Assessing vaginal wall thickness by transvaginal ultrasound in breast cancer survivors: A pilot study

Aim: There is need for a straightforward objective measure to evaluate vaginal wall changes related to hypoestrogenism. The aim of this pilot study was to evaluate a transvaginal ultrasound procedure for the quantification of vaginal wall thickness in order to differentiate between healthy premenopausal women and postmenopausal women with genitourinary syndrome of menopause using ultra-low-level estrogen status as a model. Methods: We performed a prospective, two-arm, cross-sectional pilot study comparing vaginal wall thickness measured by transvaginal ultrasound in postmenopausal breast cancer survivors using aromatase inhibitors with genitourinary syndrome of menopause (GSM group) and healthy premenopausal women (control or C group) from October 2020 to March 2022. After intravaginal introduction of 20 cm3 of sonographic gel, vaginal wall thickness was measured by transvaginal ultrasound in the anterior, posterior, and right and left lateral walls (four quadrants). The study methods followed the STROBE checklist. Results: According to the results of a two-sided t-test, the mean vaginal wall thickness of the four quadrants in the GSM group was significantly less than that of the C group (2.25 mm vs 4.17 mm, respectively; p < 0.001). Likewise, the thickness of each of the vaginal walls (anterior, posterior, right and left lateral) statistically differed between the two groups (p < 0.001). Conclusion: Transvaginal ultrasound with intravaginal gel may be a feasible objective technique to assess genitourinary syndrome of menopause, showing clear differences in vaginal wall thickness between breast cancer survivors using aromatase inhibitors and premenopausal women. Possible correlations with symptoms or treatment response should be assessed in future studies

Estimación de la incidencia de incontinencia urinaria asociada al embarazo y el parto

Incontinència urinària; Dones embarassades; Part; Incontinence; Pregnant women; Childbirth; Incontinencia urinaria; Mujeres embarazadas; PartoAquest és el primer estudi que ha avaluat prospectivament la IU en el nostre medi i s'ha fet amb una cohort de gestants nul·lípares el sòl pelvià de les quals romania intacte. Els resultats han posat de manifest l'elevada incidència d'IU durant l'embaràs i la seva correlació amb la qualitat de vida. Pel que fa als factors de risc, s'ha corroborat la importància del part vaginal i s'han confirmat altres factors identificats amb altres dissenys d'estudi. La informació obtinguda és important per destacar la IU com un problema de salut comú i, tanmateix, ocult o infravalorat. Els factors de risc identificats, tant en l'embaràs com en el part, es corresponen amb estils de vida i pràctiques obstètriques susceptibles de ser modificades

Perineal Trauma in Primiparous Women with Spontaneous Vaginal Delivery: Episiotomy or Second Degree Perineal Tear?

Introduction Historically, the use of episiotomy was common for primiparous women in order to prevent severe perineal trauma. Paradoxically, reviews indicate the opposite: episiotomy may actually contribute to severe perineal trauma rather than protect against it (1-4). Although current practice favours a reduction in episiotomies, perineal trauma rates remain high because of the increase in first and second degree tears Materials and Methods This study is a subset analysis of women who had spontaneous vaginal deliveries from an institutional review Abstract Objectives: To estimate the incidence of perineal trauma in primiparous women with spontaneous vaginal delivery and to identify the factors associated with second-degree lacerations. Materials and Methods: A subset analysis of women with spontaneous vaginal deliveries (n=489) from an institutional review board-approved parent study in healthy, nulliparous, continent pregnant women, attending the public health care system of Catalonia (northeast Spain). Primary outcome measure was perineal trauma according to the RCOG classification. For the bivariate analysis, the Student&apos;s t-test, ANOVA and the chi-squared test, or the corresponding non-parametric tests were used. Rates, relative risks and odds ratios (multivariate analysis) were estimated along with 95% confidence intervals (CI). Results: About 91% (95% CI: 88-93%) of women with vaginal deliveries showed some degree of perineal trauma. Nulliparous women with spontaneous deliveries who did not undergo an episiotomy were 9 times more likely to present a tear (any grade) than those who received an episiotomy [Relative risks (RR) = 9.6, 95% CI: 6.3%-14.6%, P&lt;0.001]. Only episiotomy reached statistical significance in bivariate and multivariate analyses (P&lt;0.0001), revealing the protective effect of episiotomy respect to second-degree tear. Conclusion: The absence of episiotomy was the only variable independently associated with second degree perineal tears, showing a clear protective effect

Alternative model of birth to reduce the risk of assisted vaginal delivery and perineal trauma

This study was conducted to evaluate the effects of an alternative model of birth (AMB) on the incidence of assisted vaginal delivery (AVD) and perineal trauma (PT). One hundred ninety-nine women with epidural anesthesia were randomized to a traditional model of birth (TMB) (n = 96) or AMB (n = 103). Women in TMB pushed immediately after complete dilatation and delivered in lithotomy position. In AMB, women followed a postural changes protocol while they delayed pushing and used a specific lateral position for delivery. AMB was associated with a significant reduction in AVD compared with TMB (19.8% vs 42.1%, p<0.001). TMB was strongly associated with AVD (OR = 4.49; p< 0.05), which, in turn, was significantly associated with nulliparity (OR = 5.52; p<0.005) and fetal head unengaged at full dilatation (OR = 5.35; p<0.05). AMB significantly increased the intact perineum rate compared with TMB (40.3% vs 12.2%, p<0.001). Episiotomy rate was significantly reduced in AMB (21.0% vs 51.4%, p<0.001). A combination of postural changes during the passive expulsive phase of labor and lateral position during active pushing time is associated with reductions in AVD and PT.FIS 05/1235Ministerio de Sanidad y ConsumoUniversidad Europea de Madrid3.956 JCR (2012) Q2, 22/78 Obstetrics & ginecology, 26/73 Urology & nephrologyUE

Estimación de la incidencia de incontinencia urinaria asociada al embarazo y el parto

Incontinència urinària; Dones embarassades; Part; Incontinence; Pregnant women; Childbirth; Incontinencia urinaria; Mujeres embarazadas; PartoAquest és el primer estudi que ha avaluat prospectivament la IU en el nostre medi i s'ha fet amb una cohort de gestants nul·lípares el sòl pelvià de les quals romania intacte. Els resultats han posat de manifest l'elevada incidència d'IU durant l'embaràs i la seva correlació amb la qualitat de vida. Pel que fa als factors de risc, s'ha corroborat la importància del part vaginal i s'han confirmat altres factors identificats amb altres dissenys d'estudi. La informació obtinguda és important per destacar la IU com un problema de salut comú i, tanmateix, ocult o infravalorat. Els factors de risc identificats, tant en l'embaràs com en el part, es corresponen amb estils de vida i pràctiques obstètriques susceptibles de ser modificades