Do Surgeons Anticipate Women’s Hopes and Fears Associated with Prolapse Repair? A Qualitative Analysis in the PROSPERE Trial

Women’s preoperative perceptions of pelvic-floor disorders may differ from those of their physicians. Our objective was to specify women’s hopes and fears before cystocele repair, and to compare them to those that surgeons anticipate. We performed a secondary qualitative analysis of data from the PROSPERE trial. Among the 265 women included, 98% reported at least one hope and 86% one fear before surgery. Sixteen surgeons also completed the free expectations-questionnaire as a typical patient would. Women’s hopes covered seven themes, and women’s fears eleven. Women’s hopes were concerning prolapse repair (60%), improvement of urinary function (39%), capacity for physical activities (28%), sexual function (27%), well-being (25%), and end of pain or heaviness (19%). Women’s fears were concerning prolapse relapse (38%), perioperative concerns (28%), urinary disorders (26%), pain (19%), sexual problems (10%), and physical impairment (6%). Surgeons anticipated typical hopes and fears which were very similar to those the majority of women reported. However, only 60% of the women reported prolapse repair as an expectation. Women’s expectations appear reasonable and consistent with the scientific literature on the improvement and the risk of relapse or complication related to cystocele repair. Our analysis encourages surgeons to consider individual woman’s expectations before pelvic-floor repair

Déclenchement et maturation cervicale par Propess® (devenir et facteurs prédictifs sur une série rétrospective de 390 cas)

Notre étude rétrospective avait pour objectif d'analyser le devenir des patientes déclenchées par Propess® et de déterminer l'existence de facteurs prédictifs de la réponse au dispositif. Nous avons analysé sur une période allant de janvier 2010 à février 2011 les 390 cas consécutifs de patientes correspondant aux critères d'inclusion et déclenchées par Propess®. Le succès a été retenu en cas d'entrée en travail ou d'obtention d'un Bishop favorable à H24. Deux groupes principaux ont été analysés : n 1 succès à H24 (n=295) vs n2 échec à H24 (n=95). Les facteurs prédictifs d'échec mis en lumière par cette étude sont : un IMC>25, la primiparité, un Bishop initial inférieur à 3, la hauteur de la présentation, l'absence d'activité utérine ou de douleur nécessitant la prise d'antalgique et l'absence de RSPDE pendant le déclenchement. De plus, l'évolution à H12 est déterminante pour la suite puisque le taux de césarienne a tendance à doubler toutes les 12 heures : 16% si entrée en travail<H12, 29% entre H12 et H24 pour atteindre 63% si échec à H24. Le Propess® a effectivement sa place en première intention chez toute patiente déclenchée avec un Bishop<5 puisque 70% des patientes accoucheront par les voies naturelles et que seulement 13,6% seront césarisées pour "échec de déclenchement". En fonction des critères maternels et de l'évolution dans les 12 premières heures, une attitude active nous semblerait justifié en proposant un autre moyen de déclenchement afin d'optimiser les chances de succès.CLERMONT FD-BCIU-Santé (631132104) / SudocSudocFranceF

Récidives de maladie thrombo-embolique veineuse après un premier épisode survenu sous contraception oestroprogestative

CLERMONT FD-BCIU-Santé (631132104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Credentialing for transvaginal mesh placement-a case for added qualification in competency

Introduction and hypothesis A process of added qualification of transvaginal mesh (TVM) placement is desirable.Methods Through a physician-led partnership of specialty societies, centers of excellence, and industry, a core curriculum encompassing mesh/graft biology, technical skills, and safety can be coupled with current educational endeavors instructing surgeons in the use of TVM. A posttest process can verify a knowledge-based competency in mesh/graft safety. An auditing process after implementation would be optimal.Results We recommend implementation of a five-step process in order to accomplish these goals.Conclusions It is hoped through these efforts, the ultimate goal of patient safety may be reached.Louisiana State Univ, Hlth Sci Ctr, Dept Urol, New Orleans, LA 70112 USAMaternite Hotel Dieu, Dept Gynecol, Clermont Ferrand, FranceUniversidade Federal de São Paulo, Dept Gynecol, Div Urogynecol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Gynecol, Div Urogynecol, São Paulo, BrazilWeb of Scienc

Ovarian thrombosis and uterine synechiae after arterial embolization for a late postpartum haemorrhage

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Perioperative morbi-mortality after pelvic organ prolapse surgery in a large French national database from gynecologist surgeons

International audienceObjective To assess morbidity and mortality following pelvic organ prolapse surgery in France, irrespective of the surgical technique, using a broad national database. Materials and methods: This descriptive multicenter retrospective study was conducted using a database populated via an application run by a professional association. Results 286 gynecologists contributed data to the database. Of the 4322 surgeries analyzed, an abdominal approach was used in 975 of cases (22.5%), a vaginal approach in 3277 (75.9%), and a combined approach in 68 (1.6%). After one year, abdominal surgery was associated with higher rates of de novo urinary incontinence, constipation, and intestinal obstruction, whereas vaginal surgery was associated with higher rates of urinary retention, hematoma, de novo chronic pain, and vaginal mesh extrusion. There was no significant difference between the groups in the incidence of severe complications. After one year, vaginal mesh-augmented cystocele repair was associated with higher rates of de novo urinary incontinence, de novo chronic pain, and reoperation than native tissue repair. Mesh repair was also associated with higher rates of severe complications at one year. Conclusion After pelvic organ prolapse surgery, the perioperative morbidity and mortality associated with transabdominal and transvaginal approaches are similar. However, transvaginal mesh repair is associated with greater perioperative morbidity than transvaginal native tissue repair

Perineal prevention and protection in obstetrics: CNGOF Clinical Practice Guidelines

International audienceINTRODUCTION:The objective of these clinical practice guidelines was to analyse all of the interventions during pregnancy and childbirth that might prevent obstetric anal sphincter injuries (OASIS) and postnatal pelvic floor symptoms.MATERIAL AND METHODS:These guidelines were developed in accordance with the methods prescribed by the French Health Authority (HAS).RESULTS:A prenatal clinical examination of the perineum is recommended for women with a history of Crohn's disease, OASIS, genital mutilation, or perianal lesions (professional consensus). Just after delivery, a perineal examination is recommended to check for OASIS (Grade B); if there is doubt about the diagnosis, a second opinion should be requested (Grade C). In case of OASIS, the injuries (including their severity) and the technique for their repair should be described in detail (Grade C). Perineal massage during pregnancy must be encouraged among women who want it (Grade B). No intervention conducted before the start of the active phase of the second stage of labour has been shown to be effective in reducing the risk of perineal injury. The crowning of the baby's head should be manually controlled and the posterior perineum manually supported to reduce the risk of OASIS (Grade C). The performance of an episiotomy during normal deliveries is not recommended to reduce the risk of OASIS (Grade A). In instrumental deliveries, episiotomy may be indicated to avoid OASIS (Grade C). When an episiotomy is performed, a mediolateral incision is recommended (Grade B). The indication for episiotomy should be explained to the woman, and she should consent before its performance. Advising women to have a caesarean delivery for primary prevention of postnatal urinary or anal incontinence is not recommended (Grade B). During pregnancy and again in the labour room, obstetrics professionals should focus on the woman's expectations and inform her about the modes of delivery

Diagnosis and management of adult female stress urinary incontinence: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians.

International audienceUrinary incontinence is a frequent affliction in women and may be disabling and costly {LE1}. When consulting for urinary incontinence, it is recommended that circumstances, frequency and severity of leaks be specified {Grade B}. The cough test is recommended prior to surgery {Grade C}. Urodynamic investigations are not needed before lower urinary tract rehabilitation {Grade B}. A complete urodynamic investigation is recommended prior to surgery for urinary incontinence {Grade C}. In cases of pure stress urinary incontinence, urodynamic investigations are not essential prior to surgery provided the clinical assessment is fully comprehensive (standardised questionnaire, cough test, bladder diary, post-void residual volume) with concordant results {PC}. It is recommended to start treatment for stress incontinence with pelvic floor muscle training {Grade C}. Bladder training is recommended at first intention in cases with overactive bladder syndrome {Grade C}. For overweight patients, loss of weight improves stress incontinence {LE1}. For surgery, sub-urethral tape (retropubic or transobturator route) is the first-line recommended technique {Grade B}. Sub-urethral tape surgery involves intraoperative risks, postoperative risks and a risk of failure which must be the subject of prior information {Grade A}. Elective caesarean section and systematic episiotomy are not recommended methods of prevention for urinary incontinence {Grade B}. Pelvic floor muscle training is the treatment of first intention for pre- and postnatal urinary incontinence {Grade A}. Prior to any treatment for an elderly woman, it is recommended to screen for urinary infection using a test strip, ask for a bladder diary and measure post-void residual volume {Grade C}. It is recommended to carry out a cough test and look for occult incontinence prior to surgery for pelvic organ prolapse {Grade C}. It is recommended to carry out urodynamic investigations prior to pelvic organ prolapse surgery when there are urinary symptoms or occult urinary incontinence {Grade C}

Safety of Vaginal Mesh Surgery Versus Laparoscopic Mesh Sacropexy for Cystocele Repair: Results of the Prosthetic Pelvic Floor Repair Randomized Controlled Trial

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