.4. Patients' charts were reviewed in order to determine the placental implantation site. Anterior location of the placenta was noted in 96 women (48%), posterior in 66 (33%), fundal in 26 (13%), and lateral in 12 (6%). The duration of the third stage was 9.5 +/- 5.5, 9.4 +/- 5.3, 12.8 +/- 9.5, and 7.6 +/- 3.5 min in anterior, posterior, fundal, and lateral groups, respectively (p < 0.05). The duration of the third stage of labor is statistically significantly longer, if the placenta is located in the fundal area of the uterus. Therefore, we believe that the placental location may be important in managing the third stage of labor.     

English- and Spanish-speaking Latina Mothers’ Beliefs about Food,Health, and Mothering

Parent beliefs regarding food, health, and child feeding behaviors among Latinos have not been well-documented. A series of eight focus groups were conducted with English-speaking and Spanish-speaking low-income Latina mothers of preschoolers to investigate their beliefs regarding how food and food preparation are related to their children’s health and to their own roles as mothers. Systematic content analysis using NUDIST 6 revealed seven themes discussed by the focus groups. Integration of these themes revealed three major areas of consideration: (1) a lack of connection between the domains of eating, overweight, and health outcomes; (2) the role of parent modeling of eating behaviors; and (3) the use of feeding strategies that may not be conducive to the development of healthy eating behaviors. Furthermore, the data suggest that there are important distinctions among Latinos based on language preference, and that a “one-size-fits-all” approach to modeling Latino mothers’ feeding beliefs may not be appropriate.     

Reversal of tubal sterilization versus IVF in the era of assisted reproductive technology: a clinical dilemma

Two treatment options are available to women who wish to become pregnant after having had tubal sterilization: microsurgical reversal or IVF. The first approach is designed to restore tubal function, whereas the second replaces it. The first, to be successful, requires the presence of sufficient tubal length and normal or treatable fertility parameters. Treatment should therefore be individualized, based upon the findings of the couple's investigation, their wishes and the costs involved. The age of the female is the most important factor that affects the outcome with both treatment options. The live birth rate per cycle with IVF is 28%, but only 65.8% are singletons; 31.0% are twins and 3.2% triplets or more. Microsurgical tubal anastomosis yields a birth rate that exceeds 55%, without increased risk of multiple pregnancy. It offers the couple multiple cycles in which to achieve conception naturally, and the opportunity to have more than one pregnancy from a single intervention. The real dilemma lies with the 'industrialization' of IVF, and its frequent use as primary treatment for infertility. The dilemma is heightened by the fact that reconstructive tubal microsurgery is being taught and practised less and less, thereby eliminating this credible surgical option in most centres.     

Laparoscopic uterine suspension using three-stitch technique

We conducted a prospective, longitudinal study to assess the efficacy of a new laparoscopic hysteropexy technique in alleviating pelvic pain. Subjects were 50 women of reproductive age with chronic pelvic pain or dyspareunia in whom the only clinical finding was uterine retroversion who underwent laparoscopic uterine suspension using three-stitch technique. There were no intraoperative complications. The only postoperative complication was abdominal pain in one woman. The technique was effective in relieving symptoms in these patients. Of the 22 women who had associated infertility for longer than 3 years, 10 became pregnant within 1 year after surgery. This benefit, however, is likely due to couples' improved sex life rather than change in surgical axis of the uterus.     

Laparoscopic tubal surgery in infertility.

Besides its diagnostic value, laparoscopy is a useful operative tool in the treatment of infertility. We have used dilatation of phimotic tubal ostia and salpingolysis by laparoscopy as our primary approach. In the total series of 33 cases a pregnancy rate of 42.1 percent was obtained.