Which technique is better to place a manoeuvrable vacuum extractor cup on the flexion point? Vacca vs. Bird technique.

Objectives The purpose of this study is to compare the vacuum extractor cup application technique described by Bird vs. the technique described by Vacca on a simulation model. Methods Six obstetricians participated in the study. Each obstetrician performed eight vacuum assisted deliveries using the Bird technique and eight vacuum assisted deliveries using the Vacca 5-Steps technique. Results A total of 96 vacuum assisted deliveries were performed. The mean distance from the centre of the cup to the flexion point was 1.78±0.96 cm for the Bird technique and 1.05±0.60 cm for the Vacca technique (p<0.001). The lateral distance (over the parietal bone) was 1.16±0.69 cm for the Bird technique and 0.66±0.52 cm for the Vacca technique (p<0.001). The vertical distance (towards the frontal or occipital bone) was 1.12±1.02 cm for the Bird technique and 0.67±0.55 cm for the Vacca technique (p=0.009). In occipito anterior positions, there were no significant differences between both techniques. Conclusions The Vacca technique was better in transverse and posterior positions.

Protective Effect of Exercise in Pregnant Women Including Those Who Exceed Weight Gain Recommendations: A Randomized Controlled Trial.

OBJECTIVE: To investigate the effect of supervised moderate to vigorous exercise on gestational weight gain, its related risks (gestational diabetes [GD]), macrosomia, and type of delivery), and the preventive effects on women who exceed the weight gain recommendations. PATIENTS AND METHODS: We conducted a single-center, 2-armed, randomized controlled trial between October 1, 2009, and June 30, 2011, in which 678 women were assessed and 345 were randomized by a central computer system to an intervention group (N=115) or a standard care group (N=230). The intervention exercise program consisted of 70 to 78 sessions (24 weeks, 3 times per week, 60-65 minutes per session, moderate to vigorous intensity). The standard care group received usual care. Excessive gestational weight (EGW) gain was calculated on the basis of the 2009 Institute of Medicine (IOM) recommendations. RESULTS: Of the 345 women randomized for treatment, 44 were lost to follow-up, leaving 301 women for analysis (intervention, 100; standard care, 201). Fewer women in the intervention group exceeded IOM recommendations (22 [22.0%] vs 69 [34.3%]; P=.03), including overweight and obese women (15 of 35 [42.9%] vs 40 of 50 [80.0%]; P=.001). Analysis of women exceeding weight recommendations revealed that the 3 main related risks were directly related to EGW gain in the standard care group (GD, P=.003; macrosomia, P<.001; type of delivery, P<.001) but not in the intervention group (GD, P>.99; macrosomia, 0%; type of delivery, P=.46). CONCLUSION: Supervised moderate to vigorous exercise performed throughout gestation was effective in the prevention of EGW gain even for women with a pregestational body mass index greater than 25 kg/m2. It also prevented its related risks (GD, macrosomia, and type of delivery) including for women exceeding the IOM recommendations, so we suggest that being active outweighs the effect of possible weight gain. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01477372.

Pelvic floor muscle training included in a pregnancy exercise program is effective in primary prevention of urinary incontinence: a randomized controlled trial.

AIMS: To investigate the effect of pelvic floor muscle training (PFMT) taught in a general exercise class during pregnancy on the prevention of urinary incontinence (UI) in nulliparous continent pregnant women. METHODS: This was a unicenter two armed randomized controlled trial. One hundred sixty-nine women were randomized by a central computer system to an exercise group (EG) (exercise class including PFMT) (n = 73) or a control group (CG) (n = 96). 10.1% loss to follow-up: 10 from EG and 7 from CG. The intervention consisted of 70-75 sessions (22 weeks, three times per week, 55-60 min/session including 10 min of PFMT). The CG received usual care (which included follow up by midwifes including information about PFMT). Questions on prevalence and degree of UI were posed before (week 10-14) and after intervention (week 36-39) using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). RESULTS: At the end of the intervention, there was a statistically significant difference in favor of the EG. Reported frequency of UI [Never: CG: 54/60.7%, EG: 60/95.2% (P < 0.001)]. Amount of leakage [None: CG: 45/60.7%, EG: 60/95.2% (P < 0.001)]. There was also a statistically significant difference in ICIQ-UI SF Score between groups after the intervention period [CG: 2.7 (SD 4.1), EG: 0.2 (SD 1.2) (P < 0.001)]. The estimated effect size was 0.8. CONCLUSION: PFMT taught in a general exercise class three times per week for at least 22 weeks, without former assessment of ability to perform a correct contraction was effective in primary prevention of UI in primiparous pregnant women.

Bandas suburetrales libres de tensión transobturatriz in-out: indicación y resultados asociados / Transobturator suburethral slings. Indication and results associated

Objetivo. Describir las características de las pacientes a las que se indica esta técnica, y valorar los resultados asociados. Sujetos y métodos. Se incluyeron todas las pacientes (162) intervenidas con esta técnica entre junio del 2005 y diciembre del 2010 en el Hospital Universitario de Fuenlabrada. Resultados. Características medias: edad, 51,64años; IMC, 28,92kg/m2, y 2,31 partos vaginales. Diagnóstico urodinámico en el 96,3%: incontinencia de esfuerzo pura en el 68,5% y mixta de predominio de esfuerzo del 25,9%. Complicaciones intraoperatorias: 3,1%; 1,2% de erosiones de malla. Porcentaje de curación global objetivo, 92%, y subjetivo, 80,3%. Conclusiones. Bajo porcentaje de complicaciones, todas ellas resueltas. Porcentajes de curación altamente satisfactorios, tanto en la incontinencia urinaria de esfuerzo pura como en mixtas de predominio de esfuerzo. La urodinamia previa a la cirugía permite realizar buenas indicaciones quirúrgicas y orientar sobre el pronóstico de la intervención (AU)

Objective. To describe the characteristics of treated patients and assess the results obtained. Subjects and methods. All patients (n=162) who underwent this technique between June 2005 and December 2010 at the Hospital de Fuenlabrada were included. Results. The mean age was 51.64 years, mean body max index was 28.92kg/m2 and the mean number of vaginal deliveries was 2.31. Urodynamic diagnosis was performed in 96.3%, with findings of pure stress incontinence in 68.5%, mixed incontinence and stress incontinence in 25.9%. Intraoperative complications occurred in 3.1%. Mesh erosions were found in 1.2%. The overall objective cure rate was 92% and the subjective cure rate was 80.3%. Conclusions. The complications rate was low and all complications were resolved. Cure rates were highly satisfactory both in pure stress urinary incontinence and in mixed urinary incontinence with a predominance of stress incontinence. Urodynamic studies before surgery allow good surgical indications and guide postsurgical prognosis (AU)