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Journal of Medical Case Reports Jun 2023Pregnancy management is difficult when pelvic organ prolapse already exists. During pregnancy, childbirth, and the days following, clinicians may come across situations...
BACKGROUND
Pregnancy management is difficult when pelvic organ prolapse already exists. During pregnancy, childbirth, and the days following, clinicians may come across situations that present management dilemmas. Here, we present conservative management of preexisting pelvic organ prolapse in pregnancy complicated with preterm premature rupture of membrane up to term.
CASE PRESENTATION
A 35-year-old Ethiopian woman, gravida V, para IV, visited our emergency obstetrics and gynecology department at 32 weeks and 1 day of pregnancy in a prolapsed uterus on the 4th of April 2022. She was referred from primary hospital as a case of preterm pregnancy, pelvic organ prolapse, and preterm premature rupture of membrane after she presented with complaints of passage of clear liquor of 10 hours duration. She was successfully managed conservatively without application of pessary until she gave birth to a 3200 g healthy male neonate by elective cesarean section at 37 weeks of gestational age. At the same operation, cesarean hysterectomy was done.
CONCLUSION
Women with preexisting pelvic organ prolapse complicated by premature rupture of membrane during the third trimester of pregnancy can be treated without the use of a pessary. Our case shows the importance of conservative management, which includes strict antenatal follow-ups, lifestyle modifications, and manual uterine reduction. Due to potential intrapartum problems from induction of labor with the occurrence of severe pelvic organ prolapse, we recommend cesarean delivery. However, to determine the optimal mode of delivery, additional comprehensive study with a large sample size is vital. If definitive management is warranted after delivery, we need to take a consideration of the status of prolapse, patient's choice, and family size.
Topics: Infant, Newborn; Pregnancy; Female; Male; Humans; Adult; Cesarean Section; Pelvic Organ Prolapse; Premature Birth; Uterine Prolapse; Labor, Obstetric
PubMed: 37291643
DOI: 10.1186/s13256-023-03901-5 -
International Neurourology Journal May 2023This clinical study sought to evaluate the possible clinical effectiveness and practicality of URINO, an innovative, incisionless, and disposable intravaginal device,...
PURPOSE
This clinical study sought to evaluate the possible clinical effectiveness and practicality of URINO, an innovative, incisionless, and disposable intravaginal device, designed for patients suffering from stress urinary incontinence.
METHODS
A prospective, multicenter, single-arm clinical trial was carried out, involving women diagnosed with stress urinary incontinence who used a self-inserted, disposable intravaginal pessary device. Comparisons were made between the results of the 20-minute pad-weight gain (PWG) test at baseline and visit 3, where the device was applied. After 1 week of device usage, compliance, satisfaction, the sensation of a foreign body, and adverse events were assessed.
RESULTS
Out of 45 participants, 39 completed the trial and expressed satisfaction within the modified intention-to-treat group. The average 20-minute PWG of participants was 17.2±33.6 g at baseline and significantly dropped to 5.3±16.2 g at visit 3 with device application. A total of 87.2% of participants exhibited a reduction ratio of PWG by 50% or more, surpassing the clinical trial success benchmark of 76%. The mean compliance was recorded as 76.6%±26.6%, the average visual analogue scale score for patient satisfaction was 6.4±2.6, and the sensation of a foreign body, measured on a 5-point Likert scale, was 3.1±1.2 after 1 week of device use. No serious adverse events were reported; there was 1 instance of microscopic hematuria and 2 cases of pyuria, all of which recovered.
CONCLUSION
The investigated device demonstrated significant clinical effectiveness and safety for patients with stress urinary incontinence. It was easy to use, showing favorable patient compliance. We propose that these disposable intravaginal pessaries could potentially be an alternative treatment for patients with stress urinary incontinence who are seeking nonsurgical options or are unable to undergo surgery. Trial Registration: The study was registered as a clinical trial (KCT0008369).
PubMed: 37280759
DOI: 10.5213/inj.2346092.046 -
Urogynecology (Philadelphia, Pa.) Jun 2023This study aimed to evaluate the 3- to 5-year retreatment outcomes for conservatively and surgically treated urinary incontinence (UI) in a population of women 66 years...
OBJECTIVE
This study aimed to evaluate the 3- to 5-year retreatment outcomes for conservatively and surgically treated urinary incontinence (UI) in a population of women 66 years and older.
METHODS
This retrospective cohort study used 5% Medicare data to evaluate UI retreatment outcomes of women undergoing physical therapy (PT), pessary treatment, or sling surgery. The data set used inpatient, outpatient, and carrier claims from 2008 to 2016 in women 66 years and older with fee-for-service coverage. Treatment failure was defined as receiving another UI treatment (pessary, PT, sling, Burch urethropexy, or urethral bulking) or repeat sling. A secondary analysis was performed where additional treatment courses of PT or pessary were also considered a treatment failure. Survival analysis was used to evaluate the time from treatment initiation to retreatment.
RESULTS
Between 2008 and 2013, 13,417 women were included with an index UI treatment, and follow-up continued through 2016. In this cohort, 41.4% received pessary treatment, 31.8% received PT, and 26.8% underwent sling surgery. In the primary analysis, pessaries had the lowest treatment failure rate compared with PT (P<0.001) and sling surgery (P<0.001; survival probability, 0.94 [pessary], 0.90 [PT], 0.88 [sling]). In the analysis where retreatment with PT or a pessary was considered a failure, sling surgery had the lowest retreatment rate (survival probability, 0.58 [pessary], 0.81 [PT], 0.88 [sling]; P<0.001 for all comparisons).
CONCLUSIONS
In this administrative database analysis, there was a small but statistically significant difference in treatment failure among women undergoing sling surgery, PT, or pessary treatment, but pessary use was commonly associated with the need for repeat pessary fittings.
Topics: Female; Aged; Humans; United States; Urinary Incontinence, Stress; Retrospective Studies; Suburethral Slings; Medicare; Urinary Incontinence
PubMed: 37235803
DOI: 10.1097/SPV.0000000000001362 -
Revista Brasileira de Ginecologia E... Apr 2023To describe a reference curve for cervical length (CL) in mid-trimester twin gestations using transvaginal ultrasound (TVU) and to investigate whether short CL... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To describe a reference curve for cervical length (CL) in mid-trimester twin gestations using transvaginal ultrasound (TVU) and to investigate whether short CL increases spontaneous preterm birth (sPTB) in asymptomatic twin pregnancies.
METHODS
This was a prospective cohort study performed at 17 outpatient antenatal facilities of Brazil with women at 18 0/7 to 22 6/7 weeks of gestation who participated in a randomized clinical trial screening phase (P5 trial) between July 2015 and March 2019. TVU was performed to provide CL measurement in all screened women. Almost all women with CL ≤ 30 mm received vaginal progesterone 200mg/day and they were also randomized to receive cervical pessary or not. We considered data from the CL distribution among asymptomatic twin pregnancies and analyzed CL and its association with PTB generating receiver operating characteristics (ROC) curves and Kaplan-Meier curves.
RESULTS
A total of 253 pregnant women with twins were included in the distribution curve. The mean CL was 33.7 mm and median was 35.5mm. The 10th percentile was 17.8mm. We identified a PTB rate of 73.9% (187/253) with 33.6% of sPTB < 37 (85/253) and 15% (38/253) of sPTB < 34 weeks. The best cutoff point to predict sPTB < 37 was 24.15 mm. However, the ROC curve showed a poor performance (0.64). The Kaplan-Meier survival curves identified that only CL values ≤ 20mm were associated to sPTB < 34 weeks.
CONCLUSION
A cutoff point of CL ≤ 20 mm can be interesting point to identify short cervix in Brazilian twin pregnancies. However, in Brazilian asymptomatic twin pregnancies, CL does not show a good performance to predict PTB.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Brazil; Cervix Uteri; Premature Birth; Prospective Studies; Vagina
PubMed: 37224838
DOI: 10.1055/s-0043-1769467 -
International Urogynecology Journal Oct 2023Vaginal pessaries are a low-cost, effective treatment for pelvic organ prolapse (POP) and an alternative to surgery. Whilst traditionally pessary management (PM) has...
INTRODUCTION AND HYPOTHESIS
Vaginal pessaries are a low-cost, effective treatment for pelvic organ prolapse (POP) and an alternative to surgery. Whilst traditionally pessary management (PM) has been provided by medical professionals, particularly gynaecologists, recent international studies found other professionals, including physiotherapists and nurses, may be involved. It is unknown which health care practitioners (HCPs) provide PM for POP in Australia or the distribution of services.
METHODS
In a cross-sectional study design, a self-reported electronic survey investigated Australian HCPs providing PM for POP. Purposive and snowball sampling targeted HCPs, professional organisations and health care facilities. Descriptive statistics described PM in relation to HCP professional profile, PM provision and geographical location.
RESULTS
There were 536 respondents (324 physiotherapists, 148 specialists, 33 general practitioners (GPs) and 31 nurses providing PM. Most worked within metropolitan regions (n = 332, 64%), 140 (27%) in rural, 108 (21%) in regional and 10 (2%) in remote areas. Most worked privately (n = 418, 85%), 153 (46%) worked publicly and 85 (17%) in both. Ring pessaries were most commonly used, followed by cube and Gellhorn. HCPs reported variable training in PM, and 336 (69%) had no mandatory workplace competency standard; however, 324 (67%) wanted further training. Women travelled long distances to access services.
CONCLUSIONS
Doctors, nurses and physiotherapists provided PM in Australia. HCPs had variable training and experience in PM, with rural and remote HCPs particularly wanting further training. This study highlights the need for accessible PM services, standardised and competency-based training for HCPs, and governance structures ensuring safe care.
PubMed: 37222737
DOI: 10.1007/s00192-023-05540-2 -
Archives of Gynecology and Obstetrics Aug 2023Pelvic floor disorders are common and associated with pregnancy and childbirth. For restitution of pelvic floor connective tissue and thereby therapy of postpartum...
PURPOSE
Pelvic floor disorders are common and associated with pregnancy and childbirth. For restitution of pelvic floor connective tissue and thereby therapy of postpartum pelvic organ prolapse and stress urinary incontinence, the Restifem pessary is approved. It supports the anterior vaginal wall behind the symphysis, the lateral sulci and the sacro-uterine ligaments and stabilises the connective tissue. We evaluated the compliance and applicability of Restifem use in women postpartum in a preventive and therapeutic approach.
METHODS
Restifem pessary was handed out to 857 women. Six weeks after birth, they started the pessary use. After 8 weeks, 3 and 6 months postpartum, women received a questionnaire via online survey for evaluation of pessary applicability and efficacy.
RESULTS
After 8 weeks, 209 women answered the questionnaire. 119 women used the pessary. Common problems were discomfort, pain and the pessary use was to circuitous. Vaginal infections were rare. After 3 months, 85 women and after 6 months, 38 women still used the pessary. 3 months postpartum, 94% of women with POP, 72% of women with UI and 66% of women with OAB stated to have an improvement of their symptoms using the pessary. 88% women without any disorder felt an improvement of stability.
CONCLUSIONS
Use of the Restifem pessary in the postpartum period is feasible and accompanied with less complications. It reduces POP and UI and leads to an increased sense of stability. So, Restifem pessary can be offered to women postpartum to improve pelvic floor dysfunction.
Topics: Pregnancy; Female; Humans; Male; Pessaries; Pelvic Floor; Prospective Studies; Postpartum Period; Parturition; Pelvic Organ Prolapse
PubMed: 37210701
DOI: 10.1007/s00404-023-07075-9 -
Urology Case Reports May 2023A pessary is a silicone ring placed on the vagina that can improve urinary incontinence. This study reports an 83-year-old patient with a pessary discovered inside her...
A pessary is a silicone ring placed on the vagina that can improve urinary incontinence. This study reports an 83-year-old patient with a pessary discovered inside her vagina after a prior urinary incontinence treatment. The prolonged presence of the pessary in the patient's body led to a complication called urosepsis. The presence of the pessary inside the patient's vagina for an extended period was not detected by the doctor who performed the gynecological checks, nor by the patient who had forgotten about it. The pessary remained inside her for 10 years until it was discovered accidently during a hysterectomy.
PubMed: 37123510
DOI: 10.1016/j.eucr.2023.102394 -
International Urogynecology Journal Sep 2023The objective was to compare the location and motion of pessaries between women with pelvic organ prolapse (POP) with a successful (fitting) and unsuccessful...
INTRODUCTION AND HYPOTHESIS
The objective was to compare the location and motion of pessaries between women with pelvic organ prolapse (POP) with a successful (fitting) and unsuccessful (non-fitting) pessary treatment on dynamic magnetic resonance imaging (dMRI).
METHODS
A cross-sectional exploratory study of 15 women who underwent a mid-sagittal dMRI of the pelvic floor at rest, during contraction and during Valsalva with three different types of pessaries. The coordinates of the pessaries cross section, inferior pubic point (IPP) and sacrococcygeal junction (SCJ) were obtained and the location (position, orientation) and the motion (translation and rotation) were calculated. Differences between the groups and between the pessaries within the groups were compared.
RESULTS
Nine women with a fitting pessary and 6 women with a non-fitting pessary were selected. In the non-fitting group, the pessaries were positioned more caudally and rotated more in clockwise direction and descended more, but not significantly, during Valsalva compared with the fitting group. The Falk pessary was positioned more anteriorly in the fitting group and more cranially in the non-fitting group compared with the ring and ring with support pessary.
CONCLUSIONS
A non-fitting pessary was positioned more caudally at rest; on Valsalva, it rotated more clockwise and moved more caudally, suggesting that the dynamic characteristics of the pessary might play an important role in its effectiveness. Findings of this study serve as a basis for the development of new pessary designs.
Topics: Female; Humans; Pessaries; Cross-Sectional Studies; Vagina; Pelvic Organ Prolapse; Urinary Bladder Diseases
PubMed: 37119269
DOI: 10.1007/s00192-023-05555-9