[Are ultrasound measurements of the cervical length and fetal head-perineum distance predictive of delivery outcome in post-term pregnancies?]. / Les mesures échographiques de la longueur cervicale et de la hauteur de la présentation fœtale sont-elles prédictives de l'issue d'accouchement chez des patientes à terme ?

OBJECTIVE: Post-term pregnancy is frequently associated with higher fetal and maternal morbidity and mortality. Its management essentially depends on clinical cervical characteristics as evaluated by the Bishop score (BS). However, BS is poorly predictive of the delivery outcome. We sought to demonstrate that ultrasound measurement of cervical length and evaluation of fetal height could predict the outcome in post-term pregnancies. METHODS: A prospective single center study was undertaken between the 21st of January and the 1st of June 2013. Fetal height was measured using a transperineal technique and cervical length was evaluated by a vaginal ultrasound on patients consulting and their term date. C-section rates were considered to be the primary judgment criteria. RESULTS: A total of 136 patients were included. C-section rates in this population was 19%. Fetal height and cervical length were not different between the C-section group and the vaginal delivery group. CONCLUSION: Our study demonstrates that ultrasound measurement of cervical length and fetal height do not show better results than BS in predicting the outcome of post-term pregnancy. Combining these ultrasound measurements has already been suggested in other studies and promising results have been shown. More studies are necessary to further these results.

Voiding difficulties after vaginal mesh cystocele repair: does the perivesical dissection matter?

INTRODUCTION AND HYPOTHESIS: Our purpose was to verify whether extensive dissection toward the sacrospinous ligament (SSL) needed for mesh fixation during anterior compartment repair increases the risk of postoperative voiding difficulties. METHODS: A total of 124 patients after anterior compartment mesh repair without simultaneous suburethral sling placement operated on in the period 2005-2012 were enrolled in this retrospective observational study. Patients with previous anti-incontinence surgery with normal urodynamics were not excluded; 30 patients with incomplete data, severe perioperative complications, and urinary retention before and after the surgery were excluded. Urinary retention was defined as post-void residual over 150 ml more than 48 h after permanent catheter removal. The rate of urinary retention after anterior compartment repair by mesh anchored to the SSL from an anterior approach (SSLS group) was compared to that following transobturator mesh repair often combined with SSL fixation from the posterior approach (TOT group). RESULTS: Of the 94 patients considered for statistical analysis, 62 were from the SLSS group and 32 from the TOT group. The groups were comparable in age (mean 65.5 vs 66.3), body mass index (24.8 vs 25.9), and parity (2.4 vs 2.9). Patients from the SSLS group had higher rates of prior vaginal reconstructive (27 vs 19 %) and anti-incontinence surgery (26 vs 19 %). Postoperative urinary retention was statistically significantly more frequent in the SSLS group compared to the TOT group [(17 (27 %) vs 2 (6.25 %), odds ratio 5.7, 95 % confidence interval 1.2-26.3, p = 0.027]. Hospital discharge with self-catheterization was statistically insignificantly more frequent in the SSLS group [8 % (5) vs 3 % (1)]. CONCLUSIONS: Extensive dissection needed for SSL suspension from an anterior approach may lead to more frequent postoperative voiding difficulties. This phenomenon could be explained by more considerable injury to pelvic splanchnic nerves during the dissection. A large prospective study is needed for validation of our results.

[Impact of bariatric surgery on obstetric prognosis]. / Impact de la chirurgie bariatrique sur le pronostic obstétrical.

OBJECTIVES: Assessment of pregnancy outcomes after bariatric surgery and analysis of follow-up particularities of such pregnancies. PATIENTS AND METHODS: A retrospective study of 63 post-bariatric surgery pregnancies compared to 259 pregnancies of obese un-operated patients. Pregnancy outcomes, neonatal datas, delay influence between surgery and pregnancy beginning, bariatric surgery type and gastric banding (GB) loosening consequences were analysed. RESULTS: In the surgical brand were developed less gestational diabetes (DG) (P=0,05), deliveries were more often normal (P=0,004) and births shown less macrosomias and small for gestational age newborns (P=0,04). Neonatal state was improved among operated patients: less Apgar scores less than 7 at 1 minute (P=0,05) and less cord blood pH less than 7,2 (P=0,03). They gained more weight during the pregnancy (P=0,0003) and only 53% had a nutritional management and assessment. Patients with GB loosening gained more weight (P=0,0003). Lastly, there were no difference due to the different bariatric surgery techniques or nutritional follow-up in the pregnancy course and neonatal state. DISCUSSION AND CONCLUSION: Bariatric surgery improves obstetric and neonatal prognosis. Improvements have to be developed in the multidisciplinary follow-up in order to avoid nutritional deficiencies or important weight gain pregnancy in case of GB.

[Utero-vaginal suspension using a bilateral vaginal anterior sacrospinous fixation with mesh. Preliminary results]. / Suspension utéro-vaginale par sacrospinofixation antérieure bilatérale prothétique par voie vaginale. Résultats préliminaires.

OBJECTIVE: To assess anatomical and functional preliminary results, and safety of a new surgical approach for a combined treatment of pelvic organ prolapse (POP) of anterior and medium compartments, using a mesh attached through the sacrospinous ligaments with the UpHold(®) system (Boston Scientific) and the Capio(®). MATERIAL AND METHODS: A longitudinal case series of 59 consecutive patients operated between October 2009 and January 2012, by five senior surgeons in a single tertiary unit. RESULTS: Mean age was 66.9 years. Ten patients (17%) had previous pelvic organ prolapse (POP) surgery. There was no intraoperative complication. Mean follow-up was 12 months. Anatomical success for both anterior and apical compartments, i.e. Ba and C/D point<1, was 93% (52/56). Anatomical results shown correction of cystocele with a mean Ba point from+0.79 cm (range -3 to +8) to -2.35 cm (range -3 to 0), correction of uterine/vaul prolapse with a mean C/D point from+0.14 cm (range -6 to+8) to -7.29 cm (range -9 to -1), and correction of rectocele with a mean Bp point from -0.68 cm (range -3 to 7) to -2.77 cm (range -3 to -1). Two patients required further surgery for mesh exposure (3.5%). One patient had a unilateral pudendal neuropathic pain postoperatively. CONCLUSION: In the current series, utero-vaginal suspension using a bilateral vaginal anterior sacrospinous fixation with mesh was associated with good anatomical success rates. Prospective, comparative and long-term data are needed.

[The diagnosis of fetal head engagement: transperineal ultrasound, a new useful tool?]. / Engagement de la tête fœtale : échographie transpérinéale, un nouvel outil diagnostique ?

OBJECTIVE: Assessment of fetal head engagement by digital examination is highly subjective even though this method remains the gold standard. Ultrasonography could be helpful to determine fetal head engagement during the second stage of labor. PATIENTS AND METHODS: Prospective unicentric study to compare the diagnostic of fetal head orientation and engagement between digital examination and ultrasonography. One hundred measurements were performed in 100 patients at complete cervical dilatation. RESULTS: In 80 % of patients, abdominal ultrasound assessments were consistent with digital examinations in depicting fetal head position. We were not able to evaluate engagement by abdominal ultrasonography. Perineum to fetal head distance was measured between 12 and 83mm by translabial ultrasonography. When the head was not engaged (-1), the mean distance was 66.4±7.53mm. The measure was 56.15±10.86mm when the head was at the upper part of the birth canal (+1), 46.47±12.49mm at the middle part (+2) and 35.81±10.42mm at the lower part (+3; +4). A threshold of 55mm was associated with a sensibility and a negative predictive value of 100 % for vaginal birth. DISCUSSION AND CONCLUSION: Abdominal intrapartum ultrasound increases the accuracy of fetal head position assessment. Translabial ultrasound is a simple and easy method to define fetal head engagement by measuring the distance between perineum and fetal head. Ultrasound during the second stage of labor may serve as an educational tool for physicians in training.