Number Of Vaginal Deliveries Research Articles

COMPARISON OF SAFETY AND EFFICACY OF INTRACERVICAL DINOPROSTONE GEL AND EXTRA-AMNIOTIC FOLEY'S CATHETER FOR INDUCTION OF LABOUR

BACKGROUND: The uterus remains quiescent throughout 9 months and begins to act on its own when full term is approached. Almost 50% women deliver in the duration of one week before and after the calculated EDD; and induction of labour is needed in about 20% of women: to increase the success of labour induction, to reduce the duration and complications of labour and to diminish the rate of caesarean sections. Cervical ripening is needed before induction of labour. There are many methods for induction of labour; however till date, none of them can claimed to be the best. To compare the AIM OF PRESENT STUDY: safety and efcacy of Dinoprostone gel versus intracervical foley's catheter for ripening of cervix and induction of labour. Compara MATERIAL AND METHODS: tive prospective study was conducted on 400 full term uncomplicated primigravida women needing induction of labour between January 2019 to June 2020 in department of obstetrics & gynecology at GMC Kota in Rajasthan.Group A: 200 women induced with Dinoprostone gel and Group B: 200 women induced with extra-amniotic Foley's catheter. Baseline characteristics like maternal age, gestational age, indication for induction were comparable in both the groups. The mean induction to delivery interval was shorter in RESULT: group A (12.69 ± 3.64 hours) as compared to Group B (18.17 ± 3.17 hours) and this difference was statistically highly signicant (P = 0.0001). There was no signicant difference observed in mode of delivery, labour progress at 18 hours, indication for caesarean section, maternal side effects, mean birth weight, Apgar score at 5 mins, number of NICU admissions between the two groups. The number of vaginal deliveries we CONCLUSION: re similar in both the groups but mean induction to delivery interval was signicantly shorter with Dinoprostone gel. However, the maternal and fetal outcomes were better in Foley's catheter group although the difference was not statistically signicant

A study on maternal mortality in a tertiary care center in South India

Introduction: Maternal mortality has long been considered as a very good indicator for healthcare quality provided. Pregnancy is considered to be a physiological phase in the lifetime of a woman carrying serious implications on morbidity and mortality. It has been agreed upon that many of the maternal deaths in developing countries can be prevented. Aim: To study the prevalence of maternal mortality between March 2014-March 2018 in our hospital. Methods and Materials: It’s a retrospective observational study done at a tertiary care centre in southern part of India. Maternal deaths from March 2014 to March 2018 were looked into. Maternal mortality ratio and causes for the maternal deaths were analyzed and compared. Demographic details were collected and data regarding parity, mode of delivery, gestational age at delivery, antenatal check-ups, co morbid conditions, causes of death were noted and neonatal outcomes were noted. Results: Overall live births in the period between March 2014-March 2018 were 18978, of which the number of LSCS were 9590(50.5%), the number of vaginal deliveries were 9388(49.5%), the number of maternal deaths were 39(MMR-205/100000 live births).The leading cause was sepsis 48.6% followed by postpartum hemorrhage (20%). The most common indirect cause was anemia (42.85%). Conclusion: Sepsis & hemorrhage emerged as the greatest killers. Many of the reasons of maternal mortality were found to be preventable. Early identification and stratification of risks with prompt initiation of necessary management measures are necessary to prevent these deaths. Keywords: Maternal mortality, Sepsis, hemorrhage, preeclampsia, direct cause, indirect cause.

Evaluation of zinc and copper levels in vaginal tissues and whole blood: correlation with age

BackgroundZinc and copper are essential trace elements and play a crucial role in the homeostasis of connective tissues. In this study, we aimed to define zinc and copper levels in the vaginal tissue and establish whether a correlation exists between the zinc and copper levels either or both in whole blood or vaginal tissue samples and whether the finding correlates with the age of the patient or at least with her menopausal status.MethodsWe collected whole blood and vaginal tissue samples from 32 women and measured their zinc and copper levels by inductively coupled plasma optical emission spectrometry. We have performed Student's t test to evaluate the differences in the mean levels of trace elements and multiple regression to evaluate the association between vaginal tissue zinc/copper levels and age, menopausal status, number of vaginal deliveries, and zinc/copper blood levels.ResultsZinc levels were significantly higher in both the vaginal tissues and whole blood samples than copper levels (p < 0.01). In the vaginal tissue samples, a strong positive correlation could be detected between zinc and copper levels (r = 0.82, p < 0.01). In the vaginal tissue, a negative correlation was found for zinc and copper levels with the age of women (r = − 0.27, p = 0.04 and r = − 0.56, p < 0.01). Multiple linear regression model (age, menopausal status, vaginal delivery and copper/zinc blood levels) showed that only age remained a significant predictor for zinc and copper vaginal tissues levels (p = 0.03, 95% CI − 2.28 to − 0.06; p = 0.004, 95% CI − 1.76 to − 0.34).ConclusionsZinc and copper levels in the vaginal tissue decline with age. Out of the examined variables (age, menopausal status, vaginal delivery, and copper/zinc levels), only age is a significant predictor of vaginal zinc/copper levels.

Gestational Risk as a Determining Factor for Cesarean Section according to the Robson Classification Groups.

To analyze and compare the frequency of cesarean sections and vaginal deliveries through the Robson Classification in pregnant women attended at a tertiary hospital in two different periods. Cross-sectional, retrospective study of birth records, comprising 4,010 women, conducted from January 2014 to December 2015 in the only public regional referral hospital for the care of high- risk pregnancies, located in Southern Brazil. The overall cesarean section rate reached 57.5% and the main indication was the existence of a previous uterine cesarean scar. Based on the Robson Classification, groups 5 (26.3%) and 10 (17.4%) were the most frequent ones. In 2015, there was a significant increase in the frequency of groups 1 and 3 (p < 0.001), when compared with the previous year, resulting in an increase in the number of vaginal deliveries (p < 0.0001) and a reduction in cesarean section rates. The Robson Classification proved to be a useful tool to identify the profile of parturients and the groups with the highest risk of cesarean sections in different periods in the same service. Thus, it allows monitoring in a dynamic way the indications and delivery routes and developing actions to reduce cesarean rates according to the characteristics of the pregnant women attended.

Factors Correlated with the Accuracy of Colposcopy-Directed Biopsy: A Systematic Review and Meta-Analysis

Purpose/aim of the study Colposcopy-directed cervical biopsy has played a major role in diagnosing cervical lesions. The precision of colposcopy-guided biopsy has been questioned. We analyzed several factors that may be correlated with the accuracy of biopsy. Methods PubMed, EMBASE were searched from January 1, 1998 to March 1, 2020. Odds ratio with 95% confidence intervals (CIs) were calculated. Selection criteria Included studies evaluated factors correlated with the accuracy of biopsy and patients’ final diagnosis was established by histological examination of the specimen obtained by conization, loop electrosurgical excision procedure (LEEP), or colpohysterectomy. Results A total of 10 studies were selected for the systematic review and meta-analysis. The pooled analysis indicated that the diagnostic inaccuracies of colposcopy-directed cervical biopsy were magnified in women who were 50 years of age or older. Postmenopausal status and transformation zone 3 type were also associated with the diagnostic inaccuracies of colposcopy-directed biopsy. High-grade squamous intraepithelial lesions had better concordance rates than low-grade squamous intraepithelial lesions. The number of vaginal deliveries, number of biopsies, and HPV type were associated with biopsy underdiagnosis and biopsy overestimation. Conclusions This meta-analysis found that the correlation between the histological findings at biopsy and after surgical treatment was influenced by women’s age, menopausal status, and the transformation zone type. The diagnostic efficacy was also better for high-grade squamous intraepithelial lesions than for low-grade squamous intraepithelial lesions. Further large-scale randomized clinical trials are required to analyze the factors correlated with biopsy underdiagnosis and biopsy overestimation.

Trends in obstetric care statistics in the Russian Federation

An analysis of obstetric care statistics, which are considered as an indicator of the population’s health both now and in the future, seems relevant.Aim. To assess the dynamics of obstetric care data in Russia from 2006 to 2015 according to official statistics.Material and methods. The official statistics were analyzed using the descriptive statistic methods.Results. During the study period, the number of births in Russia increased by 30,1% and since 2012 has exceeded the level of 1991. We also revealed an increase in the prevalence of ectopic pregnancy (1,62-2,6% of all recorded pregnancies). A high level (~80%) of maternal morbidity over the past 6 years has remained. At the same time, there was a decrease in the incidence of maternal anemia, extragenital diseases, and gestosis. The prevalence of abnormal labor decreased over 10 years by 27,5% and amounted to 88,4 per 1,000 births in 2015, which is lower than in the 1991 (96,5‰). The incidence of labor bleeding decreased during the observation period by 11,4%. It is important that there was a decrease in the number of bleedings in the postpartum and postpartum period, and hemorrhages due to placenta previa and clotting disorder became more frequent. The number of caesarean sections has doubled over 10 years.Conclusion. The analysis shows the favorable trends in reproductive statistics in Russia — a decrease in reproductive losses, certain complications of pregnancy and labor. At the same time, decrease in the number of vaginal delivery and a high incidence of bleeding and sepsis specifies ways to improve the obstetric care service.

Evaluating the efficacy of outpatient use of isosorbide mononitrate on cervical ripening in pregnant women with unfavourable cervix

The aim of the present study was to evaluate the efficacy of outpatient administration of nitric oxide donor isosorbide mononitrate for cervical ripening. A randomised clinical trial was performed on term pregnant women with Bishop Score < 6. In the case group, Isosorbide-5-mononitrate capsule and in the control group, placebo was inserted in the posterior vaginal fornix for two consecutive days. The main outcomes were increases in Bishop Score after 48 hours of intervention, number of vaginal deliveries and interval from intervention to delivery. There was a significant increase of the mean Bishop score in the isosorbide group [3.57 ± 1.12 VS 1.54 ± 1.42 respectively (p = .001)]. The other outcome variables did not show a significant difference between the two groups except for headache which was significantly more in the case group. No cases of tachysystole were observed in the two groups. Additionally, haemoglobin levels after delivery did not show a significant difference between the two groups. Impact statement: What is already known on this subject? Cervical ripening in women with an unfavourable cervix and having an indication for induction of labour is an important issue in modern obstetrics. Different methods have been used for cervical ripening and induction of labour including mechanical (i.e. laminaria tents, Dilapan-S, foley catheter), medical (i.e. PGs) and supportive methods. There is no consensus on the best option for cervical ripening What will the results of this study add to the current knowledge of this subject? Outpatient administration of nitric oxide could affect cervical ripening without a significant improvement in the duration of different stages of labour, intervention to delivery interval and number of vaginal deliveries. What are the implications of these findings for clinical practice and/or further research? Due to the contradictory results of various studies, more studies should be performed with greater sample size to evaluate nitric oxide donor isosorbide mononitrate effect on labour duration and reducing caesarean deliveries. Additional data is needed to assess the real impact of NO donors on different stages of labour and its implications.

Virus papiloma humano y factores asociados en pacientes con citología desconocida atendidas en el norte de Perú

Introducción. El virus papiloma humano es el causante del cáncer de cuello uterino, uno de los cánceres más comunes en las mujeres. Objetivo. Determinar la prevalencia del virus papiloma humano y los factores asociados en mujeres con citología desconocida. Métodos. En pacientes de ginecoobstetricia con citología desconocida atendidas en el Hospital Regional Lambayeque, en la costa norte del Perú, entre abril y junio 2019, se realizó la extracción de ADN para identificar el virus del papiloma humano basada en el método de salting out. Se procesaron las muestras mediante reacción en cadena de la polimerasa y se amplificaron para los primers MY09 y MY11, y PC04/GH20. Se empleó el análisis bivariado mediante la prueba de chi cuadrado y t-student. Resultados. Se encontró que 29,9% de las pacientes atendidas en el área de gineco-obstetricia con citología desconocida tuvieron el virus del papiloma humano. No se encontró diferencia estadística significativa entre la infección por virus del papiloma humano con la edad, edad de primera relación sexual, promiscuidad, número de partos vaginales, lesión de cuello uterino, antecedente de ITS, uso de anticonceptivo hormonal, uso del condón y tabaquismo.

Success Rates and Outcomes of Laparoscopic Mesh Sacrohysteropexy

Study Objective This study aimed to evaluate the impact of laparoscopic mesh sacrohysteropexy on symptomatic prolapse from an Australian experience. Design Retrospective cohort study. Setting Private Practice. Patients or Participants 157 patients with symptomatic prolapse underwent laparoscopic mesh sacrohysteropexy during 2007-2017. Choice of surgery was determined by the patient, after discussion about hysterectomy, future fertility, and uterine conservation. Patients electing for laparoscopic sacrohysteropexy were women with symptomatic prolapse wishing to preseve their uterus and had failed conservative measures. Exclusions to uterine preservation or complex laparoscopic surgery included significant uterine enlargement (>280cc), body mass index (BMI) >35, current cervical smear abnormalities and concomitant medical conditions that would preclude a laparoscopic approach for anaesthetic concerns. Interventions Laparoscopic mesh sacrohysteropexy. Measurements and Main Results The median age was 58 years (27-86 years), median parity was 2 (0-6), and median BMI was 26.8 (23-29.9). 134 women had a laparoscopic hysteropexy and concurrent vaginal prolapse repair and 4 women had an isolated laparoscopic hysteropexy. The mean preoperative point C was 0.60. The mean change from preoperative point C to postoperative point C was 7.6 cm (p < 0.01). Of the 136 patients (98.6%) seen at 4-6 weeks post-operative, all had Stage 0 POP-Q score. Prolapse recurrence was observed in 22 patients, while 116 patients remained cured at their last follow-up. The probability of uterovaginal prolapse recurrence was 0.8 after 24 months utilising a Kaplan-Meier curve. Prolapse recurrence was associated with anterior vaginal mesh, previous prolapse surgery, pre-operative stage III-IV disease and number of vaginal deliveries. Conclusion Laparoscopic mesh sacrohysteropexy is an effective and safe procedure with a high success rate comparable to available international data and should be considered as an alternative to hysterectomy in women with a Stage II or III pelvic organ prolapse. This study aimed to evaluate the impact of laparoscopic mesh sacrohysteropexy on symptomatic prolapse from an Australian experience. Retrospective cohort study. Private Practice. 157 patients with symptomatic prolapse underwent laparoscopic mesh sacrohysteropexy during 2007-2017. Choice of surgery was determined by the patient, after discussion about hysterectomy, future fertility, and uterine conservation. Patients electing for laparoscopic sacrohysteropexy were women with symptomatic prolapse wishing to preseve their uterus and had failed conservative measures. Exclusions to uterine preservation or complex laparoscopic surgery included significant uterine enlargement (>280cc), body mass index (BMI) >35, current cervical smear abnormalities and concomitant medical conditions that would preclude a laparoscopic approach for anaesthetic concerns. Laparoscopic mesh sacrohysteropexy. The median age was 58 years (27-86 years), median parity was 2 (0-6), and median BMI was 26.8 (23-29.9). 134 women had a laparoscopic hysteropexy and concurrent vaginal prolapse repair and 4 women had an isolated laparoscopic hysteropexy. The mean preoperative point C was 0.60. The mean change from preoperative point C to postoperative point C was 7.6 cm (p < 0.01). Of the 136 patients (98.6%) seen at 4-6 weeks post-operative, all had Stage 0 POP-Q score. Prolapse recurrence was observed in 22 patients, while 116 patients remained cured at their last follow-up. The probability of uterovaginal prolapse recurrence was 0.8 after 24 months utilising a Kaplan-Meier curve. Prolapse recurrence was associated with anterior vaginal mesh, previous prolapse surgery, pre-operative stage III-IV disease and number of vaginal deliveries. Laparoscopic mesh sacrohysteropexy is an effective and safe procedure with a high success rate comparable to available international data and should be considered as an alternative to hysterectomy in women with a Stage II or III pelvic organ prolapse.

Enduring impact of childhood adversity on lower urinary tract symptoms in adult women.

To determine whether childhood adversity is associated with self-reported lower urinary tract symptoms (LUTS) among older adult women. A convenience sample of women (≥55 years old) who presented to an academic urology practice or who had participated in a previous bladder health prevention study completed questionnaires including the LUTS Tool (on frequency and bother of LUTS), the Adverse Childhood Experiences (ACEs) Questionnaire, the Spielberger State-Trait Anxiety Inventory, and the Center for Epidemiologic Studies Depression Scale. The average age (SD) of participants (N = 151) was 64.7 (6.9) years. The total number of ACEs predicted the total number of LUTS, β = .39 (95% confidence interval [CI] = 0.14, 0.64), P = .003, as well as LUTS frequency, β = .09 (95% CI = 0.04, 0.13), P < .001. ACEs predicted bother for nocturia, β = 0.12 (95% CI = 0.03, 0.22), P = .008. Negative affect symptoms did not mediate the relationship between the total number of ACEs and the total number of LUTS. Rather, ACEs predicted LUTS and negative affect symptoms through (at least partially) independent pathways. Analyses controlled for tobacco use, number of vaginal deliveries, hypertension, overactive bladder medication use, body mass index, income, and race because these variables were significantly associated with the total number of ACEs or total number of LUTS. Childhood adversity has an enduring impact on risk for LUTS in adulthood even when controlling for potential confounds and this relationship cannot be explained by negative affect symptoms.

Radiofrequency Treatment of Labia Minora and Majora: A Minimally Invasive Approach to Vulva Restoration.

Summary:Labiaplasty has rapidly increased in popularity over the past 5 years.Traditional labiaplasty is associated with potential complications, such as dehiscence, hematoma, flap necrosis, narrowed introitus, pain, and asymmetry. Minimally invasive techniques such as radiofrequency (RF) have emerged as viable alternatives to traditional labiaplasty through a temperature-controlled bipolar mechanism to heat tissues to target temperatures of 40°C–45°C. This controlled energy delivery leads to an inflammatory cascade initiating neocollagenesis, angiogenesis, and elastogenesis over the coming 3–4 months. A single surgeon series of labia minora and majora treatment by RF (InMode, Lake Forrest, Calif.) was reviewed between April 2018–October 2018. Demographic data were collected as well grade of hypertrophy (pre/posttreatment), number of vaginal deliveries, and reason for treatment. Procedural parameters were recorded, including internal/external temperatures, total energy used, and time of treatment. All adverse events were recorded. Objective and subjective data points were obtained in the form of patient surveys and photographic evaluation by lay persons as well as plastic surgeons objective to the treatment. Ten consecutive patients were treated with bipolar RF (InMode, Lake Forrest, Calif.) between April 2018–October 2018. Mean age was 44 (29–54). Average number of pregnancies was 2 (STD 1.1). Three patients were treated for aesthetic concerns, 3 for functional complaints, and 4 desired improvement in both. Overall graded improvement in labia size/contour was +50% (STD ±15.3). Patient satisfaction scale data demonstrated 9.5/10 (±1.7). All patients (10/10) stated that they would undergo treatment again. In all cases, the surgeon observed tightening of the clitoral hood, introitus, forchett, as well as improved distribution of dark pigmentation of the labia minora. There were no significant complications and no need for additional procedures. Average recovery time was 14 days (STD 2.2). Treatment of labia hyperplasia and laxity with bipolar RF may potentially fill a treatment gap of women seeking aesthetic and functional improvements without surgical labiaplasty. A powered prospective randomized double-blinded study is needed to further elucidate the role of this technology.

Effect of Surgery for Stress Incontinence on Female Sexual Function.

To evaluate the effects of four different surgical interventions for stress urinary incontinence (SUI) on 2-year postoperative sexual function. This is a combined secondary analysis of SISTEr (Stress Incontinence Surgical Treatment Efficacy Trial) and TOMUS (Trial of Mid-Urethral Slings). Women in the original trials were randomized to receive surgical treatment for SUI with an autologous fascial sling or Burch colposuspension (SISTEr), or a retropubic or transobturator midurethral sling (TOMUS). Sexual function (assessed by the short version of the PISQ-12 [Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire]) was compared between groups at baseline, 12 and 24 months. Secondarily, the effects of subjective and objective surgical cure rates and the effect of concomitant surgical procedures on 24-month sexual function was explored. Nine hundred twenty-four women were included in this study: 249 (26.9%) had an autologous fascial sling, 239 (25.9%) underwent Burch colposuspension, 216 (23.3%) had a retropubic midurethral sling placed, and 220 (23.8%) had transobturator midurethral sling placed. Baseline characteristics (including PISQ-12 scores) were similar between the four treatment arms, with notable exceptions including race-ethnicity, prolapse stage, concomitant surgery, and number of vaginal deliveries. After adjustment for differences between the groups, there was a clinically important improvement in PISQ-12 scores over the 24-month postoperative period for all treatment groups, with no significant differences attributed to the type of anti-incontinence procedure (baseline PISQ-12: 32.6, 33.1, 31.9, 31.4; 24-month PISQ-12: 37.7, 37.8, 36.9, 37.1, P<.01). There was no significant difference in mean PISQ-12 scores between 12 months and 24 months (12-month PISQ-12: 37.7, 37.8, 36.9, 37.1; 24 months as above, P=.97). Multivariable analysis showed independent associations between objective and subjective cure rates as well as concomitant procedures with a 24-month PISQ-12 score. Women undergoing anti-incontinence surgery show overall improvement in sexual function from baseline to 24 months postoperatively, without significant differences based on surgical procedure performed. The majority of this improvement occurs in the first 12 months and is maintained over 24 months.

Prevalence and Risk Factors of Urinary/Anal Incontinence and Pelvic Organ Prolapse in Healthy Middle-Aged Iranian Women.

ObjectivesUrinary incontinence (UI) and anal incontinence (AI) cause concern, social exclusion, and ultimately reduced quality of life in women. The aim of present study was to assess the prevalence and related risk factors of UI, AI, and pelvic organ prolapse (POP).MethodsThe present study recruited 340 menopausal women living in Tabriz in northwest Iran. The data collection tools included the Pelvic Floor Distress Inventory-20 and a personal and social information questionnaire. POP was diagnosed via clinical examination using the simplified pelvic organ prolapse quantification system.ResultsThe prevalence of UI and POP was approximately 50%, and approximately 16% of participants reported AI. Based on the odds ratios, the most remarkable risk factor of urinary stress incontinence was the number of vaginal deliveries, whereas that of urinary urge incontinence was obesity. Episiotomy and age were the most major risk factors of AI and POP, respectively.ConclusionsThe results of the present study showed that the prevalence of POP, UI, and AI is remarkably high among postmenopausal women, warranting the need to prioritize the assessment of POP and various incontinences in middle-aged women in the primary health care system. Furthermore, increased emphasis should be put on modifiable risk factors.

Prevalence of symptomatic urinary incontinence and pelvic organ prolapse among women in rural Nepal.

Although pelvic floor disorders (PFDs) are a significant public health issue in higher income countries, less is known about these disorders and associated risk factors in low income countries. We aimed to determine prevalence and associated risk factors for stress urinary incontinence (SUI), urge urinary incontinence (UUI), and pelvic organ prolapse (POP) in reproductive age women in Sarlahi District in rural Nepal. We conducted a community-based cross-sectional survey of parous, reproductive age women in rural Nepal and screened for pelvic floor disorders using validated screening questions for PFDs. Overall frequency of self-reported symptoms for SUI, UUI, and POP was estimated and compared across demographic and pregnancy history information. Of 14,469 women available for analysis, the mean (SD, range) age was 33.5 (8.2, 13-52) years, and median (range) number of pregnancies was 4 (1-15). The prevalence of SUI was 24.1% (95% CI: 23.3-24.8), of UUI was 13.5% (95% CI: 13.0-14.1), and of POP was 8.0% (95% CI: 7.5-8.4). Bivariate analysis identified the risk of PFD increased incrementally with age and number of vaginal deliveries; these covariates were highly correlated. Multivariable logistic regression revealed age, vaginal deliveries, and previous pelvic surgeries were independently associated with PFD. PFDs are common in a community of parous, reproductive age women in rural Nepal. Risk factors for these conditions are similar to risk factors found in higher income countries.

A comparison between induction of labor with 3 methods of titrated oral misoprostol, constant dose of oral misoprostol and Foley catheter with extra amniotic saline infusion (EASI), in women with unfavorable cervix.

Background: Different methods of cervical ripening and induction of labor have been used in the cases of unfavorable cervix with different levels of success, but no method has been found to be the best option. The purpose of the present study was to find the effects and side effects of three different methods of cervical ripening and induction of labor. These three methods were oral titrated misoprostol, constant dose of oral misoprostol and Foley catheter with extra-amniotic saline infusion. Methods: This clinical trial was performed on women with unfavorable cervix who had been admitted in Akbarabadi Teaching Hospital for induction of labor and had bishop score of less than six; between March 2014- March 2015. The eligible women were assigned into three groups. In titrated oral misoprostol group (n=33), titrated solution of misoprostol, and in oral misoprostol group (n=33), 50µg oral misoprostol every four hours and in Foley catheter group (n=50), Foley catheter with extra-amniotic saline infusion were administered. The main outcome was the number of vaginal deliveries during the first 24 hours. In addition, number of cesarean deliveries and adverse effects were compared between the three groups. The obtained data were analyzed using SPSS 18 software. Data analysis was performed according to the intention to treat principle. Chi-square test, Fisher Exact test, Student ttest, and Mann-Whitney U test, were used for comparing data. P-value≤0.05 was considered statistically significant. Results: The three groups did not have any significant difference according to maternal age, gestational age at the time of admission, gravidity, parity, and primary Bishop Score. There was no significant difference between the three groups for the main outcome, which was vaginal delivery during the first 24 hours (p=0.887). There was no significant difference between the three groups according to hypertonicity, uterine hyperstimulation, meconium passage, non-reassuring fetal heart rate, neonatal Apgar score in minutes one and 5, and mean duration of beginning the intervention up to delivery. However, uterine tachysystole and NICU admission were more in the group to whom the titrated solution of misoprostol was administered (p=0.002 and p=0.037 respectively). The number of cesarean deliveries due to failure to progress was higher in the EASI group. However, EASI group showed the least number of none-reassuring fetal heart rate between the three groups. Meconium passage was more in the titrated misoprostol group, but the difference was not significant. Conclusion: All three methods are appropriate methods for induction of labor in the cases of unfavorable cervix; and choosing each method depends on the expertise of labor staff, accessibility to the medications, cost, and taking care for monitoring the patients and adverse effects.

Prevalence of Pelvic Floor Disorders in Female CrossFit Athletes.

This study aimed to estimate the prevalence of pelvic floor disorders by symptoms in female CrossFit athletes in the United States and characterize subjects reporting pelvic organ prolapse symptoms, urinary incontinence, and fecal incontinence. A 27-question anonymous questionnaire was distributed to owners of CrossFit-affiliated gyms. Select questions from validated questionnaires were used to define symptoms. Positive responses with "moderate, or quite a bit" bother defined the presence of urinary incontinence (with stress or urgency). A response of "yes" to "having a bulge or something falling out" defined the presence of pelvic organ prolapse. A response of "yes" to "lose stool beyond your control" questions defined the presence of fecal incontinence. Three hundred fourteen respondents had mean age of 36 ± 10 years and a mean body mass index of 25.2 ± 4 kg/m. Forty-four percent reported ≥1 vaginal delivery. For each workout, respondents reported lifting mean weights of 91 to 217 lb, and 90% reported participation in ≥3 CrossFit workouts per week. Pelvic floor disorder symptoms reported included the following: pelvic organ prolapse, 3.2% (10/314); urinary incontinence, 26.1% (82/314); and fecal incontinence, 6% (19/314). Higher age, parity, and number of vaginal deliveries were associated with urinary incontinence. Higher parity and number of vaginal deliveries were associated with prolapse. Fecal incontinence was not associated with age, body mass index, or obstetric history. The prevalence of pelvic floor symptoms in female CrossFit athletes from the general population is likely similar to the general population; however, the prevalence of bothersome urinary incontinence is higher than the general population in women younger than 40 years.

Pelvic Floor Organ Prolapse After Radical Cystectomy in Patients With Uroepithelial Carcinoma.

The aim of this study was to identify whether women who undergo a radical cystectomy for uroepithelial carcinoma are at increased risk of pelvic organ prolapse after surgical treatment. A retrospective cohort study compared female subjects who had undergone a radical cystectomy for uroepithelial carcinoma, as identified through an institutional cancer survivor database, with subjects who presented to the Pelvic Health and Continence Clinic with symptoms of either uterovaginal prolapse or urinary incontinence. Demographic data were collected regarding risk factors for prolapse, and study subjects were asked to complete a Pelvic Organ Prolapse Distress Inventory (POPDI-6). Data were collected through retrospective chart review. The primary outcome is difference in the POPDI-6 between the groups. Statistical evaluation of responses was performed, with analysis of variance used to compare the questionnaire scores between groups and correction for risk factors with χ2 tests, with a P value of 0.05 selected for statistical significance. There were 36 postcystectomy subjects who responded to the survey, 37 subjects in the prolapse group, and 44 subjects in the incontinence group. With correction for age, body mass index, and number of vaginal deliveries, the postcystectomy group reported significantly lower scores on the POPDI-6 than both the prolapse group (P < 0.0001) and the incontinence group (P = 0.0003). Radical cystectomy for uroepithelial carcinoma does not correlate with an increased risk of patient-reported symptoms of pelvic organ prolapse.

34: Unilateral sacrospinous ligament hysteropexy: a single-center experience

The primary objective of this study was to describe our experience with unilateral sacrospinous ligament hysteropexy (SSLH) performed via an incision through the anterior vaginal wall for treatment of uterovaginal prolapse. Additionally, we sought to identify factors associated with symptomatic recurrence. An IRB approved retrospective chart review was performed identifying women who underwent SSLH (CPT code 57282) from January 2013 to March 2017 performed at the University of Rochester Medical Center. Subjects were excluded if graft augmentation was used, they had a prior hysterectomy, or if bilateral suspension was performed. Demographics, comorbidities, and perioperative data were extracted from the electronic medical records. Descriptive statistics were performed and data were compared between subjects who felt their prolapse symptoms were resolved and those who felt they recurred using t test, Wilcoxon rank sum test, chi-square test, or fisher exact test as appropriate. The cohort (n = 59) consisted of predominantly white (93%), non-smoking (54%), post-menopausal women (92%) with private insurance (59%). Median age was 63 years (range, 43 – 80 years), median body mass index (BMI) was 26.8 kg/m2 (range, 18.9 – 43.1 kg/m2), and median pelvic organ prolapse quantification (POPQ) stage was 3 (range, 2 – 3) at the time of surgery. The median operative time was 80 mins (IQR: 67, 94.5 mins) including concomitant anterior (n = 49), enterocele (n = 1), and/or posterior repairs (n = 12). Concomitant retropubic sling was performed in 3 subjects. Median estimated blood loss (EBL) was 50 mL (IQR: 25, 50 mL) and median time in the post-anesthesia care unit (PACU) was 72 min (IQR: 57, 101 mins). The average milligram morphine equivalents (MME) administered in PACU was 2.1 ± 3.1 MME. Most women (81%) were discharged home on the day of surgery. We observed a recurrence rate of 25.4% which was not significantly associated with surgeon (p = 0.23), subject’s age (p = 0.51) or BMI (p = 0.56), EBL (p = 0.99), operative time (p = 0.80), number of vaginal deliveries (p = 0.71), use of permanent and/or absorbable sutures (p = 0.21), prior vaginal surgery (p = 0.15), or pre-operative POPQ stage (p = 0.73). Post-operative complications included urinary retention (n = 2), de novo stress urinary incontinence (n = 2), and urinary tract infection (n = 4). Nineteen subjects admitted to buttock pain in the first week after surgery, 4 requested additional narcotic medication, and 1 had a suture release due to persistent pain. Unilateral sacrospinous ligament hysteropexy is a well-tolerated treatment option for uterovaginal prolapse. The suspension is an efficient and effective procedure when performed through the anterior vaginal wall with a low incidence of complications and a recurrence rate of 25%.

Demographic features of female urethra length.

To determine cohort urethral length, identify epidemiological factors influencing the parameter and to establish the percentage of cases with clinically relevant outsized urethras. Prospective cohort study conducted in two tertiary clinical centers between 2013 and 2017. Nine hundred and twenty seven consecutive adult, Caucasian females attending outpatients' clinics were included. The urethral length has been measured in pelvic floor ultrasound examination. The exclusion criteria were inadequate bladder filling (<200 mL; >400 mL), previous history of pelvic floor surgery, and no consent. Urethral length varied from 19 to 45 mm. The distribution of the examined parameter was normal. Obese patients had significantly longer urethras as compared to non-obese subjects. Number of vaginal deliveries was connected with shorter urethral length. The limitations of the study are: analysis only of Caucasian patients and subjects without previous pelvic floor surgeries. Differences in urethral length in the female population were demonstrated. Thirty percent of patients have atypical urethras that may be a risk factor for sling surgery failure. We therefore postulate introduction of urethral measurement before the procedure.

Predictors of sexual function in women with stress urinary incontinence

To assess female sexual function (SF) in different grades of urodynamic stress urinary incontinence (SUI), with/without pelvic organ prolapse (POP); to investigate associations between clinical data and pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ) scores. A cross-sectional study was conducted in sexually active women (130 with SUI and 126 controls). Stamey score and POP quantification (POP-Q) were used. Urogynecological examinations were performed; all participants completed PISQ. Multivariable linear regression was used to identify negative SF predictors. SF was lower in the study group (P < 0.001), in moderate (P < 0.001), and severe SUI (P < 0.02) versus controls, in each particular domain and total PISQ-score (total score: 83.8 ± 14.8, 80.8 ± 14.5, 84.5 ± 11.1 vs 95.7 ± 10.3, respectively). Women with mild SUI had better SF in physical and partner-related domains compared to moderate SUI (33.6 ± 6.1 vs 30.7 ± 6.4, P < 0.02; 18.8 ± 2.9 vs 17.3 ± 3.3, P = 0.02, respectively). Age correlated with PISQ-scores in behavioral/emotive (r = -0.24, P = 0.006), and partner-related domains (r = -0.28, P = 0.002), and total PISQ-score (r = -0.2, P = 0.02); menopausal status with partner-related domain (r = -0.32, P = 0.000) and total PISQ-score (r = -0.19, P = 0.029); menopause duration with physical domain (r = 0.17, P = 0.045); SUI stage only with PISQ scores in physical domain (r = -0.22, P = 0.014). No correlations were found between BMI, parity, number of vaginal deliveries, POP-Q stages, with PISQ results. Age in the SUI group and controls (β = -0.18, P < 0.05) and BMI in controls (β = -0.26, P < 0.01) were independent predictors of impaired SF. Different SF predictors were found in SUI women and controls. Impaired SF was confirmed in SUI women compared to controls, with more severe SUI corresponding to lower SF.