ABSTRACT
BACKGROUND: A small prospective observational cohort study with the aim to evaluate postoperative health-related quality of life (HRQOL) at one-year follow-up after total laparoscopic hysterectomy for benign gynecological conditions and to assess postoperative functions in terms of return to work, sexual activity and driving was conducted. METHODS: Sixty out of 65 women with a mean age of 45.7±5.4 responded to the questionnaire. Change in HRQOL was assessed by comparing the preoperative and postoperative QOL on scale of 1-5 grades. RESULTS: HRQOL improved significantly at 12 months postoperatively. Multiple logistic regression analysis showed that the presence of irregular periods (P=0.048) and dyspareunia (P=0.017) were significant predictors of overall postoperative improvement in QOL by 3 or more grades. Women with ovarian preservation were more likely to report overall improvement in HRQOL by 3 or more grades compared to those who had bilateral salpingo-oophrectomy (P=0.04). There was statistically significant improvement in QOL postoperatively as compared to preoperatively (P<0.0001). CONCLUSIONS: In our study we found that women presenting with dyspareunia were more likely to report higher improvement in postoperative QOL. This highlights that dyspareunia is a symptom which is a marker for chronic pelvic pain conditions like endometriosis, adenomyosis, fibroids and adhesions.
Subject(s)
Genital Diseases, Female/surgery , Hysterectomy/methods , Laparoscopy/methods , Quality of Life , Adult , Cohort Studies , Dyspareunia/etiology , Dyspareunia/surgery , Female , Follow-Up Studies , Genital Diseases, Female/pathology , Humans , Logistic Models , Middle Aged , Ovariectomy/methods , Pelvic Pain/etiology , Prospective Studies , Salpingectomy/methods , Surveys and Questionnaires , Treatment OutcomeABSTRACT
OBJECTIVE: To determine the long-term outcome of infants born with cord pH ≤ 7.0 and no clinical evidence of asphyxia at birth. SETTING: Tertiary Referral Centre. A prospective matched cohort study was conducted. 51 term infants were recruited following singleton birth with venous cord pH ≤ 7.0. For each recruited baby a healthy baby with normal cord pH ≥ 7.20 was recruited matched for gestation, gender and mode of delivery. Ages and Stages Questionnaires (ASQ)(TM) and Health Screening Questionnaires (HSQ) were sent out at 24 months of age. Two independent assessors, blinded to the case assignment, reviewed intrapartum and neonatal events to look for clinical evidence of birth asphyxia among the cases. RESULT: From 102 infants recruited, 62 questionnaires (24 cases, 38 controls) were returned. 20 matched pairs with no clinical evidence of birth asphyxia were available for analysis. The groups were similar except in terms of birth weight; the pH ≥ 7.0 group had mean birth weight 584 g lower than controls (p = 0.005). The ASQ motor scores were lower in children born with low cord pH (p = 0.019); however, once adjusted for birth weight, the difference was not significant (p = 0.289). CONCLUSION: It is unlikely that abnormal cord pH in otherwise healthy neonates leads to a substantially increased risk of abnormal neurodevelopmental outcome or severe health problems by 2 years of age.
Subject(s)
Child Development , Fetal Blood/chemistry , Birth Weight , Case-Control Studies , Child, Preschool , Female , Follow-Up Studies , Humans , Hydrogen-Ion Concentration , Infant, Newborn , Logistic Models , Male , Prospective Studies , Single-Blind Method , Surveys and QuestionnairesABSTRACT
PURPOSE OF REVIEW: This paper reviews the literature to elucidate the international stance on induction of labour in women with previous caesarean section. RECENT FINDINGS: There is no evidence to suggest that current induction methods are less effective in women with previous caesarean section. It would, therefore, seem logical to use the same regimens as for women with intact uteri, including prostaglandins, particularly in women with unfavourable cervices. The clinical decision making and counselling, however, will always focus on safety, not effectiveness. There is no question that induction of labour is associated with higher risk of uterine rupture, but quantifying this risk remains elusive. SUMMARY: For the present, we will continue our practice, based on the sources of the best evidence available. Improvements in obstetric care have not only reduced the risks associated with uterine rupture but also risks associated with caesarean section. Therefore, both elective caesarean section and induction of labour, with or without prostaglandins, are reasonable choices for women who need induction with previous caesarean section. The efforts to better quantify the benefits/risks of various policies and regimens should continue, but should be complemented with qualitative studies to obtain crucial insight into the demands and challenges confronting women and clinicians to identify factors influencing their decision-making or their preferences.
