Follow-up of mesh complications using the IUGA/ICS category-time-site coding classification.

INTRODUCTION: The International Urogynecological Association (IUGA) and the International Continence Society (ICS) developed a complication classification to facilitate international comparison and to improve our understanding of complications. This code was applied to surgical cases for the analysis of complications after mesh insertion. METHODS: The study included patients who had undergone vaginal prolapse repair with a trocar-guided polypropylene mesh between 2006 and 2010 in a Dutch peripheral hospital. Complications were assessed at secondary follow-up and classified using category (C), timing (T), and site (S) components (CTS). RESULTS: Of the 107 women included, 84 returned for secondary follow-up (response rate 80 %, median time after surgery 36 months, range 12-64). In 45 patients no complications occurred. In the remaining 39 patients, 43 complication codes were established. Six of the seven categories of complications were found at all different time codes. Concerning the site of the complication codes S1, S2, and S3 were applicable. Perioperative complications (6 %) included hemorrhage and bladder perforation. Six patients were reoperated for symptomatic mesh exposure or local pain. At secondary follow-up exposure was diagnosed in another 4 patients (12 %). In 36 % mesh wrinkling or shrinkage was discovered, although without complaints in most. Eight women had daily complaints or dyspareunia. Eighty-two percent of patients indicated strong improvement after surgery. Several limitations of the classification are discussed. CONCLUSIONS: Despite limitations, the IUGA/ICS code is demonstrated to be useful in describing mesh complications. We advise the use of the CTS code at follow-up consultations after a minimum of 2 years for improved insight into and knowledge on the occurrence of complications.

Trial of labour after previous caesarean section in rural Zimbabwe.

OBJECTIVE: Vaginal delivery after previous caesarean section is widely accepted in Western countries. Is a trial of labour in rural Africa also safe for mother and child? STUDY DESIGN: In a case control study in rural Zimbabwe the outcome of labour of 281 women who had one or more previous caesarean sections was compared with 4501 women who had no previous caesarean section. Maternal and perinatal mortality, the percentage of vaginal birth and factors related to the achievement of vaginal delivery were studied. Data were tested for statistical significance with a Mantel-Haenszel equation for odds ratio's. RESULTS: No elective caesarean sections were performed. After previous caesarean section, 124 (44%) out of 281 women had a vaginal birth. One scar rupture occurred in a woman with thyrotoxicosis. Perinatal and maternal outcome did not differ significantly between cases and controls. A history of more than one previous caesarean section (Odds Ration (OR) = 10.0; 95% Confidence Interval (CI95%) = 4.4-23.8) or a previous caesarean section for cephalopelvic disproportion (OR = 6.2; CI95% 3.2-120) increased the risk for a repeat caesarean section significantly. CONCLUSION: A policy to allow all women a trial of labour after a previous caesarean section did not increase adverse pregnancy outcome. Also in rural Africa it seems rational to encourage a trial of labour after one or more previous caesarean sections.

Risk factors for neonatal infection.

A retrospective case-control study was designed to assess risk factors for neonatal infection. Nonprivate patients (8,215) who delivered in a period from January 1, 1983 to June 30, 1988 were studied. Ninety three cases of conjunctivitis (incidence 2.4/1,000), 104 cases of pneumonia (incidence 2.8/1,000), and 50 cases of sepsis (incidence 1.3/1,000) were identified. Group B streptococcus was cultured from septic neonates in 46%. Calculated Odds ratio's indicated prematurity/low birth-weight (OR 6.9) and antepartum fetal tachycardia (OR 6.3) as important risk factors for pneumonia/sepsis. Prematurity/low birth-weight (OR 3.0) and an abnormal presentation in the birth canal (OR 2.8) were identified as risk factors for conjunctivitis. After testing all the risk factors found by univariate analysis in a logistic regression model tachycardia (chi 2 35.21, p less than 0.001) remained an independent predictor for neonatal pneumonia/sepsis and abnormal vaginal presentation (chi 2 7.58, p 0.006) for conjunctivitis.