Pregnant Women after Physical and Sexual Abuse in Germany

Background/Aims: The aim of our study was to evaluate the prevalence of abuse among pregnant women in Germany attending our antenatal outpatient clinic and to observe whether a history of abuse had consequences for women's feelings about their pregnancy. Methods: 455 women between the 35th and 42nd weeks of gestational age were included and were asked to fill out an anonymous questionnaire concerning their pregnancy, their actual psychological state, and their history of physical/sexual abuse. 600 questionnaires were distributed (return rate 75.8%), 70 women (10.4%) were excluded because of male companionship to ensure their safety in case that they were currently in an abusive relationship with the attending man. Results: 88 women (19.3%) reported a history of sexual and/or physical abuse. Pregnant women after physical and/or sexual abuse significantly more frequently associate negative feelings with their pregnancy than nonabused women. The Hospital Anxiety Depression Scale (HADS) and the SCL-K-9 demonstrated significantly more negative feelings of depression and anxiety, strain, loneliness and less expectation of happiness for their future in abused women. Conclusion: Physical and sexual abuse are relevant problems among women in obstetric care that may complicate their pregnancies and make them feel more depressive. Copyright (C) 2009 S. Karger AG, Base

Occult incontinence in women with pelvic organ prolapse - does it matter?

<p>Abstract</p> <p>Objective</p> <p>Many surgeons perform an anti-incontinence procedure during prolapse surgery in women in whom occult stress urinary incontinence has been demonstrated. Others prefer a two-step approach. It was the aim of the study to find out how many women really need a second operation and if a positive cough stress test with the prolapse reduced is associated with the development of stress urinary incontinence after prolapse surgery.</p> <p>Methods</p> <p>233 women were operated for primary or recurrent prolapse without complaining of SUI. Preoperatively, 53/233 women had a full urogynecological workup with the prolapse reduced. Postoperatively, if the patient suffered from stress urinary incontinence, an anti-incontinence surgery was performed.</p> <p>Results</p> <p>19/53 (35.8%) women who had a stress test with the prolapse reduced before surgery were defined as occult stress incontinent. Only 3 women (15.8%) of these 19 women developed symptoms of incontinence after prolapse surgery and had to be operated because of that. 18/233 (7.7%) complained of SUI 6 weeks to 6 months after surgery and received a TVT-tape.</p> <p>Conclusion</p> <p>The incidence of stress urinary incontinence manifesting after prolapse surgery is low in this study with 7.7%. This fact and the possible severe side effects of an incontinence operation justify a two-step approach if the patient is counseled and agrees. However, there is a small subgroup of women (3/19, 15.8%) with preoperative OSUI and SUI after surgery, who would benefit from a one-step approach. Further research is required to identify these women before surgical intervention.</p

Incontinence, bladder neck mobility, and sphincter ruptures in primiparous women

<p>Abstract</p> <p>Objective</p> <p>To compare the function of the pelvic floor in primiparae before and during pregnancy with the status post partum concerning symptoms of incontinence, sphincter ruptures, bladder-neck mobility and the influence of the different modes of deliveries.</p> <p>Methods</p> <p>Questionnaire evaluating symptoms of urinary and anal incontinence in nulliparous women before and after delivery and correlating these symptoms with functional changes of the pelvic floor based on a careful gynaecologic examination as well as perineal and endoanal ultrasound.</p> <p>Results</p> <p>112 women were included in our study and came for the first visit, 99 women returned for follow-up 6 months after childbirth. Stress and flatus incontinence significantly increased from before pregnancy (3 and 12%) to after childbirth (21 and 28%) in women with spontaneous delivery or vacuum extraction. No new symptoms occurred after c-section. There was no significant difference between the bladder neck position before and after delivery. The mobility of the bladder neck was significantly higher after vaginal delivery using a vacuum extraction compared to spontaneous delivery or c-section.</p> <p>The bladder neck in women with post partum urinary stress incontinence was significantly more mobile than in continent controls. The endoanal ultrasound detected seven occult sphincter defects without any correlation to symptoms of anal incontinence.</p> <p>Conclusion</p> <p>Several statistically significant changes of the pelvic floor after delivery were demonstrated. Spontaneous vaginal delivery or vacuum extraction increases the risk for stress or anal incontinence, delivery with vacuum extraction leads to higher bladder neck mobility and stress incontinent women have more mobile bladder necks than continent women.</p

Bladder neck mobility in continent nulliparous women

To evaluate the mobility of the vesical neck during coughing and valsalva in healthy nulliparous volunteers and to test the reliability of the technique applied. Design Clinical observational study. Setting Department of Obstetrics and Gynaecology, Cantonal Hospital Lucerne, Switzerland. Population Thirty-nine nulliparous volunteers. Methods Vesical neck motion was assessed with perineal ultrasound. Intra–abdominal pressure was controlled for with an intrarectal probe. Intra-rater reliability was evaluated. Results Vesical neck mobility was significantly lower during coughing (8 mm, SD 4 mm) than during valsalva (15 mm, SD 10 mm) ( P < 0.005 ). Between individuals mobility varied from 4 mm to 32 mm during coughing and from 2 mm to 31 mm during valsalva. Test-retest-studies showed a maximum difference between to tests during coughing of 4 mm and during valsalva of 5 mm. Conclusion The bladder neck is mobile in normal continent women and bladder neck mobility is lower during coughing than during Valsalva.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74987/1/j.1471-0528.2001.00066.x.pd

A System for the Synchronized Recording of Sonomyography, Electromyography and Joint Angle

Ultrasound and electromyography (EMG) are two of the most commonly used diagnostic tools for the assessment of muscles. Recently, many studies reported the simultaneous collection of EMG signals and ultrasound images, which were normally amplified and digitized by different devices. However, there is lack of a systematic method to synchronize them and no study has reported the effects of ultrasound gel to the EMG signal collection during the simultaneous data collection. In this paper, we introduced a new method to synchronize ultrasound B-scan images, EMG signals, joint angles and other related signals (e.g. force and velocity signals) in real-time. The B-mode ultrasound images were simultaneously captured by the PC together with the surface EMG (SEMG) and the joint angle signal. The deformations of the forearm muscles induced by wrist motions were extracted from a sequence of ultrasound images, named as Sonomyography (SMG). Preliminary experiments demonstrated that the proposed method could reliably collect the synchronized ultrasound images, SEMG signals and joint angle signals in real-time. In addition, the effect of ultrasound gel on the SEMG signals when the EMG electrodes were close to the ultrasound probe was studied. It was found that the SEMG signals were not significantly affected by the amount of the ultrasound gel. The system is being used for the study of contractions of various muscles as well as the muscle fatigue

Best practice policy statement on urodynamic antibiotic prophylaxis in the non‐index patient

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136686/1/nau23253.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136686/2/nau23253_am.pd

Sexual violence in the protracted conflict of DRC programming for rape survivors in South Kivu

BACKGROUND: Despite international acknowledgement of the linkages between sexual violence and conflict, reliable data on its prevalence, the circumstances, characteristics of perpetrators, and physical or mental health impacts is rare. Among the conflicts that have been associated with widespread sexual violence has been the one in the Democratic Republic of the Congo (DRC). METHODS: From 2003 till to date Malteser International has run a medico-social support programme for rape survivors in South Kivu province, DRC. In the context of this programme, a host of data was collected. We present these data and discuss the findings within the frame of available literature. RESULTS: Malteser International registered 20,517 female rape survivors in the three year period 2005-2007. Women of all ages have been targeted by sexual violence and only few of those - and many of them only after several years - sought medical care and psychological help. Sexual violence in the DRC frequently led to social, especially familial, exclusion. Members of military and paramilitary groups were identified as the main perpetrators of sexual violence. CONCLUSION: We have documented that in the DRC conflict sexual violence has been - and continues to be - highly prevalent in a wide area in the East of the country. Humanitarian programming in this field is challenging due to the multiple needs of rape survivors. The easily accessible, integrated medical and psycho-social care that the programme offered apparently responded to the needs of many rape survivors in this area

Sexual violence in the protracted conflict of DRC programming for rape survivors in South Kivu

BACKGROUND: Despite international acknowledgement of the linkages between sexual violence and conflict, reliable data on its prevalence, the circumstances, characteristics of perpetrators, and physical or mental health impacts is rare. Among the conflicts that have been associated with widespread sexual violence has been the one in the Democratic Republic of the Congo (DRC). METHODS: From 2003 till to date Malteser International has run a medico-social support programme for rape survivors in South Kivu province, DRC. In the context of this programme, a host of data was collected. We present these data and discuss the findings within the frame of available literature. RESULTS: Malteser International registered 20,517 female rape survivors in the three year period 2005-2007. Women of all ages have been targeted by sexual violence and only few of those - and many of them only after several years - sought medical care and psychological help. Sexual violence in the DRC frequently led to social, especially familial, exclusion. Members of military and paramilitary groups were identified as the main perpetrators of sexual violence. CONCLUSION: We have documented that in the DRC conflict sexual violence has been - and continues to be - highly prevalent in a wide area in the East of the country. Humanitarian programming in this field is challenging due to the multiple needs of rape survivors. The easily accessible, integrated medical and psycho-social care that the programme offered apparently responded to the needs of many rape survivors in this area

Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016).

Aims: The aim was to establish an official interdisciplinary guideline, published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). The guideline was developed for use in German-speaking countries. In addition to the Germany Society of Gynecology and Obstetrics, the guideline has also been approved by the Swiss Society of Gynecology and Obstetrics (SGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). This is a guideline published and coordinated by the DGGG. The aim is to provide evidence-based recommendations obtained by evaluating the relevant literature for the diagnostic, conservative and surgical treatment of women with female pelvic organ prolapse with or without stress incontinence. Methods: We conducted a systematic review together with a synthesis of data and meta-analyses, where feasible. MEDLINE, Embase, Cinahl, Pedro and the Cochrane Register were searched for relevant articles. Reference lists were hand-searched, as were the abstracts of the Annual Meetings of the International Continence Society and the International Urogynecological Association. We included only abstracts of randomized controlled trials that were presented and discussed in podium sessions. We assessed original data on surgical procedures published since 2008 with a minimum follow-up time of at least 12 months. If the studies included descriptions of perioperative complications, this minimum follow-up period did not apply. Recommendations: The guideline encompasses recommendations for the diagnosis and treatment of female pelvic organ prolapse. Recommendations for anterior, posterior and apical pelvic organ prolapse with or without concomitant stress urinary incontinence, uterine preservation options, and the pros and cons of mesh placements during surgery for pelvic organ prolapse are presented. The recommendations are based on an extensive and systematic review and evaluation of the current literature and include the experiences and specific conditions in Germany, Austria and Switzerland