Objective methods cannot predict anal incontinence after primary repair of extensive anal tears.

BACKGROUND: An increased awareness of anal incontinence after delivery tears has developed during the last years. The aim of this study was to compare complaints with the results of physiological methods in women with complete sphincter ruptures primarily repaired at delivery. METHODS: Twenty-seven women, 16 with total rupture of the external anal sphincter and 11 who also had a ruptured internal anal sphincter were studied. Interviews on pelvic floor function, investigation with recto-anal manometry, single fiber EMG and anal endosonography were performed at 11.9 (2.5) months after delivery. Fifteen women vaginally delivered without sphincter rupture served as controls. RESULTS: Pelvic floor dysfunction was admitted in 74%, in particular gas incontinence (59%). Maximum squeeze pressure was significantly reduced (p<0.01) compared to controls, while resting anal pressure was unaffected. Fiber density was increased in 81% of patients and 91% had detectable defects on endosonography. Neither the degree of rupture nor the presence of complaints significantly correlated to the objective methods. CONCLUSIONS: A majority of women with primarily repaired anal sphincter ruptures at delivery were incontinent. Sphincter defects and signs of neuropathy could not precisely predict symptoms.

Fetal fibronectin and microorganisms in vaginal fluid of women with complicated pregnancies.

OBJECTIVES: To determine vaginal fetal fibronectin in women with pregnancies complicated by preterm labor (PTL), preterm premature rupture of the membranes (PPROM) or bleeding; to investigate possible relationships to the vaginal microflora; and to assess the ability to predict preterm delivery from these measures. MATERIAL AND METHODS: Group comparative study between women of the same gestational age with a normal pregnancy (n = 28) and consecutive women admitted with PTL (n = 63), PPROM (n = 18) and bleeding (n = 21). Samples of vaginal fluid were collected at the time of admission in complicated pregnancies and from the women with normal pregnancies. Fetal fibronectin was determined by enzyme immunoassay and quantitative aerobic and anaerobic microbiological cultures were performed. RESULTS: The number of positive (> or = 0.05 mg/L) vaginal fetal fibronectin values was higher among women with PTL, PPROM and bleeding compared to controls (p < 0.001). A positive fibronectin value was predictive of delivery < or = 34 weeks (sensitivity 64%, specificity 87%). The absence of hydrogen peroxide-producing lactobacilli was predictive for preterm delivery < 34 weeks (sensitivity of 100%, specificity 35%). CONCLUSIONS: The presence of vaginal fibronectin and the absence of hydrogen peroxide-producing lactobacilli was indicative of an increased risk for preterm delivery < 34 weeks.

Microorganisms in vaginal fluid from women in prolonged pregnancy.

In order to compare the vaginal microflora of women in prolonged pregnancy with that of women who delivered at term, samples for quantitative aerobic and anaerobic microbiological culture were collected from 100 women at 42 weeks of gestation and from 60 women at term. The occurrence of lactobacilli-dominated flora was similar in women at term and women with prolonged pregnancy. However, non-hydrogen-peroxide-producing lactobacilli (p < 0.01) were significantly more common and Peptostreptococci species (p < 0.05) significantly less common in postterm women as compared with term controls. In postterm women, Candida albicans was more common (p < 0.001) in microfloras dominated by non-hydrogen-peroxide-producing lactobacilli than in floras dominated by hydrogen-peroxide-producing lactobacilli. The ecosystem of the vagina in asymptomatic postterm women was disrupted concerning the composition of lactobacilli as compared with term controls.

Does simple hysterectomy alter bowel function?

BACKGROUND AND AIMS: Hysterectomy is believed to be associated with disturbed defecation, mainly constipation. This study longitudinally describes bowel function in women submitted for hysterectomy. MATERIAL AND METHODS: Rectoanal manovolumetry, whole gut transit time and detailed interviews on bowel function and dyspareunia were performed preoperatively and at 3 and 11-18 months after hysterectomy in 42 women. Twenty healthy women matched for age and parity served as manovolumetry controls. RESULTS: No significant changes in anal sphincter pressures could be demonstrated, neither early nor late after hysterectomy. Transit time was unaffected. All but one of the patients claimed that they had been suffering from one or more of the following symptoms; abdominal pain, distension, constipation and dysparenuia. While postoperative interviews revealed a significant improvement with respect to abdominal pain and dyspareunia (P < 0.01) after 3 and 11-18 months, improvement of abdominal distension and constipation proved to be transient only. CONCLUSION: Simple abdominal hysterectomy appears not to interfere adversely with bowel function. On the contrary many patients were relieved from abdominal pain present before operation.

Fetal fibronectin in vaginal fluid of women in prolonged pregnancy.

The aim of this study was to determine fetal fibronectin in vaginal fluid of women in prolonged pregnancy, its relationship to a modified Bishop score and its predictiveness of delivery within 3 days. Vaginal samples were collected from 80 women at 42 weeks of gestation for the fetal fibronectin assay. A modified Bishop score was estimated. Fetal fibronectin was determined by a quantitative enzyme immunoassay. The concentration of fetal fibronectin in vaginal fluid was elevated in only 36 of the 80 women. The Bishop score and the time between sampling and delivery were not associated with an elevated fetal fibronectin (> or = 0.05 mg/l). We conclude that fetal fibronectin is not a good indicator of delivery within 3 days. The findings add to our understanding of the complexity of the etiology of postterm labor.

Bacterial vaginosis and vaginal microorganisms in idiopathic premature labor and association with pregnancy outcome.

The vaginal microflora of 49 women in idiopathic preterm labor was compared with that of 38 term controls to determine whether the presence of bacterial vaginosis (BV) and/or specific microorganisms would influence the rate of preterm delivery. Demographic factors, pregnancy outcome, and reproductive history were also studied. BV, as defined by the presence of clue cells in a vaginal wet mount and characteristic microbial findings in a stained vaginal smear and vaginal culture, was more common in women with preterm labor and delivery than in controls (P < 0.01). The condition, diagnosed in 41% of women who had both preterm labor and delivery (n = 22) and in 11% each of women who had preterm labor but term delivery (n = 27) and controls, was associated with a 2.1-fold risk (95% confidence intervals, 1.2 to 3.7) for preterm birth prior to 37 weeks of gestation. BV was associated with low birth weight. Of 49 women with preterm labor, 67% (8 of 12) of women with BV were delivered of low-birth-weight neonates (< 2,500 g) compared with 22% (8 of 37) of women without the condition (P < 0.0005). The presence of hydrogen peroxide-producing facultative Lactobacillus spp. was strongly negatively associated with both preterm delivery and BV. BV-associated microorganisms, i.e., Mobiluncus, Prevotella, and Peptostreptococcus species, Porphyromonas asaccharolytica, Fusobacterium nucleatum, Mycoplasma hominis, and high numbers of Gardnerella vaginalis were significantly associated with preterm delivery; all species also strongly associated with BV (P = 0.0001 for each comparison). Mobiluncus curtisii and Fusobacterium nucleatum were recovered exclusively from women with preterm delivery. Our study clearly indicates that BV and its associated organisms are correlated with idiopathic premature delivery.