Impaired Neonatal Outcome after Emergency Cerclage Adds Controversy to Prolongation of Pregnancy.

OBJECTIVE: Emergency cervical cerclage is one of the treatment options for the reduction of preterm birth. The aim of this study is to assess neonatal outcome after cerclage with special focus on adverse effects in very low birth weight infants. STUDY DESIGN: Retrospective cohort study. Classification of cerclages in history-indicated (HIC, n = 38), ultrasound-indicated (UIC, n = 29) and emergency/ physical examination-indicated (PEIC, n = 33) cerclage. Descriptive analysis of pregnancy and neonatal outcome (admission to NICU, duration of hospitalization, respiratory outcome (intubation, CPAP, FiO2max), neonatal complications (ROP, IVH)). Statistical comparison of perinatal parameters and outcome of neonates <1500 g after cerclage with a birth weight matched control group. RESULTS: Neonates <1500 g after PEIC show significantly impaired outcome, i.e. prolonged respiratory support (total ventilation in days, CPAP, FiO2max) and higher rates of neonatal complications (IVH ≥ II, ROP ≥ 2). Placental pathologic evaluation revealed a significantly higher rate of chorioamnionitis (CAM) after PEIC. Neonates <1500 g after UIC or HIC show no significant difference in neonatal complications or CAM. CONCLUSIONS: In our study PEIC is associated with adverse neonatal outcome in infants <1500 g. The high incidence of CAM indicates a potential inflammatory factor in the pathogenesis. Large well-designed RCTs are required to give conclusive answers to the question whether to prolong or to deliver.

Assessing birth experience in fathers as an important aspect of clinical obstetrics: how applicable is Salmon's Item List for men?

OBJECTIVE: validated questionnaire assessment of fathers' experiences during childbirth is lacking in routine clinical practice. Salmon's Item List is a short, validated method used for the assessment of birth experience in mothers in both English- and German-speaking communities. With little to no validated data available for fathers, this pilot study aimed to assess the applicability of the German version of Salmon's Item List, including a multidimensional birth experience concept, in fathers. DESIGN: longitudinal study. Data were collected by questionnaires. SETTING: University hospital in Germany. PARTICIPANTS: the birth experiences of 102 fathers were assessed four to six weeks post partum using the German version of Salmon's Item List. MEASUREMENTS: construct validity testing with exploratory factor analysis using principal component analysis with varimax rotation was performed to identify the dimensions of childbirth experiences. Internal consistency was also analysed. FINDINGS: factor analysis yielded a four-factor solution comprising 17 items that accounted for 54.5% of the variance. The main domain was 'fulfilment', and the secondary domains were 'emotional distress', 'physical discomfort' and 'emotional adaption'. For fulfilment, Cronbach's α met conventional reliability standards (0.87). KEY CONCLUSIONS: Salmon's Item List is an appropriate instrument to assess birth experience in fathers in terms of fulfilment. Larger samples need to be examined in order to prove the stability of the factor structure before this can be extended to routine clinical assessment. IMPLICATIONS FOR PRACTICE: a reduced version of Salmon's Item List may be useful as a screening tool for general assessment.

Patient-reported quality-of-life and sexual-function outcomes after laparoscopic supracervical hysterectomy (LSH) versus total laparoscopic hysterectomy (TLH): a prospective, questionnaire-based follow-up study in 915 patients.

PURPOSE: To compare patient-reported quality-of-life and sexual function outcomes in women after laparoscopic supracervical hysterectomy (LSH) or total laparoscopic hysterectomy (TLH) for benign uterine disease. METHODS: Out of a cohort of 1,952 patients from a previous implementation study of LSH and TLH, 1,886 patients who had not undergone intraoperative conversion to laparotomy or were ineligible for other reasons were invited by mail to participate in this prospective, questionnaire-based follow-up study. RESULTS: Of the 915/1,952 (48.5 %) survey respondents included in the analysis, 788 (86.1 %) and 127 (13.9 %) had undergone LSH or TLH, respectively. Women undergoing LSH reported significantly lower pain levels (p = 0.037) and faster partial (p = 0.015) and complete (p < 0.001) resumption of normal daily activities compared to those undergoing TLH. As regards sexual function, women undergoing LSH resumed sexual activity significantly sooner (p = 0.018), rated sexual desire as higher (p = 0.023), and reported more frequently that their sexual life had improved postoperatively (p = 0.008) than did women undergoing TLH. CONCLUSIONS: Women undergoing LSH for benign uterine disease may have better outcomes regarding certain quality-of-life and sexual function parameters than women undergoing TLH for benign uterine disease.