The latest medical research on Obstetrics And Gynecology

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Transperineal ultrasound assessment of maternal pelvic floor at term and fetal head engagement.

Ultrasound in Obstetrics and Gynecology

The aim of the present study was to evaluate the correlation between pelvic floor dimensions in nulliparous women at term and fetal head engagement as assessed by transperineal ultrasound.

Transperineal ultrasound was used to measure the anteroposterior diameter of the levator hiatus (APD) and the angle of progression (AoP) at rest, under maximum pelvic floor muscle contraction, and at maximum Valsalva maneuver (before and after visual feedback), in a group of nulliparous women at term before the onset of labor. We assessed the correlation between pelvic floor static and dynamic dimensions (APD and levator ani muscle coactivation) and AoP, which is an objective index of fetal head engagement.

In total, 282 women were included in the analysis. Among these, 211 women (74.8%) had a vaginal while 71 (25.2%) had a Cesarean delivery. AoP was narrower in the Cesarean delivery group at rest, at pelvic floor muscle contraction and at Valsalva, whereas no differences in APD was found between the two groups. On the other hand, we found a negative correlation between APD at rest and at Valsalva with the second stage of labor. There was a positive correlation between AoP and APD at maximum Valsalva maneuver after visual feedback (r = 0.15, p = 0.01). Women with levator ani contraction under Valsalva's maneuver (coactivation), both pre- and post-visual feedback, had narrower AoP at rest and under maximum Valsalva. After visual feedback, women with levator ani coactivation had a longer second stage of labor (80.8 min ± 61.4 vs. 62.9 min ± 43.4; p = 0.04).

Smaller pelvic floor dimensions and levator ani muscle coactivation are associated with higher fetal head station and with a longer second stage of labor in nulliparous women at term. This article is protected by copyright. All rights reserved.

Imaging in gynecological disease: clinical and ultrasound characteristics of adnexal torsion.

Ultrasound in Obstetrics and Gynecology

To describe the clinical and ultrasound characteristics of adnexal torsion.

This is a retrospective study. From the operative records of the eight participating gynecological ultrasound centers, we identified patients with a surgically confirmed diagnosis of adnexal torsion (surgical evidence of twisted ovarian pedicle and/or twisted paraovarian cyst and/or tube on its own axis), who had undergone preoperative ultrasound examination by an experienced ultrasound examiner between 2008 and 2018. Only cases having at least two available ultrasound images or videos (one gray-scale and one with Doppler evaluation) were included. Clinical, ultrasound, surgical and histological information was retrospectively retrieved from each patient's medical record and then entered into an Excel file by the principal investigator at each center. In addition, two authors retrospectively reviewed all available ultrasound images and videos of the twisted adnexa with regard to the presence of four predefined ultrasound features reported to be characteristic of adnexal torsion: 1) ovarian stromal edema with or without peripherally displaced antral follicles, 2) follicular ring sign, 3) whirlpool sign, and 4) absence of vascularization in the twisted organ.

A total of 315 cases of adnexal torsion were identified. The median age of the patients was 30 (range 1-88) years. Most of them presented with acute or subacute pelvic pain (305/315, 96.8%). The surgical approach was laparoscopic in 239/312 (76.6%) patients and conservative surgery (untwisting or untwisting plus excision of a lesion) was performed in 149/315 (47.2%) of cases. According to the original ultrasound reports, the median of the largest diameter of the twisted organ was 83 (range 30-349) mm. Free fluid in the pouch of Douglas was detected in 196/275 patients (71.6%). "Ovarian stromal edema with or without peripherally displaced antral follicles" was reported in the original ultrasound report in167/241 (69.3%) patients, the "whirlpool sign" in 178/226 (78.8%), absent color Doppler signals in 119/269 (44.2%), and the "follicular ring sign" in 51/134 (38.1%). On retrospective review of images, the "ovarian stromal edema with or without peripherally displaced antral follicles" sign (201/254; 79.1%) and the "whirlpool sign" (139/153; 90.8%) were the most commonly detected features of adnexal torsion.

Most patients with surgically confirmed adnexal torsion are of reproductive age and present with acute or subacute pain. Common ultrasound signs are an enlarged organ, the "whirlpool sign", and "ovarian stromal edema with or without peripherally displaced antral follicles", and free fluid in the pelvis. The "follicular ring sign" and absence of Doppler signals are slightly less common signs. Recognizing ultrasound signs of adnexal torsion is important so that correct treatment, i.e. surgery without delay, can be offered. This article is protected by copyright. All rights reserved.

Cordocentesis-associated fetal loss and risk factors: experience of 6650 cases from a single center.

Ultrasound in Obstetrics and Gynecology

To identify the risk factors of fetal loss associated with cordocentesis METHODS: Based on our prospective database, a retrospective cohort study was conducted on pregnancies undergoing cordocentesis at mid-pregnancy from a single center (a tertiary hospital, teaching school). All consecutive cases were validated to retrieve those meeting the inclusion criteria, including 1) low risk pregnancies; 2) singleton pregnancies; 3) availability of the data of pregnancy outcomes; and 4) normal fetuses (no structural / chromosomal abnormalities and severe disorders). The cases with therapeutic termination of pregnancy were excluded. The various potential risk factors of fetal loss secondary to cordocentesis were tested, including effect of cordocentesis model training, procedure difficulty, placenta penetration, prolonged bleeding, fetal bradycardia, puncture site, and early gestation.

A total of 10,343 procedures were performed during the study period. Of them, 6,650 met the inclusion criteria and were available for analysis. In evaluation of influence of model training, the fetal loss rate in the first 60 cases of practice (early learning curve) of 6 performers who had no prior model training (n=360 procedures) was significantly higher than that of 18 performers with prior model training (n=1,080 procedures) (6.9% vs 1.6%, p<0.001), whereas the loss rate during the next 60 cases of practice was comparable between both groups. After excluding the first 60 procedures in the groups of no prior model training, the overall fetal loss rate was still significantly higher than that of the control (1.6% vs 1.0%; p < 0.001). Penetration of the placenta (OR=2.65;95%CI:1.71-4.10), prolonged bleeding (OR=10.85;95%CI:5.27-22.36) and fetal bradycardia (OR=3.32;95%CI:1.83-6.04) were an independent risk factor of fetal loss.

Cordocentesis model training, the only one modifiable factor, markedly reduces fetal loss in early learning curve of practice. Thus, practice without prior model training is no longer acceptable. Other significant risk factors are placental penetration, prolonged bleeding and bradycardia following the procedures. Cordocentesis-related fetal loss may be only 0.6%, much lower than that previously reported. This article is protected by copyright. All rights reserved.

Copeptin and mid-regional pro-ANP in women with suspected or confirmed pre-eclampsia: comparison with the sFlt-1/PlGF ratio.

Ultrasound in Obstetrics and Gynecology

Arginine vasopressin (AVP) and atrial natriuretic peptide (ANP) may contribute to the pathogenesis of preeclampsia, but their role remains to be elucidated. We aimed to evaluate their role as biomarkers and whether they associate with angiogenic markers and/or clinical manifestations of preeclampsia.

We measured their surrogates C-terminal pro-AVP (Copeptin) and mid-regional pro-ANP (MR-proANP) making use of a retrospective analysis of a prospective cohort study involving 526 women with suspected or confirmed preeclampsia, originally aimed to evaluate the use of soluble Fms-like tyrosine kinase-1/Placental growth factor (sFlt-1/PlGF) ratio.

Women with preeclampsia displayed elevated serum copeptin and MR-proANP in comparison with women suspected of preeclampsia. To discriminate maternal complications on top of traditional predictors (gestational age, parity, diastolic blood pressure and proteinuria), the sFlt-1/PlGF ratio displayed a higher C-index than copeptin and MR-proANP (0.76, 0.63 and 0.67, respectively, vs. 0.60 for the traditional predictors only), and the same was true for the discrimination of fetal/neonatal complications (C-index = 0.83, 0.79 and 0.80 vs. 0.79). When subdividing women according to sFlt-1/PlGF ratio (≥ 85 versus <85), no differences in copeptin levels were observed, while MR-proANP levels was elevated in women with a ratio ≥ 85. Multiple regression analysis revealed that copeptin and MR-proANP were independent determinants of proteinuria.

Copeptin and MR-proANP have limited value to predict preeclampsia-related complications when compared with the sFlt-1/PlGF ratio. However, our data suggests that both copeptin and MR-proANP contribute to the occurrence of proteinuria, with copeptin exerting this effect independently of sFlt-1/PlGF ratio. This article is protected by copyright. All rights reserved.

Robotic versus laparoendoscopic single-site hysterectomy: a systematic review and meta-analysis.

Journal of Robotic Surgery

Single-site hysterectomy (SSH) laparoscopic or robotic presented distinct advantages with regards to postoperative cosmetic outcome, wound-related ...

Telehealth Interventions to Improve Obstetric and Gynecologic Health Outcomes: A Systematic Review.

Obstetrics and Gynecology

To systematically review the effectiveness of telehealth interventions for improving obstetric and gynecologic health outcomes.

Qualifying primary studies had a comparison group, were conducted in countries ranked very high on the United Nations Human Development Index, published in English, and evaluated obstetric and gynecologic health outcomes. Cochrane Collaboration's tool and ROBINS-I tool were used for assessing risk of bias. Summary of evidence tables were created using the United States Preventive Services Task Force Summary of Evidence Table for Evidence Reviews.

Of the 3,926 published abstracts identified, 47 met criteria for inclusion and included 31,967 participants. Telehealth interventions overall improved obstetric outcomes related to smoking cessation and breastfeeding. Telehealth interventions decreased the need for high-risk obstetric monitoring office visits while maintaining maternal and fetal outcomes. One study found reductions in diagnosed preeclampsia among women with gestational hypertension. Telehealth interventions were effective for continuation of oral and injectable contraception; one text-based study found increased oral contraception rates at 6 months. Telehealth provision of medication abortion services had similar clinical outcomes compared with in-person care and improved access to early abortion. Few studies suggested utility for telehealth to improve notification of sexually transmitted infection test results and app-based intervention to improve urinary incontinence symptoms.

Telehealth interventions were associated with improvements in obstetric outcomes, perinatal smoking cessation, breastfeeding, early access to medical abortion services, and schedule optimization for high-risk obstetrics. Further well-designed studies are needed to examine these interventions and others to generate evidence that can inform decisions about implementation of newer telehealth technologies into obstetrics and gynecology practice.

Penicillin Allergy in Pregnancy: Moving From "Rash" Decisions to Accurate Diagnosis.

Obstetrics and Gynecology

The emergence of beta-lactam-resistant pathogenic organisms has resulted in limitation or even elimination of drugs such as penicillin and ampicill...

Prevention of Group B Streptococcal Early-Onset Disease in Newborns: ACOG Committee Opinion Summary, Number 797.

Obstetrics and Gynecology

Group B streptococcus (GBS) is the leading cause of newborn infection. The primary risk factor for neonatal GBS early-onset disease (EOD) is matern...

Implementing Telehealth in Practice: ACOG Committee Opinion Summary, Number 798.

Obstetrics and Gynecology

The term "telemedicine" often is used to refer to traditional clinical diagnosis and monitoring that are delivered by technology. The term "telehea...

Prevention of Group B Streptococcal Early-Onset Disease in Newborns: ACOG Committee Opinion, Number 797.

Obstetrics and Gynecology

Group B streptococcus (GBS) is the leading cause of newborn infection. The primary risk factor for neonatal GBS early-onset disease (EOD) is matern...

Implementing Telehealth in Practice.

Obstetrics and Gynecology

The term "telemedicine" often is used to refer to traditional clinical diagnosis and monitoring that are delivered by technology. The term "telehea...

Application of binocular visual navigation technique in diaphyseal fracture reduction.

Int J Med

Computer-assisted surgical navigation techniques have shown promise; however, currently popular systems have limitations. This paper presents the characterization and application of a binocular visual navigation technique in diaphyseal fracture reduction.

A binocular visual tracker (MicronTracker) was introduced to reduce diaphyseal fractures. A transformation matrix was used to acquire the reduction parameters. A transverse diaphyseal fracture was used as a control group.

Precision tests were performed with the binocular system using a simulation femoral model with a transverse fracture 12 times. All residual deformations were compared and P < 0.01.

The binocular visual navigation technique produces good results with advantages of flexibility and high positional accuracy, and shows promise. The MicronTracker might lead to further application in the remote navigation field. This article is protected by copyright. All rights reserved.