Eric Jauniaux, Christoph Lees, Amar Bhide, Elizabeth Daly-Jones, Deepa Srinivasan, Yinka Oyelese
{"title":"The placenta and umbilical cord in prenatal care: Unseen, overlooked and misunderstood.","authors":"Eric Jauniaux, Christoph Lees, Amar Bhide, Elizabeth Daly-Jones, Deepa Srinivasan, Yinka Oyelese","doi":"10.1111/1471-0528.17936","DOIUrl":"https://doi.org/10.1111/1471-0528.17936","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah Saleem, Haleema Yasmin, Janet L Moore, Anum Rahim, Iram Shakeel, Adrien Lokangaka, Antoinette Tshefu, Melissa Bauserman, Musaku Mwenechanya, Elwyn Chomba, Shivaprasad S Goudar, Avinash Kavi, Richard J Derman, Nancy F Krebs, Lester Figueroa, Manolo Mazariegos, Paul Nyongesa, Sherri Bucher, Fabian Esamai, Archana Patel, Manjushree Waikar, Poonam Shivkumar, Patricia L Hibberd, William A Petri, Sk Masum Billah, Rashidul Haque, Waldemar A Carlo, Alan Tita, Marion Koso-Thomas, Jennifer Hemingway-Foday, Elizabeth M McClure, Robert L Goldenberg
Objective: To describe the intrapartum and postpartum use of non-study antibiotics in low- and middle-income countries (LMICs) during the double-blinded NICHD Global Network Azithromycin in Labor (A-PLUS) trial.
Design: The antibiotic use sub-study was a planned prospective, observational sub-study of the A-PLUS trial.
Settings: The study was carried out in hospitals or health centres affiliated with eight sites of the Global Network for Women's and Children's Health Research (Global Network) in seven countries: Bangladesh, Pakistan, India (two sites), Kenya, Zambia, The Democratic Republic of the Congo (DRC) and Guatemala.
Population: Totally, 29 278 pregnant women enrolled in the A-PLUS trial.
Methods: We collected data on 29 278 pregnant women admitted to a facility for delivery related to non-study antibiotic use overall and during three time periods: (1) in the facility prior to delivery, (2) after delivery until facility discharge and (3) after discharge to 42 days post-partum.
Main outcome measures: Non-study antibiotic use overall and for treatment or prophylaxis by the site during the three time periods.
Results: Of the 29 278 women in the study, 5020 (17.1%; 95% CI 16.7%-17.6%) received non-study antibiotics in the facility prior to delivery, 11 956 (40.8%; 95% CI 40.3%-41.4%) received non-study antibiotics in the facility after delivery, and 13 390 (47.6%; 95% CI 47.0%-48.2%) women received non-study antibiotics after delivery and after facility discharge. Antibiotics were prescribed more often among women in the Asian and Guatemalan sites than in the African sites. In the three time-periods, among those receiving antibiotics, prophylaxis was the indication in 82.3%, 97.7% and 90.7% of the cases, respectively. The type of antibiotics used varied substantially by time-period and site, but generally, penicillin-type drugs, cephalosporin-type drugs and metronidazole were used more frequently than other types.
Conclusions: Across the eight sites of the Global Network, in the facility before delivery, and in the post-partum periods before and after facility discharge, antibiotics were used frequently, but use was highly variable by site and time-period.
{"title":"Intrapartum and postpartum antibiotic use in seven low- and middle-income countries: Findings from the A-PLUS trial.","authors":"Sarah Saleem, Haleema Yasmin, Janet L Moore, Anum Rahim, Iram Shakeel, Adrien Lokangaka, Antoinette Tshefu, Melissa Bauserman, Musaku Mwenechanya, Elwyn Chomba, Shivaprasad S Goudar, Avinash Kavi, Richard J Derman, Nancy F Krebs, Lester Figueroa, Manolo Mazariegos, Paul Nyongesa, Sherri Bucher, Fabian Esamai, Archana Patel, Manjushree Waikar, Poonam Shivkumar, Patricia L Hibberd, William A Petri, Sk Masum Billah, Rashidul Haque, Waldemar A Carlo, Alan Tita, Marion Koso-Thomas, Jennifer Hemingway-Foday, Elizabeth M McClure, Robert L Goldenberg","doi":"10.1111/1471-0528.17930","DOIUrl":"https://doi.org/10.1111/1471-0528.17930","url":null,"abstract":"<p><strong>Objective: </strong>To describe the intrapartum and postpartum use of non-study antibiotics in low- and middle-income countries (LMICs) during the double-blinded NICHD Global Network Azithromycin in Labor (A-PLUS) trial.</p><p><strong>Design: </strong>The antibiotic use sub-study was a planned prospective, observational sub-study of the A-PLUS trial.</p><p><strong>Settings: </strong>The study was carried out in hospitals or health centres affiliated with eight sites of the Global Network for Women's and Children's Health Research (Global Network) in seven countries: Bangladesh, Pakistan, India (two sites), Kenya, Zambia, The Democratic Republic of the Congo (DRC) and Guatemala.</p><p><strong>Population: </strong>Totally, 29 278 pregnant women enrolled in the A-PLUS trial.</p><p><strong>Methods: </strong>We collected data on 29 278 pregnant women admitted to a facility for delivery related to non-study antibiotic use overall and during three time periods: (1) in the facility prior to delivery, (2) after delivery until facility discharge and (3) after discharge to 42 days post-partum.</p><p><strong>Main outcome measures: </strong>Non-study antibiotic use overall and for treatment or prophylaxis by the site during the three time periods.</p><p><strong>Results: </strong>Of the 29 278 women in the study, 5020 (17.1%; 95% CI 16.7%-17.6%) received non-study antibiotics in the facility prior to delivery, 11 956 (40.8%; 95% CI 40.3%-41.4%) received non-study antibiotics in the facility after delivery, and 13 390 (47.6%; 95% CI 47.0%-48.2%) women received non-study antibiotics after delivery and after facility discharge. Antibiotics were prescribed more often among women in the Asian and Guatemalan sites than in the African sites. In the three time-periods, among those receiving antibiotics, prophylaxis was the indication in 82.3%, 97.7% and 90.7% of the cases, respectively. The type of antibiotics used varied substantially by time-period and site, but generally, penicillin-type drugs, cephalosporin-type drugs and metronidazole were used more frequently than other types.</p><p><strong>Conclusions: </strong>Across the eight sites of the Global Network, in the facility before delivery, and in the post-partum periods before and after facility discharge, antibiotics were used frequently, but use was highly variable by site and time-period.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gabriel Levin, Walter Gotlieb, Pedro Ramirez, Raanan Meyer, Yoav Brezinov
{"title":"ChatGPT in a gynaecologic oncology multidisciplinary team tumour board: A feasibility study.","authors":"Gabriel Levin, Walter Gotlieb, Pedro Ramirez, Raanan Meyer, Yoav Brezinov","doi":"10.1111/1471-0528.17929","DOIUrl":"https://doi.org/10.1111/1471-0528.17929","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Enhancing HPV vaccination and education to reduce vaginal cancer incidence.","authors":"Tomoyuki Kawada","doi":"10.1111/1471-0528.17935","DOIUrl":"https://doi.org/10.1111/1471-0528.17935","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Obstetric anal sphincter injuries during instrumental vaginal delivery.","authors":"Prathamesh Lanjewar, Avir Sarkar","doi":"10.1111/1471-0528.17931","DOIUrl":"https://doi.org/10.1111/1471-0528.17931","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evaluating waterbirth risks: A deep dive into the POOL cohort study's research gaps.","authors":"Wei-Zhen Tang, Tai-Hang Liu, Xia Lan","doi":"10.1111/1471-0528.17934","DOIUrl":"https://doi.org/10.1111/1471-0528.17934","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nina Cooper, Maya Al-Memar, Kristofer Linton-Reid, Keith Edmonds, Gillian Rose, Nuala Dixon, Cillian McNamara, Christina Fotopoulou, Katherine Van Ree, Nishat Bharwani
Objective: To correlate the clinical history with imaging findings of women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.
Design: Retrospective cohort study.
Setting: A UK IOTA and ESGO-certified tertiary referral centre for disorders of reproductive development.
Population: All patients with a diagnosis of MRKH and who had undergone an MRI pelvis between 1 January 2011 and 31 April 2021 were included.
Methods: MRI images were analysed by specialist gynaecological radiologists. Clinical data was extracted from an electronic patient record system. Statistical analysis was computed in R (version 4.1.2), R base stats package and ggstatsplot (v0.5.0).
Main outcome measures: Clinical history and predefined imaging features.
Results: One hundred and thirty-four patients were included. Median age at MRI was 18 years (10-64 years). Half (48.2%) of women presenting had a history of pain, most often abdominal (84.6%) or vaginal (9.2%). Remnants were identified in 91.8% of women (n = 123). 4.5% of women had imaging features of endometriosis (n = 6). Women with a functional remnants were significantly more likely to experience pain (p < 0.001). Pain history was not strongly associated with ectopic ovarian position. Common gynaecological pathology such as endometriosis, ovarian cysts and fibroids were also identified.
Conclusions: We identify that majority of women with MRKH will have uterine remnants with a connecting fibrous band, and an ectopic ovarian position 44.0% of cases. Abdominal pain was significantly associated with functional remnants on MRI. Further work is required to identify how other gynaecological pathology impacts women with MRKH.
{"title":"Magnetic resonance imaging and clinical features of Mayer-Rokitansky-Küster-Hauser syndrome: A 10-year review from a dedicated specialist centre.","authors":"Nina Cooper, Maya Al-Memar, Kristofer Linton-Reid, Keith Edmonds, Gillian Rose, Nuala Dixon, Cillian McNamara, Christina Fotopoulou, Katherine Van Ree, Nishat Bharwani","doi":"10.1111/1471-0528.17928","DOIUrl":"https://doi.org/10.1111/1471-0528.17928","url":null,"abstract":"<p><strong>Objective: </strong>To correlate the clinical history with imaging findings of women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>A UK IOTA and ESGO-certified tertiary referral centre for disorders of reproductive development.</p><p><strong>Population: </strong>All patients with a diagnosis of MRKH and who had undergone an MRI pelvis between 1 January 2011 and 31 April 2021 were included.</p><p><strong>Methods: </strong>MRI images were analysed by specialist gynaecological radiologists. Clinical data was extracted from an electronic patient record system. Statistical analysis was computed in R (version 4.1.2), R base stats package and ggstatsplot (v0.5.0).</p><p><strong>Main outcome measures: </strong>Clinical history and predefined imaging features.</p><p><strong>Results: </strong>One hundred and thirty-four patients were included. Median age at MRI was 18 years (10-64 years). Half (48.2%) of women presenting had a history of pain, most often abdominal (84.6%) or vaginal (9.2%). Remnants were identified in 91.8% of women (n = 123). 4.5% of women had imaging features of endometriosis (n = 6). Women with a functional remnants were significantly more likely to experience pain (p < 0.001). Pain history was not strongly associated with ectopic ovarian position. Common gynaecological pathology such as endometriosis, ovarian cysts and fibroids were also identified.</p><p><strong>Conclusions: </strong>We identify that majority of women with MRKH will have uterine remnants with a connecting fibrous band, and an ectopic ovarian position 44.0% of cases. Abdominal pain was significantly associated with functional remnants on MRI. Further work is required to identify how other gynaecological pathology impacts women with MRKH.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The impact of hormone therapy on cardiovascular risk in postmenopausal women: Insights and recommendations.","authors":"Luyang Su, Zeqing Du, Cuiqiao Meng","doi":"10.1111/1471-0528.17932","DOIUrl":"https://doi.org/10.1111/1471-0528.17932","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alice Self, Michael Schlussel, Gary S Collins, Ferdinand Dhombres, Nicolas Fries, Georges Haddad, Laurent J Salomon, Mona Massoud, Aris T Papageorghiou
Objectives: Accurate assessment of gestational age (GA) is important at both individual and population levels. The most accurate way to estimate GA in women who book late in pregnancy is unknown. The aim of this study was to externally validate the accuracy of equations for GA estimation in late pregnancy and to identify the best equation for estimating GA in women who do not receive an ultrasound scan until the second or third trimester.
Design: This was a prospective, observational cross-sectional study.
Setting: 57 prenatal care centres, France.
Participants: Women with a singleton pregnancy and a previous 11-14-week dating scan that gave the observed GA were recruited over an 8-week period. They underwent a standardised ultrasound examination at one time point during the pregnancy (15-43 weeks), measuring 12 foetal biometric parameters that have previously been identified as useful for GA estimation.
Main outcome measures: A total of 189 equations that estimate GA based on foetal biometry were examined and compared with GA estimation based on foetal CRL. Comparisons between the observed GA and the estimated GA were made using R2, calibration slope and intercept. RMSE, mean difference and 95% range of error were also calculated.
Results: A total of 2741 pregnant women were examined. After exclusions, 2339 participants were included. In the 20 best performing equations, the intercept ranged from -0.22 to 0.30, the calibration slope from 0.96 to 1.03 and the RSME from 0.67 to 0.87. Overall, multiparameter models outperformed single-parameter models. Both the 95% range of error and mean difference increased with gestation. Commonly used models based on measurement of the head circumference alone were not amongst the best performing models and were associated with higher 95% error and mean difference.
Conclusions: We provide strong evidence that GA-specific equations based on multiparameter models should be used to estimate GA in late pregnancy. However, as all methods of GA assessment in late pregnancy are associated with large prediction intervals, efforts to improve access to early antenatal ultrasound must remain a priority.
Trial registration: The proposal for this study and the corresponding methodological review was registered on PROSPERO international register of systematic reviews (registration number: CRD4201913776).
目的:准确评估孕龄(GA)对个人和人群都很重要。估算孕晚期妇女孕龄的最准确方法尚不清楚。本研究旨在从外部验证孕晚期孕龄估算公式的准确性,并确定最佳公式,以估算在妊娠第二或第三个月才接受超声波扫描的妇女的孕龄:设计:这是一项前瞻性、观察性横断面研究:地点:法国 57 家产前护理中心:在为期 8 周的时间里,招募了单胎妊娠且之前在 11-14 周的孕期扫描中观察到胎儿性别的妇女。她们在孕期的一个时间点(15-43周)接受了标准化超声波检查,测量了12个胎儿生物测量参数,这些参数之前已被确认为有助于估计胎儿性别:主要结果测量:共研究了 189 个基于胎儿生物测量的 GA 估算方程,并与基于胎儿 CRL 的 GA 估算进行了比较。使用 R2、校准斜率和截距对观察到的 GA 与估计的 GA 进行比较。还计算了 RMSE、平均差和 95% 的误差范围:共有 2741 名孕妇接受了检查。排除后,共纳入 2339 名参与者。在 20 个表现最好的方程中,截距范围从-0.22 到 0.30,校准斜率从 0.96 到 1.03,RSME 从 0.67 到 0.87。总体而言,多参数模型优于单参数模型。95% 误差范围和平均差都随着妊娠期的增加而增加。仅以测量头围为基础的常用模型并不是表现最好的模型,其 95% 误差和平均差也较高:我们提供了强有力的证据,证明基于多参数模型的GA特异性方程应用于估计孕晚期的GA。然而,由于妊娠晚期的所有 GA 评估方法都与较大的预测间期有关,因此,改善早期产前超声检查的可及性仍是当务之急:本研究的提案及相应的方法学综述已在 PROSPERO 国际系统综述注册中心注册(注册号:CRD4201913776)。
{"title":"External validation of models to estimate gestational age in the second and third trimester using ultrasound: A prospective multicentre observational study.","authors":"Alice Self, Michael Schlussel, Gary S Collins, Ferdinand Dhombres, Nicolas Fries, Georges Haddad, Laurent J Salomon, Mona Massoud, Aris T Papageorghiou","doi":"10.1111/1471-0528.17922","DOIUrl":"https://doi.org/10.1111/1471-0528.17922","url":null,"abstract":"<p><strong>Objectives: </strong>Accurate assessment of gestational age (GA) is important at both individual and population levels. The most accurate way to estimate GA in women who book late in pregnancy is unknown. The aim of this study was to externally validate the accuracy of equations for GA estimation in late pregnancy and to identify the best equation for estimating GA in women who do not receive an ultrasound scan until the second or third trimester.</p><p><strong>Design: </strong>This was a prospective, observational cross-sectional study.</p><p><strong>Setting: </strong>57 prenatal care centres, France.</p><p><strong>Participants: </strong>Women with a singleton pregnancy and a previous 11-14-week dating scan that gave the observed GA were recruited over an 8-week period. They underwent a standardised ultrasound examination at one time point during the pregnancy (15-43 weeks), measuring 12 foetal biometric parameters that have previously been identified as useful for GA estimation.</p><p><strong>Main outcome measures: </strong>A total of 189 equations that estimate GA based on foetal biometry were examined and compared with GA estimation based on foetal CRL. Comparisons between the observed GA and the estimated GA were made using R<sup>2</sup>, calibration slope and intercept. RMSE, mean difference and 95% range of error were also calculated.</p><p><strong>Results: </strong>A total of 2741 pregnant women were examined. After exclusions, 2339 participants were included. In the 20 best performing equations, the intercept ranged from -0.22 to 0.30, the calibration slope from 0.96 to 1.03 and the RSME from 0.67 to 0.87. Overall, multiparameter models outperformed single-parameter models. Both the 95% range of error and mean difference increased with gestation. Commonly used models based on measurement of the head circumference alone were not amongst the best performing models and were associated with higher 95% error and mean difference.</p><p><strong>Conclusions: </strong>We provide strong evidence that GA-specific equations based on multiparameter models should be used to estimate GA in late pregnancy. However, as all methods of GA assessment in late pregnancy are associated with large prediction intervals, efforts to improve access to early antenatal ultrasound must remain a priority.</p><p><strong>Trial registration: </strong>The proposal for this study and the corresponding methodological review was registered on PROSPERO international register of systematic reviews (registration number: CRD4201913776).</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tulsi Patel, Rodger Brown, Ennet Chipungu, Michael Breen, Jennifer Draganchuk, Patrick Nampandeni, Awol Legesse, Jeffrey Wilkinson
Objective: Globally, obstetric fistula is a tragic outcome following obstructed labour. Failure of complex repair and post-operative incontinence are common. We describe an innovative surgical technique incorporating the rectus abdominus flap at the time of fistula repair.
Design: Retrospective case series.
Setting: Malawi, Fistula Care Centre.
Methods: Patients were followed for 3 months after discharge to determine continence and healing.
Results: Five of six patients were continent at 3 months and one was lost to follow-up by dry at a one month post-operative phone call. There were no major complications.
Conclusions: The rectus abdominus flap may be a useful adjunct to repair of complex obstetric fistula.
{"title":"Novel use of the rectus abdominus muscle flap for vaginal reconstruction in complex obstetric fistula repair: A case series.","authors":"Tulsi Patel, Rodger Brown, Ennet Chipungu, Michael Breen, Jennifer Draganchuk, Patrick Nampandeni, Awol Legesse, Jeffrey Wilkinson","doi":"10.1111/1471-0528.17926","DOIUrl":"https://doi.org/10.1111/1471-0528.17926","url":null,"abstract":"<p><strong>Objective: </strong>Globally, obstetric fistula is a tragic outcome following obstructed labour. Failure of complex repair and post-operative incontinence are common. We describe an innovative surgical technique incorporating the rectus abdominus flap at the time of fistula repair.</p><p><strong>Design: </strong>Retrospective case series.</p><p><strong>Setting: </strong>Malawi, Fistula Care Centre.</p><p><strong>Methods: </strong>Patients were followed for 3 months after discharge to determine continence and healing.</p><p><strong>Results: </strong>Five of six patients were continent at 3 months and one was lost to follow-up by dry at a one month post-operative phone call. There were no major complications.</p><p><strong>Conclusions: </strong>The rectus abdominus flap may be a useful adjunct to repair of complex obstetric fistula.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}