The use of synthetic mesh for vaginal prolapse in the UK: a review of cases submitted to the British Society of Urogynaecology database.

INTRODUCTION AND HYPOTHESIS: The use of mesh for vaginal prolapse gained popularity during the 1990s. More recently, concerns have been raised regarding the safety of mesh procedures. Mesh can be inserted vaginally, laparoscopically or via an open abdominal route, but there are few data comparing the outcomes. Most previous published data relate to small numbers of procedures. METHODS: This was a review of data submitted to the British Society of Urogynaecology (BSUG) database of all cases reporting the use of mesh placed vaginally or abdominally (open or laparoscopic) between January 2006 and December 2016. The primary outcome was based on the reported patient global impression of improvement (PGI-I). RESULTS: A total of 6,709 cases of mesh prolapse repair were entered during the study period. Women in the laparoscopic group had a lower BMI and were younger. Significantly more patients in the open group (96.4%) described themselves as very much better or much better compared with the laparoscopic group (91%) and the vaginal mesh group (90.7%; p < 0.001). Only 0.5% of patients reported that they were worse or very much worse. CONCLUSIONS: This dataset suggests that the effectiveness of mesh repair might be good regardless of the route of insertion. The improvement in PGI-I seems to be greatest with open sacrocolpopexy.

A pilot randomised controlled trial of the pelvic toner device in female stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: To determine the feasibility of using the pelvic toner device (PTD) in aiding pelvic floor muscle training (PFMT) METHODS: Forty women, aged at least 18 years with symptoms of pure stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence were randomly assigned to standard PFMT (ST group), or to PFMT and additional PTD (PTD group). They were evaluated throughout a treatment period of 16 weeks, and followed up 6 months after the active treatment period, using International Consultation on Incontinence Questionnaires (ICIQ), bladder diaries, and other subjective outcome measures for symptom improvement. RESULTS: Twenty-four women were randomised to ST and 28 to PTD. Twelve women did not complete therapy and analysis was performed on 19 randomised to ST and 21 randomised to PTD on a per protocol basis. The two groups showed statistically significant symptom improvement in ICIQ responses, both at 16 weeks and at 6 months. There was no significant difference between the groups regarding improvement in SUI (ST 52.6%, PTD 52.4%) at 16 weeks. At 6 months after the active treatment period, 60% of women (50%, 8 in the PTD group and 71.4 %, 10 in the ST group) were still doing pelvic floor exercises. The sample difference observed was not statistically significant. Some women reported that the device helped with confidence that the correct muscles were being contracted, and helped motivation to sustain PFMT. CONCLUSIONS: This pilot study demonstrates the feasibility of PTD for aiding PFMT. It is a safe and well-tolerated adjunct in PFMT, which increases patient choice.

Hands on or hands off the perineum: a survey of care of the perineum in labour (HOOPS).

INTRODUCTION AND HYPOTHESIS: There seems to be a temporal association between increasing use of "hands off" the perineum in labour and reduced use of episiotomy with an increasing rate of anal sphincter injuries. We aimed to determine how common the practice of "hands off" the perineum is. METHODS: An observational postal questionnaire study of 1,000 midwives in England in which the main objective was to obtain an estimate of the number of midwives practising either "hands on" or "hands off" was conducted. RESULTS: Six hundred and seven questionnaires were returned; 299 (49.3%, 95% CI 45.2-53.3%) midwives prefer the "hands-off" method. Less-experienced midwives were more likely to prefer the "hands off" (72% vs. 41.4%, p < 0.001). A higher proportion of midwives in the "hands-off" group would never do an episiotomy (37.1% vs. 24.4%, p = 0.001) for indications other than fetal distress. CONCLUSIONS: The "hands off" the perineum technique is prevalent in the management of labour. We hypothesise that a possible consequence might be an increased incidence of obstetric anal sphincter injury.

Fetal monitoring in labor: are accelerations good enough?

OBJECTIVE: To investigate whether accelerations of the fetal heart rate in response to scalp stimulation (the scalp stimulation test) before fetal scalp blood sampling (FBS) are such a good predictor of fetal well-being as to render the FBS unnecessary. METHODS: A retrospective observational study. Cardiotocograms (CTG) from 54 fetuses during labor in whom 70 FBS procedures were performed, were analysed by an investigator blinded to the outcome, to determine whether accelerations were present in response to fetal scalp stimulation during vaginal examination (VE) prior to the FBS. This was compared with the pH obtained at FBS in a 2 x 2 table. The primary outcome measure was the false negative rate of the scalp stimulation test. RESULTS: There were accelerations at 48 VEs before FBS (n = 70). In five cases there was fetal acidosis (pH