[Intrapartum Foetal Heart Rate Monitoring and Rate of Caesarean Section: A National Survey]. / CTG-Analyse und Sectiorate ­ Ergebnisse einer deutschlandweiten Umfrage.

INTRODUCTION: The rate of Caesarean section has dramatically increased in recent decades. Foetal scalp blood sampling and computer software analysing foetal heart rate detection should help in the decision-making for or against Caesarean section. The main aim of this study was to examine how these 2 factors influence the Caesarean section rate. METHODS: A national survey of all maternity units in Germany was undertaken using a self-reported questionnaire via crowd sourcing. All variables were collected as categorised data sets. Using these data sets, correlation coefficients were calculated. The correlations were additionally analysed using visual mosaic plots. RESULTS: 97 questionnaires were analysed. There were several strong correlations between variables in the data set. Particularly, hospitals that assessed the foetal heart rate in the normal range (110-160 bpm) according to the current FIGO guidelines had a lower C-section rate. CONCLUSION: Computer-assisted foetal heart rate assessment that is based on the FIGO guidelines correlated with a lower Caesarean section rate. The use and further development of computer-based cardiotocograph assessment analysis should be continued.

Validation of psychomotor tasks by Simbionix LAP Mentor simulator and identifying the target group.

BACKGROUND: This study addresses target group reliability and task validity for training on a laparoscopic simulator. MATERIAL AND METHODS: Data were collected on 64 participants prospectively at the Department of OB/GYN, University Hospitals Schleswig-Holstein, Campus Kiel. The Simbionix LAP Mentor for laparoscopic simulation was used to test trainees. Each participant received a questionnaire to clarify his/her medical position, surgical experience, and previous virtual reality (VR) experience, including video gaming experience. Pre- and post-tests were performed. Performances were analyzed for task completion and total time. RESULTS: All participants revealed a significant improvement in the post-test compared with the pre-test (p < .005), independent of their previous level of experience. Regarding accomplishment of the assigned task, the experts revealed in the pre-test an advantage in tasks 1-4 and 6-8. The beginners revealed wide-ranging improvements in tasks 3, 5, 8, and 9 between the pre-test and the post-test compared with novices in laparoscopic surgery (residents), and a wide range of improvements relative to experts. VR experience and video gaming exposure revealed an advantage in the pre-test; however, participants without previous exposure were able to narrow the gap, revealing extensive improvements in the post-test. CONCLUSION: The trainer could be beneficial for medical students and surgical novices.

Laparoscopic pectopexy: a prospective, randomized, comparative clinical trial of standard laparoscopic sacral colpocervicopexy with the new laparoscopic pectopexy-postoperative results and intermediate-term follow-up in a pilot study.

PURPOSE: The purpose of the study was to compare the outcome of laparoscopic sacral colpocervicopexy with laparoscopic pectopexy. Our aim was to show that the safety and effectiveness of the new technique is similar to the traditional technique. We expected differences regarding defecation disorders. PATIENTS AND METHODS: We randomly assigned patients to two treatment groups: 44 in the pectopexy and 41 in the sacropexy group. If necessary, the operative procedures were planned in a so-called multicompartment setting regarding the different pelvic floor disorders. All defects were managed at the same time. Eighty-one patients were examined 12 to 37 months after treatment (mean follow-up 20.67 months). RESULTS: The long-term follow-up (21.8 months for pectopexy and 19.5 months for sacropexy) showed a clear difference regarding de novo defecation disorders (0% in the pectopexy vs 19.5% in the sacropexy group). The incidence of de novo stress urinary incontinence was 4.8% (pectopexy) vs 4.9% (sacropexy). The incidence of rectoceles (9.5% vs 9.8%) was similar in both groups. No de novo lateral defect cystoceles were found after pectopexy, whereas 12.5% were found after sacropexy. The apical descensus relapse rates, 2.3% for pectopexy vs 9.8% for sacropexy, were not statistically significant. The occurrence of de novo anterior defect cystoceles and rectoceles revealed no significant differences. CONCLUSION: Laparoscopic pectopexy is a novel method of vaginal prolapse therapy that offers clear practical advantages compared with laparoscopic sacropexy. Because laparoscopic pectopexy does not reduce the pelvic space, it results in a zero percentage of defecation disorders.

Dexamethasone decreases the duration of rocuronium-induced neuromuscular block: a randomised controlled study.

BACKGROUND: Several drugs influence the time course of neuromuscular block during general anaesthesia. OBJECTIVE: To evaluate the effect of a single dose of dexamethasone 8 mg on the time course of a rocuronium-induced neuromuscular block. DESIGN: A randomised controlled, unblinded, monocentre trial. SETTING: Kreiskrankenhaus Dormagen, Dormagen, Germany. PATIENTS: One hundred and eight adult patients scheduled for elective gynaecological laparoscopic surgery allocated to three groups. INTERVENTIONS: Patients received dexamethasone 8 mg intravenously 2 to 3 h prior to surgery (Group A), during induction of anaesthesia (Group B) or after recovery of the neuromuscular block (Group C, control). MAIN OUTCOME MEASURES: The time course of the neuromuscular block of rocuronium 0.3 mg kg was assessed using acceleromyography. The primary end point was the time from start of injection of rocuronium until recovery to a train-of-four ratio of 0.9. RESULTS: The clinical duration was decreased in Group A (15.8 ±â€Š4.5 min) compared with Group B (18.7 ±â€Š5.8 min; P = 0.031). The recovery index was reduced in Group A (6.8 ±â€Š1.8 min) compared with Group B (8.1 ±â€Š2.6 min; P = 0.018) and Group C (8.3 ±â€Š2.8 min; P = 0.01). The recovery to a train-of-four ratio of 0.9 was shorter in Group A (30.4 ±â€Š6.9 min) than in Groups B (36.3 ±â€Š10.7 min; P = 0.031) and C (36.8 ±â€Š11.3 min; P = 0.02). CONCLUSION: A single dose of dexamethasone 8 mg attenuated rocuronium-induced block by 15 to 20% if administered 2 to 3 h prior to induction of anaesthesia. However, the administration of dexamethasone during induction of anaesthesia did not influence the time course of the neuromuscular block. TRIAL REGISTRATION: ClinicalTrial.gov Identifier: NCT01782820.

Laparoscopic pectopexy: a new technique of prolapse surgery for obese patients.

PURPOSE: Obesity is a chronic disease which affects a substantial number of patients. It also increases a person's risk of genital prolapse. Conventional techniques of prolapse repair (sacropexy, transvaginal meshes and sacrospinal fixation) are used in very adipose women, but the effectiveness of this technique is sometimes restricted due to the difficultly of performing the surgery. METHOD: Here we will describe a new method of endoscopic prolapse surgery, which is especially developed for obese patients. The lateral parts of the iliopectineal ligament are used for a bilateral mesh fixation of the descended structures. We have already used this method successfully in 12 patients without any complications. RESULT AND CONCLUSION: This method provides a stable and durable repair. The laparoscopic access reduces morbidity. The operation time for this procedure is approximately 50 min.

Endoscopic cystocele surgery: lateral repair with combined suture/mesh technique.

The lateral repair is an accepted method for the reconstitution of paravaginal defects. Several open or vaginal approaches have been described, but there is still a deficit of reproducible laparoscopic approaches. Thus, only a few clinics perform the laparoscopic approach although it offers several advantages compared to open or vaginal surgery. This article describes our modified laparoscopic approach with inlay of a polypropylene mesh. Operation time will go on about 50 minutes using the here-presented modified approach. The inlay of a mesh with induction of connective tissue may increase long-term stability.