Obstetric Procedures Research Articles

Magnitude and associated factors of caesarean section deliveries among women who gave birth in Southwest Ethiopia: institutional-based cross-sectional study

BackgroundCaesarean section is a life-saving comprehensive obstetric procedure of women and newborn performed during childbirth-related complications and should be universally accessible for all pregnant mothers globally. Appropriate use of caesarean section can reduce maternal and perinatal mortality. However, inappropriate use of caesarean section can negatively affect infant health, women health, and future pregnancies. The magnitude and factors associated with caesarean section delivery were not consistent and will vary between different hospitals of Ethiopia. Hence, this study aimed at assessing the magnitude and factors associated with caesarean section deliveries in Southwest Ethiopia.Methods and MaterialsAn institutional-based cross-sectional study was conducted from January 1 to February 29, 2020. A systematic random sampling technique was used to select 551 study participants. A pretested, structured, and face-to-face interview was used to collect data. Data were entered into Epi-data version 4.2.0 and exported to SPSS version 23 for analysis. Bivariate and multivariate analyses were used to identify factors associated with caesarean section deliveries. P values < 0.05 result were considered as a statistically significant association.ResultsThe magnitude of caesarean section deliveries was found to be 32.5 % (95 % CI; 28.6%-36.7 %). Mothers resided in an urban area [AOR = 2.58, (95% CI; 1.66–4.01)], multiple pregnancies [AOR = 3.15, (95% CI; 1.89–5.23), malpresentation [AOR = 3.05, (95% CI; 1.77–5.24)], and previous history of caesarean section [AOR = 3.55, (95% CI; 2.23–5.64) were factors associated with caesarean section deliveries.ConclusionsCaesarean section deliveries were found high in the study area. Mothers resided in an urban area, multiple pregnancies, malpresentation, and previous history of caesarean section were factors associated with caesarean section deliveries. Therefore, counselling of mothers on the risk of giving birth through elective caesarean section without absolute and relative medical indications and giving enough time for the trial of vaginal birth after caesarean section are recommended.

A comparison of the efficacy of single-dose cefazolin versus single-dose cefazolin plus 7-day mupirocin ointment wound application in preventing surgical site infection among patients undergoing major obstetric and gynecologic procedures at a tertiary university hospital

BACKGROUND: Surgical site infection (SSI) is a common complication among all surgical cases. It is the most common nosocomial infection identified in the developing world with pooled incidence of 11.8 per 100 surgical procedures. In our institution, the SSI rate in major obstetric and gynecologic cases in years 2000–2013 is 12.68%. OBJECTIVE: To compare the efficacy of a single-dose cefazolin versus a single dose cefazolin plus 7-day mupirocin ointment wound application in preventing SSI among women undergoing major obstetric and gynecologic abdominal surgical procedures. MATERIALS AND METHODS: The study included are 164 female participants, aged 18–65 years old who underwent major obstetric and gynecologic surgical procedures. Participants were randomly assigned to Groups A and B, wherein all participants were given single dose of 2 g cefazolin, intravenous, 30 min before skin incision. For the participants in Group B, an additional 7-day application of mupirocin ointment on incisional wound during the postoperative period was given. Assessment for occurrence of SSI and healing time using a standardized collection tool and Southampton wound scoring system, respectively, was done on the 8th, 15th, and 30th postoperative days. RESULTS: The incidence of SSI is 2.45% (4 out of 164 participants). It was slightly higher in the Cefazolin only arm having three cases, while only one case in the Cefazolin plus mupirocin group. However, the difference of SSI occurrence between the two groups is not statistically significant. Wound healing time was also evaluated which was comparable between treatment groups. CONCLUSION: Single dose Cefazolin plus 7-day once daily Mupirocin ointment application is comparable to single dose of cefazolin in preventing SSI in patients undergoing major low-risk obstetric and gynecologic surgeries. Therefore, the addition of mupirocin in uncomplicated major obstetric and gynecologic surgical cases is not cost-beneficial.

Determining Competence in Performing Obstetric Combined Spinal-epidural Procedures in Junior Anesthesiology Residents: Results From a Cumulative Sum Analysis

(Int J Obstet Anesth. 2020;44:33–39) Epidural techniques can be challenging to master and require practice. The required number of cases to demonstrate competency in epidural procedures varies widely. Residents must complete 40 epidural or combined spinal-epidurals (CSEs) to show competency according to Accreditation Council for Graduate Medical Education International (ACGME-I) requirements. At the study center, CSE training consists of didactic teaching, 10 one-on-one supervised sessions using a model, and 10 supervised and coached CSEs, followed by 3 Direct Observation of Procedures assessments. This study used cumulative sum (CUSUM) analysis, a tool for defining failure rates, plotting learning curves and mapping levels of competence, to determine the minimum experience needed to demonstrate competency in obstetric CSE procedures among junior residents.

English

BACKGROUND Most commonly done obstetric procedure globally is caesarean section. The incidence of C-section is continuously increasing because risk associated with vaginal delivery after caesarean, previous caesarean section is an important indication for Csection. The purpose of this study was to assess the difficulties during intra-operative period in women who undergo caesarean section repeatedly and also to study the comparison between difficulties with women with previous one caesarean section and women with previous 2 or more C-sections. METHODS It is a prospective observational study conducted on 150 women in the Department of Obstetrics &amp; Gynaecology in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar in women with history of previous caesarean sections (one or more). The women were divided into two groups - Group 1 - Those with previous one caesarean section and Group 2 - Those with previous two or more caesarean sections. RESULTS Out of 150 cases randomly selected and studied who had repeated caesarean section,90 had 1 previous lower segment caesarean section (LSCS), 60 had two or more caesarean sections, the highest number of caesarean sections were performed on women between the age group of 20 - 29 years. Out of these, some cases did not show intra-operative complications, some showed variety of intra-operative complications. Most common type of complications that they came across were adhesions (44 %) in 1 previous LSCS, 65 % in 2 or more LSCS. There were no cases of scar rupture, uterine rupture, bowel injury, caesarean hysterectomy in the study population, probable reason could be that cases were taken elective or taken with a short trial of labour with high level of intrapartum monitoring. CONCLUSIONS Higher incidence of intra-operative complication is seen in women with previous caesarean sections. KEY WORDS Repeat C - Section, Adhesions, Intra-operative Complications

Pudendal nerve block: a safe, simple and effective approach in surgical proctological patients.

Pudendal nerve block (PNB) is commonly used in pudendal neuralgia (PN) and, as anesthesiological technique, in obstetrical and urological procedures. The purpose of this retrospective study was to compare the efficacy of PNB with other anesthesiolocal techniques in proctological surgery. A total of 362 patients were seen from a 22-month-time interval. Surgical indication was placed after a conservative therapy. Seventy-eight patients underwent surgery: 42 with spinal anesthesia with PNB and 36 with PNB alone according to their anatomical characteristics. All the patients underwent PNB in lithotomy position and with a perirectal approach. The success rate of PNB was evaluated in postoperative pain control with the VAS score, after the first and the second evacuation. The follow-up also included a third check on the seventh day after surgery. In postoperative period, the mean VAS score found after the first evacuation in patients undergoing PNB was 2.66, after the second evacuation was 1.55, while the VAS score on the seventh day was 0.38. The mean VAS score in the group who underwent spinal anesthesia and PNB were respectively 3.71 and 1.80 after the first and second evacuation. The VAS score calculated on the seventh day was 0.50. There were no statistically significant differences in the VAS score between the 2 groups (P>0.05). PNB may be a valid alternative to spinal anesthesia in proctological patients. PNB has proven to be both safe and effective technique.

Oh Baby! There's a Pregger in My PACU…

<h3>Background Information</h3> With a trending increase in patient volume and acuity in the Post-Anesthesia Care Unit (PACU)s in a large academic medical center, it was noted that one of the demographics fostering this growth is the Obstetric (OB) population. It is important to note that the OB patients presenting to the PACUs required post-anesthesia care for non-OB procedures and interventions with the exception of OB procedures requiring general anesthesia. Hospital leadership and nursing staff noticed that caring for the OB patient in a non-OB PACU setting offered some distinct challenges related to the special considerations unique to the OB population. Instead of viewing OB patients in the PACU as a quagmire, the PACUs viewed this as an opportunity to collaborate with the OB department, promulgating maternal care in the PACU. <h3>Objectives of Project</h3> The objective was to create a program increasing knowledge related to the care of the OB patient in the PACU. <h3>Process of Implementation</h3> Collaborative gap analyses by the PACU and OB educators revealed that fundamental knowledge, skills, and adherences to professional organization recommendations regarding standards of care were opportunities for improvement. "Special Population Considerations: The OB Patient" was created and added to the existing PACU Residency/ Transition to Practice and PACU Preceptor curriculums which offer didactic and simulation activities to facilitate learning. Topics addressed included OB assessment, fetal monitoring (FM) expectations, postpartum hemorrhage care, and OB emergencies and equipment guided by professional practice guidelines and recommendations. Further, the OB department committed to collaborative care for FM and additional resources as needed, easing the anxiety of PACU nurses. Knowledge assessment was performed pre and post offering to measure changes in knowledge and program evaluation. <h3>Statement of Successful Practice</h3> After completion of the program by five cohorts, the average preassessment score of 30.6% increased to 85.6% post assessment showing an increase in knowledge and program success. Further, 100% of participants found the program beneficial. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> In addition to the new OB curriculum being offered, OB learning enrichment opportunities should be added to unit in-services, yearly skills and drills, and/ or unit-based competencies to ensure that PACU nurses are retaining knowledge regarding the care of the OB patient in the PACU.

Clinical and laboratory characteristics in gynecologic and obstetric patients with surgical site infection

The frequency of surgical site infection (SSI) is different according to the different hospitals and is not completely known in the hospital. To describe the clinical and laboratory characteristics in gynecological and obstetric patients with SSI, as well as its frequency, associated risk factors and the most frequently isolated microorganism in cultures. Descriptive, cross-sectional, retrospective and observational study. The total number of SSI patients in the gynecology and obstetrics services were studied, consulting the database of the epidemiology service, clinical and electronic records; the data collection and the statistical analysis were carried out, reporting the results with means, standard deviations and percentages. In the 11,967 surgeries performed in 2017, SSI was detected in 110 gynecological patients and 249 obstetric patients. The relevant risk factors were obesity and previous abdominal surgeries. The most commonly isolated microorganism in cultures in both patients was Escherichia coli. The frequency of SSI was 2.4% for gynecological procedures and 3.3% for obstetric procedures, similar to that reported by the Centers for Disease Control and Prevention.

“Screaming, ‘No! No!’ It was Literally Like Being Raped”: Connecting Sexual Assault Trauma and Coerced Obstetric Procedures

Abstract How does the victimization of women’s bodies in medical interactions contribute to their experience of gendered violence? We answer this question by joining sexual assault and birth trauma literatures with the medical sociology conversation on the power of hospitals as organizations and the hierarchy of the doctor-patient relationship to analyze the interviews of 101 women who identify as having experienced a coerced, pressured, or forced labor or birth procedure. We find some respondents analogize their experiences to that of someone who has been sexually assaulted, and they and other respondents describe the aftermath effects in ways similar to those who have been victims of sexual assault. Our research demonstrates that clinicians and hospitals are harming patients, often through the normal application of established hospital protocols and behaviors, when women do not feel involved in decisions about their care.

Case report: Caesarean scar endometriosis - A rare entity.

Introduction and importanceCaesarean scar endometriosis (CSE) is a rare form of endometriosis due to previous surgical scars from obstetrical and gynecological procedures. The incidence of CSE was 0.08% and quite difficult to diagnose.Case presentationA 37-year-old multiparous woman came with intermittent pain in her lower left abdominal region and lump with a bluish color and solid consistency on the left side of the caesarean scar. Ultrasounds findings show a solid mass, measured 45 × 40 × 39 mm with neovascularization color score: 4. In April 2021, we performed mass resection, intraoperatively we found solid mass with no adhesion and infiltration found. Histological examination results confirm external endometriosis from the mass and the fascia was free from endometriosis. The symptoms reported relief after the procedure.Clinical discussionScar endometriosis is largely related to previous abdominal surgery like caesarean section, the mass increase in size during menses and becomes symptomatic. CSE develop ranging 12 months to 21 years and could mimic other hernias or tumor, that's why careful and precise examination is needed. The imaging modality we use in this case was ultrasonography which is the best and most accessible, reliable and cost-effective to diagnose. We performed large surgical excision of the lesion with reconstruction of damaged tissue to prevent recurrence and conversion to malignancy.ConclusionCaesarean scar endometriosis should be considered in women of reproductive age with lower abdominal pain and/or mass at the caesarean scar from previous delivery or following obstetric-gynecologic surgery.

Outpatient Foley catheter induction protocol provides clinical and cost benefits.

Obstetric induction procedures are expensive, and little is known of the specific difference in cost between inpatient and outpatient protocols for these procedures. The objective of this study was to examine the difference in health care costs, maternal and neonatal morbidity, and cesarean birth rates for inpatient versus outpatient Foley induction protocols. We conducted a retrospective study using deliveries from 2013 to 2015 that received an outpatient or inpatient Foley catheter induction. Inductions were matched by race, parity, and maternal age. We used univariate and multivariate logistic regression to test the association between type of induction, length of stay, and cost. Maternal and neonatal factors and cesarean rates were also considered. A total of 163 outpatient Foley inductions were matched 1:1 to inpatient inductions. Outpatient inductions were more likely to have a shorter length of hospitalization from admission to discharge (a 7.17-hour difference, 95% CI, 71.00, 77.59) and lower costs of hospitalization ($408 per patient, 95% CI, 4305, 4714). In the univariate analysis, there was no difference in rate of cesarean birth (OR 0.95, 95% CI, 0.61, 1.48). However, in the multivariate analysis, there was a decreased rate of cesarean for outpatient inductions (OR 0.5, 95% CI, 0.26, 0.97). Outpatient Foley catheter induction appears to be a safe, cost-effective method for induction of labor. Generating protocols allowing patients to receive quality care in an outpatient setting is increasingly important in current health care environments.

Prenatal and Obstetric Parameters of Late Terminations: A Retrospective Analysis.

Background In Germany, the highly sensitive issue of late terminations of pregnancy and feticide is regulated in Sec. 218a para. 2 of the German Penal Code (medical indication). This study aimed to investigate the prenatal obstetric approach after feticide and the rate of maternal complications. Material and Methods All feticides of singleton pregnancies carried out at Leipzig University Hospital (n = 164) in the period between 01/2016 and 12/2019 were retrospectively analyzed. Selective feticides of multiple pregnancies were excluded from the study. Target indicators for the prenatal obstetric approach were sonographic accuracy of estimation, method used to induce feticide, time between feticide and delivery, and whether curettage was required. The rate of maternal complications was defined as blood loss of ≥ 500 ml. Results The number of feticides as a percentage of the total number of births during the investigation period was 1.6%. None of the terminations were performed primarily because of a serious risk to the motherʼs physical health; all of the indications to terminate the pregnancy were based on the psychosocial burden and the risk to the motherʼs mental health as outlined in Sec. 218a StGB (German Penal Code). The most common fetal diagnoses in the context of a maternal psychosocial emergency were central nervous system abnormalities (29.3%), numerical chromosomal aberrations (29.3%) and structural chromosomal aberrations/syndromes (21.3%). Sonographic measurements were used to estimate fetal weight and the weight of around half of the fetuses was underestimated (− 121.8 ± 155.8 g). The margin of estimation error increased with increasing gestational age (p < 0.001). Misoprostol was the most common drug administered to induce labor. No significant association was found between the method chosen for induction, parity, fetal birth position, fetal anomaly, fetal gender, birth mode or the number of previous cesarean sections and Δdelivery . However, a significantly higher loss of blood was observed with longer Δdelivery (p = 0.02). The likelihood of requiring curettage increased with increasing loss of blood. The number of maternal complications as a percentage of the total patient population was 10.4%. Only 11% of patients agreed to a postmortem examination. Conclusion Late terminations of pregnancy carried out in accordance with Sec. 218a para. 2 StGB are a reality and must be understood and accepted as a possible consequence of modern prenatal medicine. The complication rate after feticide and the subsequent obstetric procedure was 10% for the above-defined maternal complication. Late terminations and their obstetric management should be carried out in specialized perinatal centers which offer interprofessional expertise.

Evaluation of Inappropriate COVID-19 RT-PCR Test Utilization at an Academic Medical Center.

BackgroundAn evolving COVID-19 testing landscape and issues with test supply allocation, especially in the current pandemic, has made it challenging for ordering providers. We audited orders of the Xpert® Xpress SARS-CoV-2 RT-PCR platform—the fastest of several other testing modalities available—to illuminate these challenges utilizing a multidisciplinary laboratory professional team consisting of a pathology resident and microbiology lab director.MethodsRetrospective review of the first five hundred Xpert® Xpress SARS-CoV-2 RT-PCR test orders from a 2-week period to determine test appropriateness based on the following indications: emergency surgery, emergent obstetric procedures, initial behavioral health admission, and later including discharge to skilled care facilities and pediatric admissions. Our hypothesis was that a significant proportion of orders for this testing platform were inappropriate.ResultsUpon review, a significant proportion of orders were incorrect, with 69.8% (n = 349, p < 0.0001) not meeting indications for rapid testing. Of all orders, 249 designated as emergency surgery were inappropriate, with 49.0% of those orders never proceeding with any surgical intervention; most of these were trauma related (64.6% were orders associated with a trauma unit).ConclusionsSignificant, pervasive inappropriate ordering practices were identified at this center. A laboratory professional team can be key to identifying problems in testing and play a significant role in combating inappropriate test utilization.

Causes contributing to the excess maternal mortality risk for women 35 and over, United States, 2016-2017.

To better understand age-related disparities in US maternal mortality, we analyzed 2016–2017 vital statistics mortality data with cause-of-death literal text (actual words written on the death certificate) added. We created a subset of confirmed maternal deaths which had pregnancy mentions in the cause-of-death literals. Primary cause of death was identified and recoded using cause-of-death literals. Age-related disparities were examined both overall and by primary cause. Compared to women <35, the 2016–2017 US maternal mortality rate was twice as high for women aged 35–39, four times higher for women aged 40–44, and 11 times higher for women aged 45–54 years. Obstetric hemorrhage was the leading cause of death for women aged 35+ with rates 4 times higher than for women <35, followed by postpartum cardiomyopathy with a 3-fold greater risk. Obstetric embolism, eclampsia/preeclampsia, and Other complications of obstetric surgery and procedures each had a two-fold greater risk of death for women aged 35+. Together these 5 causes of death accounted for 70.9% of the elevated maternal mortality risk for women aged 35+. The excess maternal mortality risk for women aged 35+ was focused among a few causes of death and much of this excess mortality is preventable. Early detection and treatment, as well as continued care during the postpartum year is critical to preventing these deaths. The Alliance for Innovation on Maternal Health has promulgated patient safety bundles with specific interventions that health care systems can adopt in an effort to prevent these deaths.

Increased incidence of post-operative respiratory failure in patients with pre-operative SARS-CoV-2 infection

ObjectiveWhile studies have reported increased post-operative pulmonary complications with SARS-CoV-2 infection, many are limited by use of historical controls or focus on less severe respiratory complications. We characterized the association between pre-operative SARS-CoV-2 infection and post-operative respiratory failure (PORF). Design and settingThis was a single center retrospective cohort study in New York City between March 14–June 14, 2020. PatientsExclusion criteria were age < 18-years, obstetric procedures, absence of SARS-CoV-2 PCR testing, and pre-operative respiratory failure. A total of 778 patients met criteria, of which 87 had SARS-CoV-2. MeasurementsThe primary outcome, PORF, included inability to extubate for ≥24 h or unplanned re-intubation within 5 days. Multiple exposures were measured including SARS-CoV-2 infection 4 weeks before or 5 days after surgery. Multivariable logistic regression was performed to adjust for pre-operative hypoxemia, oxygen use, and pneumonia as well as tachycardia, gender, Charlson Comorbidity Index (CCI), Surgical Mortality Probability Model (S-MPM) index, and peri-operative blood transfusion. Main resultsSARS-CoV patients had higher CCI (P = 0.007) and S-MPM scores (P = 0.02). The incidence of PORF was 16% versus 7% in uninfected comparators (P = 0.001). Amongst infected individuals, 39% exhibited symptoms of COVID-19 and PORF was more common in these patients compared to asymptomatic individuals (26% vs. 9%, P = 0.04). Adjusted analysis revealed increased odds of PORF with infection (OR 2.8, 95% CI 1.2–6.2). This persisted even when adjusting for probable mediators such as pre-operative hypoxemia. Infected patients also demonstrated increased adjusted odds of 30-day mortality (OR 3.5, 95% CI 1.4–9.1). ConclusionsDetection of SARS-CoV-2 infection within 4 weeks before or 5 days after surgery is associated with increased odds of 5-day PORF and 30-day mortality. This supports delaying elective surgery, but questions remain regarding the applicability of this recommendation for asymptomatic patients needing urgent or semi-urgent procedures such as oncologic surgery.

Use of 25 MCG for early induction of labour in active management of labour –Study of 100 cases in private setup

Induced labour is one in which pregnancy is terminated artificially, any time after fetal viability is attained by a method that aims to secure vaginal delivery. It is one of the important procedures in obstetrics. The key factor for a successful induction is the cervical status, consistency and dilatation which is determined by the Bishop’s score. Prostaglandins are more effective in cases of unfavourable cervix or in the pregnancies remote from the term. Misoprostol, a prostaglandin E1 analogue is relatively inexpensive, can be easily stored at room temperature and has fewer systemic adverse effects. It has rapid absorption both orally and vaginally.To determine the efficacy and safety of vaginally administered misoprostol for third trimester cervical ripening or induction of labour in a study conducted on 100 patients in Mahaveer Hospital, Scientific Research Institute, Surendranagar, Gujarat.This was prospective study conducted in private setup from October 2020 to February 2021. Study population comprised of 100 subsequent pregnant women who required induction of labour were recruited after applying inclusion and exclusion criteria. The progress of labour was charted on the partograph. The mean induction delivery interval, mode of delivery, maternal and neonatal outcome and complications were observed.

Study of Stripping of Membranes at Term Gestation to Reduce Post-Term Pregnancies

Introduction: Any pregnancy which has passed beyond the expected date of delivery is called a prolonged pregnancy &amp; which have passed 42 weeks, 294 days is called postmaturity or post term pregnany [1], these are at an increased risk for fetal postmaturity syndrome, macrosomia, fetal intolerance of labor, oligohydramnios, meconium-stained amniotic fluid, and cesarean delivery [2]. The clinical evidence of an increased potential for these poor perinatal outcomes has triggered a movement toward increased antenatal testing between 37- 42 weeks of gestation, and cervical ripening with labor inductions at or before 42 weeks of gestation. While a ripe cervix is usually suggestive of fetal maturity to find an unripe cervix does not exclude maturity. Induction of labor is one of the most common procedures in obstetrics and is carried out in approximately 20% of pregnancies [3]. Mechanical and biochemical means have been used to affect cervical ripening and to induce labor. Methods of induction include amniotomy, membrane stripping or sweeping, prostaglandins, laminaria and oxytocin. Membrane stripping or sweeping is a commonly use procedure aimed at preventing the post term pregnancy and avoid the application of formal method of induction of labour. Aims and Objectives: 1. to determine the effectiveness &amp; safety of membrane stripping at term pregnancy as a OPD procedure weekly which can reduce the incidence of Post term pregnancy, labour induction and its complication. 2. To determine what factors occurring after digital separation of the chorionic membranes from the lower uterine segment (membrane stripping) are involved in observed clinical changes compared with patients not so treated. Material and Methods: Study Design: This was a prospective study conducted at department of Obstetrics and Gynaecology at our hospital. Study Duration: Study was conducted during the period of duration September 2014 to September 2016. Results: After documenting the confirm gestational dating criteria and obtaining inform consent 200 patients at 37 complete week of gestation were randomly selected for the study. Data were collected from findings at 1,2,3 week and during labour, which is compaired by pearson chi-square and fischer exact test. Conclusion: Stripping of membranes is a very old procedure. This causes the release of plasma prostaglandin F2, Increase in endocervical phospholipase A activity and oxytocin release have also been observed. This will initiate uterine contraction and onset of labour. It is safe, cheap, effective and even an out patient procedure. It is associated with earlier delivery and decreased incidence of posterm gestation and hence maternal and fetal complication related to post maturity.

Scar endometrioma in previous caesarean section: Two case reports with review of literature

Scar endometriosis is one of the rare types among the extra pelvic endometriosis which is challenging to diagnose. Cystic or solid nodular mass caused by endometriosis are called as endometrioma. It commonly follows obstetrical and gynaecological procedures where there are endometrial manipulations. The symptoms typically involve abdominal wall pain near scar site. Here we report two cases of scar endometrioma involving rectus sheath following caesarean section which are pathology confirmed with a classical clinical presentation and image findings on ultrasonography. By presenting these cases, we emphasize on evaluation, diagnosis, and treatment of caesarean scar endometrioma and increase awareness on this entity.

Can uterine artery embolization be an alternative to plastic and reconstructive uterus operation by minimally invasive surgery?

Introduction: Plastic and reconstructive minimally invasive surgery has been established as gold standard in myomectomy. Therapy failure eventually leads to future surgical interventions or hysterectomy: surgeons and patients should be aware of the risks and benefits. We conducted a systematic review to analyse the evidence on the therapeutic indications and adverse events associated with uterine artery embolization and thereby evaluating if this method could be a valid alternative therapy. Methods: In concordance with PRISMA guidelines, literature research was made in PubMed, Cochrane Library, UpToDate, Amboss and Medline databases. Clinical trials, reviews and case reports published in English between January 2010 and June 2020 were included. Results: 44 articles were included out of 838 papers identified at initial search. Regarding uterine fibroids, three original papers and one Cochrane review reported the benefits of the procedure as an alternative to surgery, even in large and giant fibroids. Furthermore, several studies discussed the use of embolization for postpartum haemorrhage to decrease rates of hysterectomy after other haemostatic methods were exhausted, because of the potential risk of abnormal placentation in a future pregnancy. The procedure can also be successfully used as prophylactic method in different obstetrical procedures. Conclusions: The use of embolization in different uterine pathologies is a minimally invasive procedure as an alternative to surgery, especially in women who desire to preserve their uterus. Its related complications are described and can be avoided by a stringent indication of the procedure. More evidence regarding fertility after UAE, use of the procedure prophylactically in obstetrical haemorrhage or in adenomyosis is needed.

E-health and interventional radiology in gynecology

PurposeThis paper aims to summarize the radiological interventions that can be used by obstetricians and gynecologists.Design/methodology/approachE-health systems apply in all hospital sectors in the world; interventional radiology (IR) now includes transcatheter and percutaneous techniques that can be applied to various organ systems, including the female reproductive system and pelvis. Interventional radiologists can now offer many services to obstetricians and gynecologists. With the advent of new procedures and refinement of existing techniques, there are now a number of procedures that can be used to treat both vascular and non-vascular diseases. This review summarizes the radiological interventions that can be used by obstetricians and gynecologists.FindingsThis review is intended to help gynecologists and obstetricians understand the role of IR in their specialty. Many valuable vascular and nonvascular interventional services can be provided by radiologists for both obstetric and gynecological indications. Many of these IR procedures are minimally invasive with less risk to the patients.Originality/valueIR is now being used to treat some conditions encountered in obstetrics and gynecology, in particular, uterine leiomyomas, placenta accreta, postpartum hemorrhage and pelvic congestion syndrome. Moreover, with the help of IR, radiologists can also manage several nonvascular pathologies, including drainage of pelvic abscesses, fallopian tube recanalization, image-guided biopsy and fluid collections involving ovarian lesions. The major challenges faced when performing obstetric IR procedures are reduction of radiation exposure for the patient and fetus and preservation of fertility. This review highlights the role of IR in the treatment of various vascular and nonvascular pathologies encountered in obstetrics and gynecology.

Outcome of publicly funded nationwide first-tier noninvasive prenatal screening

PurposeNoninvasive prenatal screening (NIPS) using cell-free DNA has transformed prenatal care. Belgium was the first country to implement and fully reimburse NIPS as a first-tier screening test offered to all pregnant women. A consortium consisting of all Belgian genetic centers report the outcome of two years genome-wide NIPS implementation. MethodsThe performance for the common trisomies and for secondary findings was evaluated based on 153,575 genome-wide NIP tests. Furthermore, the evolution of the number of invasive tests and the incidence of Down syndrome live births was registered. ResultsTrisomies 21, 18, and 13 were detected in respectively 0.32%, 0.07%, and 0.06% of cases, with overall positive predictive values (PPVs) of 92.4%, 84.6%, and 43.9%. Rare autosomal trisomies and fetal segmental imbalances were detected in respectively 0.23% and 0.07% of cases with PPVs of 4.1% and 47%. The number of invasive obstetric procedures decreased by 52%. The number of trisomy 21 live births dropped to 0.04%. ConclusionExpanding the scope of NIPS beyond trisomy 21 fetal screening allows the implementation of personalized genomic medicine for the obstetric population. This genome-wide NIPS approach has been embedded successfully in prenatal genetic care in Belgium and might serve as a framework for other countries offering NIPS.