The latest medical research on Obstetrics And Gynecology
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about obstetrics and gynecology gathered by our medical AI research bot.
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Safe transition to opioid-free pathway after robotic-assisted laparoscopic prostatectomy.Journal of Robotic Surgery
To determine whether local anesthetic infiltration and non-narcotic pain medications can safely reduce or eliminate opioid use following robotic-as...
''Comparison of Two Surgical Techniques for the Treatment of Transverse Olecranon Fractures: A Finite Element Study''.Int J Med
In this study, we aimed to compare the stability of traditional tension band wiring (TBW) and screw combined TBW (SC-TBW) fixation methods performed for a transverse olecranon osteotomy-fracture during different degrees of elbow movement by using finite element analysis (FEA).
Three-dimensional solid modeling of the olecranon was obtained by computed tomography (CT) images. Transverse olecranon fracture was created and fixed by TBW and SC-TBW with respect to triceps muscle force. Open-angle, twisting angle and interplanar translation occurring on the fracture line were evaluated at 45° and 90° elbow flexion.
Open-Angle: 0.71°, 0.87° at 45° and 0.64°, 0.67° at 90° elbow flexion for TBW and SC-TBW respectively. Twisting-Angle: -0.01°, -0,19° at 45° flexion and 0.19°, 0.30° at 90° flexion for TBW and SC-TBW respectively. Interplanar Translation: 1.93 mm, 4.65 mm at 45° flexion and 1,78 mm, 3,95 mm at 90° flexion for TBW and SC-TBW respectively.
TBW fixation provides more stability than SC-TBW fixation model. This article is protected by copyright. All rights reserved.
A new robotically assisted system for total knee arthroplasty: A sheep model study.Int J Med
We investigated the accuracy and safety of a new HURWA robotic-assisted total knee arthroplasty (TKA) system in a sheep model.
Ten male Small-tailed Han sheep were used in this study. Sheep were imaged by computed tomography scan before and after bone resection and the cutting errors between actual bone preparation and preoperative planning of the femur and tibia in 3 dimensions were measured .
The overall accuracies after surgery compared with that from preoperative surgical planning of the left and right femurs were 1.93±1.02° and 1.93±1.23°, respectively. Additionally, similarly high overall accuracies for the left and right tibia of 1.26±1.04 and 1.68±0.92°, respectively, were obtained. The gap distances of the distal cut, anterior chamfer, anterior cut, posterior chamfer, and posterior cut on the medial side were 0.47±0.35 mm, 0.41±0.37 mm, 0.12±0.26 mm, 0.41±0.44 mm, and 0.12±0.23 mm, respectively. No intraoperative complications, such as intraoperative fracture, massive bleeding or death, occurred CONCLUSION: This new HURWA robotic-assisted TKA system is an accurate and safe tool for TKA surgery based on the sheep model. This article is protected by copyright. All rights reserved.
Transamniotic Stem Cell Therapy for Experimental Congenital Diaphragmatic Hernia: Structural, Transcriptional, and Cell Kinetics Analyses in the Nitrofen Model.Fetal Diagnosis Therapy
We examined select pulmonary effects and donor cell kinetics after transamniotic stem cell therapy (TRASCET) in a model of congenital diaphragmatic hernia (CDH).
Pregnant dams (n = 58) received nitrofen on gestational day 9.5 (E9) to induce fetal CDH. Fetuses (n = 681) were divided into 4 groups: untreated (n = 99) and 3 groups receiving volume-matched intra-amniotic injections on E17 of either saline (n = 142), luciferase-labeled amniotic fluid-derived mesenchymal stem cells (afMSCs; n = 299), or acellular recombinant luciferase (n = 141). Pulmonary morphometry, quantitative gene expression of pulmonary vascular tone mediators, or screening for labeled afMSCs were performed at term (E22). Statistical comparisons were by Mann-Whitney U-test, nested ANOVA, and Wald test.
TRASCET led to significant downregulation of endothelial nitric oxide synthase and endothelin receptor-A expressions compared to both untreated and saline groups (both p < 0.001). TRASCET also led to a significant decrease in arteriole wall thickness compared to the untreated group (p < 0.001) but not the saline group (p = 0.180). Donor afMSCs were identified in the bone marrow and umbilical cord (p = 0.035 and 0.015, respectively, vs. plain luciferase controls).
The effects of TRASCET in experimental CDH appear to be centered on the pulmonary vasculature and to derive from circulating donor cells.
Enhanced Recovery after Surgery: Benefits for the Fetal Surgery Patient.Fetal Diagnosis Therapy
The fetoscopic approach to the prenatal closure of a neural tube defect (NTD) may offer similar advantages to the newborn compared to prenatal open closure of a NTD, with a reduction in maternal risks. Enhanced recovery after surgery (ERAS) protocols have been applied to different surgical procedures with documented advantages. We modified the perioperative care of patients undergoing in utero repair of myelomeningocele with the goal of enhancing the recovery. A retrospective study comparing traditional management to the ERAS protocol was conducted.
Primary aim was to evaluate the length of stay (LOS). Secondary outcomes included pain scores, time to oral intake, opioid-induced side effects, and respiratory complications.
Thirty patients who underwent a mid-gestation fetoscopic closure of a NTD were included. Data analyzed include demographics, comorbidities, LOS, anatomical location of the NTD, magnesium sulfate doses and duration of administration, oxygen requirements, duration of the postoperative epidural infusion, duration of surgery and anesthesia, incidence of postoperative nausea and vomiting, respiratory complications, time to oral intake, pain scores, and sedation scores. Differences between the treatment groups were compared using the independent sample t-test or Mann-Whitney Ʋ test.
Of the 30 patients, 10 patients were managed according to the ERAS protocol and 20 patients according to the traditional management (1:2 ratio). The mean gestational age at the time of intervention for the traditional and ERAS groups was 24.9 ± 0.5 weeks and 24.8 ± 0.5 weeks, respectively. Compared to the traditional group, the LOS was reduced in the ERAS group to 112.5 ± 12.6 h (4.7 ± 0.5 days) from 179.7 ± 87.9 h (7.5 ± 3.7 days) (p = 0.012). The time to oral intake was also shorter 502.6 ± 473.4 min versus 1015.6 ± 698.2 min; p = 0.049. Oxygen requirements were prolonged in the traditional group (1843.7 ± 1262.6 min vs. 1051.7 ± 1078.1 min p = 0.052). The total duration of magnesium sulfate was longer for patients in the traditional group (2125.6 ± 727.1 min vs. 1429.5 ± 553.8 min; p = 0.006). No statistically significant difference in pain scores was observed between the groups.
Establishing an ERAS protocol for fetoscopic in utero repair of NTDs approach is feasible with the advantages of decreased postoperative LOS, reduced oxygen requirements, lower duration of magnesium sulfate infusion, and facilitation of earlier oral intake without compromising the pain scores.
Fetal hydrops and the Incremental yield of Next generation sequencing over standard prenatal Diagnostic testing (FIND) study: prospective cohort study and meta-analysis.Ultrasound in Obstetrics and Gynecology
Determine the incremental yield of next generation sequencing (predominantly exome sequencing (ES)) over quantitative fluorescence-polymerase chain reaction (QF-PCR) and chromosome microarray analysis (CMA)/karyotyping in; (i) all cases of prenatally diagnosed non-immune hydrops fetalis (NIHF); (ii) isolated NIHF; (iii) NIHF associated with additional structural anomalies and; (iv) NIHF according to severity (i.e., two cavities versus three or more cavities affected).
A prospective cohort study (from an extended group of the Prenatal Assessment of Genomes and Exomes (PAGE) study) of n=28 cases of prenatally diagnosed NIHF undergoing trio ES following a negative QFPCR and CMA/karyotype was combined with a systematic review of the literature. Electronic searches of relevant citations from MEDLINE, EMBASE and CINAHL and clinicaltrials.gov (January 2000 - October 2020) databases was performed. Studies included were those with: (i) ≥ n=2 cases of NIHF undergoing sequencing; (ii) testing initiated based on prenatal ultrasound-based phenotype and; (iii) a negative CMA/karyotype. PROSPERO Registration No. CRD42020221427.
The PAGE cohort study noted the additional diagnostic yield of ES was 25.0% (n=7/28) for all NIHF, 21.4% (n=3/14) for isolated NIHF and 28.6% (n=4/14) for non-isolated NIHF. From the meta-analysis, the pooled incremental yields from n=21 studies (n=306 cases) were 29% (95% CI 24-34%, I2 =0%, p<0.00001) in all NIHF, 24% (95% CI 16-33%, I2 =0%, p<0.00001) in isolated NIHF and; 38% (95% CI 28%-48%, I2 =6%, p<0.00001) in NIHF associated with additional anomalies. In the latter, congenital limb contractures were the most prevalent additional structural anomaly at 17.3% (n=19/110). Incremental yield did not differ significantly based upon hydrops severity. The commonest genetic disorders identified were RASopathies in 30.3% (n=27/89), most commonly due to PTPN11 variants in 44.4% (n=12) and the predominant inheritance pattern was autosomal dominant in monoallelic disease genes 57.3% (n=51/89), of which most were de novo 86.3% (n=44).
Use of prenatal next generation sequencing in both isolated and non-isolated NIHF should be considered in developing clinical pathways. Given the wide range of potential syndromic diagnoses and heterogeneity in prenatal phenotypes of NIHF, exome or whole genome sequencing may prove to be a more appropriate testing approach than a targeted gene panel testing strategy. This article is protected by copyright. All rights reserved.
Fusion imaging in the preoperative assessment of the extension of disease in patients with advanced ovarian cancer: feasibility and agreement with laparoscopic findings.Ultrasound in Obstetrics and Gynecology
Fusion imaging is an emerging technique that can fuse real time ultrasound examination with other imaging modalities such as computed tomography (CT), magnetic resonance, and positron emission tomography. The primary aim of the study was to evaluate the Fusion imaging feasibility in patients with advanced ovarian cancer. The secondary aims were: 1) to compare agreement laparoscopic findings with Fusion, CT scan alone and ultrasound alone in assessing the extension of intra-abdominal disease; 2) to evaluate the time required by the Fusion technique.
patients with clinical and/or radiographic suspicion of advanced ovarian or peritoneal cancer and candidate to surgery were prospectively enrolled between December 2019 and September 2020. All patients underwent CT scan, ultrasound and Fusion examination in order to evaluate the presence/absence of the following abdominal cancer features according to the laparoscopy-based scoring model (PIV: Predictive Index Value): supracolic omentum disease, visceral carcinomatosis on the liver, lesser omental carcinomatosis and/or visceral carcinomatosis on the lesser curvature of stomach and/or on the spleen, parietal peritoneal involvement of paracolic gutter/-s and/or anterior abdominal wall, parietal peritoneal involvement of diaphragm and visceral carcinomatosis on small and large bowel (except rectosigmoid). Feasibility of the Fusion examination was evaluated. Agreement between each imaging method (ultrasound, CT scan and Fusion) and laparoscopy (considered as reference standard) was calculated using Cohen's kappa coefficient.
52 patients were enrolled in the study. Fusion examination was feasible in 51/52 (98%) patients (in one patient the CD was not working). Two other patients were excluded because laparoscopy was not performed. 49 women were considered for final analysis. Kappa values between CT, ultrasound, Fusion and laparoscopy in assessing the PIV parameters were respectively: 0.781, 0.845 and 0.896 for great omentum; 0.329, 0.608 and 0.847 for liver surface, 0.472, 0.549 and 0.756 for lesser omentum and/or stomach and/or spleen; 0.385, 0.588 and 0.795 for parietal peritoneum; 0.385, 0.497 and 0.657 for diaphragm; 0.336, 0.410 and 0.469 for bowel. The median time needed to perform Fusion examination was 20 (range 10-40) minutes.
Fusion of CT and ultrasound images is feasible in patients with advanced ovarian cancer and improves the agreement with the surgical findings when compared with the single imaging methods (ultrasound or CT scan). This article is protected by copyright. All rights reserved.
The position of the choroid plexus of the fourth ventricle in the first- and second-trimester fetuses: an early different approach to diagnostic imaging of cystic posterior fossa anomalies.Ultrasound in Obstetrics and Gynecology
The aim of this study was to describe the sonographic appearance and position of the choroid plexus of the fourth ventricle (4thVCP) between 12 and 21 weeks' gestation in normal fetuses and in fetuses with posterior fossa anomalies.
Two-dimensional ultrasound (US) images of the midsagittal and coronal views of the brain through the posterior fontanelle and three-dimensional volumes datasets were obtained between 12 and 21 weeks prospectively from 90 normal singletons and retrospectively from 41 fetuses identified as having an abnormal posterior brain on first-trimester ultrasound examination. In all cases the diagnosis was confirmed at MRI, prenatally and/or postnatally, and/or at postmortem examination.
During the study period, 41 fetuses, with apparently isolated cystic posterior fossa anomaly based on first trimester ultrasound assessment of intracranial spaces, were reviewed in the second trimester and were found to have Dandy Walker Malformation (DWM) in 8 cases, Blake's Pouch Cyst (BPC) in 29 and they were normal in 4 patients. The position of 4thVCP was different in DWM, BPC and normal cases either at first and at second trimester examination. In particular, in normal fetuses no cyst was present, and on median and coronal planes of posterior fossa the choroid plexus appeared as an echogenic and oval shaped structure located inside the 4th ventricle apparently attached to the cerebellar vermis. In fetuses with DWM, on median view of posterior fossa, it was not possible to visualize the CP. It was infero-laterally dislocated due to the presence of a cyst which displaced the 4thVCP and could be visualized only on a coronal plane of the posterior brain. In all DWM cases the CP was positioned outside the cyst. In BPC, the 4VthCP was always located inside the cyst, on its superior part, near the vermis and was visualized on median and coronal planes.
Our study demonstrated that a longitudinal ultrasound assessment of 4thVCP and its temporal changes from 12 to 21 weeks is feasible. The ability to define the position of the 4thVCP as inside or outside the cyst is a novel finding which can be assessed in the first trimester of pregnancy and it is useful to differentiate DWM from BPC, consistently with the pathophysiology of the two conditions. This article is protected by copyright. All rights reserved.
The "breech progression angle": a new feasible and reliable transperineal ultrasound parameter for the fetal breech descent in the birth canal.Ultrasound in Obstetrics and Gynecology
The aim of the present study was to assess the feasibility and reliability of transperineal ultrasound in the assessment of breech descent in the birth canal, by measuring the "breech progression angle".
We recruited pregnant women with singleton pregnancies and fetuses in breech presentation between 34 and 41 weeks' gestation. We acquired transperineal ultrasound images in the midsagittal view for each woman twice by an operator and once by another. Each operator measured the breech progression angle after anonymization of the transperineal ultrasound images. Breech progression angle was defined as the angle between a line running along the long axis of the pubic symphysis and another line extending from the most inferior portion of the symphysis tangentially to the lowest recognizable fetal part in the maternal pelvis. Each operator was blinded from any other measurement performed for the same woman. The intra- and interobserver reproducibility were evaluated with intraclass correlation coefficient (ICC). To investigate the presence of any bias, intra- and interobserver agreement was also analyzed using the Bland-Altman plot. Student's t-test and Levene's W0 test were used to investigate whether a number of clinical factors had an effect on systematic differences (t-test) and homogeneity (W0 test) between breech progression angle measurements.
Overall, 44 women were included in the analysis. Breech progression angle was successfully measured by both operators on all images. Both intra- and interobserver agreement analyses showed excellent reproducibility, with an ICC of 0.88 (95% CI, 0.80 to 0.93) and 0.83 (95% CI, 0.71 to 0.90), respectively. Mean differences for intraobserver repeatability was 0.4 (95%CI, -1.4 to 2.2) and for interobserver repeatability was -0.4 (95%CI, -2.6 to 1.8). The upper limits of agreement were 12.0 (95% CI, 8.9 to 15.1) and 13.6 (95% CI, 9.9 to 17.3) for intraobserver and interobserver repeatability, respectively. The lower limits of agreement were -11.2 (95% CI, -14.3 to -8.1) and -14.4 (95% CI, -18.2 to -10.7) for intraobserver and interobserver repeatability, respectively. No systematic difference was found both in the intra- and interobserver agreement analyses. None of the clinical factors examined (maternal body mass index, maternal age, gestational age at the ultrasound scan and parity) showed a statistically significant effect on intra- and interobserver reliability.
Breech progression angle represents a new feasible and highly reproducible tool for the evaluation of fetal breech descent in the birth canal. Future studies assessing its usefulness in the prediction of successful external cephalic version and the success of breech vaginal delivery are needed. This article is protected by copyright. All rights reserved.
Adherence to best practice: Preventing surgical site infection following caesarean section in Australia.Australian and New Zealand Journal
Surgical site infection (SSI) following caesarean section is a serious but underreported problem with an estimated incidence of 5-9%. It is essential to identify adherence to established prevention strategies to reduce the incidence rate.
The aims of this study were to quantify unwarranted variation from evidence-based practice on the prevention of SSI at caesarean section in Australia; and to identify predictors of not implementing an existing infection prevention bundle: pre-incision antibiotic prophylaxis, vaginal preparation and spontaneous placenta removal.
An online cross-sectional survey of obstetricians and obstetric Diplomates was conducted in 2016. The primary outcome was adherence to an existing infection prevention bundle, with demographic and clinical variables predicting adherence through multivariable binary logistic regression.
Forty-nine percent of respondents (response rate 39.6%) reported implementing zero or only one element of the infection prevention bundle. The types of respondents most likely to have poor adherence were Diplomates (adjusted odds ratio (aOR) 2.58), obstetricians practising in private hospitals (aOR 3.34), those usually practising in public and private hospitals (aOR 2.23), and those not usually implementing a surgical safety checklist (aOR 3.77).
Adherence to best practice at caesarean section is low among many Australian obstetricians. Infection control practitioners and obstetricians need to collaboratively implement surgical safety checklists at caesarean section, and monitor implementation using process key performance indicators, and audit and feedback. These strategies will reduce unwarranted variation from evidence-based infection control practice.
Shoulder dystocia, umbilical cord blood gases and neonatal encephalopathy.Australian and New Zealand Journal
The interpretation of umbilical cord gases may not be straightforward following shoulder dystocia. We reviewed Perinatal and Maternal Mortality Rev...
Navigation assisted total knee arthroplasty in 54,114 patients: No increased risk in acute complications and hospital utilisation.Int J Med
The advent of navigation in total knee arthroplasty (TKA) has generated interest in attempt to improve component positioning as desired and clinical outcomes. The aim of this study was to evaluate 90-day complication and cost of navigation-assisted TKAs (NTKA) compared to conventional TKAs (CTKA) using a national database.
III. Retrospective cohort study.
NTKA was associated with a significant decrease in 90-day postoperative major and minor complications. NTKA was also associated with a decrease in 90-day hospital utilization with lower rates of emergency department visits and readmissions. The cost of hospitalization and total 90-day costs were lower in NTKA, with an average savings of $800.
The adoption of navigation in TKA is safe and efficaceous compared to CTKA.