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European Journal of Obstetrics,... Dec 2016The risk of obstetric anal sphincter injury (OASIS) is increased in vacuum-assisted delivery. However, it remains unclear whether episiotomy may protect against OASIS in... (Meta-Analysis)
Meta-Analysis Review
The risk of obstetric anal sphincter injury (OASIS) is increased in vacuum-assisted delivery. However, it remains unclear whether episiotomy may protect against OASIS in this type of delivery. The objective of this study was to assess whether mediolateral or lateral episiotomy affects the risk of OASIS in vacuum-assisted delivery among primiparous women. Data were found searching The PubMed, Cochrane library and Embase databases electronically. Studies investigating the risk of OASIS in vacuum-assisted delivery with and without the use of mediolateral or lateral episiotomy were considered for inclusion. Of the 452 studies found, 15 observational studies were included in this meta-analysis. All authors assessed risk of bias of the included studies using the Scottish Intercollegiate Guideline Network (SIGN) quality score. According to this meta-analysis, mediolateral or lateral episiotomy significantly reduced the risk of OASIS in vacuum-assisted deliveries in primiparous women (OR 0.53 (95% CI 0.37-0.77)). Numbers needed to treat (NNT) was 18.3 (95% CI 17.7-18.9). The protective effect of episiotomy seemed most pronounced when performed in more than 75% of vacuum-assisted deliveries (OR 0.37 (95% CI 0.15-0.92)). In conclusion, this meta-analysis showed that mediolateral or lateral episiotomy was protective against OASIS and may be considered in vacuum-assisted delivery in primiparous women. Randomized controlled trials to further investigate this finding are warranted.
Topics: Anal Canal; Dilatation, Pathologic; Episiotomy; Female; Humans; Observational Studies as Topic; Obstetric Labor Complications; Perineum; Pregnancy; Risk; Vacuum Extraction, Obstetrical
PubMed: 27865945
DOI: 10.1016/j.ejogrb.2016.10.013 -
Journal of Advanced Nursing Jun 2024The aim of this paper is to present the evidence on the effectiveness of non-surgical interventions to improve health and well-being in women living with... (Review)
Review
AIM
The aim of this paper is to present the evidence on the effectiveness of non-surgical interventions to improve health and well-being in women living with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome.
DESIGN
Systematic review guided by Preferred Reporting Items for Systematic Reviews checklist.
DATA SOURCES
The search was conducted between June and September 2022 across the following databases: CINAHL, EMBASE, Medline, PsycINFO and Cochrane. Trial registries (clinicaltrials. gov, World Health Organization International Clinical Trials Registry Platform (ICTRP), Cochrane Controlled Trials Register-CCTR), Google scholar, dissertations, conference proceedings and reference lists of included studies were also searched. Corresponding authors, formal and informal MRKH groups were contacted to obtain any significant studies or reviews.
REVIEW METHODS
Eligible were only English-language empirical studies of any time period. The review followed narrative synthesis.
RESULTS
Twenty-three studies were identified that fit the inclusion criteria which included 1540 MRKH syndrome affected women. Four studies were on psychological interventions (n = 85) and 19 studies (vaginal dilation therapy n = 897, coital dilation n = 57) focused on non-surgical vaginal dilation as a measure to vaginal agenesis in MRKH syndrome.
CONCLUSIONS
Clearly, vaginal dilation is a viable initial treatment option for women with MRKH syndrome. There is limited evidence that 'coital dilation' is an effective method of dilation for vaginal agenesis. The literature, however, supports the need for psychological intervention to improve health and well-being.
IMPACT
Women with MRKH syndrome who require dilation can receive guidance and support from their healthcare providers, particularly sexual and reproductive health nurses, clinical nurse specialists and gynaecologists. From the point of diagnosis, clinical psychologists should be involved. As much as feasible, family and partner support can be encouraged.
PATIENT OR PUBLIC CONTRIBUTION
No patient or public contribution.
Topics: Humans; Female; 46, XX Disorders of Sex Development; Congenital Abnormalities; Mullerian Ducts; Adult; Quality of Life; Middle Aged; Young Adult; Adolescent
PubMed: 37994266
DOI: 10.1111/jan.15976 -
International Urogynecology Journal Mar 2019The treatment and mental support of patients with Mayer-Rokitansky-Küster-Hauser syndrome are very important. Many of these patients seek treatment to improve their...
INTRODUCTION AND HYPOTHESIS
The treatment and mental support of patients with Mayer-Rokitansky-Küster-Hauser syndrome are very important. Many of these patients seek treatment to improve their sexual relationships and the quality of their sexual life. This systematic review sought to evaluate the sexual satisfaction of patients with MRKH syndrome following various types of vaginoplasty and non-surgical procedures over the past 10 years.
METHODS
A systematic review of studies published in English during 2008-2018 was performed. Electronic databases and valid sites, including PubMed, EMBASE, Science Direct, Cochrane Library, SCOPUS, Ovid, and ProQuest, were searched for articles published from the beginning of 2008 to February 2018. Literature restricted to women with Mayer-Rokitansky-Küster-Hauser syndrome who underwent vaginoplasty surgery or a non-surgical technique was reviewed. Of 195 papers identified, 45 articles were analyzed. All studies that reported sexual and functional outcomes following various vaginoplasty procedures and non-surgical procedures were selected.
RESULTS
Greater vaginal length and higher sexual satisfaction were observed following surgical procedures than after non-surgical techniques. A range of complications was reported following the use of different surgical approaches. The Female Sexual Function Index (FSFI) was the most commonly applied tool to measure sexual satisfaction, but its results were not always in agreement with the findings of other research tools. Finally, women who underwent surgical techniques had higher sexual activity levels than those who received non-surgical procedures.
CONCLUSION
The reviewed studies highlighted the need for further quantitative and qualitative research on the sexual performance and outcomes of patients with MRKH syndrome.
REGISTRATION NUMBER
None.
Topics: 46, XX Disorders of Sex Development; Congenital Abnormalities; Dilatation; Female; Humans; Mullerian Ducts; Orgasm; Plastic Surgery Procedures; Sexual Behavior; Vagina
PubMed: 30612182
DOI: 10.1007/s00192-018-3854-5 -
Archives of Gynecology and Obstetrics Jul 2019Acute colonic pseudo-obstruction or Ogilvie's syndrome (OS) is a rare form of postsurgical or posttraumatic complication. OS rarely occurs in the postoperative course of...
BACKGROUND
Acute colonic pseudo-obstruction or Ogilvie's syndrome (OS) is a rare form of postsurgical or posttraumatic complication. OS rarely occurs in the postoperative course of gynecologic and obstetric patients and is difficult to diagnose.
CASE PRESENTATION
We present the case of an 83-years-old patient with carcinosarcoma of the uterus who developed OS with non-obstructive dilation of the right hemicolon and intraabdominal compression after total abdominal hysterectomy, omentectomy, and lymphadenectomy. Laparotomy with colonic decompression and abdominal dressing was performed. Subsequently, the patient developed pneumonia and peritonitis and died due to septic shock.
SYSTEMATIC LITERATURE REVIEW
We identified 49 case reports and 10 case series describing 17 gynecologic (cervical cancer, n = 2; carcinosarcoma of the uterus, n = 1; benign gynecologic condition, n = 14) and 76 obstetric patients (cesarean section, n = 66; OS during pregnancy or after vaginal delivery, n = 10). Outcome data were available for 59 patients. First-line treatment was conservative in 22/59 (37%) cases, laparotomy with decompression or colon resection was performed in 20/59 (34%) cases, endoscopic decompression in 12/59 (20%) cases, and i.v. neostigmine in 4/59 (7%) cases. Resolution was achieved in 22/59 (37%) of patients. The most common second-line treatment was right hemicolectomy. Adverse events grade 3 and 4 were observed in 8/59 and 31/59 patients (together 66%), respectively, mortality was 3/59 (5%).
CONCLUSION
OS is a rare postoperative complication of gynecologic and obstetric patients with a good prognosis, but a high morbidity. Pregnancy seems to be a predisposing factor for OS. Conservative treatment is a successful first-line approach.
Topics: Acute Disease; Aged, 80 and over; Colonic Pseudo-Obstruction; Female; Genital Diseases, Female; Humans
PubMed: 31093741
DOI: 10.1007/s00404-019-05170-4 -
American Journal of Perinatology Mar 2019To assess available evidence regarding the use of oxytocin in conjunction with Foley balloon (FB) for cervical ripening. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess available evidence regarding the use of oxytocin in conjunction with Foley balloon (FB) for cervical ripening.
METHODS
Databases from MEDLINE (U.S. National Library of Medicine, 1980-May 12, 2017), MEDLINE (Ovid, 1980-June 30, 2017), the Cochrane Library Controlled Trials Register, ClinicalTrials.gov, and Web of Science were queried for studies on FB cervical ripening with or without oxytocin in pregnant women. Search terms included: "balloon dilatation" OR "mechanical methods" OR "mechanical method" OR "mechanical dilation" OR "mechanical dilatation" OR "mechanical dilations" OR "mechanical dilatations" OR "balloon" OR "Foley" AND "Pitocin" OR "oxytocin." All relevant references were reviewed. Literature for inclusion and methodological quality were reviewed based on the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.
RESULTS
Out of 344 citations, six randomized clinical trials (1,133 patients) fulfilled our inclusion criteria. The pooled estimate showed that the cesarean delivery (CD) rate did not differ (relative risk [RR]: 0.91 (95% confidence interval [CI] [0.76-1.10]; = 0.23) between patients who underwent preinduction cervical ripening with FB alone versus those who received oxytocin in addition to FB. Heterogeneity was not significant among studies ( 0.0%; = 0.64). Furthermore, no differences in other outcomes such as composite and maternal outcomes were detected between these two groups. Compared with simultaneous use of oxytocin with FB, the Foley alone cervical ripening group had a longer induction to delivery time, and lower deliveries within 12 and 24 hours. Subgroup analysis showed that only multiparous women in the Foley alone group had lower rate of vaginal delivery within 24 hours (RR: 0.74, 95% CI [0.61-0.89], = 0.002) along with a trend toward higher CD rates.
CONCLUSION
Adding oxytocin to FB at the time of preinduction cervical ripening does not reduce cesarean rates nor improve maternal or neonatal outcomes. Multiparous women who received FB alone seem to have lower rates of vaginal deliveries within 24 hours, but these results should be interpreted with caution.
Topics: Catheterization; Cervical Ripening; Cesarean Section; Female; Humans; Labor, Induced; Oxytocics; Oxytocin; Parity; Pregnancy; Pregnancy Outcome; Time Factors
PubMed: 30130821
DOI: 10.1055/s-0038-1668577 -
The Cochrane Database of Systematic... Aug 2020The setting in which induction of labour takes place (home or inpatient) is likely to have implications for safety, women's experiences and costs. Home induction may be... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
The setting in which induction of labour takes place (home or inpatient) is likely to have implications for safety, women's experiences and costs. Home induction may be started at home with the subsequent active phase of labour happening either at home or in a healthcare facility (hospital, birth centre, midwifery-led unit). More commonly, home induction starts in a healthcare facility, then the woman goes home to await the start of labour. Inpatient induction takes place in a healthcare facility where the woman stays while awaiting the start of labour.
OBJECTIVES
To assess the effects on neonatal and maternal outcomes of third trimester home induction of labour compared with inpatient induction using the same method of induction.
SEARCH METHODS
For this update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (31 January 2020)), and reference lists of retrieved studies.
SELECTION CRITERIA
Published and unpublished randomised controlled trials (RCTs) in which home and inpatient settings for induction have been compared. We included conference abstracts but excluded quasi-randomised trials and cross-over studies.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed study reports for inclusion. Two review authors carried out data extraction and assessment of risk of bias independently. GRADE assessments were checked by a third review author.
MAIN RESULTS
We included seven RCTs, six of which provided data on 1610 women and their babies. Studies were undertaken between 1998 and 2015, and all were in high- or upper-middle income countries. Most women were induced for post dates. Three studies reported government funding, one reported no funding and three did not report on their funding source. Most GRADE assessments gave very low-certainty evidence, downgrading mostly for high risk of bias and serious imprecision. 1. Home compared to inpatient induction with vaginal prostaglandin E (PGE) (two RCTs, 1028 women and babies; 1022 providing data). Although women's satisfaction may be slightly better in home settings, the evidence is very uncertain (mean difference (MD) 0.16, 95% confidence interval (CI) -0.02 to 0.34, 1 study, 399 women), very low-certainty evidence. There may be little or no difference between home and inpatient induction for other primary outcomes, with all evidence being very low certainty: - spontaneous vaginal birth (average risk ratio (RR) [aRR] 0.91, 95% CI 0.69 to 1.21, 2 studies, 1022 women, random-effects method); - uterine hyperstimulation (RR 1.19, 95% CI 0.40 to 3.50, 1 study, 821 women); - caesarean birth (RR 1.01, 95% CI 0.81 to 1.28, 2 studies, 1022 women); - neonatal infection (RR 1.29, 95% CI 0.59 to 2.82, 1 study, 821 babies); - admission to neonatal intensive care unit (NICU) (RR 1.20, 95% CI 0.50 to 2.90, 2 studies, 1022 babies). Studies did not report serious neonatal morbidity or mortality. 2. Home compared to inpatient induction with controlled release PGE (one RCT, 299 women and babies providing data). There was no information on whether the questionnaire on women's satisfaction with care used a validated instrument, but the findings presented showed no overall difference in scores. We found little or no difference between the groups for other primary outcomes, all also being very low-certainty evidence: - spontaneous vaginal birth (RR 0.94, 95% CI 0.77 to 1.14, 1 study, 299 women); - uterine hyperstimulation (RR 1.01, 95% CI 0.51 to 1.98, 1 study, 299 women); - caesarean births (RR 0.95, 95% CI 0.64 to 1.42, 1 study, 299 women); - admission to NICU (RR 1.38, 0.57 to 3.34, 1 study, 299 babies). The study did not report on neonatal infection nor serious neonatal morbidity or mortality. 3. Home compared to inpatient induction with balloon or Foley catheter (four RCTs; three studies, 289 women and babies providing data). It was again unclear whether questionnaires reporting women's experiences/satisfaction with care were validated instruments, with one study (48 women, 69% response rate) finding women were similarly satisfied. Home inductions may reduce the number of caesarean births, but the data are also compatible with a slight increase and are of very low-certainty (RR 0.64, 95% CI 0.41 to 1.01, 2 studies, 159 women). There was little or no difference between the groups for other primary outcomes with all being very low-certainty evidence: - spontaneous vaginal birth (RR 1.04, 95% CI 0.54 to 1.98, 1 study, 48 women): - uterine hyperstimulation (RR 0.45, 95% CI 0.03 to 6.79, 1 study, 48 women); - admission to NICU (RR 0.37, 95% CI 0.07 to 1.86, 2 studies, 159 babies). There were no serious neonatal infections nor serious neonatal morbidity or mortality in the one study (involving 48 babies) assessing these outcomes.
AUTHORS' CONCLUSIONS
Data on the effectiveness, safety and women's experiences of home versus inpatient induction of labour are limited and of very low-certainty. Given that serious adverse events are likely to be extremely rare, the safety data are more likely to come from very large observational cohort studies rather than relatively small RCTs.
Topics: Ambulatory Care; Catheterization; Cervical Ripening; Cesarean Section; Delayed-Action Preparations; Dinoprostone; Female; Hospitalization; Humans; Infant, Newborn; Labor, Induced; Length of Stay; Oxytocics; Patient Safety; Patient Satisfaction; Pregnancy; Pregnancy Outcome; Randomized Controlled Trials as Topic
PubMed: 32852803
DOI: 10.1002/14651858.CD007372.pub4 -
BJOG : An International Journal of... Nov 2023Over one-quarter of women in the UK have a caesarean birth (CB). More than one in 20 of these births occurs near the end of labour, when the cervix is fully dilated...
Over one-quarter of women in the UK have a caesarean birth (CB). More than one in 20 of these births occurs near the end of labour, when the cervix is fully dilated (second stage). In these circumstances, and when labour has been prolonged, the baby's head can become lodged deep in the maternal pelvis making it challenging to deliver the baby. During the caesarean birth, difficulty in delivery of the baby's head may result - this emergency is known as impacted fetal head (IFH). These are technically challenging births that pose significant risks to both the woman and baby. Complications for the woman include tears in the womb, serious bleeding and longer hospital stay. Babies are at increased risk of injury including damage to the head and face, lack of oxygen to the brain, nerve damage, and in rare cases, the baby may die from these complications. Maternity staff are increasingly encountering IFH at CB, and reports of associated injuries have risen dramatically in recent years. The latest UK studies suggest that IFH may complicate as many as one in 10 unplanned CBs (1.5% of all births) and that two in 100 babies affected by IFH die or are seriously injured. Moreover, there has been a sharp increase in reports of babies having brain injuries when their birth was complicated by IFH. When an IFH occurs, the maternity team can use different approaches to help deliver the baby's head at CB. These include: an assistant (another obstetrician or midwife) pushing the head up from the vagina; delivering the baby feet first; using a specially designed inflatable balloon device to elevate the baby's head and/or giving the mother a medicine to relax the womb. However, there is currently no consensus for how best to manage these births. This has resulted in a lack of confidence among maternity staff, variable practice and potentially avoidable harm in some circumstances. This paper reviews the current evidence regarding the prediction, prevention and management of IFH at CB, integrating findings from a systematic review commissioned from the National Guideline Alliance.
Topics: Infant; Female; Pregnancy; Humans; Cesarean Section; Labor, Obstetric; Fetus; Uterus; Cervix Uteri
PubMed: 37303275
DOI: 10.1111/1471-0528.17534 -
World Journal of Urology Feb 2020To provide a literature review of the urological and obstetric outcomes during and after pregnancy following urinary diversion using bowel segments.
PURPOSE
To provide a literature review of the urological and obstetric outcomes during and after pregnancy following urinary diversion using bowel segments.
METHODS
A systematic literature research by specific keywords was performed in February 2017. Relevant articles were assessed and available parameters such as, e.g., number of included patients, indication for and type of urinary diversion, birth mode and complications during and after pregnancy were evaluated.
RESULTS
We found 61 relevant articles published between 1961 and 2017. Overall, data of 282 females carrying 330 babies within 395 pregnancies were listed. Birth was via vaginal delivery in 132 cases, while 183 females delivered via elective or emergency cesarean. The main urological complications during pregnancy were urinary tract infections, pyelonephritis and dilatation of the upper urinary tract. In total, 155 episodes of pyelonephritis (39.2%) were reported, but no major or persisting complications occurred.
CONCLUSION
After urinary diversion, pregnancy is possible without major complications. Due to an increased risk of pyelonephritis and dilatation of the upper urinary tract requiring intervention, these pregnancies should be considered high risk. Vaginal delivery as well as delivery by cesarean is feasible, but should be carried out in centers of expertise with urological stand-by.
Topics: Female; Humans; Intestines; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Urinary Diversion; Urinary Reservoirs, Continent
PubMed: 31028456
DOI: 10.1007/s00345-019-02781-z -
BMC Women's Health Dec 2022Women's adherence is essential to physiotherapeutic treatment of pelvic floor dysfunction, but its related factors are not usually considered in the development of...
BACKGROUND
Women's adherence is essential to physiotherapeutic treatment of pelvic floor dysfunction, but its related factors are not usually considered in the development of treatment approaches. This study aims to understand how women with pelvic floor dysfunction experience pelvic floor conservative non-pharmacological treatment options.
METHODS
A systematic review of qualitative studies. The electronic search was performed in MEDLINE/PubMed, CINAHL, Lilacs, SCOPUS, and Web of Science databases. Primary articles on qualitative methods focused on the experience of women regarding pelvic floor conservative non-pharmacological interventions, i.e., pelvic floor muscle training (PFMT), either associated or not with biofeedback, perineal massage, vaginal dilators, and others. A meta-aggregation was performed.
RESULTS
It was included 22 manuscripts in this review. It was found seven studies about the use of vaginal devices, two about manual intervention and 14 studies on women's experience with PFMT. The findings were synthesized as follows: I) women's experience of manual interventions; II) women's experience using vaginal devices changes according to health professional attitudes; III) women's experiences using vaginal devices varied depending on their pelvic floor dysfunction; IV) reported side effects due to the use of vaginal devices; V) external factors influencing PFMT performance; VI) women's perception of their own personal factors influencing PFMT performance; VII) PFMT characteristics influencing women's adherence; VIII) strategies used by women to include PFMT in their routine.
CONCLUSION
Women's experience with pelvic floor conservative non-pharmacological treatment options is a complex phenomenon that involves many more variables than simply personal aspects. This is a systematic review of qualitative studies registered in the PROSPERO (CRD42018080244).
Topics: Female; Humans; Pelvic Floor; Exercise Therapy; Qualitative Research; Attitude of Health Personnel
PubMed: 36503437
DOI: 10.1186/s12905-022-02097-y -
The use of misoprostol for cervical priming prior to hysteroscopy: a systematic review and analysis.Drug Design, Development and Therapy 2016The effects of misoprostol use on cervical priming prior to hysteroscopy have been controversial. Therefore, a systematic literature review and meta-analysis of studies...
The effects of misoprostol use on cervical priming prior to hysteroscopy have been controversial. Therefore, a systematic literature review and meta-analysis of studies were conducted to assess the effect of misoprostol on cervical priming prior to hysteroscopy. All studies published before July 2014 with data related to the use of misoprostol for cervical priming compared with placebo or no medication prior to hysteroscopy, were identified. Twenty-five randomized controlled trials involving 2,203 females were systematically analyzed. The results showed that, compared with placebo or no medication, the use of misoprostol prior to hysteroscopy led to a significant relief of the need for cervical dilatation, resulted in a significantly greater cervical width, had fewer hysteroscopy complications, and mild and insignificant side effects. Subgroup analyses revealed that the regimen of 200 or 400 μg vaginal misoprostol may be a simple and effective method for cervical priming, especially prior to operative hysteroscopy.
PubMed: 27660411
DOI: 10.2147/DDDT.S111625