Acta obstetricia et gynecologica Scandinavica
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Acta Obstet Gynecol Scand · Jun 2019
The retropubic tension-free vaginal tape procedure-Efficacy, risk factors for recurrence and long-term safety.
The retropubic tension-free vaginal tape has been the preferred method for primary surgical treatment of stress urinary incontinence and stress-dominated mixed urinary incontinence in women for more than 20 years. This study presents long-term safety and efficacy data and assesses risk factors for long-term recurrence. ⋯ The tension-free vaginal tape procedure has a high long-term durability. Mixed urinary incontinence as an indication for surgery predicted long-term recurrence. Long-term complications were rare.
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Acta Obstet Gynecol Scand · Jun 2019
ReviewThe role of angiogenic factors in the management of preeclampsia.
Preeclampsia is a pregnancy disorder causing substantial maternal and fetal morbidity and mortality. In the UK, its diagnosis currently depends upon new onset hypertension and proteinuria. There is a clinical need for enhanced screening to prevent unnecessary resource use and improve outcomes. ⋯ The soluble fms-like tyrosine kinase 1/placental growth factor ratio seems particularly promising as a screening measure, able to predict accurately the short-term absence of preeclampsia and suggest the likelihood of adverse events within 4 weeks. The ratio could be used to allocate specific management plans to patients according to risk. An understanding of angiogenic factors may also lead to new therapeutic options for a condition currently only curable by delivery, although it must be remembered that the factors are markers of underlying syncytiotrophoblast stress, which would not be resolved by targeting them.
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Acta Obstet Gynecol Scand · Jun 2019
Observational StudyA comparable rate of levator ani muscle injury in operative vaginal delivery (forceps and vacuum) according to the characteristics of the instrumentation.
Forceps delivery is associated with a high rate of levator ani muscle (LAM) trauma (avulsion) at 35%-65% whereas data on avulsion rates after vacuum delivery vary greatly. Nevertheless, a common characteristic of all previous studies carried out to evaluate the association between instrumental deliveries (forceps and vacuum) and LAM avulsion, is the fact that characteristics of the instrumentation have not been described or evaluated. The objective of this study is to compare the rate of LAM avulsion between forceps and vacuum deliveries according to the characteristics of the instrumentation. ⋯ We consider that, in our population, LAM avulsion rate should not be a factor taken into account when choosing the type of instrumentation (Malmström vacuum or Kielland forceps) in an operative delivery.
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Acta Obstet Gynecol Scand · Jun 2019
Operator experience affects the risk of obstetric anal sphincter injury in vacuum extraction deliveries.
Delivery by vacuum extraction is a major risk factor for obstetric anal sphincter injury. The aim of this study was to assess risk factors for obstetric anal sphincter injury in vacuum extraction in nulliparous women, specifically operator-related factors. A secondary aim was to assess other complications of vacuum extraction that are dependent on operator experience. ⋯ The adjusted risk of obstetric anal sphincter injury in nulliparous women was five times higher in vacuum extractions performed by residents compared with those performed by obstetricians. Vacuum extractions performed by gynecologists did not carry an increased risk of obstetric anal sphincter injury. Experience in years of training, rather than frequency of the procedure, seemed to have the highest impact on reducing obstetric anal sphincter injury in vacuum extractions, which indicates a need for increased training and supervision.