POPQ measurements with the Valsalva maneuver preoperatively and under general anesthesia with uterine traction intraoperatively.

<p>All values expressed in mean±standard deviation.</p><p>Aa – anterior vaginal wall 3 cm proximal to the hymen.</p><p>Ba – most distal position of the remaining upper anterior vaginal wall.</p><p>C – most distal edge of the cervix or vaginal cuff.</p><p>D – posterior fornix.</p><p>Ap – posterior vaginal wall 3 cm proximal to the hymen.</p><p>Bp – most distal position of the remaining upper posterior vaginal wall.</p

Stage of prolapse with Valsalva maneuver preoperatively and under general anesthesia with uterine traction intraoperatively.

<p>Stage 0 no prolapse.</p><p>Stage 1 stage 0 criteria not met + leading edge < −1 cm.</p><p>Stage 2 leading edge ≥ −1 cm but ≤ +1 cm.</p><p>Stage 3 leading edge +1 cm but < +(tvl −2) cm.</p><p>Stage 4 leading edge ≥ +(tvl −2) cm.</p><p>Leading edge, cervix – uterine (apical) prolapse.</p><p>Leading edge, anterior – anterior wall prolapse.</p><p>Leading edge, posterior – posterior wall prolapse.</p

Patients with ovarian carcinoma treated without surgical intervention – flowchart of expected outcomes.

<p>Patients with ovarian carcinoma treated without surgical intervention – flowchart of expected outcomes.</p

Patient characteristics at diagnosis of ovarian carcinoma.

<p>FIGO-International Federation of Gynecology and Obstetrics.</p

First line chemotherapy for patients never treated surgically.

<p>First line chemotherapy for patients never treated surgically.</p

Background characteristics of study participants by mode of delivery.

<p>Background characteristics of study participants by mode of delivery.</p

Patient's characteristics.

<p>Patient's characteristics.</p

Outcome of vaginal mesh reconstructive surgery in multiparous compared with grand multiparous women: Retrospective long-term follow-up

<div><p>We aimed to compare the long-term surgical outcome and complications of multiparous and grand multiparous women undergoing reconstructive surgery with vaginal mesh implants for repair of pelvic organ prolapse. This retrospective, long-term follow-up (28.17±20.7 months) comprised 113 women who underwent surgical reconstructive surgery with vaginal polypropylene mesh in a high parity rate population medical center. The women were divided into 2 groups (multiparous and grand multiparous) and each group was evaluated for objective and subjective surgical outcome. Patient demographics and surgical data were retrieved from electronic medical records. Outcome measure included POP-Q exam as objective outcome and validated Pelvic Floor Distress Inventory questionnaire (PFDI) to assess subjective outcome. Average age of patients was 62±7.9 (range 42–83) years. Average parity was 5.6±3.1 (range 1–14). There were 54 (47.7%) multiparous women and 59 (52.3%) grand multiparous women. The grand multiparous women were younger than the multiparous women and had a significantly higher degree of prolapse. At the last follow-up, the only significant difference was related to symptoms of an overactive bladder. In conclusion, long-term follow-up demonstrates that vaginal mesh surgery in grand multiparous women offers anatomical and subjective cure rates comparable to multiparous women.</p></div

POP Q^* for multiparous women before and after the procedure.

<p>POP Q^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0176666#t005fn001" target="_blank">*</a>} for multiparous women before and after the procedure.</p

POP Q^* for grand multiparous women, before and after the procedure.

<p>POP Q^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0176666#t006fn001" target="_blank">*</a>} for grand multiparous women, before and after the procedure.</p