Vaginal pH versus cervical length in the mid-trimester as screening predictors of preterm labor in a low-risk population

OBJECTIVE: To assess the accuracy of a sign of bacterial vaginosis and a sign of cervical insufficiency in predicting preterm labor (PTL, occurring in the 37th week or earlier) and early PTL (occurring in the 34th week or earlier) in a low-risk cohort of 316 pregnant women. ----- METHOD: Vaginal pH was assessed using test gloves and cervical length (CL) was measured by transvaginal ultrasound. A pH value less than 5.0 (the 95th-percentile threshold) and a CL greater than 26 mm (the 5th-percentile threshold) were considered normal. ----- RESULTS: There were 14 participants (4.4%) with an elevated vaginal pH and 15 (4.7%) with a shortened CL. The incidence of PTL (<37 weeks) was 7.2%, while incidence of early PTL (≤34 weeks) was 2.5%. A shortened CL was significantly correlated with PTL (likelihood ratio [LR] weighted by prevalence; 2.7; 95% CI, 1.1-6.7) but not with early PTL (LR, 0.8; 95% CI, 0.4-1.8). An elevated vaginal pH was a better predictor of PTL (LR, 3.7; 95% CI, 1.3-10.4) and early PTL (LR, 1.7; 95% CI, 1.1-3.1). ----- CONCLUSION: An elevated vaginal pH was a better predictor of early PTL than a shortened CL in this cohort of pregnant women at low risk

Placental site does not change background uterine electromyographic activity in the middle trimester of pregnancy

OBJECTIVE: This study was performed in order to assess the potential influence of placental implantation site on transabdominal electromyographic (EMG) assessment of the uterine electrical activity in the middle trimester of pregnancy. - - - - - STUDY DESIGN: In this prospective study 251 unselected, nulliparous asymptomatic women with a singleton pregnancy underwent transabdominal uterine EMG. Uterine electrical activity was recorded using bipolar electrodes placed on the abdominal surface for 20min. Regarding the placental implantation site and presence of action potentials (AP) pregnant women were divided into two groups: the anterior placenta group (APG) and the posterior placenta group (PPG). Outcome measures were differences in the median frequency (MF) and median amplitude (MA) of AP between the two groups. - - - - - RESULTS: Action potentials were detected in 56 women: 33/56 in the APG versus 23/56 in the PPG. The parameters analyzed (MF, p=0.527, Fisher's exact test, and MA, p=0.255, Fisher's exact test) did not produce any statistical significant differences between the two groups. - - - - - CONCLUSION: Background uterine EMG activity measured from the abdominal surface in the middle trimester of pregnancy does not depend on the placental implantation site

Hyperreactio luteinalis could be a risk factor for development of HELLP syndrome: case report

OBJECTIVE: To report a unique case of hyperreactio luteinalis in pregnancy associated with ovarian torsion and subsequent development of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. DESIGN: Case report. ----- SETTING: University medical center. ----- PATIENT(S): A 34-year-old primigravida woman with ovarian torsion in 13 weeks of pregnancy and subsequent intrauterine growth restriction (IUGR) and HELLP syndrome. ----- INTERVENTION(S): Laparoscopic salpingo-oophorectomy due to the ovarian torsion and cesarean section (CS) due to the development of HELLP syndrome. ----- MAIN OUTCOME MEASURE(S): HELLP syndrome. ----- RESULT(S): In the first trimester the patient had symptoms of acute abdomen due to the ovarian torsion. Both ovaries were enlarged and multicystic. Hormonal studies confirmed an abnormally elevated level of hCG (192.000 IU/L), mild hyperthireosis, and hyperandrogenemia. Laparoscopic salpingo-oophorectomy was performed. At 30 weeks of pregnancy, IUGR was confirmed sonographically and clinically, and at 33 weeks severe preeclampsia developed. One week later, HELLP syndrome occurred. Emergency CS was preformed, and she delivered a female newborn weighing 1,640 g. Seven days after delivery, blood pressure and hormonal status returned to normal. ----- CONCLUSION(S): Hyperreactio luteinalis due to the abnormally high level of hCG in the first trimester could be a consequence of inappropriate trophoblast invasion and an early sign of subsequently developing preeclampsia, eclampsia, and HELLP syndrome

Outcome and efficacy of a transobturator polypropylene mesh kit in the treatment of anterior pelvic organ prolapse

OBJECTIVE: To report the efficacy and complications of anterior pelvic organ prolapse (POP) repair with mesh placed through the transobturator route (Perigee system; AMS, Minnetonka, MN, USA). ----- METHODS: In total, 198 women with anterior POP grade II or higher according to the POP Quantification (POP-Q) system were treated with the Perigee procedure. The primary outcome was defined as anterior POP grade I or lower at 12months' follow-up. The secondary outcomes included the incidences of perioperative, mesh-related, short-term, and long-term postoperative complications. ----- RESULTS: The cure rate was 92.9% overall and 90.6% among women who had previously undergone a hysterectomy or a traditional anterior colporrhaphy. The mean POP-Q Aa and Ba values were significantly improved after the procedure (Aa 2.2cm [0.0 to 3.0cm] versus -2.1cm [-3.0 to -1.2cm]; Ba -2.5cm [-1.0 to 4.2cm] versus -2.2cm [-5.5 to -1.0cm]; P<0.001). Vaginal or bladder erosions were observed in 3 patients. Other short- and long-term complications were infrequent and not statistically significant. ----- CONCLUSION: The Perigee procedure is effective in the treatment of anterior POP and does not have serious complications even among women with previous hysterectomy or traditional anterior colporrhaphy