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Background: This study compares the effect of vaginal administration of evening primrose oil with misoprostol on cervical preparation in prim gravid women at ≥40 weeks gestation. Materials and Methods: This was a double-blind randomized clinical trial conducted in Isfahan, Iran during 2019-2020 on 110 prim gravid pregnant women with a gestational age of 40 weeks and more and cephalic presentation of the fetus with the obstetrical indication for pregnancy termination. After obstetric examinations to rule out cephalo pelvic disproportion and calculation of the Bishop score by the researcher, patients were randomized to receive 25 µg misoprostol tablets (n = 55) or 1000 mg evening primrose oil Pearls (n = 55) administrated vaginally by a midwife. We compared Bishop's score before and after the intervention, time of cervical ripening, a dose of intervention for cervical ripening, need to induce labor, the interval between cervical preparation and induction of labor, duration of oxytocin use, need for cesarean section, and its cause, Apgar score at 5 and 10 minutes, neonatal birth weight. Results: Mean baseline Bishop Score was not significant between the groups (P = 0.45); after the intervention, it was significantly higher in the primrose oil group (P < .001). Significantly fewer patients required cesarean sections in the primrose oil group (P = 0.03). The other outcomes were. not significant between the groups (P > 0.05). Conclusion: Misoprostol and primrose oil administration appear to positively affect cervical readiness. Primrose oil resulted in significantly better Bishop Scores and fewer cesarean sections compared to misoprostol in pregnancy 40 weeks and more.
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Background: The aim of the present study was to compare the six-month results in terms of prolapse symptoms in postmenopausal patients with advanced pelvic prolapse (POP) who underwent LeFort colpocleisis surgery or with pessary placement. Methods: In this prospective cohort study, 110 older women were enrolled from April 2016 to January 2018. The women were diagnosed with stage III or higher genital prolapse according to the POP quantification (POP-Q) system. The patients were divided into two groups: surgical (LeFort colpocleisis surgery; n=55) and non-surgical (pessary placement, n=55). The study population underwent LeFort colpocleisis surgery or pessary placement in two university clinics (Beheshti or Alzahra Hospitals). All patients completed the Pelvic Floor Distress Inventory Questionnaire-20 (PFDI-20). The main short-term outcome measurement (six months) was the manifestation of a pelvic prolapse in the groups. Results: The patients had a mean age of 68.98±8.79 years in the non-surgical group and 64.76±7.04 years in the surgical group. The analytic results showed a significant difference between the two groups (P=0.006). After treatment, the prolapse symptoms improved in both groups (p<0.001). However, the total PFDI-20 score did not show any significant differences at the end of the six-month follow- up (P=0.19). Conclusion: Both strategies (pessary placement or LeFort colpocleisis surgery) provide a short-term option for the treatment of older women with stage III or higher POP. The findings of this study could assist with treatment options and allow better guidance for older patients with symptomatic POP in the treatment decision process.
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BACKGROUND: One of the complications of urodynamic study is urinary tract infection. The aim of this study was to determine the rate of urinary tract infection (UTI) after UDS in patients referred to the pelvic floor clinic with regard to the specific conditions of these patients, such as presence of pelvic organ prolapse and high post voiding residual volume (PVR). METHODS: In a prospective descriptive-analytic study, 146 female candidates for UDS from January 2016 to June 2017 entered the study. Patients were examined for urinary tract infection before UDS (up to 5 days before USD) and were enrolled in the study if they did not have bacteriuria or urinary tract infection. Patients did not receive antibiotic prophylaxis before performing UDS. The patients were asked to do U/A and U/C three days after the UDS test. RESULTS: Among the 146 patients, 9 (6.2%) patients had considerable bacteriuria and 7 (4.8%) patients had UTI. The mean maximum detrusor pressure during urination and abnormal PVR before UDS had a significant correlation with positive urinary cultures after UDS (p<0.05). CONCLUSION: The results showed that this diagnostic procedure is low risk and the prophylactic antibiotic therapy is not required before UDS in pelvic floor clinic. It seems that prophylactic antibiotic therapy is only appropriate in case of PVR greater than 50 ml and possibly of the high detrusor pressure.
