@article {3582, title = {An unusual long-term complication of transobturator polypropylene mesh.}, journal = {Arch Gynecol Obstet}, volume = {290}, year = {2014}, month = {2014 Dec}, pages = {1273-4}, abstract = {

Serious complications associated with surgical mesh for transvaginal repair of POP, as infections, vaginal mesh exposure, painful mesh shrinkage and dyspareunia, are not rare. A 48-year-old woman underwent the Perigee procedure because of a stage 3 anterior wall prolapse. Eleven months after surgery, the patient became suddenly unable to walk because of a strong pain to the left thigh root after running. The MRI revealed an external obturator left muscle hyperintensity consistent with muscular oedema; the patient was treated with oral corticosteroids with a complete resolution of the pain. We could hypothesize that the posterior arm of the mesh caused a laceration of the muscles of the obturator space with consequent oedema and pain. The use of the meshes in prolapse surgery can cause unexpected long-term complications.

}, keywords = {Cystocele, Dyspareunia, Female, Glucocorticoids, Humans, Middle Aged, Pelvic Organ Prolapse, Polypropylenes, Postoperative Complications, Prednisone, Surgical Mesh, Treatment Outcome, Vagina}, issn = {1432-0711}, doi = {10.1007/s00404-014-3368-4}, author = {Sartore, Andrea and Zennaro, Floriana and Banco, Rubina} } @article {1946, title = {The clinical interpretation and significance of electronic fetal heart rate patterns 2 h before delivery: an institutional observational study.}, journal = {Arch Gynecol Obstet}, volume = {286}, year = {2012}, month = {2012 Nov}, pages = {1153-9}, abstract = {

PURPOSE: To evaluate the clinical significance of intrapartum fetal heart rate (FHR) monitoring in low-risk pregnancies according to guidelines and specific patterns.

METHODS: An obstetrician, blinded to neonatal outcome, retrospectively reviewed 198 low-risk cases that underwent continuous electronic fetal monitoring (EFM) during the last 2 h before delivery. The tracings were interpreted as normal, suspicious or pathological, according to specific guidelines of EFM and by grouping the different FHR patterns considering baseline, variability, presence of decelerations and bradycardia. The EFM groups and the different FHR-subgroups were associated with neonatal acid base status at birth, as well as the short-term neonatal composite outcome. Comparisons between groups were performed with Kruskal-Wallis test. Differences among categorical variables were evaluated using Fisher{\textquoteright}s exact test. Significance was set at p < 0.05 level.

RESULTS: Significant differences were found for mean pH values in the three EFM groups, with a significant trend from "normal" [pH 7.25, 95 \% confidence interval (CI) 7.28-7.32] to "pathological" tracings (pH 7.20, 95 \% CI 7.17-7.13). Also the rates of adverse composite neonatal outcome were statistically different between the two groups (p < 0.005). Among the different FHR patterns, tracings with atypical variable decelerations and severe bradycardia were more frequently associated with adverse neonatal composite outcome (11.1 and 26.7 \%, respectively). However, statistically significant differences were only observed between the subgroups with normal tracings and bradycardia.

CONCLUSIONS: In low-risk pregnancies, there is a significant association between neonatal outcome and EFM classification. However, within abnormal tracings, neonatal outcome might differ according to specific FHR pattern.

}, keywords = {Acidosis, Bradycardia, Female, Fetal Blood, Fetal Monitoring, Heart Rate, Fetal, Humans, Hydrogen-Ion Concentration, Infant, Newborn, Labor, Obstetric, Predictive Value of Tests, Pregnancy, Pregnancy Outcome, Retrospective Studies, Single-Blind Method, Statistics, Nonparametric, Time Factors}, issn = {1432-0711}, doi = {10.1007/s00404-012-2446-8}, author = {Maso, Gianpaolo and Businelli, Caterina and Piccoli, Monica and Montico, Marcella and De Seta, Francesco and Sartore, Andrea and Alberico, Salvatore} } @article {1945, title = {The effects of uterine fundal pressure (Kristeller maneuver) on pelvic floor function after vaginal delivery.}, journal = {Arch Gynecol Obstet}, volume = {286}, year = {2012}, month = {2012 Nov}, pages = {1135-9}, abstract = {

PURPOSE: To evaluate the role of uterine fundal pressure during the second stage of labor (Kristeller maneuver) on pelvic floor dysfunction (urinary and anal incontinence, genital prolapse, pelvic floor strength).

METHODS: 522 primiparous women, enrolled 3 months after vaginal delivery, were divided in two groups: group A (297 women) identifies the women who received Kristeller maneuvers with different indications (e.g. fetal distress, failure to progress, mother exhaustion), group B (225 women) the women without maneuver. Participants were questioned about urogynecological symptoms and examined by Q-tip test, digital test, vaginal perineometry and uroflowmetric stop test score.

RESULTS: Mediolateral episiotomies, dyspareunia and perineal pain were significantly higher in Kristeller group, whereas urinary and anal incontinence, genital prolapse and pelvic floor strength were not significantly different between the groups.

CONCLUSIONS: Kristeller maneuver does not modify puerperal pelvic floor function but increases the rate of episiotomies.

}, keywords = {Delivery, Obstetric, Dyspareunia, Dystocia, Episiotomy, Fatigue, Fecal Incontinence, Female, Fetal Distress, Humans, Labor Stage, Second, Pain, Postoperative, Pelvic Floor, Pelvic Organ Prolapse, Perineum, Pregnancy, Pressure, Puerperal Disorders, Urinary Incontinence, Uterus}, issn = {1432-0711}, doi = {10.1007/s00404-012-2444-x}, author = {Sartore, Andrea and De Seta, Francesco and Maso, Gianpaolo and Ricci, Giuseppe and Alberico, Salvatore and Borelli, Massimo and Guaschino, Secondo} }