European Journal of Obstetrics & Gynecology and Reproductive Biology

Systematic review and meta-analysis of “inside-out” versus “outside-in” transobturator tapes in management of stress urinary incontinence in women

2012-01-24

Abstract: Objectives: To directly compare the current evidence for the efficacy, complications, quality of life and cost to health services of both transobturator tension free vaginal tape procedures – “inside-out” versus “outside-in” – in the surgical treatment of female stress urinary incontinence.Study design: A prospective peer-reviewed protocol was prepared a priori, and a systematic search of relevant databases from 1966 to January 2011 was performed. Meta-analyses of five randomised trials and three cohort studies were performed separately in accordance with PRISMA and MOOSE, respectively.Results: There was no significant difference in patient-reported cure/improvement (OR 1.25, 95%CI 0.78, 1.99; p=0.35) nor in objective cure/improvement (OR 1.66, 95%CI 0.8, 3.43, p=0.17) between the two groups at 12-month follow-up. Vaginal angle injuries were significantly higher with the outside-in route (OR 0.14, 95%CI 0.05, 0.41, p=0.0003). Groin/thigh pain and de-novo urgency were non-significantly higher with the inside-out route (OR 1.42, 95%CI 0.94, 2.13, p=0.10 and OR 1.46, 95%CI 0.63, 3.36, p=0.38, respectively). There was no significant difference in postoperative quality of life scores between the two groups (WMD -1.65; 95% CI -5.76, 2.46, p=0.43). None of the trials reported a “health-cost” analysis. Meta-analysis of cohort studies confirmed similar results.Conclusions: This is the first reported direct meta-analysis comparing both routes of transobturator tapes. It showed no evidence of significant differences in the efficacy and impact on women's quality of life between “inside-out” and “outside-in” transobturator tapes up to one-year follow-up. The “inside-out” route was associated with significantly fewer vaginal angle injuries but with trends towards higher risk of postoperative groin pain. Long-term follow-up of adequately powered RCTs is required to assess if these results pertain.

The effect of maternal ketanserin use on the circulation of the neonate: a prospective, observational study

2012-02-06

Abstract: Objective: High ketanserin levels are found in the umbilical cord after maternal treatment. However, the effect on the circulation of the neonate has never been investigated.Study design: A prospective, observational study was performed at the neonate ward at the Medical Centre Leeuwarden, The Netherlands. All neonates exposed in utero to ketanserin administered to the mother, from May 2007 to December 2009 (n=58), were included. We studied the effect of ketanserin exposure on the circulation of the neonate, by monitoring heart rate and blood pressure during the first 24h of life. Non-parametric as well as parametric tests were used to analyze the effect of gestational age, birth weight, gender, various ketanserin factors (cumulative dosage, duration of therapy and last dosage rate), other maternal drug use and maternal diagnosis on the blood pressure of the neonate.Results: Eight neonates became hypotensive during the first 8h of life (13.8%). The last dosage rate as well as the mean dosage rate (cumulative dosage divided by duration of therapy in hours) were significantly higher in the group with hypotension (P=.005 and P=.002, respectively). All hypotensive neonates were exposed to a last dosage rate of at least 8mg/h. Maternal HELLP syndrome was diagnosed more often in hypotensive compared to normotensive neonates (P=.048).Conclusion: In utero exposure to ketanserin lowers the blood pressure of the neonate. The risk of hypotension is associated with the last dosage rate of maternal ketanserin treatment and the co-existence of maternal HELLP syndrome.

Obstetric and neonatal outcome after surgical treatment of cervical dysplasia

Marie Van Hentenryck, Jean Christophe Noel, Philippe Simon — 2012-02-16

Abstract: Objectives: Conization is the gold standard today for the management of severe cervical dysplasia. However, with the increasing delay until first pregnancy, obstetric follow-up of patients with a history of conization is a growing concern.Study design: Retrospective case–control study using data from the electronic database of a university hospital. We compared the obstetric and neonatal outcome of 106 pregnancies delivered after conization with the outcome of 212 pregnancies of patients with no history of conization.Results: A significant reduction in the mean gestational age at delivery (38.23±2.51 weeks vs. 39.15±1.56 weeks) was observed, together with a higher rate of premature rupture of the membrane (9.4% vs. 1.9%), premature onset of labor (9.4% vs. 2.4%), premature delivery (17% vs. 3.8%) and neonatal hospitalization (17.9% vs. 6.6%) in the group of patients with history of conization. Children born to women who had surgery had a significantly lower birth weight (3146.9±611g vs. 3347.3±502g) and size (49.1±2.6cm vs. 50.0cm±2.2cm) than those of the control group. Furthermore, these children were more frequently admitted in the neonatal intensive care unit (22.6% vs. 10.4%, p=0.004).Conclusions: Conization is an important risk factor for premature birth and women with a history of conization require cautious obstetric management during pregnancy. Anti-HPV vaccination and proactive surveillance of low-grade or moderate dysplasia, instead of immediate surgery, should be encouraged in young patients.

Effect of delayed umbilical cord clamping on blood gas analysis

2012-02-16

Abstract: Objective: To ascertain if there are differences in umbilical cord blood gas analysis between immediate and delayed cord clamping.Study design: In a prospective observational study on 60 vaginally delivered healthy term newborns, we sampled umbilical cord blood immediately after delivery and at the time umbilical cord pulsation spontaneously ceased.Results: There were significant decreases in pH, oxygen saturation (sO2), glycemia, oxygen content (ctO2), bicarbonate (HCO3−) and base excess (BE). Lactate and increased. Delayed cord clamping pH correlated with immediate cord clamping pH, , ctHb, sO2 and time (r2=0.77, p<0.000). Delayed cord clamping lactate was associated with immediate cord clamping lactate and time (r2=0.83, p<0.000). Delayed BE was associated with previous pH, lactate, glycemia, ctHb and time (r2=0.83, p<0.000).Conclusions: Delayed cord clamping alters acid–base parameters and lactate values compared to immediate cord clamping. Those variations depend mainly on time, prior pH and lactate.

Acute antepartum pyelonephritis in pregnancy: a critical analysis of risk factors and outcomes

2012-02-17

Abstract: Objective: To test the incidence and sonographic parameters of pyelonephritis during pregnancy, and to examine risk factors and pregnancy outcomes of women with acute antepartum pyelonephritis.Study design: A retrospective population-based study comparing all singleton pregnancies of patients with and without acute antepartum pyelonephritis was performed. Patients lacking prenatal care as well as multiple gestations were excluded from the study. Multiple logistic regression models were used to control for confounders.Results: Out of 219,612 singleton deliveries in 1988–2010, 165 women (0.07%) suffered from acute antepartum pyelonephritis. Abnormal sonographic findings were found in 85.7% of the patients with pyelonephritis. Pyelonephritis was significantly associated with nulliparity (46.1% vs. 24.4%, p<0.001), younger maternal age (26.3±6.0 vs. 28.6±5.8 years, p<0.001), intrauterine growth restriction (IUGR) (6.7% vs. 2.1%, p<0.001), placental abruption (3.6% vs. 0.7%, p<0.001), low 1min Apgar scores (10.3% vs. 6.0%, p<0.05), urinary tract infection (UTI) (4.2% vs. 0.4%, p<0.001) and preterm delivery (less than 37 weeks gestation; 20.0% vs. 7.8%; p<0.001). Using a multivariable analysis, independent risk factors for acute antepartum pyelonephritis were nulliparity (OR 2.0; 95% C.I 1.4–2.9; p<0.001), UTI (OR 10.3; 95% C.I 4.8–22.1; p<0.001) and younger maternal age (OR 0.96; 95% C.I 0.93–0.99; p=0.009). Using another multivariable analysis, with preterm delivery as the outcome variable, acute antepartum pyelonephritis was found as an independent risk factor for preterm delivery (OR 2.6; 95% C.I 1.7–3.9; p<0.001).Conclusion: Acute antepartum pyelonephritis is associated with adverse perinatal outcomes and specifically is an independent risk factor for preterm delivery.

Impact of non-invasive fetal RhD genotyping on management costs of rhesus-D negative patients: results of a French pilot study

2012-02-20

Abstract: Objectives: Fetal rhesus D (RhD) status determination using circulating cell-free fetal DNA from maternal plasma or serum is now recognized in Europe as a reliable and useful tool. A few countries are presently using this test in their management policy of rhesus D negative patients. The objective of this study is to evaluate the impact of this test on the costs of managing RhD-negative pregnant women, whether or not they are allo-immunized.Study design: A prospective follow-up of rhesus D negative women during their pregnancy was performed in three French obstetric departments. Non-invasive fetal RhD genotyping was performed in the first trimester and pregnancies were followed The costs of all procedures (biological tests and medication) associated with patient management in relation to their RhD-negative status were calculated according to different management options.Results: A comprehensive follow-up, including medical and biological monitoring, was obtained for 99 of the 101 patients included in the study. Patients were separated into two groups: the “Adverse Event” group (AE, n=23) for which a potentially sensitizing event occurred and the “No Adverse Event” group (NAE, n=76). Fetal RhD status was accurately determined in all cases. The mean cost per patient was estimated at 237€ (range: 115–644) with differences observed depending on the group, notably 331€ (range: 236–644) for the AE group and 208€ (range: 115–366) for the NAE group. Various cost simulations were performed according to various policies of allo-immunization antenatal prophylaxis. Variations ranged from +36.2% to +105.3%.Conclusion: This study demonstrates that fetal RhD genotyping early during pregnancy is not an effective cost-reduction strategy whether or not antenatal prophylaxis is given. The economic issues could, however, be overcome by the fact that there is a major clinical benefit to offering the test systematically to all RhD-negative pregnant women while avoiding unnecessary testing and immunoglobulin injections.

Post-mortem examination after stillbirth: views of UK-based practitioners

2012-02-24

Abstract: Objectives: Worldwide, around four million stillbirths occur annually. The UK was recently ranked as 33rd out of 35 developed nations for stillbirth rates. The reasons for many stillbirths remain unexplained. Post-mortem examination (PME) can provide information for grieving families, and for future pregnancies. Rates of consent for PME are decreasing in the UK. The views of professionals may influence their approach to bereaved families, and, therefore, rates of consent. Arguably, obtaining qualitative insights into emotive areas such as PME from large numbers of practitioners is increasingly possible as electronic surveys become more sophisticated. Therefore we aimed to describe, using electronic media, the views of UK obstetricians, midwives and perinatal pathologists about PME for stillbirth.Study design: 10,000 UK midwives, 1136 UK obstetricians and all 40 UK perinatal pathologists received a link to an Internet survey via their professional organizations. A box was included for free-text responses. Iterative thematic analysis generated five themes and a ‘line of argument’ synthesis.Results: 683 midwives, 98 obstetricians, and 11 perinatal pathologists provided open comments, generating five themes and the following line of argument: both professional views and family decision-making about postmortem after stillbirth are affected by the education and training of staff, local resources, and the quality of information available. All of these structural issues are interpreted by individual staff, women and families through personal beliefs and emotions, and professional and social discourses.Conclusions: Internet-based surveys can generate valuable qualitative data. Effective decision-making for post-mortem after stillbirth may be improved by the introduction of user-friendly information and consent procedures, and staff training that takes account of existing innovations, and of the emotions and prior experiences of both staff and parents.

Quality of life of early school-age French children born preterm: a cohort study

2012-03-05

Abstract: Objectives: To describe the health-related quality of life (HRQL) of a cohort of children aged 6–10 years who were born preterm; and to determine whether sociodemographic factors, neonatal features and neurocognitive status were affecting their HRQL.Study design: All singleton infants born between 24 and 32 weeks of gestation between January 1997 and December 2001 at the study hospital, who were still alive in 2007 (age 6–10 years), and who had undergone complete clinical paediatric follow-up were included in the study. Maternal and perinatal data were obtained by chart review and regular clinical examination. The ‘Battery for Rapid Evaluation of Cognitive Functions’ (BREV) was used for cognitive evaluation when children were aged 4–8 years. HRQL data were collected in 2007 using the ‘Vécu et Santé Perçue de l’Adolescent et de l’Enfant’ (VSP-A) questionnaire (parent version). The HRQL of the preterm children was compared with that of a French reference population.Results: Of 202 children who fulfilled the inclusion criteria, 82 children participated in the study. Their mean age was 7.9 years [standard deviation (SD) 1.4], mean birth weight was 1130.0g (SD 361.4), 23 children were born before 28 weeks of gestation, 46 were female and 11 had major neurocognitive disorders. These data were not significantly different for the non-respondents (n=120). Parents of preterm children reported a significantly lower perception of HRQL of their child compared with parents of children in the reference population, as reflected by VSP-A global index scores and scores for the ‘body image’, ‘vitality’, ‘psychological well-being’ and ‘school performance’ dimensions. In multivariate analyses, three factors were found to be significantly associated with at least one dimension in the VSP-A scale in the preterm children: presence of major neurocognitive disorders, negatively correlated with ‘vitality’, ‘relationships with friends’, ‘physical well-being’ and ‘school performance’ dimensions; maternal parity, positively correlated with the ‘psychological well-being’ dimension; and socio-economic status of family, positively correlated with the ‘relationships with friends’ dimension. The maximum R2 was 15%.Conclusion: In addition to neurocognitive disorders, other variables such as socio-economic status of the family have a significant impact on the HRQL of preterm children at 6–10 years of age. Given the low proportion of variability in HRQL explained by the models, there is a need to explore other factors (e.g. environmental).

How deviations from STAN guidelines contribute to operative delivery for suspected fetal distress

Mona Massoud, Fanny Bloc, Pascal Gaucherand, Muriel Doret — 2012-02-27

Abstract: Objective: To evaluate how deviations from STAN guidelines contribute to operative delivery for suspected fetal distress in a high-risk population.Study design: This retrospective cohort study was conducted in a tertiary referral center with about 3000 deliveries a year. During the study period, STAN usage rate was 15.2%. All consecutive patients monitored with STAN who had an operative delivery for suspected fetal distress were included in the index group. Patients who delivered spontaneously or had an operative delivery for any reason other than suspected fetal distress were included as controls. Case review was performed by three referent obstetricians for STAN technology blinded to neonatal outcomes. Main outcome was agreement between decision made and decision recommended by STAN clinical guidelines. Secondary outcomes were reasons explaining guideline deviation and ST event to birth interval in cases with a significant ST event.Results: Eighty-three patients were included in each group. Decision made was consistent with STAN clinical guidelines in 124 patients (74.7%): 50 patients (60.2%) in the index group and 74 patients (89.2%) in the control group (p<0.05). Among these patients, no fetal metabolic acidosis was reported. Decision made was not consistent with STAN labor management guidelines in 42 patients (24.3%): 33 patients (39.8%) in the index group and 9 (10.8%) in the control group (p<0.05). Including ST event to birth interval, interventions were outwith STAN clinical guidelines in 51.4% of patients with suspected fetal distress. CTG misclassification was involved in over 75% of cases.Conclusion: STAN guideline deviations contribute to an increased operative delivery rate in patients with suspected fetal distress and normal neonatal outcomes. Guideline deviations are more frequent in patients with suspected fetal distress than in controls. CTG misclassification was the leading cause of guideline deviation. STAN guideline deviations may contribute to alter STAN specificity.

Repeat transvaginal ultrasound-guided ovarian interstitial laser treatment improved the anovulatory status in women with polycystic ovarian syndrome

2012-02-27

Abstract: Objective: To assess the effectiveness of repeated transvaginal ultrasound-guided ovarian interstitial laser treatment in the management of anovulatory patients with polycystic ovary syndrome (PCOS).Study design: A retrospective study was performed in our department on 27 anovulatory PCOS women who failed to respond to the first ultrasound-guided transvaginal ovarian interstitial laser treatment. Each woman received a repeat procedure and postoperative rates of ovulation and pregnancy were monitored.Results: Of 27 patients, 18 (66.67%) ovulated spontaneously following the repeated ultrasound-guided transvaginal ovarian interstitial laser treatment Ten women became pregnant within six postoperative months and a cumulative pregnancy rate of 37.04% was achieved. There were no significant operative complications.Conclusion: Repeated ultrasound-guided transvaginal ovarian interstitial laser treatment is an effective and safe management in anovulatory PCOS patients who fail to respond or have a transient response to the first transvaginal ovarian interstitial laser treatment.

Are plasma levels of visfatin and retinol-binding protein 4 (RBP4) associated with body mass, metabolic and hormonal disturbances in women with polycystic ovary syndrome?

2012-02-29

Abstract: Objective: To analyze potential interactions of visfatin and retinol-binding protein 4 (RBP4) levels with body mass, metabolic, and hormonal status in normal weight and obese women with PCOS.Study design: Body composition was determined by bioimpedance in 83 women (44 obese) diagnosed with PCOS and in 67 women (36 obese) without PCOS. In addition, serum glucose, lipids, androgens, FSH, LH, SHBG, insulin, visfatin, and RBP4 were measured in a fasting state and the free androgen index (FAI) was calculated, as was insulin resistance using the HOMA-IR assessment.Results: Plasma RBP4 levels were significantly higher in women of normal weight compared to obese subjects when both were diagnosed with PCOS (14.1±4.6 vs.10.9±4.5ng/mL, p<0.001); while in non-PCOS subjects the opposite was found (10.8±4.5 vs. 18.4±11.6ng/mL, p<0.01; respectively). Plasma visfatin levels were similar in PCOS and non-PCOS subjects. In non-PCOS subjects, positive correlations between RBP4 level and anthropometric parameters were observed. In PCOS, RBP4 levels inversely correlated with serum insulin levels and HOMA-IR values. No correlation was found between plasma visfatin levels and anthropometric parameters in all study groups. Similarly, no correlation was found in PCOS and non-PCOS subgroups. Additionally, there was an inverse correlation between RBP4 and LH concentrations and LH/FSH ratio in all study subjects.Conclusions: Plasma visfatin level is not a useful biomarker of insulin resistance and hyperandrogenism. RBP4 level reflects visceral body fat content in non-PCOS women. Decreasing RBP4 release along with increasing insulin resistance and hormonal disturbances may be a compensatory mechanism preventing deterioration in obese PCOS.

Does it really matter how far from the fundus embryos are transferred?

Peter Kovacs, Attila Sajgo, Ferenc Rarosi, Steven G Kaali — 2012-03-07

Abstract: Objective: Embryo transfer (ET) is an important last step during the process of IVF. Over the years much has been learned about the importance of the details of this procedure including the potential impact of transfer depth on outcome. The objective of our study was to evaluate whether transfer depth assessed by air bubble location after ET is associated with clinical outcome.Study design: Retrospective analysis of the association between transfer distance from the fundus (assessed by air bubble location after ET) and IVF outcome based on cycles (N=409) of patients with good prognosis undergoing infertility treatment for various indications. Treatments followed standard stimulation, IVF-ICSI and ET procedures. The distance of the air bubble as a surrogate marker of embryo location after transfer was measured and was correlated with implantation (IR) and pregnancy rates (PR) after day 3 and day 5 ET. Univariate comparisons were performed by nonparametric methods and multiple logistic regression was used to further evaluate the association between pregnancy rate and those factors that might influence outcome.Results: The distance of the bubble was similar in those cycles that led to a pregnancy and those that did not (6.7 vs 6.5mm; p=0.48) and PR were comparable when the transfer was in the upper or middle third of the cavity. The IR did not differ when embryos were transferred into the upper, middle or lower third of the uterine cavity. Outcome was analyzed separately based on the day of transfer (cleavage vs blastocyst stage) and the IR did not differ based on the location of the transfer.Conclusions: Transfer depth does not affect implantation and pregnancy rates when the ET is in the middle or upper third of the uterus.

Salpingectomy for ectopic pregnancy by transumbilical single-site laparoscopy with the SILS® system

2012-01-27

Abstract: Objective: To evaluate the feasibility in everyday practice and the advantages of salpingectomy for ectopic pregnancy by single-incision laparoscopic surgery with the SILS® system.Study design: This single-center prospective observational study included 37 women requiring salpingectomy for ectopic pregnancy who underwent single-incision laparoscopic salpingectomy with the SILS® system. Information about feasibility and intra- and post-operative data were collected. The data for these patients were compared with those of a control group of 40 women treated by standard laparoscopy.Results: Thirty-six (97%) patients were treated successfully with the SILS® system. After laparoscopic confirmation of the ectopic pregnancy, salpingectomy was performed with bipolar forceps and scissors. In one case, conversion to classic laparoscopy was performed because SILS was not feasible. Compared with the control group, operative time was longer (50±35 vs 35±30min, p=0.001) but duration of hospitalization shorter with single-site laparoscopy (1.5±1.5 vs 2.3±1.5 days, p=0.02).Conclusions: Laparoscopic salpingectomy for ectopic pregnancy appears to be feasible in everyday practice by single-incision laparoscopic surgery with the SILS® system and appears to reduce the duration of hospitalization. Larger series are necessary to confirm this conclusion.

Does single-port access (SPA) laparoscopy mean reduced pain? A retrospective cohort analysis between SPA and conventional laparoscopy

2012-01-27

Abstract: Objective: To compare perioperative outcomes, including pain, between single-port access (SPA) and conventional laparoscopy in patients with presumed benign gynecological adnexal diseases.Study design A retrospective cohort study was performed at Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea. All operations in each group were performed consecutively by a single surgeon.Results: A total of 188 patients were enrolled, with 94 patients per group. Baseline characteristics before surgery were similar between groups. Visual analogue scale pain scores 24h after laparoscopy were lower in the SPA group than in the conventional laparoscopy group (2, 0–7 vs. 3, 2–6 P=0.006). In addition, we found that the SPA group had less supplementary analgesic use (parenteral Ketoprofen intramuscular injection, 1 ampule=100mg) per patient after surgery compared to that in the conventional group (1 ampule, 0–7 vs. 2 ampule, 0–6, P=0.010).Conclusions: These results add to the evidence suggesting an advantage of SPA laparoscopy over conventional laparoscopy in terms of decreasing postoperative pain. Additional large, randomized controlled trials are needed to confirm these findings and to investigate long-term outcomes such as quality of life and cosmesis.

Simple ovarian cysts in postmenopausal women: scope of conservative management

Madhutandra Sarkar, Mark G. Wolf — 2012-02-02

Abstract: Objective: This study was done to evaluate/investigate the natural history of simple ovarian cysts in postmenopausal women and to determine the risk for malignant transformation of these cysts.Study design: Ultrasound reports of all the postmenopausal women who attended St. Francis Hospital and Medical Center, Hartford, USA from January 1997 to April 2010 with an ultrasound diagnosis of simple cysts of ovary were reviewed retrospectively. A total of 619 patients with 743 simple ovarian cysts were evaluated. It was found that 305 out of 619 patients (49.27%) were lost in follow-up. Therefore, 314 patients (50.73%) with 378 cysts could be followed further by ultrasound study.Results: One hundred and seventy-five (46.30%) of the 378 cysts that could be followed further had spontaneous resolution and 166 cysts (43.91%) persisted unchanged over the follow-up period. Thirty cysts (7.94%) turned into complex cysts and four cysts (1.06%) significantly increased in size. One cyst significantly decreased in size, though it did not resolve. Only one patient developed papillary serous carcinoma (high grade) of the ovary. This occurred three years after her last ultrasound for simple cyst surveillance.Conclusion: Simple ovarian cysts during the menopause can be followed conservatively because their risk for malignant transformation is low. The majority of these cysts either resolve spontaneously or persist unaltered on follow-up.

The surgical management of complications of vulval lichen sclerosus

Mahalakshmi Gurumurthy, Nneka Morah, Giorgio Gioffre, Margaret E. Cruickshank — 2012-02-13

Abstract: Objective: To review the surgical procedures used to treat the complications of vulval lichen sclerosus at a single tertiary referral institution in north-east Scotland over a ten year period.Study design: A retrospective case note review of women who had surgery for ano-genital lichen sclerosus at Aberdeen Royal Infirmary between January 1999 and December 2009.Results: The total number of women was 25 and the two most common procedures were Fenton's procedure (median perineotomy) and laser division of adhesions. Initial surgery resulted in an improvement of symptoms for 80% of women.Conclusions: When surgery for vulval lichen sclerosus is reserved for highly selected cases where there are complications secondary to adhesions, the proportion of women benefiting is high.

Prevalence of premenstrual syndrome and premenstrual dysphoric disorder in a population-based sample in China

2012-02-16

Abstract: Objective: To investigate the prevalence of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), and the frequency and severity of the symptoms in a population-based sample of Chinese women of reproductive age.Study design: Women aged 18–45 years were screened for suspected PMS and PMDD based on the ACOG recommendations for a diagnosis of PMS and diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV). For those who were consistent with PMS diagnostic criteria, the daily record of severity of problems (DRSP) questionnaire was used to assess the symptoms prospectively over 2 months. Participants were then categorized as having no perceived symptoms, mild PMS, moderate PMS, and PMDD, based on a validated algorithm.Results: Among the study group, the incidence of PMDD was 2.1% and PMS was 21.1%. The most common symptoms were irritability (91.21%), breast tenderness (77.62%), depression (68.31%), abdominal bloating (63.70%) and angry outbursts (59.62%).Conclusion: The prevalence of PMS/PMDD and the frequency and severity of the symptoms have their own characteristics in Chinese women.

Diameter of dominant leiomyoma is a possible determinant to predict coexistent endometriosis

Wataru Isono, Osamu Wada-Hiraike, Yutaka Osuga, Tetsu Yano, Yuji Taketani — 2012-02-16

Abstract: Objective: To identify the frequency and assess risk factors for unexpected discovery of peritoneal endometriotic implants in patients who underwent myomectomy or hysterectomy for symptomatic uterine leiomyomas.Study design: We retrospectively collected medical records of 829 patients with symptomatic leiomyomas in The University of Tokyo Hospital. All the patients underwent abdominal or laparoscopic surgeries between January 2001 and December 2010 and the presence or absence of endometriosis during surgery was analyzed. Possible determinant to predict coexistent endometriosis was statistically investigated.Results: In total, 105 leiomyoma cases (12.7% in 829 patients) were diagnosed with endometriosis. Patients with small dominant leiomyomas were significantly complicated by peritoneal endometriotic implants (small leiomyomas were classified as <8cm). The patients with both diagnoses were more likely to be infertile and at age 39 years or younger than those with leiomyoma alone.Conclusions: Women undergoing myomectomy or hysterectomy with both endometriosis and leiomyomas have several different clinical features compared with women with only leiomyomas. The size of largest leiomyoma may provide an important clue for coexistent endometriosis. Women with substantial infertility despite a smaller leiomyomas burden may be more likely to have a surgical indication for concomitant endometriosis.

A historical cycle control comparison of two drospirenone-containing combined oral contraceptives: ethinylestradiol 30μg/drospirenone 3mg administered in a 21/7 regimen versus ethinylestradiol 20μg/drospirenone 3mg administered in a 24/4 regimen

Joachim Marr, Christoph Gerlinger, Michael Kunz — 2012-02-15

Abstract: Objectives: To compare the bleeding patterns and cycle control of an oral contraceptive (OC) containing ethinylestradiol (EE) 30μg/drospirenone (drsp) 3mg administered in a 21/7 regimen versus a lower-dose OC containing EE 20μg/drsp 3mg administered in a 24/4 regimen, using data from two identically designed studies.Materials and methods: In the first study, 326 healthy women (18–35years) received EE 30μg/drsp 3mg in a 21/7 regimen. In the second study, 1027 healthy women (17–36years) received EE 20μg/drsp 3mg in a 24/4 regimen. Participants recorded bleeding using daily completed diaries over 13 treatment cycles.Results: During cycles 1–12, the prevalence of scheduled withdrawal bleeding was lower with EE 20μg/drsp 3mg 24/4 than with EE 30μg/drsp 3mg 21/7 (82.0–91.7% versus 94.8–100.0% of women, respectively); moreover, a higher proportion of women reported a maximum intensity of light scheduled withdrawal bleeding with EE 20μg/drsp 3mg 24/4 than with EE 30μg/drsp 3mg 21/7 (30.9–39.0% versus 13.8–20.5% of women, respectively). In cycles 2–13, unscheduled intracyclic bleeding was reported by 7.7–13.8% of EE 20μg/drsp 3mg 24/4 recipients and 3.8–7.9% of EE 30μg/drsp 3mg 21/7 recipients; these were mainly single bleeding days. During reference periods 1–4, the mean number of bleeding episodes was similar between groups (3.1–3.3 episodes with EE 20μg/drsp 3mg 24/4 versus 3.2 episodes with EE 30μg/drsp 3mg 21/7).Conclusions: A low-dose 24/4 regimen OC containing EE 20μg/drsp 3mg is generally comparable in terms of bleeding to a higher-dose 21/7 regimen OC containing EE30μg/drsp 3mg. Between-treatment differences in bleeding intensity and unscheduled intracyclic bleeding rates were observed.

Association between endometriosis and polymorphisms in insulin-like growth factor binding protein genes in Korean women

Hoon Kim, Seung-Yup Ku, Seok Hyun Kim, Young Min Choi, Jung Gu Kim — 2012-02-15

Abstract: Objective: Genetic factors are known to be associated with the development and progression of endometriosis, but the genes related to endometriosis have not been defined. Insulin-like growth factor binding proteins (IGFBPs) are believed to be involved in the proliferation and apoptosis of cells that play an important role in the pathophysiologic mechanism of endometriosis. This study aimed to determine the association between endometriosis and polymorphisms of the IGFBP genes in Korean women.Study design: In a case–control study, the rs1995051, rs1065780 and c.759A>G single nucleotide polymorphisms (SNPs) in the IGFBP1 gene and the −672A>G, −202A>C and c.95C>G SNPs in the IGFBP3 gene were analyzed in 128 women with endometriosis and 108 normal control women.Results: The haplotype genotype composed of a combination of three IGFBP1 gene polymorphisms was not related to endometriosis, while the haplotype genotype of the IGFBP3 gene had a significant association with endometriosis. Women not carrying the AAG (−672A/−202A/c.95G) haplotype allele of three IGFBP3 gene polymorphisms have a 3.19-times higher risk of endometriosis compared with women with AAG homozygotes, and this trend was found in women with advanced endometriosis but not in women with early endometriosis.Conclusions: The AAG haplotype allele of the −672A>G, −202A>C and c.95C>G polymorphisms in the IGFBP3 gene may be associated with advanced endometriosis in Korean women.

Cost-minimisation analysis of endometrial thermal ablation in a day case or outpatient setting under different anaesthesia regimens

Sari Ahonkallio, Markku Santala, Hannu Valtonen, Hannu Martikainen — 2012-02-20

Abstract: Objective: To evaluate the cost difference between a daycase endometrial thermal ablation performed under general anaesthesia and an outpatient endometrial ablation using local anaesthetic.Study design: Calculations using real reported resource use in 20 daycase procedures and 16 outpatient procedures.Results: The costs were 1865 euros for daycase procedure versus 1065 euros for outpatient procedure.Conclusion: The cost of endometrial thermal ablation can be considerably minimised by taking the procedure out of the theatre and performing it under local anaesthetic instead of general anaesthesia. This setting makes endometrial thermal ablation cost-effective.

Peritoneal tuberculosis mimicking ovarian cancer

2012-03-01

Abstract: Objective: To evaluate the characteristics of 20 patients diagnosed as tuberculous peritonitis (TBP) mimicking ovarian cancer during a 10-year period at a single center.Study design: Among 612 operations for ovarian malignancy we retrospectively reviewed the surgical and pathological reports of 20 patients suspected preoperatively as having ovarian malignancy but whose pathological results revealed TBP, between 2000 and 2011 in a university clinic. Demographic characteristics, physical and pelvic examination, laboratory investigations and radiological imaging of the patients were evaluated retrospectively.Results: Diagnostic laparotomy, laparoscopy and ultrasound guided tru-cut biopsy were performed in 11, 2 and 7 of the 20 patients, respectively. The mean age of the patients was 37.5±17.3 years (range 16–70 years). The most common symptoms were abdominal pain (n=14%, 70%) and abdominal distension (n=13%, 65%). Serum CA 125 was elevated in 16 (80%) cases and the average CA 125 level was 289±186.2IU/ml. During ultrasonographic imaging and CT scans, ascites and a pelvic mass were detected in 19 (85%) and 12 (60%) patients respectively. TBP was suspected in 7 (35%) patients and ultrasound guided tru-cut biopsy was preferred as a first-line approach. Surgery was performed in 11 patients (55%) and during exploration widespread miliary nodules (n=9%, 81%), widespread adhesion (n=5%, 45%), adnexal mass (n=8%, 72%) and caseous necrotic substance (n=4%, 36%) were observed. Patients underwent unilateral (n=3% 27%) or bilateral (n=4%, 36%) salpingo-oophorectomy in seven (63%) cases.Conclusion: Since ovarian cancer is a serious condition and preoperative diagnosis of TBP is difficult, laparotomy is usually mandatory to distinguish these two entities. Ultrasound guided tru-cut biopsy is useful in selected patients and frozen section analysis avoids hazardous radical surgery at operation.

Theories of urinary incontinence causation: aetiological descriptions by sub-Saharan African women

2012-02-17

Abstract: Objective: To describe the perceived causes of urinary incontinence (UI) and factors associated with awareness of causes of UI among women in the community.Study design: Secondary analysis of data extracted from the Ibadan Urinary Incontinence Household Survey (IUIHS), a multi-stage community survey conducted among 5001 women in Nigeria.Results: The mean age was 34.8 years (SD=14.2). The majority had at least secondary education and were currently married. Within this population, 13% had ever leaked urine. On their perception of possible aetiological factors of UI, 20.5% mentioned pelvic floor or bladder-related causes such as stress incontinence triggers and bladder problems; 14.6% mentioned uncontrollable factors such as medical comorbidity, age and prior surgery; 8.8% attributed the cause to being female; and 6.8% mentioned sex-related factors. Multiple logistic regression analysis revealed significantly lower odds of awareness of the aetiology of urinary incontinence among women aged less than 30 years, those with lower level of education, rural women, those with five or more children and women without history of urine leakage.Conclusions: The study shows a low level of awareness of possible cause of UI amongst women surveyed. We recommend health education and mobilization of women on the right aetiological factors of UI.

The use of synthetic mesh in vaginal prolapse surgery: a survey of Dutch urogynaecologists

E.J.M. Lensen, M.I.J. Withagen, J.A. Stoutjesdijk, K.B. Kluivers, M.E. Vierhout — 2012-02-27

Abstract: Objective: To evaluate the use of mesh in vaginal prolapse surgery amongst members of the Dutch Urogynaecologic Society.Study design: A questionnaire evaluating the use of mesh vs. native tissue repair in vaginal prolapse surgery was sent out by email to all members. Some specific questions on standard measures of infection prevention were included.Results: One hundred and thirty-three completed questionnaires were received. The response rate was 65%. Seventy-one percent of respondents stated that they apply use synthetic meshes in their patients. The mean percentage of mesh use in overall vaginal pelvic organ prolapse surgery was 14%. Most responders use mesh in recurrent surgery only. Prolift® is the most commonly used brand. All women received prophylactic antibiotics. Although only half of the respondents changed gloves.Conclusions: Meshes are commonly used in the Netherlands. The major indication is repair of a recurrent prolapse.

Ruptured ectopic pregnancy 11 years after supracervical hysterectomy: a case report

R. Anupama, T.R. Haleema Beegum, R.N. Indu — 2012-02-06

After hysterectomy ectopic pregnancy is a very rare phenomenon. Wendeler in 1895 was the first to describe the occurrence of ectopic pregnancy after hysterectomy. Since then 55 cases have been reported . There are only three previous case reports of ectopic pregnancy occurring after supracervical hysterectomy: of these, one was immediate and two were 3 years and 6 years after the hysterectomy . We report a case of tubal ectopic pregnancy occurring 11 years after supracervical hysterectomy.

Rapid growth of parasitic myoma in early pregnancy: previously undescribed manifestation of a rare disorder after laparoscopic-assisted myomectomy

Akihiro Takeda, Sanae Imoto, Masahiko Mori, Junko Yamada, Hiromi Nakamura — 2012-02-13

A 27-year-old unmarried nulligravida with hypermenorrhea and lower abdominal distension received gasless laparoscopic-assisted myomectomy for a symptomatic intramural myoma, 11cm in diameter, in the posterior wall of the uterus (A and B). Extraction of the myoma node was performed through a suprapubic incision with tissue morcellation by cold knife. Two years later, a solitary asymptomatic solid mass, 1.4cm in diameter was identified in the retrovesical area (C, arrow). Over the next two years it did not markedly change its size.

Valsalva retinopathy secondary to hyperemesis gravidarum

Louise A.H. Ramskold, Riaz H. Asaria — 2012-02-27

Valsalva retinopathy is a condition in which increased intraocular venous pressure causes rupture of fragile retinal capillaries and subsequent detachment of the internal limiting membrane, causing subhyaloid (preretinal), intraretinal or vitreous haemorrhages. The pressure rise is secondary to rapid rises in intra-abdominal or intra-thoracic pressures during Valsalva manoeuvres—such as forceful straining in labour or when lifting, coughing or vomiting .

Ischemic stroke after ovulation induction in a patient with cardiac and thrombophilic abnormalities

2012-02-27

We found that ovarian hyperstimulation syndrome (OHSS) is a potentially lethal and disabling complication of ovulation induction, especially in female with polycystic ovaries (PCO) and other predisposing conditions. Indeed, it has been shown that finding PCO before assisted reproduction identifies a population at special risk of OHSS and is an opportunity for primary prevention of OHSS .