[Local investigation concerning psychic and sexual functioning a short time after hysterectomy]. / Enquête régionale sur le retentissement psychique et sexuel à court terme de l'hystérectomie.

UNLABELLED: Hysterectomy is one of the most common operations done throughout the world. Patients' concerns about sexual functioning after hysterectomy is great. OBJECTIVE: We wanted to evaluate, through a local investigation based on a questionnaire, the psychosexual impact of this operation and to compare our data to those available in the literature. PATIENTS AND METHODS: 534 patients operated between of 01.01.1997 and 31.12.1997 for a benign uterine pathology (prolapse excluded) were included. Questions were about sexual and psychological functioning after hysterectomy. The main outcome measures were changes in the sexual life, sexual desire, orgasm, dyspareunia, frequency of sexual relations. Abdominal and vaginal surgical approaches were compared for some items when possible. RESULTS: After the operation, 83.3% of the patients felt better, 30.4% of the patients mentioned changes in their sexual life, 32% of low libido rates was noticed (and there was a significant difference between abdominal and vaginal surgical approaches), 27.6% of the patients had less frequent orgasm and only 8.8% experienced orgasm more frequently, 15% suffer from dyspareunia, and 15% were more engaged in sexual intercourse. CONCLUSION: Psychosexual impact of hysterectomy is limited and is not more frequent when vaginal surgery is performed, but pre- and post-operative prevention can be useful.

Transvaginal sonography of the uterine cervix prior to labor induction.

OBJECTIVES: To compare the Bishop score and transvaginal sonographic measurement of cervical length for predicting the mode of delivery following medically indicated induction of labor in term patients. METHODS: The study was conducted prospectively in 179 women who required medically indicated induction of labor. Inclusion criteria were singleton pregnancy, gestational age > 37 weeks of amenorrhea, cephalic presentation and intact fetal membranes. Cervical length was measured upon arrival in the labor room but was not considered when choosing the induction procedure. Two receiver-operating characteristic curves were plotted to calculate the best threshold value for the Bishop score and for cervical length for predicting the risk of Cesarean section. RESULTS: Fifty-three women (29.6%) had a Cesarean section. The Bishop score was not predictive of the delivery mode, although Cesarean section for failure to progress was more frequent when the Bishop score was < or = 5. Among the women with a Bishop score > 5, the cervical length was not predictive of the induction outcome. However, among the women with a Bishop score < or = 5, a cervical length < 26 mm was associated with a lower Cesarean section rate (20.6 vs. 42.9%; P = 0.006). Furthermore, the interval between the beginning of cervical ripening and delivery was shorter in the case of a short cervix (11.01 +/- 6.7 vs. 18.55 +/- 7.07 h; P < 10(-5)). CONCLUSION: The length of the uterine cervix, measured by transvaginal sonography, is a better predictor of the risk of Cesarean section than the Bishop score after induction of labor for medical reasons. In women with an unfavorable Bishop score, a cervical length of < 26 mm is associated with a lower risk of Cesarean section and a shorter duration of labor.

[Transvaginal ultrasonography of the uterine cervix before induction of labor]. / Echographie endovaginale du col utérin avant déclenchement artificiel du travail.

OBJECTIVE: To compare the Bishop score and transvaginal ultrasonographic measurement of cervical length for predicting the mode of delivery following medically indicated induction of labor in term patients. METHOD: The study was conducted prospectively among 134 women who required medically indicated induction of labor. Inclusion criteria were singleton pregnancy, gestational age > or = 37 weeks of amenorrhea, cephalic presentation, and intact fetal membranes. Transvaginal ultrasonography was performed for measurement of the cervical length but the patients were managed without considering this parameter. A receiver-operating characteristic curve was constructed to determine the best cut-of value of cervical length for predicting the risk of cesarean section following induction of labor. RESULTS: Thirty six patients (26.9%) underwent cesarean section and cervical dilatation at time of the cesarean section was < 8 cm in 25 cases. The Bishop score was not predictive for the mode of delivery in this study. In contrast, the cesarean section rate was significantly lower in women with a uterine cervix < 26 mm (18.9 vs 36.6%, p = 0.02). Moreover, the difference has concerned only the cesarean sections performed before 8 cm dilatation (9.5 vs 30.0%, p = 0.002). CONCLUSION: Cervical length measured with transvaginal ultrasonography is a better predictor than the Bishop score for predicting the risk of cesarean section following medically indicated induction of labor.