BJOG : an international journal of obstetrics and gynaecology
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The aim of this study was to determine the concentrations of and factors associated with decidual insulin-like growth factor-binding protein-1 (IGFBP-1) in the lower genital tract in early- and mid-gestation in singleton pregnancies. ⋯ The rate of phIGFBP-1 concentrations > or =10 micrograms/l, both in the vagina and in the cervix, was significantly lower during the second trimester compared with the first trimester. The low rate of levels > or =10 micrograms/l in vaginal samples compared with cervical samples during both trimesters indicates that the exact site of sampling is important when phIGFBP-1 is used as a decidual marker. Nulliparity and history of vaginal bleeding were independently associated with phIGFBP-1 concentrations > or =10 micrograms/l in cervical samples during both trimesters.
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Over the past decade, there has been an exponential growth of robot-assisted procedures and of publications concerning robotic-assisted laparoscopic surgery. From a review of the available literature, it becomes apparent that this technology is safe and allows more complex procedures in many fields of surgery, be it at relatively high costs. Although randomised controlled trials in gynaecology are lacking, available evidence suggests that particularly in gynaecology robotic surgery might not only reduce morbidity but also be cost effective if performed in high-volume centres. Training in robotic surgery and programs for safe and effective implementation are necessary.
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To examine fear of childbirth according to parity, gestational age, and obstetric history. ⋯ Severe fear of childbirth was more common in nulliparous women, in later pregnancy, and in women with previous caesarean section or VE. Caesarean section as a preferred mode of childbirth was strongly associated with high score in both W-DEQ and VAS.
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Multicenter Study
Estimation of population-based incidence of pregnancy-related illness and mortality (PRIAM) in two districts in West Java, Indonesia.
We introduce a new and untested approach for the measurement of life-threatening maternal morbidity in populations where not all women give birth in a health facility. By defining complications at the very extreme end of the severity spectrum, we postulate that its count in hospitals can be used to represent the incidence in the general population. ⋯ The approach tested in this study--relying on conditions that are 'absolutely' life-threatening such that their count in hospitals can be used to represent the incidence in the general population--is promising but needs further testing in populations with varied disease epidemiology and access to care. Continued investments in hospital-based audits of life-threatening morbidity may ultimately improve the quality and reliability of information on obstetric complications and facilitate the development of rigorous and standard criteria for the definition of life-threatening morbidity.
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Multicenter Study Clinical Trial
A prospective cohort study of maternal and neonatal morbidity in relation to use of episiotomy at operative vaginal delivery.
To evaluate the maternal and neonatal morbidity of operative vaginal delivery in relation to the use of episiotomy. ⋯ The use of episiotomy did not reduce or greatly increase anal sphincter tears and was associated with greater maternal and neonatal morbidity. This may reflect the complexity of deliveries. The role of episiotomy at operative vaginal delivery should be evaluated in a randomised controlled trial.