Objective: The aim of this study was to evaluate the effect of using uterine fundal pressure during the second stage of delivery on obstetric anal sphincter injury (OASI), among primiparous women using three-dimensional transperineal ultrasonography. Design: Case control study Setting: Tertiary Urogynecology Unit Population: Nulliparous women with term, singleton, cephalic presentation gestation delivered with fundal pressure in second stage of labour. Main Outcome Measure: Complete, incomplete IAS and EAS defect in transperineal tomographic ultrasound imaging Method: A total of 73 women who had their first vaginal birth were included in the study, 37 of them applied fundal pressure and 36 of them delivered spontaneously without fundal pressure. Tomographic ultrasound imaging with 3D transperineal assessment was performed within 48 h of delivery, IAS and EAS defect were determined. Results: Five (13.5%) women in the fundal pressure group, 7 (20%) women in the control group had complete EAS (p = 0.4). Complete IAS was observed in 1 (2.7%) women in the fundal pressure group and 2 (5.7%) women in the control group (p = 0.5). Half-moon sign was observed in 1 woman in both groups (p = 0.9). The rate of other signs were similar in both groups. Multivariate regression models revealed that none of, age, episiotomy, length of second stage of labour, fundal pressure application status and number were independent predictor of complete IAS or EAS defect. Conclusions: Fundal pressure during the second stage of delivery is not cause increase in rate of OASI detected with ultrasonography.
Objective: Intra-abdominal pressure (IAP) was defined as the steady state pressure concealed within the abdominal cavity. Sustained increased in IAP has become the focus of attention in many disciplines which is has impact on pulmonary, cardiovascular systems. Pelvic organ prolapse might be the consequences of compensation of abdominal compliance to increased IAP. The aim of this study was to evaluate the effect of laparoscopic sacrocolpopexy in patients with severe uterovaginal prolapse on intraabdominal presurre. Design: Prospective, case control study Setting: Tertiary Urogynecology Unit Population: Women with advanced symptomatic stage ≥3 uterovaginal prolapse. Method: IAPs were measured in 13 women, before and 6 month after laparoscopic sacrocolpopexy and in 13 controls. Main Outcome Measure: Preoperative and postoperative IAP. Results: The mean preoperative IAP of controls (4.5 ± 1 mmHg) was not significantly different than to women with stage ≥3 uterovaginal prolapse (p=0.1). The mean postoperative IAP at 6 months control was 8.6 ±2.5 mmHg and significantly higher than postprocedure IAP of control group (4.8 ± 1.1 mmHg) (p<0.0001). IAP of prolapse group was significantly correlated with gravidy (r = 0.65, P < 0.01) and parity (r = 0.87, P < 0.001). Conclusions: IAP significantly increases after pelvic reconstructive surgery in our pilot study. The association of increased IAP with pelvic organ prolapse and its clinical consequences should be evaluated with large, well designed, with studies
Sacrohysteropexy procedures require advanced suturing and dissection skills and are associated with complications such as mesh exposure, dyspareunia, ileus, de novo bowel dysfunction. New technique is composed of insertion of mid-urethral sling tape into the cervix vaginally and suspend of uterus bilaterally via free arms of tape under the peritoneal tunnel formed with the aid of modified semicircular disposable grasper. This novel hysteropexy technique is an easy, feasible and minimally invasive way to correct primarily apical or multicompartment defects with the advantages of a minimal mesh load, short operation time and anatomical result that mimics the normal sacrouterine ligament.