Uterine Prolapse Research Articles

Unattended uterine prolapse during pregnancy in a low-income setting: a case report.

A 34-year-old Gravid4Para3 pregnant woman in the 33rd week of gestation presented with refractory vaginal pain. She had a remarkable history of second-degree UP. Upon presentation, the anterior and posterior cervical lips were swollen, bluish, and protruding through the vagina. Considering the severe pain, the alarming examination findings, and the impossibility of pushing back the protruding mass, a total vaginal hysterectomy was performed. The postoperative pathological study revealed a massive hemorrhage with edematous changes in the vaginal cuff and cervical mucosa in addition to features of placenta accreta, placenta previa, and placenta abruption. UP is a rare but potentially serious condition, especially if it is related to pregnancy. Moreover, managing UP could be challenging in low-income settings, where even simple conservative methods might be unavailable or financially unattainable.

Association Between Enlarged Genital Hiatus and Composite Surgical Failure After Vaginal Hysterectomy With Uterosacral Ligament Suspension

ABSTRACT Commonly performed at the time of total vaginal hysterectomy to combat uterovaginal prolapse, uterosacral ligament suspension and sacrospinous ligament fixation are native tissue apical suspensions. Because recurrent pelvic organ prolapse increases over time after apical suspensions, nonmodifiable and modifiable risk factors have been explored. It is suggested by numerous studies that 1 risk factor for recurrent prolapse is an enlarged preoperative and postoperative genital hiatus (GH). An enlarged GH may be indicative of a caudal shift in pelvic viscera, increasing stress on vaginal supports. However, short-term follow-up, retrospective design, and lack of patient perspectives on prolapse outcomes limited the overall impact of those findings. The SUPeR trial (Study of Uterine Prolapse Procedures-Randomized) compared vaginal mesh hysteropexy with vaginal hysterectomy with uterosacral ligament suspension in a randomized trial design with long-term follow-up postoperatively. Postoperative assessments included the patient’s assessment of prolapse symptoms. The primary objective of this manuscript was to evaluate the efficacy of the vaginal hysterectomy with uterosacral ligament suspension amidst groups defined by surgical changes in GH size. The hypothesis predicted higher prolapse recurrence proportions for those with persistently enlarged GH size at 4–6 weeks postoperatively, compared with those with smaller preoperative and postoperative GH sizes. SUPeR participants included in this ancillary analysis underwent vaginal hysterectomy with uterosacral ligament suspension and then completed a 2-year follow-up. Based on preoperative to postoperative GH measurement changes, participants were divided into 3 groups. These groups were (1) persistently enlarged GH (“persistently enlarged”), (2) improved GH (“improved”), and (3) stable or normal GH preoperatively and postoperatively (“stably normal”). Prolapse was defined as any compartment with prolapse 1 cm or more beyond the hymen. The primary aim was comparison of composite surgical failure across the GH groups at 24 months, defined by any of the following conditions: anatomic failure, retreatment for prolapse, or symptoms of bothersome vaginal bulge. Secondary outcomes included the composite surgical failure components, postoperative complications, POP-Q measurements, and pain during intercourse. A total of 81 women were included in this secondary analysis. Predominant characteristics included a median age of 65.6 years, with 50 patients in the “improved group,” 14 patients in the “persistently enlarged” group, and 17 patients in the “stably normal” group. Notably, the prevalence of advanced anterior prolapse at baseline was greatest in the persistently enlarged group compared with that of both the improved and stably normal groups. Also, the prevalence of posterior colporrhaphy during the index procedure varied across groups and was more common in the improved group than the stably normal group. The surgery performed for almost all patients was a vaginal hysterectomy with uterosacral ligament suspension. The study found that following vaginal hysterectomy, after adjustment for the prevalence of advanced anterior prolapse, a woman with persistently enlarged GH at 4–6 weeks would not be at higher of composite surgical failure 2 years postsurgery when compared with other groups. The adjusted odds ratio for composite surgical failure in the persistently enlarged group compared with the stably normal group was 6.0 (95% confidence interval, 1.0–37.5; P = 0.06). Ultimately, baseline GH size is not a modifiable risk factor; however, there does appear to be an association between postvaginal hysterectomy and anterior vaginal wall prolapse when performing a presurgical and postsurgical comparison of normal GH measurements. Nonetheless, this study was not able to confirm a significant relationship between risk of recurrent prolapse and patients grouped by GH size in this manner.

Surgery for women with apical vaginal prolapse.

Surgery for women with apical vaginal prolapse.

Risk Factors of Uterovaginal Prolapse

Background: Pelvic organ prolapse refers to protrusions of the pelvic organs into or out of the vaginal canal. Vaginal prolapse can occur without uterine prolapse but uterus cannot descend without carrying the upper vagina with it. Therefore, genital prolapse is divided into two broad categories; one is uterine prolapse the other is vaginal prolapse. They are again divided into different subgroups. Objective: To find out risk factors that will help to reduce the incidence of uterovaginal prolapse. Method: It is a retrospective case control study conducted in the department of Obst & Gynae, BSMMU, Dhaka during the period of October 2009 to June 2010. We included 50 uterovaginal prolapse women as a case and 50 reasonably healthy women as a control. Vault prolapse after abdominal hysterectomy, vaginal hysterectomy, only cystocele, only rectocele, was excluded from study. Results: In this study, 62% women were 45-65 years of age and in control group this was 46%, P value was .001. In case group most of the women were multiparous, 84% were > 5, in control group this was 20%. P value was .001. Most of the patients had history of repeated childbirth, <3yrs, in control group it was >5yrs, p value is 0.001 which is highly sigficant. Most of the patients were coming from low socio-economic condition. In case group it was 56% and control group 34%, P value was 0.191. In this study, most of the patient had history of prolong labour (14.6%). Instrumental delivery 0.4% In case group, 80% patients showed easy vaginal delivery, 4.2% had obstructed labour. Almost 100% patients had history of something coming down per vagina. 42% complaining of frequency, 58% incomplete voiding, 10% retention of urine, 4% had stress incontinence, P value of incomplete voiding .001. 74% patients had history of constipation and 30% patients had history of difficulty in defecation. P value .001. 68% in case group complaining watery per vaginal discharge, 12% in control group. P Value .001. 22% in case group complaining of chronic cough, P value .001. 74% cases signifiquent history of heavy physical work. P value .001. 72% cases were 2nd degree uterine prolapse, 18% 1st degree and 10% 3rd degree prolapse. Conclusion: Early marriage, difficult childbirth, low socio-economic condition, poor nutrition status, delivery conducted by untrained dais, no rest in puerperium and complication of delivery are found to be recommended risk factors of utero-vaginal prolapse. In our socio-economic condition, it is need of ours to strengthen the existing maternal services at the basic level of community and build up the awareness to overcome & remove the risk factors of prolapse.

From inflammation to prolapse: Chronic cervicitis and the development of uterocervical prolapse- A clinical insight

Uterine prolapse is the herniation of the uterus into or beyond the vagina as a result of the failure of ligamentous and fascial supports. It is almost always accurately diagnosed by clinical examination but maybe sometimes confused with its differential diagnoses.

Long-Term Results after Bilateral Sacrospinous Colposuspension: A Prospective Study.

The loss of apical support is usually present in patients with pelvic organ prolapse. An effective correction for the vaginal apex may be an essential part of a durable repair for these women. Apical suspension of the sacrospinous ligament is likely one of the best treatments by the vaginal route. We proposed the evaluation of the functional and anatomical long-term results of an ultralight and macroporous sling. In this prospective study, bilateral sacrospinous colposuspension was performed in 32 patients with a specific mesh. Functional assessment with several validated quality of life questionnaires and pelvic examination was performed at 1, 6, 12, and 24 months after surgery. Pelvic examination using the POP-Q classification showed a very good efficacy of the BSC mesh with only three prolapse recurrences at 24 months after surgery. All the following QoL scores were significantly improved by two years: PFIQ-7 (p < 0.0001), PFDI-20 (p < 0.0001), and SF-12 (p < 0.0001). No improvement was achieved by the PISQ12 questionnaire. This vaginal minimally invasive procedure is effective, quick, reproducible, and easy. It may be a relevant option for a vaginal vault or cervical or uterine prolapse.

Management of Iatrogenic Obstetric Fistulas in the Urology Department of CHU Point G, Apropos of 62 Cases

Objective: Analyze the epidemiological, anatomo -clinical, therapeutic and evolutionary aspects of iatrogenic obstetric fistulas linked to a gynecological/obstetric procedure (caesarean section, hysterectomy, myomectomy, use of forceps, treatment of uterine prolapse, or vaginal surgery). Patients and Methods: This was a descriptive prospective study, concerning 62 patients hospitalized in the Urology department of the Point-G University Hospital from January 5, 2010 to June 30, 2014 for iatrogenic obstetric fistulas. The epidemiological, anatomo -clinical, therapeutic and evolutionary aspects were analyzed. Results: Iatrogenic obstetric fistulas were found in 19% of patients out of 321 cases of urogenital fistulas hospitalized in urology. The average age was 32 years with extremes of 15 and 52 years. The revealing clinical signs were: permanent loss of urine (87.10%), loss of urine while standing (9.70%), loss of urine while lying down (3.20%). Gynecological/obstetric procedures: caesarean section n= 39, hysterectomy n= 15, myomectomy n= 1, use of forceps n= 5, cure of uterine prolapse, vaginal surgery n= 1) were the most common causes. Type V fistulas were the most encountered with 74.20% and among these V fistulas, retro-trigonal fistulas were the most represented with 37.80% of cases followed by uretero-vaginal fistulas (31.10%) and vesico-uterine fistulas (15.60%). The upper route was used in 41 cases; followed by the low way in 18 cases and the mixed way in 3 cases. Trigono -cervico-uterine duplication was performed in 23 cases followed by uretero -vesical reimplantation in 19 cases. The treatment was satisfactory in 55 cases, i.e. 88.70% (no leakage) and poor in 7 cases.

Is It Possible to Diagnose Surgical Uterine Prolapse With Transperineal Ultrasound? Multicenter Validation of Diagnostic Software.

To validate an ultrasound software that uses transperineal ultrasound to diagnose uterine prolapse (UP). Multicenter, observational and prospective study with 155 patients that had indications for surgical intervention for dysfunctional pelvic floor pathology. Each patient underwent an examination with Pozzi tenaculum forceps was performed in the operating room with the patient anesthetized, followed by surgical correction of stages II-IV UP. Transperineal ultrasound was used to assess the difference in the pubis-uterine fundus measurement. With a multivariate logistic regression binary model (with the measurement ultrasound at rest, the Valsalva maneuver and age) using nonautomated methods to predict UP. With the purpose of evaluating the model, a table with coordinates of the receiver operating characteristic (ROC) curve, after which sensitivity and specificity were assessed. A total of 153 patients were included (73 with a diagnosis of surgical UP). It was obtained from the AUC (0.89) of the probabilities predicted by the model (95% confidence interval, 0.84-0.95; P < .0005). Based on the ROC curve for the model, obtaining a sensitivity of 91.8% and a specificity of 72.7%, values that were superior to those for the clinical exam for surgical UP (sensitivity: 80.8%; specificity: 71.3%). We validated software that uses transperineal ultrasound of the pelvic floor and patient age to generate a more reliable diagnosis of surgical UP than that obtained from clinical examinations.

Obstetrical Management of Partial Uterine Prolapse in a Mare

Uterine Prolapse is termed as the eversion of the uterus or casting of ‘’wethers’’ or casting of calf bed. It is a common complication of the third stage of labor and more common in pleuripara than primipara. Uterine prolapse is common in cows and ewes, but rarely seen in mares, dogs, and cats. A six-year-old female pony was brought to the emergency unit at the Obstetrics Unit of Veterinary Clinical Complex, Veterinary College and Research Institute Orathanadu, with a history of aborted pre-term (eight months) a day before and the mass hanging through the vulva. On clinical examination, the animal was dull and in a standing posture, the congested mucous membrane with tachycardia was noticed. Further examination of the mass revealed severe congestion and edema of the prolapsed uterus with no evidence of fetal membrane remnants. A vaginal examination explored constricted cervix. Blood samples were collected for hematology and serum biochemistry. Upon epidural anesthesia, the prolapsed mass was washed with potassium permanganate solution and then a hypertonic solution. After 10 minutes, the mass was washed with warm normal saline. Using Cetrimide cream as a lubricant and an antiseptic, the mass was reduced and repositioned. No Buhner’s suture was applied. Mare has received 40 IU of oxytocin for the involution process to begin. Systemic antibiotics and anti-inflammatory drugs were administered for five days. Uterine lavage was done for three days with normal saline and povidone-iodine to aid in uterine clearance. On consequent days, the mare had improved and the cervix was closed with no discharge. The mare had an uneventful recovery.

Pathologic Profile of Hysterectomy Cases in Saudi Arabia: A Tertiary Center Experience.

Hysterectomies are increasingly being replaced by more conservative management modalities and are now only used for limited clinical indications. The agreement between these indications and the final pathology is understudied. This study aimed to correlate the preoperative clinical diagnoses with the pathological findings detected in hysterectomies in Saudi women of different age groups. This retrospective study analyzed the preoperative clinical indications and the subsequent clinical and pathological data of all hysterectomies conducted at a single tertiary care hospital in the Eastern Province of Saudi Arabia between January 2010 and December 2021. There was no decline in the frequency of hysterectomies across the study period. Abnormal uterine bleeding was the most common clinical indication across all age groups, followed by symptomatic fibroid and uterine prolapse in women aged <50 and ≥50 years, respectively. A total of 9.2% of the cases were indicated for therapeutic reasons, either as an emergency procedure for peripartum hemorrhage or for suspected uterine premalignant and malignant lesions. Besides these, 41.2% of patients had more than one pathology, with the most common combination being leiomyoma and adenomyosis (43.4%). The difference in age between malignant and benign cases (52.3 vs. 48.8 years, respectively) was not statistically significant (P = 0.109). Most of our cohort had benign lesions. Perceptible misuse of the procedure in this cohort was unlikely, as a large proportion of the patients had more than one pathology corresponding to each clinical indication.

Gynecologists’ perspectives on surgical treatment for apical prolapse: a qualitative study

Introduction and hypothesisVaginal sacrospinous fixation (VSF) without mesh and sacrocolpopexy (SCP) with mesh are the most frequently performed surgical procedures for apical prolapse in the Netherlands. There is no long-term evidence suggesting the optimal technique, however. The aim was to identify which factors play a role in the choice between these surgical treatment options.MethodsA qualitative study using semi-structured interviews amongst Dutch gynecologists was carried out. An inductive content analysis was performed with Atlas.ti.ResultsTen interviews were analyzed. All gynecologists performed vaginal surgeries for apical prolapse, six gynecologists perform SCP themselves. Six gynecologists would perform VSF for a primary vaginal vault prolapse (VVP); three gynecologists preferred a SCP. All participants prefer a SCP for recurrent VVP. All participants have stated that multiple comorbidities could be a reason for choosing VSF, as this procedure is considered less invasive. Most participants choose a VSF in the case of older age (6 out of 10) or higher body mass index (7 out of 10). All treat primary uterine prolapse with vaginal, uterine-preserving surgery.ConclusionsRecurrent apical prolapse is the most important factor in advising patients which treatment they should undergo for VVP or uterine descent. Also, the patient’s health status and the patient’s own preference are important factors. Gynecologists who do not perform the SCP in their own clinic are more likely to perform a VSF and find more reasons not to advise a SCP. All participants prefer a vaginal surgery for a primary uterine prolapse.

Delusion of uterine prolapse following medical termination of pregnancy.

Delusion of uterine prolapse following medical termination of pregnancy.

Modified Oxford technique of colpopexy for the treatment of uterine and vaginal vault prolapse: a retrospective pilot cohort study.

Pelvic organ prolapse is a common health issue that affects 30.8% of women. Laparoscopic sacrocolpopexy and colpopectopexy are two of the most common procedures to restore the pelvic anatomy. Mesh application on the other hand carries an increased complications risk over the short and long terms. The aim of this study is to provide a basis for meshless sacrocolpopexy and colpopectopexy. This study is a retrospective cohort pilot study that analyzed the data of patients with a pelvic organ prolapse according to the pelvic organ prolapse quantification system and underwent the modified technique for sacrocolpopexy and colpopectopexy. Descriptive statistics were used to express the different variables. A total of 36 patients met the inclusion criteria and provided consent for the participation in this study. The majority of patients were postmenopausal. 22 out of 36 patients received a previous prolapse surgery. All patients presented with reducible vaginal lump. Dyspareunia and sexual dysfunction were the most commonly reported symptoms. The intraoperative complications rate was 0%. Only one patient had a postoperative persistent urinary retention that was managed medically. Sacrocolpopexy and colpopectopexy seems to be a safe alternative to the mesh-based pelvic surgeries with a very low rate of intraoperative complications and favorable follow up outcomes.

The EnPlace® sacrospinous ligament fixation-A novel minimally invasive transvaginal procedure for apical pelvic organ prolapse repair: Safety and short-term outcome results.

The EnPlace® device is a novel minimally invasive tool allowing transvaginal sacrospinous ligament (SSL) fixation of apical pelvic organ prolapse (POP). The study aimed to investigate the safety and short-term efficacy of the EnPlace® SSL fixation for significant apical POP repair. A retrospective cohort study of 123 consecutive patients (mean age 64.4 ± 11.1 years) with stage III or IV apical POP who underwent SSL fixation by the EnPlace® device. Safety and 6-month outcome results were analyzed and compared between 91 (74%) patients with uterine prolapse versus 32 (26%) patients with vaginal vault prolapse. There were no intraoperative or early postoperative complications. The mean (± standard deviation) duration of surgery was 30 ± 6.9 min and mean blood loss was 30.5 ± 18.5 mL. The average position of point C by POP-Quantification measurements before surgery and at 6 months postoperatively was 4.5 ± 2.8 cm and -3.1 ± 3.3 cm, respectively. Of 91 patients with preoperative uterine prolapse, eight (8.8%) patients developed a recurrent uterine prolapse within 6 months postoperatively. Of 32 patients with preoperative vault prolapse, two patients (6.3%) had recurrent vault prolapse. Short-term outcome results of EnPlace® SSL fixation suggest that it is a safe and effective minimally invasive transvaginal procedure for significant apical POP repair.

Association of Body Condition Score with Lactation and Reproductive Performance in Murrah Cross Buffaloes in Chitwan, Nepal

Body condition score (BCS) is a precise method for determining the stored energy reserves of dairy animals, which are located in the form of subcutaneous fat tissue, indicated by the animal’s degree of accomplished nutrition, and could be used as a management and selection tool to improve reproductive performance. The objective of this research was to investigate and quantify relationships between BCS and milk production, milk composition, and reproductive performance in Murrah cross buffalo. For this purpose, a semi-structured questionnaire was created and BCS was calculated using a visual technique based on a BCS chart. The sampling approach employed was a completely randomized design. A total of 165 Murrah cross buffaloes from 59 household farms were used in the study, where 130 milk samples were collected and used to assess the milk parameters by lacto-scan. Four BCS groups were namely 2.5-2.99, 3.0-3.49, 3.5-3.99, and 4.0-4.99 where the BCS score was found to grow during the dry period until calving, then decreased as milk production increased. BCS group (3.5-3.99) had higher performance during all the lactation periods with a peak milk yield of 11.4 ± 1.1 kg. At the late lactation stage BCS group (3.5-3.99) showed higher values of SNF (9.77), protein (4.01), and lactose (3.82), followed by BCS groups 4.0-4.49, 3.0-3.49, and 2.5-2.99. At the early, lactation stages, the BCS group (3.5-3.99) had the highest (P&lt;0.01) average milk yield of 10.28, 9.50, 9.37 kg, and the BCS group (4- 4.49) had highest (P&lt;0.01) average fat percent of 9.19, 10.20, and 10.32, respectively. The buffaloes of BCS group 3.5-3.99 had shorter post-partum estrus (61.14days) (P&lt;0.01), fewer services for conception (1.30) (P&lt;0.01) and higher first service conception rate (79.87%) (P&lt;0.01). Similarly, the incidence of associated reproductive disorders such as uterine prolapse, retained placenta, metritis, and mastitis are lowest in BCS group 3.5-3.99 with values of 7.69%, 3.44%, 3.44%, and 6.89% respectively. It can be concluded that the BCS group (3.5–3.99) provided the greatest production results in both milk and reproductive function. For optimal animal lactation and reproductive performance, the nutrition management of dairy cows should be necessarily monitored using the BCS score.

Observation of Rearing System of Small Ruminants in Jumla District

Small ruminant production is one of the main sources of meat in Jumla district and contributes in the food security of the nation. A study was carried out at Guthichaur and surrounding areas of Jumla district to observe the rearing system and management practices of small ruminant. Twenty farmers from Guthichaur, Jumla with a flock size of 100 to 350 animals were interviewed about the rearing system, management practices, and health problems. Sheep was a major livestock commodity and most of the farmers raised sheep and goat together in transhumance system (migratory sheep flock). Baruwal, Bhyanglung and their crosses in case of sheep while Sinhal in case of goat were found to be common in the study areas. From the beginning of summer season (Falgun-Jestha), the animals were grazed in the nearby field during the day and kept in shed at night. In winter, where it snows, they were kept in shed and fed hay and stored corn due to limited grazing area. At night, some farmers kept their sheep, goats in shed while some farmers kept their sheep outside in field. From third week of Jestha to fourth week of Bhadra, farmers moved their flock to high hills called Patan to graze on locally available herbs. Farmers performed open castration on their animals by themselves and besides deworming the debilitated animals, they generally didn’t deworm or vaccinate their animals. Some of the major health problems observed in the animals were plant poisoning, parasitic infestations, scabies and lice infestation, pneumonia, abortion, uterine prolapse, vaginal prolapsed, and inbreeding. Farmers kept the same male for seed material for many years and were found to be unfazed by the consequence of inbreeding.

Initial evaluation treatment results of laparoscopic pectopexy in the management of uterine prolapse

Background: In recent years, laparoscopic pectopexy has become increasingly prevalent in the treatment of pelvic organ prolapse; nonetheless, this technique has only been used at Khanh Hoa General Hospital since 2020.&#x0D; Objectives: To evaluate the effectiveness of laparoscopic pectopexy in patients with uterine prolapse and to evaluate the quality of life of patients after the surgery.&#x0D; Subjects and methods: A case series with follow-up on 58 patients with uterine prolapse ≥ grade 2, who had laparoscopic pectopexy at Khanh Hoa General Hospital between February 2020 and July 2021.&#x0D; Results: Complication rates during and after the procedure were low, blood loss was minimal, and there were no instances requiring blood transfusions during the procedure. During a 6-month follow-up, no patient had surgical infection, erosion, or transplant rejection. The typical procedure lasted between 90 and 120 minutes. Most postoperative patients only had minor discomfort. The recurrence rate was minimal (1.7%) during the 6-month follow-up period. 95% of patients were satisfied with the surgical procedure. Prior to surgery, the QoL of patients was relatively poor, with a mean PFDI-20 (Pelvic Floor Distress Intervention) score of 130 and a PFIQ-7 (Pelvic Floor Impact Questionnaire) score of 148. The worse the uterine prolapse, the worse the patient’s quality of life. Three months after surgery, the average PFDI-20 score was 8 and the average PFIQ-7 score was 10; six months after surgery, the average scores for these two indices were nearly 0.&#x0D; Conclusion: If there are no contraindications, laparoscopic pectopexy should be utilized to treat uterine prolapse.

The relationship between women’s sexual function and type of delivery and pelvic organ prolapse: A cross-sectional study

ABSTRACTs The probable relationship between type of delivery and postpartum sexual function is one of the reasons behind women’s tendency to cesarean. This study was performed with 250 women participants. Female Sexual Function Index and examination form were used to determine pelvic organ prolapse and its severity and type based on POP-Q. Our results showed the difference between the mean performance score in the dimensions of desire (p = .19), lubrication (p = .08), orgasm (0.13), pain (p = .08), and satisfaction (p = .06) was not significant in the two groups of vaginal delivery and cesarean, but the difference between the mean score of sexual function in the dimension of total score (p = .002) was significant in the two groups. Regarding the relationship between sexual function and pelvic organ prolapse, the total score of sexual function in women with uterine, cystocele, and rectocele prolapse was significantly lower (p < .001). Researchers should work to provide more evidence on relationship of female sexual function and the type of delivery and pelvic organ prolapse.

Clinical Effect of Uterosacral and Cardinal Ligament Fixation versus Sacrospinous Ligament Fixation of Vaginal Vault Prolapse: A Retrospective Analysis.

This study aimed at comparing sacrospinous ligament fixation (SSLF) with uterosacral and cardinal ligament fixation (USCLF) concerning complications and outcomes in patients with pelvic organ prolapse (POP). A retrospective analysis was performed on the clinical data of patients with POP stage III or above uterine prolapse treated at Wenzhou People's Hospital from January 2013 to December 2019. Patients were divided into two groups: USCLF group and SSLF group. The perioperative indicators, postoperative complications, pelvic organ prolapse quantification (POP-Q), Pelvic Floor Distress Inventory-20 (PFDI-20), and POP/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) scores of the groups were analyzed and compared. (1) The operative time and intraoperative blood loss in the USCLF group were lower than those in the SSLF group, with statistical significance (p < 0.05). (2) The incidence of postoperative buttock pain in the SSLF group was 10.7% (6/56), higher than that in the USCLF group (0/56) (Fisher's exact test, p = 0.027). (3) At one year of follow-up, significant improvement in Aa, Ba, C, Ap, and Bp values was observed in both groups (p < 0.05). The values of the Aa and Ba sites in the USCLF group were lower than those in the SSLF group one year after surgery (p < 0.05). (4) The PFDI-20 and PISQ-12 scores of the groups one year after surgery were lower than those before surgery (p < 0.05). Uterosacral and cardinal ligament suture fixation leads to less bleeding and better postoperative quality of life than preoperative and may be better than SSLF at preventing the recurrence of anterior wall prolapse after surgery.

Efficiency of umbilical vessel water infusion in the management of retained fetal membranes after elective C-section in mares

Cesarian section (C-section) has been described as a potential predisposing factor to retained fetal membranes (RFM) in mares. RFM should be diagnosed quickly, and therapy started to increase the likelihood of a positive outcome (Canisso et. al. JEVS. 2013; 33:570-579). This study aimed to describe the use of umbilical vessel water infusion for the treatment of RFM after elective C-section in mares (License CEUA 019854/2021-51). Pregnant Criollo type-mares (n=9), at 315 days of gestation, were evaluated daily to check their readiness for birth. Mares were submitted to an elective C-section when they showed udder development, waxing of the teats, and the pH of mammary secretions reached ≤ 6.4. All mares had RFM, as defined by the placenta not being expelled within 3 hours after careful extraction of the foal by C-section. Mares were randomly assigned into two groups: “Dutch technique” (n=4): use of low-pressure infusion of 0.9% saline solution into the umbilical vessel (Meijer et. al. AAEP Proceedings. 2015; 61:478-484); or “Counterweight” (n=5): use of small weights (e.g. 500-1000mL bottles of saline) tied to the bottom of the exposed fetal membranes (Turner R. AAEP Proceedings. 2007; 53:305-319). Oxytocin was not used after C-section or during RFM treatment. Mares that showed full separation and expulsion of the fetal membranes within 40 min of treatment starting were classified as responsive to treatment. The index of mares' responses among groups was compared by Fisher's exact test. Continuous data wereanalyzed by a Two sample T-test, and results were expressed as mean ± SD and ranges. Significance was set at p<0.05. There were no differences between gestational length (333±10, 328-360d), foal weight (36±3, 30-40 Kg), the time taken to perform the C-section (124±16, 90-150 min), and the time of uterine manipulation during C-section (57 ± 8, 45-70 min) between groups of treatment. As result, 75% (n=3/4) of mares showed full separation and expulsion of fetal membranes within 40 min of umbilical vasculature infusion. None (0%, n=0/5) of the mares with “tie small counterweights” responded within 40 min (p<0,05). The average time to release the fetal membranes in the Counterweight group was 5h (335±158, 180-600min, n=5) while mares that responded to the Dutch technique took 0.5h (30±10, 20-40min, n=3). Mares that experienced the Dutch technique did not show severe signs of discomfort, pain, or additional secondary side effects (i.e., uterine hemorrhage, uterine prolapse, metritis or colic) after the procedure. In conclusion, umbilical vessel water infusion (Dutch technique) is an effective, safe, and practical method for the treatment of retained fetal membranes after C-section in mares. Acknowledgments. The funding agencies CAPES, FAPERGS and CNPq.