Perioperative Efficiency of Sugammadex Following Laparoscopic Cholecystectomy in Clinical Practice.

Background: Studies have proposed that the routine use of the modified gamma-cyclodextrin, sugammadex, could provide perioperative time savings. However, these investigations have been limited to small group analyses. The purpose of this study was to test the effectiveness of sugammadex on perioperative times when compared to neostigmine under general clinical practice conditions following rocuronium-induced neuromuscular blockade for laparoscopic cholecystectomy. Methods: Following institutional review board approval, data from 1,611 consecutive surgical records for laparoscopic cholecystectomy were reviewed. Patient characteristics, type of primary neuromuscular blocking reversal agent, operating room (OR) discharge times, and postanesthesia care unit (PACU) recovery times were the measures of interest. Equivalence testing was used to determine the between-group differences of the reversal agents in the two perioperative time periods of interest. Results: OR discharge times averaged 10.9 (95% CI, 10-11.8) minutes for patients administered sugammadex and 8.9 (95% CI, 8.2-9.7) minutes for patients administered neostigmine. PACU recovery times averaged 77.6 (95% CI, 74.1-81.1) minutes for sugammadex and 68.6 (95% CI, 65.9-71.3) minutes for neostigmine. Equivalence testing demonstrated no improvement in the two perioperative times with sugammadex. Conclusion: These results suggest no perioperative time savings with sugammadex when compared to neostigmine following laparoscopic cholecystectomy under general clinical practice conditions.

Novel Catheter Multiscope: A Feasibility Study.

Open Challenges: Continuous monitoring of fundamental cardiovascular hemodynamic parameters is essential to accomplish critical care diagnostics. Today's standard of care measures these critical parameters using multiple monitoring technologies. These state-of-the-art technologies require expensive instrumentation and complex infrastructure. Therefore, it is challenging to use current technologies to accomplish monitoring in a low resource setting. OBJECTIVE: In order to address the challenges caused by having to use multiple monitoring systems, a point of care monitoring device was developed in this work to provide multiple critical parameters by uniquely measuring the hemodynamic process. METHODS: To demonstrate the usability of this novel catheter multiscope, a feasibility study was performed using an animal model. The developed measurement system first acquires the dynamics of blood flow through a minimally invasive catheter. Then, a signal processing framework was developed to characterize the blood flow dynamics and to obtain critical parameters such as heart rate, respiratory rate, and blood pressure. The framework used to extract the physiological data corresponding to the acoustic field of the blood flow consisted of a noise cancellation method and wavelet-based source separation. RESULTS: The preliminary results of the acoustic pressure field of the blood flow revealed the presence of acoustic heart and respiratory pulses. A unique framework was also developed to extract continuous blood pressure from the acoustic pressure field of the blood flow. Finally, the computed heart and respiratory rates, systolic and diastolic pressures were benchmarked with actual values measured using conventional devices to validate the hypothesis. CONCLUSION: The results confirm that catheter multiscope can provide multiple critical parameters with clinical reliability. SIGNIFICANCE: A novel critical care monitoring system has been developed to accurately measure heart rate, respiratory rate, systolic and diastolic pressures from the blood flow dynamics.

Psychological maltreatment: An international challenge to children's safety and well being.

BACKGROUND: Child psychological maltreatment (PM), also known as emotional abuse and neglect, mental violence, and emotional maltreatment, is the least recognized and addressed of the four major forms of child maltreatment. OBJECTIVES: This article provides an 1) the history of PM and its relationship to children's rights, 2) an overview of the current state of knowledge, 3) implications of diversity for the topic of PM, 4) an example of a topic-relevant intervention, and 5) a vision for further progress in addressing this form of child maltreatment. PARTICIPANTS AND SETTINGS: NA. METHOD: Literature review, intervention description of fabricated or induced illness, and expert opinion. RESULTS: PM is directly implicated in seven of the articles of the Convention. PM is common, reliable definitions of PM exist and need to be applied to practice and public health surveillance, harmfulness has been empirically established but is not fully appreciated, and countries vary dramatically in terms of incidence. CONCLUSIONS: PM is a human rights issue that must be addressed through child protection and promotion of child wellbeing. Adoption of reliable definitions of the different aspects of PM for Child Protective Service practice is a top policy goal. The development of empirically supported curricula on PM for training professionals and parents and culturally sensitive interventions to change social norms on the use of psychologically aggressive disciplinary practices and other forms of PM are critical research needs. Well-validated interventions to support quality parent-child relationships and support families exist and need to be widely adopted. Individual child protective measures should be confined to cases of ongoing serious PM when interventions have failed to reduce harm to the child.

Cost-effectiveness of a preoperative pelvic MRI in pelvic organ prolapse surgery.

OBJECTIVE: To investigate the cost-effectiveness of preoperative pelvic magnetic resonance imaging (MRI) in identifying women at high risk of surgical failure following apical repair for pelvic organ prolapse (POP). METHODS: A decision tree (TreeAgePro Healthcare software) was designed to compare outcomes and costs of screening with a pelvic MRI versus no screening. For the strategy with MRI, expected surgical outcomes were based on a calculated value of the estimated levator ani subtended volume (eLASV) from previously published work. For the alternative strategy of no MRI, estimates for surgical outcomes were obtained from the published literature. Costs for surgical procedures were estimated using the 2008-2014 National Inpatient Sample (NIS). A cost-effectiveness analysis from a third-party payer perspective was performed with the primary measure of effectiveness defined as avoidance of surgical failure. Deterministic and probabilistic sensitivity analyses were performed to assess how robust the calculated incremental cost-effectiveness ratio was to uncertainty in decision tree estimates and across a range of willingness-to-pay values. RESULTS: A preoperative MRI resulted in a 17% increased chance of successful initial surgery (87% vs. 70%) and a decreased risk of repeat surgery with an ICER of $2298 per avoided cost of surgical failure. When applied to annual expected women undergoing POP surgery, routine screening with preoperative pelvic MRI costs $90 million more, but could avoid 39,150 surgical failures. CONCLUSION: The use of routine preoperative pelvic MRI appears to be cost-effective when employed to identify women at high risk of surgical failure following apical repair for pelvic organ prolapse.

The Association Between Hospital Surgical Volume and the Uptake of Minimally Invasive Surgical Approach and Outpatient Setting for Hysterectomy.

BACKGROUND: There are large variations in the use of minimally invasive surgery (MIS), and outpatient hysterectomy (OP) among Medicare patients according to hospital surgical volume and geographical distribution. OBJECTIVE: To explore the changing trend in OP and MIS hysterectomy in the United States. STUDY DESIGN: We used all Medicare fee-for-service claims data for 2012 and 2014 to determine the incidence of OP and MIS hysterectomy according to hospital surgical volume and geographical distribution. MIS included both laparoscopy and robotic surgery. OP procedures included only same-day discharge hysterectomies. RESULTS: A total of 55,562 and 53,054 hysterectomies were performed in the years 2012 and 2014, respectively. OP rate in 2014 in high-volume centers (16,828 [47.1%]) exceeded low-volume centers (136 [16%]) by 31.1% (p<0.001). Time trends between 2014 and 2012 show that a rise in OP rate was 17.7% and 7% for high- and low-volume hospitals (p<0.001), respectively. High-volume hospitals showed an increase of 3.1% (p=0.003) in MIS hysterectomy rate in 2014 (69%) as compared to 2012 (65.9%). There was no change in MIS rate among low-volume hospitals. CONCLUSION: In the Medicare population, the rate of OP and MIS hysterectomy for high-volume centers is significantly different form low-volume centers. Over the years, outpatient hysterectomy is being practiced widely but an increase in MIS rate is limited to high-volume centers.

Automated contour tracking and trajectory classification of pelvic organs on dynamic MRI.

A method is presented to automatically track and segment pelvic organs on dynamic magnetic resonance imaging (MRI) followed by multiple-object trajectory classification to improve understanding of pelvic organ prolapse (POP). POP is a major health problem in women where pelvic floor organs fall from their normal position and bulge into the vagina. Dynamic MRI is presently used to analyze the organs' movements, providing complementary support for clinical examination. However, there is currently no automated or quantitative approach to measure the movement of the pelvic organs and their correlation with the severity of prolapse. In the proposed method, organs are first tracked and segmented using particle filters and [Formula: see text]-means clustering with prior information. Then, the trajectories of the pelvic organs are modeled using a coupled switched hidden Markov model to classify the severity of POP. Results demonstrate that the presented method can automatically track and segment pelvic organs with a Dice similarity index above 78% and Hausdorff distance of [Formula: see text] for 94 tested cases while demonstrating correlation between organ movement and POP. This work aims to enable automatic tracking and analysis of multiple deformable structures from images to improve understanding of medical disorders.

A Simplified Novel Approach for Total Laparoendoscopic Single-Site (LESS) Hysterectomy.

Total laparoendoscopic single-site (LESS) hysterectomy is a technically challenging minimally-invasive gynecologic procedure. Multiple technological innovations assist surgeons to overcome the challenges that are usually encountered during this advanced approach. Simplifying the steps of this advanced surgery is an invaluable addition in overcoming associated challenges with this procedure. We present our novel technique for a total laparoscopic hysterectomy that will optimize a single-site approach (LESS) for surgeons.

A novel acoustic catheter stethoscope based acquisition and signal processing framework to extract multiple bio signals.

In this study, a novel acoustic stethoscope based on an intravenous catheter was introduced to measure vascular pressures from a Yorkshire pig. Our hypothesis is that by means of this single device (measurement system) and by applying signal analysis and processing framework, multiple vital bio signals can be extracted. In contrast, current conventional state-of-the-art technologies use multiple devices to provide the same information. The framework used to extract these bio signals consisted of a noise cancellation technique and wavelet based source separation. The preliminary results obtained from the acquired pressure data revealed the presence of acoustic heart and respiratory pulses. Finally, the computed heart and respiratory rates were benchmarked with actual values measured using conventional devices to validate our hypothesis.

Demonstration of a box-stitch technique for laparoscopic uterosacral ligament suspension.

AIM: We demonstrate a novel box stitch technique of laparoscopic post-hysterectomy uterosacral ligament suspension for apical prolapse in restorative pelvic reconstructive surgery. MATERIAL AND METHODS: We present a case of a 58yo female with symptomatic stage III pelvic organ prolapse with a history of a total abdominal hysterectomy 30 years prior. She strongly desired the usage of no synthetic or biologic mesh for her restorative surgical repair. This video provides a step-by-step guide on how to perform a laparoscopic box stitch as a technique for uterosacral ligament suspension as an apical native tissue option for patients with the need for post hysterectomy apical prolapse. CONCLUSION: This video demonstrates a novel box-stitch technique of laparoscopic post-hysterectomy uterosacral ligament suspension as a native tissue option for minimally invasive reconstructive surgery. The procedure is a reasonable option to address apical prolapse in patients who do not desire or who are unable to have synthetic or biologic mesh placed for restorative reconstructive prolapse surgery.

Evaluation of patient preparedness for surgery: a randomized controlled trial.

BACKGROUND: Patient preparedness for pelvic reconstructive surgery has important implications for patient satisfaction and the perception of improvement after surgery. The ideal method in which to optimally prepare patients for surgery has not been determined. OBJECTIVE: The objective of the study was to evaluate the impact of a preoperative patient education video on patient preparedness prior to sacrocolpopexy as measured by a preoperative preparedness questionnaire. STUDY DESIGN: We performed a single-blind, randomized, stratified clinical trial at a single academic center evaluating the use of a preoperative patient education video as an adjunct to preoperative counseling on patient preparedness. Eligible patients presenting for their preoperative appointment prior to undergoing pelvic reconstructive surgery were randomized to watch a preoperative video vs usual care. Preoperative questionnaires assessing patient preparedness, understanding, perception of time, and actual time spent with a health care team were administered at the end of this visit. The primary outcome was patient preparedness for pelvic reconstructive surgery as measured by a preoperative preparedness questionnaire. Secondary outcomes included actual time spent during the physician-patient encounter, perception of time spent with the health care team, and identification of patient factors associated with patient preparedness. RESULTS: Of the total 100 recruited patients, 52 were randomized to the video group and 48 to the usual-care group. The use of the video did not increase overall patient preparedness (71.1% with video vs 68.8% usual care, P = .79) prior to surgery. The use of the video did not decrease the amount of time spent during the physician-patient encounter (16.9 ± 5.6 min vs 17.1 ± 5.4 min, P = .87). There was a significant association between patient preparedness and perception that the health care team spent sufficient time with the patient (89.5% vs 10.5%; P < .001), but no association was observed between preparedness and actual time spent (17.4 ± 5.4 min vs16.5 ± 5.5 min, P = .47). Those with a history of a previous surgery (82.1% vs 33.3%, P = .002) and those with more significant apical prolapse (0.6 ± 4.6 vs -1.6 ± 3.9, P = .05) were more likely to report feeling prepared for surgery. CONCLUSION: The majority of patients undergoing pelvic surgery at our institution felt prepared prior to undergoing surgery. The use of preoperative education video did not increase overall patient preparedness for surgery. Greater preparedness was associated with patient perception of how much time the health care team spent with the patient but not actual time spent.

Automatic vertebra segmentation on dynamic magnetic resonance imaging.

The automatic extraction of the vertebra's shape from dynamic magnetic resonance imaging (MRI) could improve understanding of clinical conditions and their diagnosis. It is hypothesized that the shape of the sacral curve is related to the development of some gynecological conditions such as pelvic organ prolapse (POP). POP is a critical health condition for women and consists of pelvic organs dropping from their normal position. Dynamic MRI is used for assessing POP and to complement clinical examination. Studies have shown some evidence on the association between the shape of the sacral curve and the development of POP. However, the sacral curve is currently extracted manually limiting studies to small datasets and inconclusive evidence. A method composed of an adaptive shortest path algorithm that enhances edge detection and linking, and an improved curve fitting procedure is proposed to automate the identification and segmentation of the sacral curve on MRI. The proposed method uses predetermined pixels surrounding the sacral curve that are found through edge detection to decrease computation time compared to other model-based segmentation algorithms. Moreover, the proposed method is fully automatic and does not require user input or training. Experimental results show that the proposed method can accurately identify sacral curves for nearly 91% of dynamic MRI cases tested in this study. The proposed model is robust and can be used to effectively identify bone structures on MRI.

Association Between Obesity and Perioperative Morbidity in Open Versus Laparoscopic Sacrocolpopexy.

OBJECTIVES: The aim of this study was to compare differences in 30-day perioperative morbidity and mortality for women undergoing open sacrocolpopexy (OSCP) versus laparoscopic sacrocolpopexy (LSCP) across all body mass index (BMI) groups and between patients of ideal versus elevated BMI (includes overweight, obese, and morbidly obese). MATERIALS AND METHODS: Data for this retrospective review were obtained from the American College of Surgeons-National Surgical Quality Improvement Project database using current procedural terminology. All women older than 18 years who underwent an OSCP or LSCP from 2005 to 2013 were included. Patients were divided into 4 BMI (weight [kg]/[height (m)]) subgroups: (1) less than 25, (2) 25 to 29.9, (3) 30 to 39.9, and (4) 40 or greater. The data were analyzed using Student t or χ test and Fisher exact test. RESULTS: A total of 4894 women underwent an OSCP or LSCP. Shorter operative times were observed with OSCP (P < 0.05) in all BMI groups except morbidly obese patients. Compared with patients of ideal body weight, overweight and obese patients had significantly longer operation times during LSCP (P < 0.05), a difference that was not observed during OSCP. For all BMI subgroups, the length of hospital stay was significantly shorter for LSCP (1 [1-1]) versus OSCP (2 [2-3]) (P < 0.05). Statistically significant increases in the rate of superficial surgical site infections were observed in OSCP in patients of both ideal and overweight BMIs (P < 0.05). CONCLUSIONS: Obesity increases the operative time during LSCP. For patients in all BMI groups, LSCP offers the benefit of shorter hospital stays when compared with OSCP.

Trends of Bilateral Salpingectomy During Vaginal Hysterectomy With and Without Laparoscopic Assistance Performed for Benign Indications in the United States.

STUDY OBJECTIVE: To estimate the recent temporal trends of concurrent bilateral salpingectomy (BS) during vaginal hysterectomy (total vaginal hysterectomy [TVH] and laparoscopic-assisted vaginal hysterectomy [LAVH]) in the United States. DESIGN: A cross-sectional analysis was conducted using data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, including all female patients 18 years and older whose inpatient discharge record indicated a TVH or LAVH performed for benign indications between January 1, 1998, and December 31, 2011. Joinpoint regression was used to identify statistically significant changes in overall and subgroup temporal trends of TVH and LAVH as well as concomitant BS during the 14-year study period (Canadian Task Force Classification II). SETTING: Not applicable. PATIENTS: All patients who underwent TVH and LAVH from 1998 to 2011 registered in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: Regarding TVH, between 1998 and 2001, there was a steep negative trend with an annual percentage change of -5.2 (95% confidence interval [CI], -8.8 to -2.2). From 2001 to 2011, the negative trend was still observed but with a more gradual 2% annual decrease (95% CI, -2.4 to -1.3). Conversely, the rate of LAVH increased at a rate of 4.4% each year (95% CI, 3.7-5.0). From 1998 to 2004, the national rate of BS during TVH increased sharply with an annual increase of 42.8% (95% CI, 22.7-66.3). Beginning in 2004, the BS rate during TVH decreased and remained stable. During LAVH, the rate of concomitant BS increased an estimated 15% each year during the entire study period (95% CI, 11.9-17.8). CONCLUSION: The proportion of annual LAVH with concomitant BS procedures performed across the nation is on the rise while TVH is declining with a stable rate of concomitant BS.

Barbed Sutures in Minimally Invasive Gynecologic Surgery.

The introduction of knotless barbed suture into the surgical market has decreased the challenges of laparoscopic suturing. Since its introduction, barbed suture has gained popularity in the field of minimally invasive gynecologic surgery and is now commonly used to close the vaginal cuff in total laparoscopic hysterectomy, to re-approximate the myometrium after laparoscopic myomectomy, and to shorten the procedure time during a laparoscopic sacrocolpopexy. Barbed sutures facilitate rapid and consistent wound closure, allowing for equal distribution of tissue tension across the suture line, and thereby providing a more secure wound closure. The most commonly encountered complication after the use of barbed sutures is postoperative bowel obstruction. Proposed methods to decrease the likelihood of this complication include ensuring that the ends of the barbed suture are either buried, over-sewn, or cut flush with the tissue.

Comparing Single and Dual Console Systems in the Robotic Surgical Training of Graduating OB/GYN Residents in the United States.

Objective. To assess the impact of a single versus dual console robotic system on the perceptions of program directors (PD) and residents (RES) towards robotic surgical training among graduating obstetrics and gynecology residents. Design. An anonymous survey was developed using Qualtrics, a web-based survey development and administration system, and sent to obstetrics and gynecology program directors and graduating residents. Participants. 39 program directors and 32 graduating residents (PGY4). Results. According to residents perception, dual console is utilized in about 70% of the respondents' programs. Dual console system programs were more likely to provide a robotics training certificate compared to single console programs (43.5% versus 0%, p = 0.03). A greater proportion of residents graduating from a dual console program perform more than 20 robotic-assisted total laparoscopic hysterectomies, 30% versus 0% (p = 0.15). Conclusions. Utilization of dual console system increased the likelihood of obtaining robotic training certification without significantly increasing the case volume of robotic-assisted total laparoscopic hysterectomy.

Association between Fellowship Training, Surgical Volume, and Laparoscopic Suturing Techniques among Members of the American Association of Gynecologic Laparoscopists.

Study Objective. To compare surgical volume and techniques including laparoscopic suturing among members of the American Association of Gynecologic Laparoscopists (AAGL) according to fellowship training status. Design. A web-based survey was designed using Qualtrics and sent to AAGL members. Results. Minimally invasive gynecologic surgery (FMIGS) trained surgeons were more likely to perform more than 8 major conventional laparoscopic cases per month (63% versus 38%, P < 0.001, OR [95% CI] = 2.78 [1.54-5.06]) and were more likely to perform laparoscopic suturing during these cases (32% versus 16%, P < 0.004, OR [95% CI] = 2.44 [1.25-4.71]). The non-fellowship trained (NFT) surgeons in private practice were less likely to perform over 8 conventional laparoscopic cases (34% versus 51%, P = 0.03, OR [95% CI] = 0.50 [0.25-0.99]) and laparoscopic suturing during these cases (13% versus 27%, P = 0.01, OR [95% CI] = 0.39 [0.17-0.92]) compared to NFT surgeons in academic practice. Conclusion. The surgical volume and utilization of laparoscopic suturing of FMIGS trained surgeons are significantly increased compared to NFT surgeons. Academic practice setting had a positive impact on surgical volume of NFT surgeons but not on FMIGS trained surgeons.

Estimated levator ani subtended volume: a novel assay for predicting surgical failure after uterosacral ligament suspension.

BACKGROUND: Levator ani muscle complex plays an important role in pelvic support and defects or laxity in this muscle complex contributes to pelvic organ prolapse and recurrence after surgical repair. OBJECTIVE: The purpose of this study was to determine whether estimated levator ani subtended volume can predict surgical outcomes for laparoscopic bilateral uterosacral ligament suspension. STUDY DESIGN: A retrospective cohort study was performed in patients who underwent laparoscopic uterosacral ligament suspension from 2010-2012. Only patients with a preoperative pelvic magnetic resonance image were included. Surgical failure was defined as a composite score that included the presence of anatomic bulge beyond the hymen with sensation of vaginal bulge or repeat treatment for prolapse via pessary or surgery by 1-year follow-up evaluation. Standard protocol pelvic magnetic resonance imaging measurements pubococcygeal line, H-line, and M-line were collected along with the calculation of the width of the levator ani hiatus. Estimated levator ani subtended volume was calculated for each subject. An optimal cutoff point was calculated and compared against categoric values of surgical success/failure. A Fisher exact test, an area under receiver operating characteristics curve, and logistic regression analysis were performed. A probability value of <.05 was considered statistically significant. RESULTS: Ninety-three women underwent laparoscopic bilateral uterosacral ligament suspension during study period. Of these, 66 women had a standardized preoperative pelvic magnetic resonance image per institutional protocol. Thirteen patients (19.6%) met the criteria for surgical failure by 1 year. An optimal cutoff point of 38.5 was calculated by Liu's method for optimization. Among the patients with defined surgical failures, 84.6% (11/13) had an estimated levator ani subtended volume above cutoff point of 38.5. Among the patients with defined surgical success, 39.6% (21/53) had an estimated levator ani subtended volume above the cutoff point (84.6% vs 39.6%; P = .0048) with a significant odds ratio of 8.38 (95% confidence interval, 1.69-41.68; P = .009). An area under receiver operating characteristics curve of 0.725 (95% confidence interval, 0.603-0.847), sensitivity of 84.6% (95% confidence interval, 54.6%-98.1%), and specificity of 60.4% (95% confidence interval, 46%-73.5%) at 38.5 were predictors of surgical success/failure by 1 year. Logistic regression analysis demonstrated no significant confounders among age, body mass index, stage, or parity. CONCLUSIONS: Estimated levator ani subtended volume may predict surgical failure for laparoscopic bilateral uterosacral ligament suspension. Patients with a calculated estimated levator ani subtended volume above 38.5 on a preoperative pelvic magnetic resonance imaging were associated with an increased risk for surgical failure by 1 year, regardless of age, body mass index, stage, or parity. Future investigation that will include repeatability, reliability analysis, and a prospective study is warranted.

Automated Localization of Multiple Pelvic Bone Structures on MRI.

In this paper, we present a fully automated localization method for multiple pelvic bone structures on magnetic resonance images (MRI). Pelvic bone structures are at present identified manually on MRI to locate reference points for measurement and evaluation of pelvic organ prolapse (POP). Given that this is a time-consuming and subjective procedure, there is a need to localize pelvic bone structures automatically. However, bone structures are not easily differentiable from soft tissue on MRI as their pixel intensities tend to be very similar. In this paper, we present a model that combines support vector machines and nonlinear regression capturing global and local information to automatically identify the bounding boxes of bone structures on MRI. The model identifies the location of the pelvic bone structures by establishing the association between their relative locations and using local information such as texture features. Results show that the proposed method is able to locate the bone structures of interest accurately (dice similarity index >0.75) in 87-91% of the images. This research aims to enable accurate, consistent, and fully automated localization of bone structures on MRI to facilitate and improve the diagnosis of health conditions such as female POP.

Automated tracking, segmentation and trajectory classification of pelvic organs on dynamic MRI.

Pelvic organ prolapse is a major health problem in women where pelvic floor organs (bladder, uterus, small bowel, and rectum) fall from their normal position and bulge into the vagina. Dynamic Magnetic Resonance Imaging (DMRI) is presently used to analyze the organs' movements from rest to maximum strain providing complementary support for diagnosis. However, there is currently no automated or quantitative approach to measure the movement of the pelvic organs and their correlation with the severity of prolapse. In this paper, a two-stage method is presented to automatically track and segment pelvic organs on DMRI followed by a multiple-object trajectory classification method to improve the diagnosis of pelvic organ prolapse. Organs are first tracked using particle filters and K-means clustering with prior information. Then, they are segmented using the convex hull of the cluster of particles. Finally, the trajectories of the pelvic organs are modeled using a new Coupled Switched Hidden Markov Model (CSHMM) to classify the severity of pelvic organ prolapse. The tracking and segmentation results are validated using Dice Similarity Index (DSI) whereas the classification results are compared with two manual clinical measurements. Results demonstrate that the presented method is able to automatically track and segment pelvic organs with a DSI above 82% for 26 out of 46 cases and DSI above 75% for all 46 tested cases. The accuracy of the trajectory classification model is also better than current manual measurements.