History Of Vaginal Delivery Research Articles

Dilapan-S versus Phloroglucinol for Cervical Dilatation in Operative Hysteroscopy and Polyp Resection: A Prospective Cohort Study

Background: To compare the effects of Dilapan-S versus phloroglucinol on cervical dilation in hysteroscopic polyp resection. Methods: This prospective, observational study enrolled non-menopausal patients with endometrial polyps who underwent operative hysteroscopy for transcervical polyp resection between October 2021 and October 2022. The patients were given Dilapan-S or phloroglucinol for cervical dilation. The primary outcome was cervical dilation time; secondary outcomes included cervical softening and adverse events. Non-inferiority was prespecified with a margin of 6 seconds. Results: Among 105 included patients, 55 were given phloroglucinol and 50 Dilapan-S. There were no significant differences in age, body mass index (BMI), history of vaginal delivery, hysteroscopic electrotomy, and cervical conization between the two groups (all p > 0.05). The cervical dilation time in the Dilapan-S group was shorter than in the phloroglucinol group (41.74 ± 8.68 s vs. 62.04 ± 9.55 s, non-inferiority p < 0.001). Also, more patients achieved highly effective cervical softening in the Dilapan-S group compared to the phloroglucinol group (44/50 vs. 1/55, p < 0.001). There were 4 cases of diarrhea (p = 0.103), 12 cases of vaginal bleeding (p < 0.001), and 4 cases of abdominal pain in the Dilapan-S group (p = 0.103), and none in the phloroglucinol group. There were also 5 cases of intraoperative water leakage in the phloroglucinol group and 8 cases in the Dilapan-S group (p = 0.283). Conclusions: Dilapan-S is found to be equally effective for cervical dilation as phloroglucinol; however, it is associated with a higher incidence of diarrhea, vaginal bleeding, and abdominal pain complications.

Recent trends in term trial of labor after cesarean by number of prior cesarean deliveries

Cesarean delivery is a major source of maternal morbidity, and repeat cesarean delivery accounts for 40% of cesarean delivery, but recent data on the trial of labor after cesarean and vaginal birth after cesarean are limited. This study aimed to report the national rates of trial of labor after cesarean and vaginal birth after cesarean by number of previous cesarean deliveries and examine the effect of demographic and clinical characteristics on these rates. This was a population-based cohort study using the US natality data files. The study sample was restricted to 4,135,247 nonanomalous singleton, cephalic deliveries between 37 and 42 weeks of gestation, with a history of previous cesarean delivery and delivered in a hospital between 2010 and 2019. Deliveries were grouped by number of previous cesarean deliveries (1, 2, or ≥3). The trial of labor after cesarean (deliveries with labor among deliveries with previous cesarean delivery) and vaginal birth after cesarean (vaginal deliveries among trial of labor after cesarean) rates were computed for each year. The rates were further subgrouped by history of previous vaginal delivery. Year of delivery, number of previous cesarean deliveries, history of previous cesarean delivery, age, race and ethnicity, maternal education, obesity, diabetes mellitus, hypertension, inadequate prenatal care, Medicaid payer, and gestational age were examined concerning the trial of labor after cesarean and vaginal birth after cesarean using multiple logistic regression. SAS software (version 9.4) was used for all analyses. The trial of labor after cesarean rates increased from 14.4% in 2010 to 19.6% in 2019 (P<.001). This trend was seen in all categories of number of previous cesarean deliveries. Moreover, vaginal birth after cesarean rates increased from 68.5% in 2010 to 74.3% in 2019. The trial of labor after cesarean and vaginal birth after cesarean rates were the highest for deliveries with a history of both 1 previous cesarean delivery and a vaginal delivery (28.9% and 79.7%, respectively) and the lowest for those with a history of ≥3 previous cesarean deliveries and no history of vaginal delivery (4.5% and 46.9%, respectively). Factors associated with the trial of labor after cesarean and vaginal birth after cesarean rates are similar, but several factors have different directions of effect, such as non-White race and ethnicity, which is associated with a higher likelihood of trial of labor after cesarean but a lower likelihood of successful vaginal birth after cesarean. More than 80% of patients with a history of previous cesarean delivery deliver by repeat scheduled cesarean delivery. With vaginal birth after cesarean rates increasing among those who attempt a trial of labor after cesarean, emphasis should be put on safely increasing the trial of labor after cesarean rates.

Association Between Previous Cesarean Section and Subsequent Ectopic Pregnancy: A Comparative Observational Study

Background: The rise in cesarean delivery rates across the world has raised concerns about its potential impact on the outcome of subsequent pregnancies. Among the concerns is the increased risk of ectopic pregnancy, particularly in the tubal or scar site. This study aimed to assess the connection between previous cesarean delivery and subsequent ectopic pregnancy. Methodology: This is a comparative observational study conducted over a period of 1.5 years at Lalla Ded Hospital in Srinagar. The study recruited 148 cases with clinical symptoms of ectopic pregnancy and confirmed diagnosis, along with 4852 matched controls with intrauterine pregnancies. The inclusion criteria comprised women with a previous history of normal vaginal delivery or cesarean section. Patients with a history of ectopic pregnancy, pelvic inflammatory disease, abortions, tubal pathology or surgery, ARTs, and use of intrauterine contraceptive devices were excluded. The data were analyzed using SPSS version 20.0. Results: Out of the 148 eligible cases, 106 (4.2%) had a previous cesarean section, and 42 (1.7%) had a normal vaginal delivery. The odds ratio for women with a previous cesarean section was 2.59 (95% confidence interval= 1.81 to 3.75), which means that they had a 2.59 times higher risk of having subsequent ectopic pregnancy than those with normal vaginal delivery. Conclusion: The study concludes that a previous cesarean section is linked to an increased risk of subsequent ectopic pregnancy. Women with a history of cesarean section should receive close monitoring during early pregnancy to detect and manage ectopic pregnancy promptly. Further research is necessary to identify the underlying mechanisms and develop strategies to reduce the risk of ectopic pregnancy in these women. Keywords: cesarean delivery, ectopic pregnancy, long-term morbidity, risk factors

Prevalence and Correlated Factors of Urinary Incontinence in Geriatic

Abstract. Background. Urinary incontinence is involuntary or uncontrollable urine passing. This is very disruptive, it causes a lot of problems and is often seen as an embarrassing thing. The prevalence of urinary incontinence was found to increase with age. The number in the geriatric population is 22.2%, more significant when compared to the adult population of 12.0%. Objectives. This research aimed to determine the prevalence and factors associated with the incidence of urinary incontinence in geriatric patients at the Haji Adam Malik General Central Hospital and the University of North Sumatra Hospital. Method. This type of research is an analytic observational study with a cross-sectional design. The research sample is determined by consecutive sampling technique using a questionnaire as primary data. Results. Out of 100 respondents, 22 geriatric patients experienced urinary incontinence, with the majority experiencing moderate severity and stress urinary incontinence. Based on bivariate analysis using chi-square found gender (p=0.617), age (p=0.617), overweight (p=&lt;0.001), diabetes mellitus (p=&lt;0.001), hypertension (p=0.001), history of chronic cough (p=&lt;0.001), history of pelvic surgery (p=&lt;0.001), and history of vaginal delivery (0=0.055). Conclusion. There are 22% (22 patients) of geriatric patients experienced urinary incontinence. In this study, the risk factors associated with urinary incontinence are overweight, diabetes mellitus, hypertension, and a history of chronic cough while risk factors that are not found to be associated in this study are age, sex, and history of vaginal delivery.

Can transvaginal cervical length and cervical strain elastography predict mid-trimester medical induction to abortion intervals?

Objective Mid-trimester pregnancy terminations are becoming an increasingly common practice in obstetrics. Accurate prediction of delay from induction to abortion may help in planning the optimal time for the medical induction process and optimising the use of healthcare services. Therefore, we aimed to assess whether the transvaginal cervical length and cervical elastography can predict the time interval from medical induction to abortion in cases of medically indicated mid-trimester pregnancy termination. Materials and methods We performed a prospective observational pilot study between January 2022 and October 2022 in patients who have undergone medically indicated mid-trimester pregnancy termination with a non-dilated cervix for foetal morphological, chromosomal abnormalities or preterm premature rupture of membranes. Cervical length (CL) and cervical strain ratio (CSR) were measured by transvaginal sonography. The predictive value of CL and CSR on the induction to abortion interval was calculated after medical induction with misoprostol. Results Fifty-three eligible pregnant women were evaluated. The mean gestational age at abortion was 17.61 ± 2.81 weeks. The mean time interval from induction to abortion was 31.72 ± 16.57 h. In multivariate linear regression analysis, CL and the history of previous vaginal delivery were the significant independent predictors of the induction to abortion interval (all p < 0.01), with no additional significant contribution from CSR. Conclusion Transvaginal CSR is unlikely to be useful in the prediction of induction to abortion interval in the mid-trimester medically indicated termination of pregnancy. SHORT CONDENSATION Transvaginal cervical length is the significant independent predictor of the induction to abortion interval in the mid-trimester medically indicated termination of pregnancy with no additional significant contribution from cervical strain ratio.

Comparison of the Effects of Vaginal and Cesarean Delivery History on Anxiety Level in a Current Pregnancy-Case Control Study

Objective: This study aims to compare the effects of vaginal delivery (VD) and cesarean section (CS) on anxiety experienced in the subsequent pregnancy. Methods: It was held in Aydın Adnan Menderes University Hospital between 01.06.2013-01.06.2014. Our study is a case-control study. 172 pregnant women were included in the study. The patients were divided into two groups CS and VD, according to the type of delivery that occurred in their previous pregnancy. The Beck Anxiety Inventory (BAI) was applied to each patient. The data of the research were evaluated in SPSS v.15 and Minitab v.13.0 package programs. Results: A total of 172 patients were included in our study, including 86 pregnant women who gave birth with CS in their previous pregnancy and 86 pregnant women who had VD. The average age of pregnant women is 28.23. According to BAI results, 50 (29.1%) of 172 patients had mild anxiety, 40 (23.3%) had moderate anxiety, and 14 (8.1%) had severe anxiety. The number of those who did not show any symptoms is 68. According to BAI, the most common finding in patients was irritability (1.0412) and a sense of bad things will happen (1.0765). When examining whether there is a significant relationship between the previous delivery method and BAI scores, a statistically significant relationship was not found in the relationship study performed with the T-Test (p&gt;0.05). Conclusion: Giving birth with a VD or CS does not affect current pregnancy and birth anxiety.

Risk Factors for Perineal Wound Breakdown in Early Postpartum: A Retrospective Case-Control Study.

We conducted a retrospective case-control study in patients presenting a perineal tear (second degree or higher) or episiotomy complicated by wound breakdown during maternity stay to identify risk factors associated with wound breakdown in early postpartum with a view to improving the quality of care. We collected ante- and intrapartum characteristics and outcomes at the postpartum visit. In all, 84 cases and 249 control subjects were included. In univariate analysis, primiparity, absence of history of vaginal delivery, a longer second phase of labour, instrumental delivery, and a higher degree of laceration emerged as risk factors for early perineal suture breakdown postpartum. Gestational diabetes, peripartum fever, streptococcus B, and suture technique did not emerge as risk factors for perineal breakdown. Multivariate analysis confirmed that instrumental delivery (OR = 2.18 [1.07; 4.41], p = 0.03) and a longer second phase of labour (OR = 1.72 [1.23; 2.42], p = 0.001) were risk factors for early perineal suture breakdown.

Factors Associated With Stress Urinary Incontinence and Diastasis of Rectus Abdominis in Women at 6-8 Weeks Postpartum.

In recent years, pelvic-abdominal dynamics has become a research topic in the field of pelvic floor dysfunction (PFD), and the relationship between diastasis of the rectus abdominis (DRA) and stress urinary incontinence (SUI) has been controversial. The study is helpful to further strengthen perinatal education, accurately identify the risk factors of SUI and DRA, and improve the quality of life of puerperae. This study aimed to investigate the association of SUI and DRA in women with PFD as measured by vaginal palpation or pelvic floor biofeedback machine testing. A total of 301 patients diagnosed with female PFD who were 6-8 weeks postpartum at The Fifth People's Hospital of Zhuhai between May 2018 and April 2021 were enrolled. The prevalence rates and potential influencing factors of SUI and DRA were analyzed. A total of 29.5% (89 of 301) of the patients were diagnosed with SUI, and 31.9% (96 of 301) were diagnosed with DRA. Binary logistic regression showed that a history of delivery ( P = 0.012; odds ratio [OR], 1.982) and vaginal delivery with perineal lacerations or episiotomy ( P = 0.016; OR, 2.187) were risk factors for SUI. High birth weight (weight>4.0 kg, P < 0.001; OR, 14.507) was a risk factor for DRA. A history of delivery and vaginal delivery with perineal lacerations or episiotomy increased the risk of SUI, and high birth weight was an independent risk factor for DRA. Early intervention, including exercise therapy, manual therapy, and neuromuscular electrical stimulation, may be important for patients with PFD having these risk factors.

Risk factors for massive transfusion in obstetrical hemorrhage and consideration of a whole blood program.

Postpartum hemorrhage (PPH) is one of the leading causes of obstetric complications. The goal of this study was to identify risk factors for obstetric (OB) massive transfusion (MT) and determine the feasibility of developing a low-titer group O RhD-positive whole blood (LTO + WB) protocol for OB hemorrhage. A retrospective study of OB patients who received transfusion within 24 h. MT patients were those who received >3 U of pRBC within 1 h or > 10 U in 24 h. Patient demographics, OB history, comorbidities, blood type, antibody status, and known risk factors for PPH and maternal-fetal outcomes were compared. Logistic regression was used for univariate and multivariate analyses. Of the 610 transfused OB patients, 12.0% (n = 73) required MT. Groups were well matched for body mass index (BMI), maternal comorbidities, and history of spontaneous vaginal deliveries. The incidence of the previous cesarean section was higher in the MT group. Exactly 93.9% of patients were RhD-positive and 3.77% of all patients possessed an antibody on pretransfusion testing. Patients with MT had a longer length of stay (LOS), higher rate of intensive care unit (ICU) admission, fetal death, and hysterectomy. Multivariate analysis found age >35, PPH, placenta percreta, accreta, and increta to be significant (p < .05) risk factors for MT. Patients over 35 years and those with abnormal placentation are at increased risk of requiring MT. With a time to delivery of 2 days, potential MT patients can be identified early, and with a 94% rate of RhD-positive+, they are eligible to receive low-titer O whole blood (LTOWB) providing hemostatic resuscitation with reduced donor exposure.

Assessing the predictive accuracy of the new vaginal birth after cesarean delivery calculator

The vaginal birth after cesarean delivery calculator by the Maternal-Fetal Medicine Units Network was created to help providers counsel patients on predicted success of trial of labor after cesarean delivery using individualized risk assessment. The inclusion of race and ethnicity as predictors of vaginal birth after cesarean delivery in the 2007 calculator was problematic and potentially exacerbated racial disparities in obstetrics. Thus, a modified calculator without race and ethnicity was published in June 2021. This study aimed to assess the accuracy of the 2007 and 2021 Maternal-Fetal Medicine Units vaginal birth after cesarean delivery calculators in predicting vaginal birth after cesarean delivery success among racial/ethnic minority patients receiving obstetrical care at a single urban tertiary medical center. All patients with 1 previous low transverse cesarean delivery who underwent a trial of labor at term with a vertex singleton gestation at an urban tertiary medical center from May 2015 to December 2018 were reviewed. Demographic and clinical data were collected retrospectively. Associations between maternal characteristics and success of vaginal birth after cesarean delivery were assessed using univariate and multivariable logistic regression. Predicted vaginal birth after cesarean delivery success rates using the Maternal-Fetal Medicine Units calculator were compared with actual outcomes (ie, successful trial of labor after cesarean delivery/vaginal birth after cesarean delivery vs repeated cesarean delivery) across each racial and ethnic group. A total of 910 patients met eligibility criteria and attempted trial of labor after cesarean delivery; 662 (73%) achieved vaginal birth after cesarean delivery. The rate of vaginal birth after cesarean delivery was highest among Asian women (81%) and lowest among Black women (61%). Univariate analyses demonstrated that success of vaginal birth after cesarean delivery was associated with maternal body mass index <30 kg/m2, history of vaginal delivery, and absence of indication of arrest of dilation or descent for previous cesarean delivery. Multivariate analyses evaluating predictors of vaginal birth after cesarean delivery reported in the 2021 calculator showed that maternal age, history of arrest disorder for previous cesarean delivery, and treated chronic hypertension were not significant in our patient population. Most patients who were of White, Asian, or "Other" race with a vaginal birth after cesarean delivery had a 2007 calculator-predicted probability of vaginal birth after cesarean delivery of >65%, whereas most Black and Hispanic patients with a vaginal birth after cesarean delivery were more likely to have a predicted probability of vaginal birth after cesarean delivery between 35% and 65% (P<.001). Most White, Asian, and Other-race patients with a repeated cesarean delivery had a 2007 calculator-predicted probability of vaginal birth after cesarean delivery of >65%, whereas most Black and Hispanic patients with a repeated cesarean delivery had a predicted probability of vaginal birth after cesarean delivery between 35% and 65%. Across all racial and ethnic groups, most patients with a vaginal birth after cesarean delivery had a 2021 calculator-predicted probability of vaginal birth after cesarean delivery of >65%. The inclusion of race/ethnicity in the 2007 Maternal-Fetal Medicine Units vaginal birth after cesarean delivery calculator underestimated predicted vaginal birth after cesarean delivery success rates among Black and Hispanic patients receiving obstetrical care at an urban tertiary medical center. Thus, we support the use of the 2021 vaginal birth after cesarean delivery calculator without race/ethnicity. Excluding race and ethnicity from vaginal birth after cesarean delivery counseling may be one way in whichproviders can ultimately contribute toward the reduction of racial and ethnic disparity in maternal morbidity in the United States. Further research is needed to understand the implications of treated chronic hypertension for the success of vaginal birth after cesarean delivery.

Pelvic organ prolapse after hysterectomy: A 10-year national follow-up study.

Hysterectomy may have an effect on the pelvic floor. Here, we evaluated the rates and risks for pelvic organ prolapse (POP) surgeries and visits among women with a history of hysterectomy for benign indication excluding POP. In this retrospective cohort study 3582 women who underwent hysterectomy in 2006 were followed until the end of 2016. The cohort was linked to the Finnish Care Register to catch any prolapse-related diagnoses and operation codes following the hysterectomy. Different hysterectomy approaches were compared according to the risk for a prolapse, including abdominal, laparoscopic, laparoscopic-assisted vaginal and vaginal. The main outcomes were POP surgery and outpatient visit for POP, and Cox regression was used to identify risk factors (hazard ratios [HR]). During the follow-up, 58 women (1.6%) underwent a POP operation, of which a posterior repair was the most common (n=39, 1.1%). Outpatient visits for POP symptoms occurred in 92 (2.6%) women of which posterior wall prolapses (n=58, 1.6%) were the most common. History of laparoscopic-assisted vaginal hysterectomy were associated with risk for POP operation (HR 3.0, p =0.02), vaginal vault prolapse operation (HR 4.3, p=0.01) and POP visits (HR 2.2, p < 0.01) as compared to the approach of abdominal hysterectomy. History of vaginal deliveries and concomitant stress urinary continence operation were associated with the risk for a POP operation (HR 4.4 and 11.9) and POP visits (HR 3.9 and 7.2). Risk for POP operations and outpatient visits for POP symptoms in hysterectomized women without a preceding POP seems to be small at least 10 years after hysterectomy. History of LAVH, vaginal deliveries and concomitant stress urinary incontinence operations increased the risk for POP operations after hysterectomy. These data can be utilized in counseling women considering hysterectomy for benign indication.

MP07-17 NATIVE TISSUE ANTERIOR SACROSPINOUS HYSTEROPEXY IS AN EFFECTIVE AND SAFE APPROACH FOR PRIMARY UTEROVAGINAL PROLAPSE COMPARED TO MESH AUGMENTED REPAIR

You have accessJournal of UrologyCME1 Apr 2023MP07-17 NATIVE TISSUE ANTERIOR SACROSPINOUS HYSTEROPEXY IS AN EFFECTIVE AND SAFE APPROACH FOR PRIMARY UTEROVAGINAL PROLAPSE COMPARED TO MESH AUGMENTED REPAIR Tyler Overholt, Liliya Velet, Mark Xu, Rahul Dutta, and Catherine Matthews Tyler OverholtTyler Overholt More articles by this author , Liliya VeletLiliya Velet More articles by this author , Mark XuMark Xu More articles by this author , Rahul DuttaRahul Dutta More articles by this author , and Catherine MatthewsCatherine Matthews More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Anterior sacrospinous hysteropexy (SSH) was popularized by transvaginal mesh kits. Following market withdrawal, we hypothesized similar efficacy could be achieved through native tissue reattachment of the pubocervical fascia to the cervix with fixation of the anterior cervix to the sacrospinous ligament. Few analyses exist for the efficacy of anterior SSH using native tissue versus mesh augmented repair. METHODS: A retrospective analysis of women who underwent transvaginal SSH at a tertiary center between 01/16-12/21 was performed. Women underwent mesh augmented repair using the Uphold Lite Vaginal Support System or a native tissue anterior SSH. Demographic, clinical, and operative data were reviewed. Composite success was defined as no bulge symptoms, no prolapse retreatment, and no recurrent prolapse beyond the hymen with apex non descended > 1/3 the total vaginal length. Descriptive and bivariate statistics were performed as indicated. RESULTS: We compared the data for 97 women (40 mesh augmented; 57 native tissue). There was no difference in age, BMI, or vaginal delivery history between groups (p > 0.05). Median pre operative POP Q was stage III. Those in the mesh augmented group were more likely to have undergone a prior prolapse (p=0.003) or intra abdominal (p=0.015) surgery. There was no difference in surgical time (p=0.211) between groups (Table 1). The median post procedure follow up time was 8.2 months. The composite success rate was 95% for all women (Table 1). Anatomic success was demonstrated in 100% of patients. Vaginal bulge symptoms were reported by 2 women in the mesh augmented group compared to 3 in the native tissue group (p=0.999). One woman in the mesh augmented group underwent retreatment (pessary) compared to 3 in the native tissue group (2 pessary, 1 surgery; p=0.639). There was no difference in intra operative (p=0.999) or 30 day post operative (p=0.775) complication rate between groups (Table 1). CONCLUSIONS: Ninety five percent of women who underwent an anterior SSH achieved surgical success. The use of mesh augmentation did not confer any added benefit in terms of efficacy or complications when compared to native tissue. Further long term data is needed to continue our assessment of native tissue anterior SSH. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e91 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tyler Overholt More articles by this author Liliya Velet More articles by this author Mark Xu More articles by this author Rahul Dutta More articles by this author Catherine Matthews More articles by this author Expand All Advertisement PDF downloadLoading ...

The association of coital incontinence with clinical factors and single voiding cycle ambulatory urodynamic monitoring findings in women.

Coital incontinence (CI) is a frequent problem in women with urinary incontinence (UI) with significant impact on female sexuality and quality of life. The underlying mechanism is controversial; it has been known that CI is associated with both stress urinary incontinence (SUI) and detrusor overactivity (DO). However, recently it has been reported that CI is mainly related with SUI and urethral incompetence, but not with DO. Ambulatory urodynamic monitoring (AUM) has been shown to be a sensitive tool for the detection of DO. The aim of this study was to investigate the clinical risk factors for CI and the association of CI with urodynamic diagnoses at single voiding cycle AUM. Records of sexually active women with urinary incontinence attending the urogynaecology unit of a university hospital, who completed the PISQ-12 were reviewed retrospectively (n = 1,005). Patients were grouped using the 6th question; patients answering "never" to this question were considered as continent during coitus (n = 591) and patients reporting any urinary leakage at coitus were considered to have CI (n = 414). Demographics, clinical examination findings, incontinence severity measured by the Sandvik Incontinence Severity Index, scores of Turkish validated questionnaires (PFDI-20, IIQ-7, OAB-V8, and PISQ-12) and single voiding cycle AUM findings were compared, and univariate and multivariate logistic regression analyses were performed. Among all sexually active women with UI, 41.2% had CI; UI was more severe, symptom bother was higher, related quality of life (p < 0.001) and sexual function were worse (≤0.018) in these women. Younger age (OR 0.967, p < 0.001), history of vaginal delivery (OR 2.127, p = 0.019), smoking (OR 1.490, p = 0.041), postural UI (OR 2.012, p = 0.001), positive cough stress test (OR 2.193, p < 0.001), and positive SEST (OR 1.756, p = 0.01) were found as independent clinical factors associated with CI. Urodynamic SUI (OR 2.168, p = 0.001) and MUI (OR 1.874, p = 0.002) were found as significant and independent urodynamic diagnoses associated with CI, whereas no association was found with DO or UUI. Both clinical and AUM findings supported that CI is a more severe form of UI that it is mainly related with SUI and urethral incompetence, but not with UUI or DO.

Assessing Obstetric Anal Sphincter Injuries: A Comparison of Exoanal and Endoanal Ultrasound.

To explore the differences in assessing obstetric anal sphincter injuries (OASI) between transperineal ultrasound (TPUS) and endoanal ultrasound (EAUS) and test relationships between ultrasound findings and anal incontinence (AI) symptoms. A group of 196 women with a history of vaginal delivery was recruited. OASI was detected in a set of 5 slices by EAUS and 8 slices by TPUS. OASI grading was performed on TPUS rules and EAUS rules. A "significant sphincter defect" was diagnosed by TPUS and EAUS using "2/3 rules." Symptoms of AI were determined using the St Mark's Incontinence Score (SMIS). Ultrasound findings were compared between the two methods and correlated with symptoms. Of 196 women, 29 (14.8%) suffered from AI with a mean SMIS of 12.1 ± 4.5, and 70 (35.7%) women with a mean age of 57 years had suspected OASI on imaging. Twenty-one (10.7%) "significant defects" were diagnosed by TPUS and 24 (12.2%) by EAUS. OASI Grades on TPUS had good agreement with EAUS rules (k=0.70, P < .001). Logistic regression analysis showed that OASI Grade on imaging and "significant sphincter defects" seen on both forms of imaging were associated with AI symptoms. The odds ratio was 46 and 38 for "significant defects" on TPUS and EAUS, and 14 and 7 for OASI 3b+ on TPUS and EAUS in predicting AI, respectively. "Significant defects" diagnosed by EAUS or TPUS and OASI Grade 3b+ predict AI symptoms. The diagnostic performance of endoanal and exoanal ultrasound (EAUS and TPUS) appear to be very similar.

Endocervical adenocarcinoma implantation in episiotomy scar: a case report and review of the literature

BackgroundCervical cancer is a rare malignancy in the 1st months of pregnancy. Implantation of this cancer in an episiotomy scar is a condition that is rarely reported.Case presentationWe reviewed the literature on this condition and reported a 38 year-old Persian patient who had been diagnosed with cervical cancer, clinically stage IB1, 5 months after a term vaginal delivery. She underwent transabdominal radical hysterectomy with ovarian preservation. Two months later she presented with a mass-like lesion in the episiotomy scar which was proved to be of cervical adenocarcinoma origin after biopsy. The patient was scheduled for chemotherapy with interstitial brachytherapy, an alternative to wide local resection, with successful long-term disease-free survival.ConclusionImplantation of adenocarcinoma in an episiotomy scar is a rare occurrence in patients with a history of cervical cancer and previous vaginal delivery near the time of diagnosis which requires extensive local excision as a primary treatment when feasible. The proximity of the lesion to the anus can lead to major complications of extensive surgery. Alternative chemoradiation combined with interstitial brachytherapy can be successful in eliminating cancer recurrence without compromising the functional outcome.

A Sexual Dysfunction And Quality Of Life Problems Caused By Perineal Pain Cicatrix In A Woman: A Case Report

Introduction: Sexual dysfunction is a complaint that could happened because of disturbance in complex processwhich coordinated by neurology system, vascular and endocrine system.1 One cause of sexual disfunction isdyspareunia which also followed by quality of life problems. Problems of dyspareunia, sexual dysfunction andquality of life can be measure with VAS, FSFI and WHOQOL instruments. VAS, Visual Analogue Scale, is one ofthe pain rating scales used in epidemiologic and clinical research to measure the intensity or frequency of varioussymptoms.2 FSFI, Female Sexual Function Index, is a multidimensional questionnaire that can show female sexualfunction. This questionnaire consists of 6 domains in which sexual desire, sexual arousal, lubrication, orgasm,sexual satisfaction and pain.3,4,5 WHOQOL-BREF, World Health Organization Quality-of-Life Scale, is a qualityof life assessment developed by the WHOQOL Group with fifteen international field centres, simultaneously, inan attempt to develop a quality of life assessment that would be applicated by cross-culturally.Case Report : Patient came with complaint of pain in genital opening and perineum that felt since 5 months ago.Patient also came with complaint of dyspareunia. Patient had history of vaginal delivery which causing her aperineal rupture. For 5 months, patient could not get intercourse and made her desperated and suffered becauseof her husband desire. Patient also felt inferiority and these problems disturbed her daily activity. VAS was 8,FSFI was 3, and WHOQOL was 71. The perinel ruptured was sutured at the moment of delivery, but after 1 weekpatient started to felt pain at her birth canal. It was the first pregnancy, delivery process was without anyproblems, baby born with 2900 gram of birth weight. From gynecology examination, found a cicatrix at 5 o’clockdirection, any other gynecology organs within normal limit. Diagnose was dyspareunia ec perineal cicatrix withsexual dysfunction and quality of life problems, then urogynecologist decided to do surgery

MATERNAL AND FETAL OUTCOMES IN PATIENTS WITH PREVIOUS CAESAREAN SECTION UNDERGOING TRIAL OF VAGINAL BIRTH

Background: Vaginal birth after cesarean section (VBAC) is one of the strategies developed to control the rising rate of cesarean sections (CSs). It is a trial of vaginal delivery in selected cases of a previous CS in a well-equipped hospital. In 1916, Cragin popularized the dictum, once a caesarean section, always a caesarean section. That was the era of the classical CS. In the present era of lower segment caesarean section (LSCS), cesarean-related morbidity and mortality are significantly reduced. The dictum now is once a caesarean section, always an institutional delivery in a well-equipped hospital. The reasons which led to the reversal of the old dictum are based upon the newer concepts of the assessment of scar integrity, fetal well-being, and improved facilities of emergency Cesarean Section. Successful vaginal birth after cesarean section is more comfortable than repeat emergency or elective cesarean section. Antenatal examinations are important in selection for trial of labor, while birth management can be difficult when the patients present at emergency condition. But there is an increased chance of vaginal birth with advanced cervical dilation.Nevertheless, a previous CS does cast a shadow over the outcome of future pregnancies. With present techniques and skill, the incidence of cesarean scar rupture in subsequent pregnancies is very low. The strength of the uterine scar and its capacity to withstand the stress of subsequent pregnancy and labor cannot be completely assessed or guaranteed in advance. These cases require the assessment and supervision of a senior obstetrician during labor. Hence, the present study is undertaken to assess the success and safety of VBAC in selected cases of one previous LSCS and to evaluate the maternal and fetal outcome in these cases. Methods:This prospective observational study was conducted over a period of 18 months from 1st August 2019 to 28th February 2021 at the department of obstetrics and Gynaecology, tertiary care hospital Pune, Maharashtra, India. After achieving ethic committee approval, informed consent of patients enrolled for the study taken, a thorough history and physical examination was done as per proforma. Cases were evaluated thoroughly to collect maternal age, gestational age at admission, association of success rate of VBAC and Parity, Mode of delivery, whether instrumentation was required, indication of previous LSCS, indication of caesarean section in repeat emergency caesarean section, history of prior vaginal delivery, interpregnancy interval. Maternal and fetal outcomes in both successful VBAC and emergency caesarean section were observed.Data collected in structured pro-forma, entered in Microsoft Office Excel format, and statistical analysis was performed using SPSS software. The data so collected was presented with graphical representation. Results: Out of 65 patients undergoing TOLAC, a total of 51 patients had successful vaginal birth and for 14 patients emergency caesarean section was needed. Therefore, the success rate of VBAC in this study in 78%. The most common indication of failed TOLAC was fetal distress. Factors affecting success of TOLAC seen in the study were inter-pregnancy interval, fetal weight and previous caesarean section done for non-recurrent indications. No significant fetal or maternal morbidity was observed in this study. There was no fetal and maternal mortality. Conclusion:Trial of labor after one caesarean section should be undertaken in selected patients in well-equipped hospitals where facilities to deal with emergencies are available.Despite the risks, trial of labor after caesarean remains safer option for many patients as there are fewer complications with less maternal morbidity and will lead to a successful outcome in a high percentage of cases.

Comparative Study of Abnormal Uterine Bleeding with History of Cesarean Section and Vaginal Delivery in Women Referring to Gynecology Clinic of Ali-Ebn-Abitaleb Hospital in Zahedan

Background: The aim of this study was to compare the abnormal uterine bleeding with a history of cesarean section and normal delivery in women referred to the gynecology and obstetrics clinic of Ali Ibn Abitaleb Hospital in Zahedan, Iran in 2020-21.&#x0D; Methods: Patients were divided into two groups of 100 patients. For each patient, information including demographic characteristics and evaluation of the causes of abnormal uterine bleeding in patients based on paraclinical procedures, BMI calculation, vaginitis and Pelvic inflammatory disorder (PID) were obtained.&#x0D; Results: The mean age of patients in the normal delivery group was 30.14 ± 6.26 years and in the cesarean section patients was 29.13 ± 6.70 years. There was no statistically significant difference between the two groups in terms of age. There was a statistically significant difference between the two groups in terms of type between menorrhagia (p value = 0.047) and in comparison between the two groups in terms of bleeding causes, anatomical cause (p value = 0.02) and neoplasia (p value = 0.04).&#x0D; Conclusion: The present findings showed that the incidence of menorrhagia was higher in cesarean delivery and the incidence of abnormal uterine bleeding (AUB) in cesarean delivery may occur after delivery with a shorter time interval than the delivery time. The most important cause of abnormal bleeding in both groups was infection, but with regards to anatomical causes, the most important cause was fibroids in both groups.

Risk Factors and Countermeasures of Stress Urinary Incontinence after Mesh Implantation for Patients with Pelvic Organ Prolapse.

We aimed to explore the risk factors and countermeasures of stress urinary incontinence (SUI) after mesh implantation for patients with pelvic organ prolapse (POP). A total of 224 POP patients undergoing mesh implantation from January 2018 to December 2021 were divided into group A (n = 68, postoperative new-onset SUI) and group B (n = 156, without postoperative new-onset SUI). Their clinical data were collected, and the treatment outcomes were analyzed. The independent risk factors for postoperative new-onset SUI were determined through multivariate logistic regression analysis. A risk-scoring model was established and assessed. The patients with postoperative new-onset SUI were divided into low-, moderate- and high-risk groups using this model. Mesh implantation significantly improved the pelvic floor muscle strength and function of patients. Multivariate logistic regression analysis revealed that age ≥50 years old, gravidity ≥3 times, parity ≥3 times, history of macrosomia delivery, history of chronic respiratory diseases, vaginal delivery, and perineal laceration were independent risk factors for postoperative new-onset SUI, and pelvic floor muscle training by biofeedback electrical stimulation was a protective factor (p < 0.05). The risk-scoring model was safe, reliable and practical, with high discrimination, accuracy and efficiency. Age ≥50 years old, gravidity ≥3 times, parity ≥3 times, history of macrosomia delivery, history of chronic respiratory diseases, vaginal delivery, and perineal laceration are independent risk factors for postoperative new-onset SUI, and pelvic floor muscle training by biofeedback electrical stimulation is a protective factor. Therefore, POP patients with new-onset SUI following mesh implantation should receive more pelvic floor muscle training.

Роды с рубцом на матке через естественные родовые пути: клинический опыт

The article presents the clinical experience of conservative delivery of 1124 women with a scar on the uterus at Republican Clinical Perinatal Center in Ufa. It was established that a woman’s age less than 40 years, certain indications for the previous caesarean section and the absence of indications for the previous cesarean section at this gestation, the history of vaginal delivery, the development of spontaneous labor should be considered criteria associated with the success of «trial» births. Pregnant women who meet these criteria can be delivered through the natural birth canal. Such a tactic allows avoiding unnecessary caesarean sections and improving maternal morbidity and mortality.