Intrauterine Pressure Research Articles

Women’s Perceptions of Childbirth Risk and Place of Birth

In the United States, clinical interventions such as epidurals, intravenous infusions, oxytocin, and intrauterine pressure catheters are used almost routinely in births in the hospital setting, despite evidence that the overutilization of such interventions likely plays a key role in increasing the need for cesarean section (CS).' In 2010, according to the U.S. Centers for Disease Control and Prevention, approximately 32.8 percent of births in the U.S. were by CS.2 The U.S. National Institutes of Health has reported that CS increases avoidable maternal and neonatal morbidity and mortality.3To increase understanding of what might motivate the overuse of CS in the U.S., we investigated the factors that influenced women's decision making around childbirth, because women's conscious and unconscious choices about giving birth could influence whether they would choose or allow delivery by CS. In this article, we report findings about women's decisions related to place of birth-at home or in a hospital. We found that choosing a place of birth was significant in how women in our study attempted to mitigate their perceptions of the risks of childbirth for themselves and their infant. Concern for the safety of the infant was a central, driving factor in the decisions women made about giving birth, and this concern heightened their perceptions of the risks of childbirth. Heightened perceptions of risk about the safety of the fetus during childbirth were found to affect women's ability to accurately assess the risk of using clinical interventions such as the time of admission, epidural anesthesia, oxytocin, or cesarean birth, which has important implications for clinical practice, prenatal education, perinatal research, medical decision making, and informed consent.

Internal versus external tocodynamometry during induced or augmented labour.

Uterine contractions can be registered by external tocodynamometry (ET) or, after rupture of the membranes, by internal tocodynamometry (IT). Monitoring of the frequency of contractions is important especially when intravenous oxytocin is used as excessive uterine activity (hyperstimulation or tachysystole) can cause fetal distress. During induction of labour as well as during augmentation with intravenous oxytocin, some clinicians choose to monitor frequency and strength of contractions with IT rather than with ET as an intrauterine pressure catheter measures intrauterine activity more accurately than an extra-abdominal tocodynamometry device. However, insertion of an intrauterine catheter has higher costs and also potential risks for mother and child. To assess the effectiveness of IT compared with using ET when intravenous oxytocin is used for induction or augmentation of labour. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2013) and PubMed (1966 to 6 April 2013). We included all published randomised controlled trials with data from women in whom IT was compared with ET in induced or augmented labour with oxytocin. We excluded trials that employed quasi-randomised methods of treatment allocation. We found no unpublished or ongoing studies on this subject. Two review authors independently assessed trial eligibility and risk of bias, and independently extracted data. Data were checked for accuracy. Where necessary, we contacted study authors for additional information. Three studies involving a total of 1945 women were included. Overall, risk of bias across the three trials was mixed. No serious complications were reported in the trials and no neonatal or maternal deaths occurred. The neonatal outcome was not statistically different between groups: Apgar score less than seven at five minutes (RR 1.78, 95% CI 0.83 to 3.83; three studies, n = 1945); umbilical artery pH less than 7.15 (RR 1.31, 95% CI 0.95 to 1.79; one study, n = 1456); umbilical artery pH less than 7.16 (RR 1.23, 95% CI 0.39 to 3.92; one study, n = 239); admission to the neonatal intensive care unit (RR 0.34, 95% CI 0.07 to 1.67; two studies, n = 489); and more than 48 hours hospitalisation (RR 0.92, 95% CI 0.71 to 1.20; one study, n = 1456). The pooled risk for instrumental delivery (including caesarean section, ventouse and forceps extraction) was not statistically significantly different (RR 1.05, 95% CI 0.91 to 1.21; three studies, n = 1945). Hyperstimulation was reported in two studies (n = 489), but there was no statistically significant difference between groups (RR 1.21, 95% CI 0.78 to 1.88). This review found no differences between the two types of monitoring (internal or external tocodynamometry) for any of the maternal or neonatal outcomes. Given that this review is based on three studies (N = 1945 women) of moderate quality, there is insufficient evidence to recommend the use of one form of tocodynamometry over another for women where intravenous oxytocin was administered for induction or augmentation of labour.

Chorioamnionitis

Chorioamnionitis most often occurs during labor, affecting as many as 10% of laboring women. When intrapartum chorioamnionitis occurs, women are at peripartal risk for endometritis, cesarean birth, and postpartum hemorrhage; and the neonate is at significant risk for sepsis, pneumonia, respiratory distress, and death. The impact is greater for preterm infants where the incidence of chorioamnionitis is nearly 30%. When chorioamnionitis is believed to be present, antibiotics are administered, but not without potential adverse consequence to the mother/fetus, as well as significantly increased healthcare cost. A number of factors increase the risk of chorioamnionitis, including use of intrauterine pressure catheters and fetal scalp electrodes, urogenital tract infections, prolonged rupture of membranes, digital vaginal examinations, and the nature of perineal hygiene. This article presents key intrapartum factors and those nursing actions that can help to reduce rates of chorioamnionitis and improve perinatal outcomes.

Chelidonium majus and its effects on uterine contractility in a perfusion model

ObjectiveThe herbal agent celandine is thought to have mainly spasmolytic effects, but in the uterus it is regarded as promoting contractions, which can offer promising and innovative options for optimizing artificial reproduction. The aim of the present study was to investigate the effect of celandine on the uterine muscle, using a perfusion model of swine uteri. Study designSixteen swine uteri were perfused with Krebs–Ringer solution. Celandine (Chelidonium, Paverysat; Johannes Bürger Ysatfabrik Ltd., Bad Harzburg, Germany) was administered at increasing dosages. Intrauterine pressure (IUP) was recorded using an intrauterine double-chip microcatheter (Urobar 8 DS-F, Raumedic, Rehau AG & Co., Rehau, Germany). Differences in pressure (ΔP) and area under the curve (ΔAUC) after drug administration in the uterine body and uterine horn in the various dilution series were noted. A paired Student's t-test was used to evaluate differences between groups, with significance set at P<0.05. ResultsA significant initial increase in uterine activity was visible at each dosage. Inhibition of uterine activity was seen over longer periods of 5 and 10min, particularly for a medium-dose range of 1–2mg/ml. At a dosage of 2mg/ml in particular, celandine almost always led to significant values. ConclusionFollowing intra-arterial administration in a swine uterus perfusion model, celandine initially causes a significant increase in contractility, which is followed over time by a relaxation phase. This suggests interesting hypotheses on whether Chelidonium majus might be used to promote targeted sperm transport.

The risks and benefits of internal monitors in laboring patients

The purpose of this study was to estimate the impact of internal monitors (fetal scalp electrode [FSE] and intrauterine pressure catheter [IUPC]) on maternal and neonatal outcomes. The study comprised a retrospective cohort of all women who were admitted for labor from 2004-2008. Women with internal monitors (FSE, IUPC, or both) were compared with women without internal monitors. Maternal outcomes were maternal fever and cesarean delivery. Neonatal outcomes were a composite of 5-minute Apgar score of ≤3, cord pH <7.1, cord base excess ≤-12, or admission to level 3 nursery. Logistic regression was performed to estimate the impact of internal monitors with adjustment for confounding variables, including time in labor. Of 6445 subjects, 3944 women (61.2%) had internal monitors. Women with internal monitors were more likely to have a fever than women without internal monitors (11.7% vs 4.5%; adjusted odds ratio [AOR], 2.0; 95% confidence interval [CI], 1.6-2.5). FSE alone was not associated with an increased risk of fever (AOR, 1.5; 95% CI, 1.0-2.1), but IUPC alone was (AOR, 2.4; 95% CI, 1.8-3.2). The risk of cesarean delivery was higher in women with internal monitors (18.6% vs 9.7%; AOR, 1.3; 95% CI, 1.0-1.5). Risk of cesarean delivery was lower in women with an FSE alone (AOR, 0.5; 95% CI, 0.4-0.7) but higher in women with both an FSE and an IUPC (AOR, 1.6; 95% CI, 1.4-2.0). Risk of the composite neonatal outcome was not higher in women with internal monitors (3.3% vs 3.6%; AOR, 0.8; 95% CI, 0.6-1.1). Routine use of an IUPC in laboring patients should be avoided because of an increased risk of maternal fever.

Clinical validation of the nursing diagnosis labor pain

OBJECTIVE: The study intends to identify the presence of clinical indicators of pain during labor and to correlate the verbal reference of pain intensity with uterine contractions as a proposal to validate the clinical nursing diagnosis Labor Pain. METHOD: Observational study of the 22 clinical indicators that represented the defining characteristics for the diagnosis. RESULTS: There were 55 participants in labor (18 in the initial active stage, 6 in the final active stage and 31 in both stages), over 18 years old, in their first pregnancy, with effective contractions and cervical dilation of 4cm or more. Among the 22 defining characteristics tested, 6 were present in most participants during the two stages: verbal or codified report, noted evidence of uterine contraction, altered muscle tension, noted evidence of pain, expressive behavior and facial expression of pain. There were differences between the stages in relation to perspiration, facial expression of pain, protective gestures, anodyne position, distractive behavior, self-focus and perineum pressure feeling. CONCLUSIONS: A positive linear correlation was noted between pain intensity scores and the extent of intra-uterine pressure in the initial stage. Labor pain was proven to be compatible with a nursing diagnosis.

Congenital Malalignment of the Fourth Toenail with Congenital Curved Nail of the Contralateral Fourth Toe

Dear Editor: A 3-month-old boy was presented with nail deformity on both of his fourth toenails. His left fourth toenail was not parallel to the distal phalanx, and right one had a curved shape (Fig. 1A, B). Both had been observed since birth. He had no family history or suspicious past history, such as trauma. Accompanied abnormalities were not observed. Radiologic examination of both feet revealed an absence of bone deformity or soft tissue defect (Fig. 2). We diagnosed his left fourth toenail as congenital malalignment, and the right one as congenital curved nail. Regular follow-up has been planned to prevent permanent deformity and complications. Fig. 1 (A) Laterally deviated left fourth toenail without any complication. (B) The nail of the right fourth toe curves plantarly. Fig. 2 Radiologic examination does not reveal any bony or soft tissue abnormalities. Congenital malalignment is defined as a condition of horizontal nail matrix deviation, compared with the longitudinal axis of the distal phalanx1. There are some etiologic hypotheses. Genetic factors, hereditary and embryological abnormalies and environmental factors such as intrauterine pressure on nails of the fetus have been thought as possible etiologic factors2. Congenital malalignment usually involves great toe nails; however, it may rarely involve other toenails and fingernails as well2. Although half of all patients have shown spontaneous improvement, the remainders suffer from severe complications, such as ingrown nail, onychogryphosis and persistent nail bed dystrophy3. Therefore, we decided to conduct regular follow-up of the patient until 2 years old. If his nail disorder persists, surgical intervention will be needed as a definite treatment. Baran and Haneke2 invented a surgical method, consisting of periungual wedge resection and rotation of the wedge-resected flap parallel to the distal phalanx. A modified surgical method has recently been tested to reduce proximal nail fold damage. Congenital curved nail of the fourth toe is characterized by a plantarly curved nail plate, which is parallel to the longitudinal axis of the distal phalanx. Actually, it is secondary nail deformity caused by congenital hypoplasia or loss of the distal phalanx4. However, similar to our case, some cases without underlying bony or soft tissue defect have been reported5. There have been no published case reports of congenital curved nail, which has involved other than the fourth toenail. Therefore, it is called congenital curved nail of the fourth toe. However, recently we experienced a case with congenital curved nail involving the bilateral second, third and fourth toenails; although it has not been published yet. It is thought that congenital curved nail can also be developed in other toenails except for the fourth nail. On the other hand, other disorders of fingernails and toenails are not accompanied with congenital curved nail, because it is thought to be a mesodermal defect, not an ectodermal defect4. Because of the underlying defects of the bone or soft tissue, definite treatment is very difficult. Therefore, conservative treatments such as avoiding trauma are recommended for the alleviation of onycholysis and further nail dystrophy. Due to low prevalence of congenital malalignment of the toenail and congenital curved nail of the fourth toenail, this report is meaningful. In addition, it presents the first case that combines these two nail disorders concurrently in one patient.

Automated Conduction Velocity Analysis in the Electrohysterogram for Prediction of Imminent Delivery: A Preliminary Study

Background. Analysis of the electrohysterogram (EHG) is a promising diagnostic tool for preterm delivery. For the introduction in the clinical practice, analysis of the EHG should be reliable and automated to guarantee reproducibility. Study Goal. Investigating the feasibility of automated analysis of the EHG conduction velocity (CV) for detecting imminent delivery. Materials and Methods. Twenty-two patients presenting with uterine contractions (7 preterm) were included. An EHG was obtained noninvasively using a 64-channel high-density electrode grid. Contractions were selected based on the estimated intrauterine pressure derived from the EHG, the tocodynamometer, and maternal perception. Within the selected contractions, the CV vector was identified in two dimensions. Results. Nine patients delivered within 24 hours and were classified as a labor group. 64 contractions were analyzed; the average amplitude of the CV vector was significantly higher for the labor group, 8.65 cm/s ± 1.90, compared to the nonlabor group, 5.30 cm/s ± 1.47 (P < 0.01). Conclusion. The amplitude of the CV is a promising parameter for predicting imminent (preterm) delivery. Automated estimation of this parameter from the EHG signal is feasible and should be regarded as an important prerequisite for future clinical studies and applications.

Prediction of Uterine Contractions Using Knowledge-Assisted Sequential Pattern Analysis

The usage of the systemic opioid remifentanil in relieving the labor pain has attracted much attention recently. An optimal dosing regimen for administration of remifentanil during labor relies on anticipating the timing of uterine contractions. These predictions should be made early enough to maximize analgesia efficacy during contractions and minimize the impact of the medication between contractions. We have designed a knowledge-assisted sequential pattern analysis framework to 1) predict the intrauterine pressure in real time; 2) anticipate the next contraction; and 3) develop a sequential association rule mining approach to identify the patterns of the contractions from historical patient tracings (HT).

The perfused swine uterus model: long-term perfusion

BackgroundIt has previously been shown that the viability of swine uteri can be maintained within the physiological range in an open perfusion model for up to 8 hours. The aim of this study was to assess medium- to long-term perfusion of swine uteri using a modified Krebs–Ringer bicarbonate buffer solution (KRBB) in the established open perfusion model.MethodsIn an experimental study at an infertility institute, 30 swine uteri were perfused: group 1: n = 11, KRBB; group 2: n = 8, modified KRBB with drainage of perfusate supernatant; group 3: n = 11, modified KRBB with drainage of perfusate every 2 h and substitution with fresh medium. Modified and conventional KRBB were compared with regard to survival and contraction parameters: intrauterine pressure (IUP), area under the curve (AUC), and frequency of contractions (F).ResultsModified KRBB showed significantly higher IUP, AUC, and F values than perfusion with conventional KRBB. In group 3, the organ survival time of up to 17 h, with a 98% rate of effective contraction time, differed significantly from group 1 (P < 0.001).ConclusionsUsing modified KRBB in combination with perfusate substitution improves the open model for perfusion of swine uteri with regard to survival time and quality of contraction parameters. This model can be used for medium- to long-term perfusion of swine uteri, allowing further metabolic ex vivo studies in a cost-effective way and with little logistic effort.

Characterization of the tissue‐level Ca2+ signals in spontaneously contracting human myometrium

In the labouring uterus, millions of myocytes forming the complex geometrical structure of myometrium contract in synchrony to increase intrauterine pressure, dilate the cervix and eventually expel the foetus through the birth canal. The mechanisms underlying the precise coordination of contractions in human myometrium are not completely understood. In the present study, we have characterized the spatio-temporal properties of tissue-level [Ca2+]i transients in thin slices of intact human myometrium. We found that the waveform of [Ca2+]i transients and isotonic contractions recorded from thin slices was similar to the waveform of isometric contractions recorded from the larger strips in traditional organ bath experiments, suggesting that the spatio-temporal information obtained from thin slices is representative of the whole tissue. By comparing the time course of [Ca2+]i transients in individual cells to that recorded from the bundles of myocytes we found that the majority of myocytes produce rapidly propagating long-lasting [Ca2+]i transients accompanied by contractions. We also found a small number of cells showing desynchronized [Ca2+]i oscillations that did not trigger contractions. The [Ca2+]i oscillations in these cells were insensitive to nifedipine, but readily inhibited by the T-type Ca2+ channel inhibitor NNC55-0396. In conclusion, our data suggest that the spread of [Ca2+]i signals in human myometrium is achieved via propagation of long-lasting action potentials. The propagation was fast when action potentials propagated along bundles of myocytes and slower when propagating between the bundles of uterine myocytes.

Vaginal Birth After Cesarean Delivery

Evidence-based guidelines regarding vaginal birth after cesarean from 3 countries (United States, Canada, and United Kingdom) were reviewed. The similarities in the 3 national guidelines (trial of labor after 1 previous cesarean, informed consent, delivery facility and available resources, epidural analgesia, continuous fetal monitoring, and induction and augmentation of labor) are understandable. Differences in recommendations (uterine rupture risk, success rate, intrauterine pressure catheter, and mechanical cervical ripening) are not explained. The likelihood of recommendations being categorized as level A differed: United States, 27% (3/11); Canada, 32% (6/19); and United Kingdom, 0% (0/17). Only 6 publications were cited by all 3 guidelines.

Mode de déclenchement du travail et conduite du travail en cas d’utérus cicatriciel

To evaluate the benefits and risks of labor induction in patients previously delivered by at least one low transverse cesarean section. To define how labor should be managed in patients attempting a vaginal birth after cesarean section (VBAC). A literature search was performed using the Pubmed(®) and Cochrane(®) databases. Foreign societies guidelines were also consulted. Labor induction is associated with an increased risk of uterine rupture that could be estimated at 1% with oxytocine and 2% with vaginal prostaglandins (Level 2). Mechanical methods have been insufficiently studied. Misoprostol seems to dramatically increase the risk of uterine rupture (Level 3). The routine use of intrauterine pressure catheter does not prevent uterine rupture (Professional agreement). A moderate increase of uterine rupture was also found with augmentation (Level 3). The risk of uterine rupture increases when cervical dilatation is arrested for 3 hours or more when a good uterine dynamic is obtained (Professional agreement). The use of epidural analgesia should be encouraged (Grade C). Routine digital exploration of the uterine scare postpartum is not necessary (Grade C). Women attempting a VBAC should be aware of the modalities of labor management. When labor induction is warranted, women should also be informed of the indication and the increased risk of uterine rupture. The choice of labor induction method should take into consideration maternal and obstetrical characteristics.

Multiscale forward electromagnetic model of uterine contractions during pregnancy

BackgroundAnalyzing and monitoring uterine contractions during pregnancy is relevant to the field of reproductive health assessment. Its clinical importance is grounded in the need to reliably predict the onset of labor at term and pre-term. Preterm births can cause health problems or even be fatal for the fetus. Currently, there are no objective methods for consistently predicting the onset of labor based on sensing of the mechanical or electrophysiological aspects of uterine contractions. Therefore, modeling uterine contractions could help to better interpret such measurements and to develop more accurate methods for predicting labor. In this work, we develop a multiscale forward electromagnetic model of myometrial contractions during pregnancy. In particular, we introduce a model of myometrial current source densities and compute its magnetic field and action potential at the abdominal surface, using Maxwell’s equations and a four-compartment volume conductor geometry. To model the current source density at the myometrium we use a bidomain approach. We consider a modified version of the Fitzhugh-Nagumo (FHN) equation for modeling ionic currents in each myocyte, assuming a plateau-type transmembrane potential, and we incorporate the anisotropic nature of the uterus by designing conductivity-tensor fields.ResultsWe illustrate our modeling approach considering a spherical uterus and one pacemaker located in the fundus. We obtained a travelling transmembrane potential depolarizing from −56 mV to −16 mV and an average potential in the plateau area of −25 mV with a duration, before hyperpolarization, of 35 s, which is a good approximation with respect to the average recorded transmembrane potentials at term reported in the technical literature. Similarly, the percentage of myometrial cells contracting as a function of time had the same symmetric properties and duration as the intrauterine pressure waveforms of a pregnant human myometrium at term.ConclusionsWe introduced a multiscale modeling approach of uterine contractions which allows for incorporating electrophysiological and anatomical knowledge of the myometrium jointly. Our results are in good agreement with the values reported in the experimental technical literature, and these are potentially important as a tool for helping in the characterization of contractions and for predicting labor using magnetomyography (MMG) and electromyography (EMG).

Rupture utérine : prédiction, diagnostic et prise en charge

To evaluate predictors of uterine rupture (UR) after previous cesarean birth. To define the diagnosic criteria of UR, management and prognosis of subsequent pregnancies. Analysis of Medline database(®), Cochrane Library Database(®) and international guidelines. Uterine rupture is a serious complication both for mother (mortality<1 %, severe morbidity 15 %) and child (mortality at term 3-6%, perinatal asphyxia 6-15%), occurring in 0,2 to 0,8 % of trial of labour after cesarean (TOLAC). The individual risk for UR after TOLAC is multifactorial and predictive scores showed no clinical utility in routine (grade B). The risk of UR is decreased in case of previous vaginal delivery and increased in case of classical C-section, previous UR, induction of labour (especially using prostaglandins), more than one previous caesarean section, fetal macrosomia and interval less than 6 months before the next pregnancy. Monitoring of labor, including intrauterine pressure catheters, do not allow to anticipate the diagnosis. This one relies on a combination of severe pathologic patterns of FHM with unusual pelvic pain. Suspected UR requires expedited laparotomy (consensus opinion). A subsequent pregnancy is not contraindicated, but the risk of recurrent UR is high and a repeat cesarean section is then recommended (grade B).

Monitoring uterine activity during labor: a comparison of 3 methods

Tocodynamometry (Toco; strain gauge technology) provides contraction frequency and approximate duration of labor contractions but suffers frequent signal dropout, necessitating repositioning by a nurse, and may fail in obese patients. The alternative invasive intrauterine pressure catheter (IUPC) is more reliable and adds contraction pressure information but requires ruptured membranes and introduces small risks of infection and abruption. Electrohysterography (EHG) reports the electrical activity of the uterus through electrodes placed on the maternal abdomen. This study compared all 3 methods of contraction detection simultaneously in laboring women. Upon consent, laboring women were monitored simultaneously with Toco, EHG, and IUPC. Contraction curves were generated in real-time for the EHG, and all 3 curves were stored electronically. A contraction detection algorithm was used to compare frequency and timing between methods. Seventy-three subjects were enrolled in the study; 14 were excluded due to hardware failure of 1 or more of the devices (n = 12) or inadequate data collection duration (n = 2). In comparison with the gold-standard IUPC, EHG performed significantly better than Toco with regard to the Contractions Consistency Index (CCI). The mean CCI for EHG was 0.88 ± 0.17 compared with 0.69 ± 0.27 for Toco (P < .0001). In contrast to Toco, EHG was not significantly affected by obesity. Toco does not correlate well with the gold-standard IUPC and fails more frequently in obese patients. EHG provides a reliable noninvasive alternative, regardless of body habitus.

Does the type of surgery for early-stage endometrial cancer affect the rate of reported lymphovascular space invasion in final pathology specimens?

Laparoscopically assisted vaginal hysterectomy (LAVH), which usually involves the use of an intrauterine manipulator for optimal surgical control, has been shown to be as effective and safe as conventional total abdominal hysterectomy (TAH) for the staging of endometrial carcinoma. The purpose of this study was to determine whether the use of an intrauterine manipulator was associated with an increase in the pathologic reporting of lymphovascular space invasion (LVSI), which is an important determinant in choosing adjuvant therapy. We hypothesized that intracavitary manipulation and an increase of the intrauterine pressure could cause pseudolymphovascular invasion. We performed a retrospective chart review of endometrial cancer patients treated at our institution from January 1996 through January 2006. Records were reviewed for patient's age, preoperative diagnosis, procedure type, final surgical staging, and final pathology report. Using the 2009 International Federation of Gynecology and Obstetrics staging, we included all patients having stage IA or IB endometrioid-type endometrial cancer who had undergone either a TAH or LAVH with or without pelvic and paraaortic lymph node dissection. The χ2 and Fisher exact tests were used to measure the association between risk of positive lymphovascular invasion and surgical groups. Of 568 women identified as having endometrioid-type endometrial cancer, 486 (85.6%) met criteria for stage IA-IB endometrioid histology, grade 1, 2, or 3. LVSI was reported in 553/568 cases, with LVSI positivity in 16.9% (n = 96/568). The mean ages of the LAVH and TAH groups were significantly different (59.4 vs 62.4 years, respectively, P = .0050). Also, mean estimated blood loss and uterine weight significantly varied between TAH and LAVH groups (P = .0001 and .008, respectively). For stage IA, 17/220 (7.7%) who had been treated with LAVH had positive LVSI compared with 20/199 (10.1%) of patients receiving TAH (P = .73). For stage IB, 11/25 (44.0%) of patients treated with LAVH had positive LVSI compared with 10/31 (32.3%) of patients receiving TAH (P = .53). The stage I cancer patients were further subdivided into histological grades 1, 2, and 3, and LVSI was not significantly different between TAH and LAVH groups per grade of cancer. We found no differences between TAH and LAVH in early-stage endometrial cancer (stage IA and IB), with respect to the presence of positive peritoneal washings. In early-stage endometrial cancer (stage IA and IB), there were no differences between TAH and LAVH in the final pathologic report of LVSI. The use of an intrauterine manipulator for LAVH was not associated with an increased detection of LVSI.

The Aquilex™ Fluid Control System Performance during Hysteroscopic Procedures

This study assessed the performance and ease of use of the automated Aquilex™ fluid control system compared to manual fluid management during hysteroscopic procedures. Non-randomized, comparative study. One obstetrics and gynecology practice in the U.S. 21 patients, 18 to 65 years of age, with an indication for hysteroscopy and/or a therapeutic hysteroscopic procedure. Hysteroscopic procedures, including polypectomy or myomectomy using the MyoSure® tissue removal device (n = 11), diagnostic hysteroscopy (n = 8), and the Adiana® permanent contraception procedure (n = 2), were performed according to standard medical practice using the Aquilex system with concurrent manual fluid measurements. Manual and automated calculations of the total fluid volume used and the final fluid deficit were compared for the total sample of procedures (n = 21). Intrauterine pressure ranges were recorded. Physician and nurse satisfaction with the Aquilex system was evaluated using a 5 point Likert scale. Preliminary results showed strong agreement between the Aquilex system and manual measurements of the mean fluid volume used (intraclass correlation coefficient (ICC): 0.99) and the final fluid deficit (ICC: 0.91). The mean low and high intrauterine pressures for all procedures were 81.0 ± 13.7 mmHg and 108.1 ± 24.2 mmHg, respectively. The Aquilex system performance was rated as excellent for ease of tubing set up, system set up and fluid canister exchange, and rated above average for distention and visualization. In all cases, there was agreement or strong agreement that the Aquilex system improved the ease of performing hysteroscopic procedures compared to manual fluid management. There were no adverse events. These results demonstrate physician and nurse satisfaction with the Aquilex fluid control system. There was strong agreement between the Aquilex system and manual fluid measurements during hysteroscopic procedures.

Does the Type of Surgery for Early-Stage Endometrial Cancer Affect the Rate of Reported Lymph Vascular Invasion in Final Pathology Specimens?

Does the Type of Surgery for Early-Stage Endometrial Cancer Affect the Rate of Reported Lymph Vascular Invasion in Final Pathology Specimens?

Oxytocin discontinuation during active labor in women who undergo labor induction

The purpose of this study was to determine whether there is an increase in the cesarean delivery rate in women who undergo induction when oxytocin is discontinued in the active phase of labor. We conducted a prospective randomized controlled trial of women who underwent induction of labor at term; they were assigned randomly to either routine oxytocin use (routine) or oxytocin discontinuation (DC) once in active labor. Analysis was by intention to treat. Two hundred fifty-two patients were eligible for study analysis: 127 patients were assigned randomly to the routine group and 125 patients were assigned randomly to the DC group. Cesarean delivery rate was similar between the groups (routine, 25.2% [n = 32] vs the DC group, 19.2% [n = 24]; P = .25). There was a higher chorioamnionitis rate and slightly longer active phase in those women who were assigned to the DC group. In adjusted analysis, the rate of chorioamnionitis was not different by randomization group but was explained by the duration of membrane rupture and intrauterine pressure catheter placement. Discontinuation of oxytocin in active labor after labor induction does not increase the cesarean delivery rate significantly.