Intrahepatic cholestasis of pregnancy - prevalence and ethnic distribution in northern Israel

OBJECTIVES

Intrahepatic cholestasis of pregnancy (ICP) is charachterized by pruritis and elevated serum bile acids (BA) and is associated with adverse obstetrical outcomes. ICP etiology is poorly understood and its incidence varies with ethnicity and geographical distribution.

OBJECTIVES

Explore the prevalence and characteristics of ICP in the different Northern Israeli ethnic groups and compare maternal and perinatal outcomes according to disease severity.

MATERIAL AND METHODS

Single-center retrospective study. Women who were diagnosed with ICP based on clinical presentation and elevated fasting BA (≥ 10 μmol/L) were included. Disease incidence, maternal and neonatal complications were explored according to ethnic subgroups analysis and obstetrical complications were examined according to disease severity.

RESULTS

The incidence of ICP in the study population was 0.58%. Higher ICP incidence was found in our cohort compared with other reports arising from Central Israel (p < 0.001). The Christian patients had a higher incidence of ICP (1.1%) and preeclampsia (23.1%). A higher rate of neonatal intensive care unit (NICU) admissions was found in the Arab Muslim and Christian groups compared with the Jewish and Druze groups (p = 0.007). A higher rate of preeclampsia was found in the severe (BA ≥ 40 μmol/L) ICP group (p < 0.001). Patients in the severe ICP group had earlier gestational age at delivery (37 versus 38.14 weeks, p < 0.001). Birth weight was significantly lower in the severe ICP group (p = 0.018).

CONCLUSIONS

The incidence of ICP at our institution was 0.58%, which is higher compared with previous reported Israeli incidence. Higher ICP and preeclampsia incidence were found among Arab Christian patients.

Vulvar High-Grade Squamous Intraepithelial Lesions and Cancer as a Risk Factor for Anal Cancer: A Review

OBJECTIVES

Anal squamous cell carcinoma (ASCC) has a higher incidence described in certain groups, namely, in women with vulvar high-grade squamous intraepithelial lesions (vHSILs) and/or human papillomavirus squamous cell carcinoma (VSCC). This review describes terminology, vHSIL, and VSCC in their association with ASCC and the published recommendations for early detection of this cancer in these women.

MATERIALS AND METHODS

A narrative review was conducted by the authors on vHSIL and VSCC as risk factors for ASCC.

RESULTS

The ASCC and VSCC incidence are increasing. Women with vHSIL and/or VSCC can present with ASCC at diagnosis, being one of the highest-risk groups. Suspicious symptoms include rectal bleeding, pain, and a sensation of an anal mass. Digital anorectal examination can help detect early ASCC. Sensitivity of anal cytology in women with vHSIL and VSCC seems low, with the exception of immunosuppressed women with genital neoplasia (cervix, vagina, and vulva). There are still insufficient data on high-resolution anoscopy in women with vHSIL and/or VSCC as a screening method.

CONCLUSIONS

Clinicians need be aware that women with vHSIL and VSCC comprise one of the highest-risk groups for ASCC. Inquiring suggestive symptoms of ASCC and a digital anorectal examination can help in the early detection of this type of cancer.

Rate of hourly change in serum beta-human chorionic gonadotropin levels in ectopic pregnancy can predict the success of treatment with single-dose methotrexate: A retrospective observational study

OBJECTIVE

To determine whether the success of treatment with single-dose methotrexate (SD MTX) for ectopic pregnancy can be predicted using the rate of change in serum β-human chorionic gonadotropin (β-hCG) level.

STUDY DESIGN

This was a retrospective observational study conducted at a tertiary referral centre. The study population included women who underwent treatment with SD-MTX for ectopic pregnancy. We analysed data of 119 women treated with SD-MTX for ectopic pregnancy at the Galilee Medical Centre between 2012 and 2016. Success was defined as a <15% decrease in β-hCG level between days 4 and 7, with no need for a second dose of MTX or surgical intervention. The dynamics of serum β-hCG levels before treatment were considered as the main outcomes.

RESULTS

SD-MTX administration was successful in 77 (65%) patients. The average baseline β-hCG level was significantly lower in women with successful outcomes than in those without successful outcomes (763.1 vs. 1429.63 mIU/L, respectively, p < 0.0048). The hourly change in β-hCG level was significantly lower in those with successful outcomes than in those without successful outcomes (0.38 vs. 5.73 mIU/mL, respectively, p < 0.0023). The percentage change in β-hCG level was 13.1%, which was not significantly different between the groups (p < 0.133). At serum β-hCG level < 946 mIU/mL and sac size < 2.55 cm, the treatment was successful in 88% of women.

CONCLUSIONS

We propose a predictive model of hourly change in β-hCG to achieve successful treatment using SD-MTX in ectopic pregnancy based on objective and measurable criteria.

Outcomes of a fixed skeletonised mini mesh implant for pelvic organ prolapse repair with uterine preservation

Mesh repair of pelvic organ prolapse (POP) is complicated, causing erosions, postoperative pain and surgical failure. We hypothesised that reducing the mesh size and fixating it would result in significant cure rates and reduce complication rates. Here, we present the effectiveness of mini mesh implants in POP reconstruction. Sixty women who underwent repair of stage III and IV apical prolapse with cystocele or rectocele using skeletonised mesh implant Seratom PA MR MN® were evaluated. Anatomical outcomes were assessed using modified POP-quantification (POP-Q) staging and functional outcomes were self-reported by patients - one and three months post-operatively. Apical support with anterior and/or posterior colporrhaphy was performed, resulting in 96.6% success rate. Follow-up conducted one and three months post-operatively revealed significant improvement on the modified POP-Q (p < .001) and no complaints of dyspareunia. Para-vesicular fixation using a skeletonised mini mesh implant is feasible and effective in POP repair and has low surgical complication risk.Impact StatementWhat is already known on this subject? Mesh repair for pelvic organ prolapse (POP) is currently under scrutiny as it may result in erosions, postoperative pain, and surgical failure.What do the results of this study add? The use of an apical support with mini-mesh implants resulted in a 96.6% (58/60) success rate and excellent outcomes at 1- and 3-month follow-up.What are the implications of these findings for clinical practice and/or further research? Reconstruction using skeletonised and fixated mini-mesh implants may be safe and effective for POP treatment.

Mechanically Supporting Uterosacral Ligaments for the Relief of Provoked Vulvodynia: A Randomized Pilot Trial

Purpose

Provoked vulvodynia (PV) is the most common cause of vulvar pain and dyspareunia. Although its etiology is unknown, it has been associated with musculoskeletal dysfunction. The inability of the lax uterosacral ligaments (USLs) to support the adjoining T11/L2 and S2-4 nerve plexuses is considered to cause PV. This study aimed to determine whether providing mechanical support to the USLs would improve PV.

Patients and Methods

PV patients were randomly divided into two groups. The participants in each group underwent sham manipulation (inserting a wide swab in the vagina without applying pressure) and trial manipulation (supporting the posterior fornix with a wide swab sufficiently broad to mechanically support the USLs). This was a cross-over trial, and the participants alternated between the sham and trial manipulation. Using a 0-10 visual analog pain scale (VAS), PV-associated pain levels experienced by participants were recorded during each manipulation, and the results were compared with baseline levels.

Results

The pain level significantly reduced with USL support compared with the baseline value and the sham manipulation pain level (P = 0.003). Pain during sham manipulation was not significantly different from that recorded at baseline. The average reduction in pain with USL support was 18.4% ± 2.2%. The manipulation order did not affect changes in the pain level during trial manipulation (P = 0.512).

Conclusion

Applying mechanical support to the posterior fornix temporarily alleviates provoked vulvar pain in some women.

Compliance with a new quality standard regarding administration of prophylactic antibiotics before cesarean section

OBJECTIVE

Administering prophylactic antibiotics before cesarean section (CS) decreases postpartum infections significantly. They should be administered within 60 min prior to CS. In 2014 the Israeli Ministry of Health introduced the administration of pre-operative antibiotic prophylaxis for CS as a quality criterion. This was immediately adopted by the Galilee Medical Center (GMC). This study aimed to examine the compliance to this quality standard in the GMC under 3 criteria: the type of antibiotics, timing of administration, and use of one dose only.

STUDY DESIGN

Data of women who underwent CS from the day of introducing the new quality standard on January 1, 2014, to July 31, 2015, were retrospectively analyzed.

RESULTS

The study included 1790 women who delivered by elective (24.4%) or emergency CS. In general, the medical staff's compliance to this quality standard was 90.9; 95.6% of the patients received the correct antibiotic, 94.6% had it within 65 min before surgery to 5 min after it, and 100% received it in less than 24 h. There was an increase in the overall compliance rate with time (logistic regression, p = .001). During the day shift, 60.4% of CS were emergency surgeries while during the on-call shift (evening and night) almost all (99%) of the CS were emergencies (p < .001, 2-sided). In morning shift's emergency CS, only 4.1% of the cases were not given prophylactic antibiotics as against 7.8% in the on-call shift (p = .005).

CONCLUSION

Over a period of 18 months, the compliance to the new quality standard of administering prophylactic antibiotics before CS was 90.9%. It was particularly high in the subgroup of elective CS during the morning shift. This high compliance rate may be attributed to the introduction of clear guidelines and assignment of a specific team member, the anesthesiologist, to administer the medication.Key pointsCompliance rate to the guideline was 90.9%.Compliance was better in the morning shift.Compliance was better for elective cesarean section.Compliance was not affected by time.

Early planned labor induction vs expectant management in late preterm pre-labor rupture of membranes: maternal and neonatal outcomes

OBJECTIVES

To compare expectant management with early planned labor induction in pregnancies complicated by late preterm pre-labor rupture of membranes (PPROM).

MATERIAL AND METHODS

A retrospective file review was conducted in a single tertiary center from January 2015 to Sep-tember 2019. Singleton pregnancies complicated by late PPROM at 34-36 completed weeks of gestation were enrolled. We compared maternal and neonatal complications between expectant management and early planned labor induction.

RESULTS

We retrospectively assigned 41 women to the expectant management group and 39 to the early planned labor induction group. No difference was found in the mode of delivery between the groups. Women in the expectant manage-ment group had a longer antepartum hospital stay compared with the induction group (median of three versus one day, p < 0.01). Neonates were delivered at a more advanced gestational age in the expectant management group compared with that in the induction group (35 5/7 versus 35 2/7 weeks, p < 0.01). In the induction group, 74.4% of the neonates were admitted to the intensive care unit (ICU), and 66.7% received antibiotics compared with 51.2% of neonates admitted to ICU and 29.3% receiving antibiotics in the expectant management group (p = 0.04 and p < 0.01, respectively).

CONCLUSIONS

In pregnancies complicated by late PPROM, early labor induction was associated with a shorter antepartum maternal hospital stay but a higher neonatal ICU admission rate and more frequent antibiotic administration than expect-ant management. We consider expectant management to be an acceptable alternative to early labor induction in PPROM.

A possible association between hydatidiform mole and the COVID-19 pandemic: A retrospective cohort study

Objective

To confirm an increase in the number of women with molar pregnancy during the COVID-19 pandemic.

Methods

In this retrospective cohort study, all patients with complete or partial mole diagnosed at our institution between January 1, 2010 and October 31, 2020, were included. To verify whether there was an increase in the incidence of hydatidiform mole (HM) and deliveries in 2020, the incidences for each year from January 2010 to October 2020 were recorded. In addition, we identified all women who were diagnosed with HM from January to October 2020, and compared them with a control group who underwent uterine evacuation for missed abortion of a singleton pregnancy during the same period. We also documented the time taken to diagnose missed abortion or molar pregnancy to check if a delay in diagnosis can explain the increase in HM incidence.

Results

Between 2016 and 2019, there was a statistically significant increase in the incidence of molar pregnancy. A further increase occurred in 2020 (odds ratio = 2.071). The mean gestational age of the embryo at the time of diagnosis was smaller in the HM group than in the missed abortion group (6.3 ± 1.67–7.4 ± 2.4, one-sided P = 0.034), meaning that it took more time (days) to diagnose molar pregnancy than missed abortion (22.38 ± 10.32 vs. 15.83 ± 7.83 days, P = 0.012).

Conclusion

There was a significant increase in the incidence of molar pregnancy during the COVID-19 pandemic, possibly because of the delay in receiving medical care. We recommend providing gynecological primary care services during a crisis, such as a pandemic.

Long-Term Efficacy of Physical Therapy for Localized Provoked Vulvodynia

Purpose

The origin of provoked vulvodynia (PV), the main cause of entry dyspareunia, remains unclear, and the treatment is empiric. In this study, we aimed to investigate the long-term effects of physical therapy on PV in subjects using questionnaire concerning PV symptoms immediately after physical therapy and at least 10 years later.

Patients and Methods

This study included a total of 24 women diagnosed with PV and referred by their primary physicians to Maccabi Physical Therapy Clinic for pelvic floor rehabilitation between 2004 and 2008. Criteria such as pain relief, sexual functioning, and treatment satisfaction were assessed.

Results

The average pain scores of the 24 participants reduced significantly after therapy, and 42% had no pain between treatment and the time of survey. Eighty-three percent did not undergo additional treatment after the initial physical therapy and reported high or very extremely high levels of pain reduction following treatment. Multiple regression analysis found that onset type of PV and age were not associated with the treatment outcome (p = 1.0).

Conclusion

Physical therapy is an effective long-term treatment for primary or secondary PV, resulting in pain reduction and improved sexual function.

Evaluation of human papilloma virus in semen as a risk factor for low sperm quality and poor in vitro fertilization outcomes: a systematic review and meta-analysis

OBJECTIVE

To analyze the effect of human papilloma virus (HPV) sperm infection on sperm parameters and in vitro fertilization (IVF) outcomes.

DESIGN

Systematic review and meta-analysis.

SETTING

Not applicable.

PATIENTS

Men with HPV sperm infection and couples undergoing IVF.

INTERVENTIONS

Searches were conducted in the following databases: Medline(R), PubMed, Embase, Web of Science, Scopos, and the Cochrane Library. We included studies examining sperm parameters and IVF results in patients with and without HPV sperm infection.

MAIN OUTCOME MEASURES

Sperm analysis (concertation, count, volume, motility, morphology), according to the World Health Organization manual, pregnancy rate (PR), and miscarriage rate (MR).

RESULTS

Sixteen studies were included in this meta-analysis. The presence of HPV had a significant association with impaired sperm parameters in terms of concentration (mean difference [MD] -4.48, 95% confidence interval [CI] - 6.12 to -2.83), motility (MD -11.71, 95% CI - 16.15 to -7.26), and morphology (MD -2.44, 95% CI - 4.08 to -0.79. A review of the literature regarding ART outcomes showed an association between HPV infection and decreased PR, and an even stronger association between HPV infection and increased MR.

CONCLUSION

Our meta-analysis shows a negative effect of HPV on sperm concentration, motility, and morphology. Further subgroup and categorical analysis confirmed the clinical significance of impaired sperm motility in HPV-infected sperm, although the sperm count and morphology must be carefully analyzed. The studies reviewed reported lower PR and increased MR in couples with HPV-infected sperm. As most studies had a moderate risk of bias, these observations warrant further large, well-designed studies before introducing clinical management recommendations.

PROSPERO REGISTRATION NUMBER

CRD42019127419.

Three-Year Follow-up of 2-Dose Versus 3-Dose HPV Vaccine

BACKGROUND AND OBJECTIVES

Human papillomavirus (HPV) antibody responses to the 9-valent human papillomavirus (9vHPV) vaccine among girls and boys (aged 9-14 years) receiving 2-dose regimens (months 0, 6 or 0, 12) were noninferior to a 3-dose regimen (months 0, 2, 6) in young women (aged 16-26 years) 4 weeks after last vaccination in an international, randomized, open-label trial (NCT01984697). We assessed response durability through month 36.

METHODS

Girls received 2 (months 0 and 6 [0, 6]: n = 301; months 0 and 12 [0, 12]: n = 151) or 3 doses (months 0,2, and 6 [0, 2, 6]: n = 301); boys received 2 doses ([0, 6]: n = 301; [0, 12]: n = 150); and young women received 3 doses ([0, 2, 6]: n = 314) of 9vHPV vaccine. Anti-HPV geometric mean titers (GMTs) were assessed by competitive Luminex immunoassay (cLIA) and immunoglobulin G-Luminex immunoassay (IgG-LIA) through month 36.

RESULTS

Anti-HPV GMTs were highest 1 month after the last 9vHPV vaccine regimen dose, decreased sharply during the subsequent 12 months, and then decreased more slowly. GMTs 2 to 2.5 years after the last regimen dose in girls and boys given 2 doses were generally similar to or greater than GMTs in young women given 3 doses. Across HPV types, most boys and girls who received 2 doses (cLIA: 81%-100%; IgG-LIA: 91%-100%) and young women who received 3 doses (cLIA: 78%-98%; IgG-LIA: 91%-100%) remained seropositive 2 to 2.5 years after the last regimen dose.

CONCLUSIONS

Antibody responses persisted through 2 to 2.5 years after the last dose of a 2-dose 9vHPV vaccine regimen in girls and boys. In girls and boys, antibody responses generated by 2 doses administered 6 to 12 months apart may be sufficient to induce high-level protective efficacy through at least 2 years after the second dose.

Intrauterine bacterial growth in elective and non-elective caesarean sections

We assessed intrauterine bacterial growth for elective and non-elective caesarean sections (CSs). Aerobic uterine cultures were obtained from the uterine cavity immediately following placental removal from 1376 patients who underwent CS in one center during one year. About 13.8% (115/832) of elective CS were positive vs. 55.9% (304/544) of non-elective CS (p < .001). Of non-elective CSs, 28.6% (56/196) of those without ruptured membranes (ROM) were positive vs. 71.3% (248/348) with ROM (p < .001). Mean birth weight and 1-minute Apgar scores were significantly lower in women with positive cultures, elective and non-elective, than negative cultures. A higher percentage of women with positive uterine cultures presented with postpartum endometritis (p < .05). Intrauterine bacteria in elective CSs demonstrate that the uterine cavity is not sterile. Non-elective CS, particularly after membrane rupture, is a significant risk factor for positive uterine culture. Positive uterine culture is associated with lower birth weight, lower one-minute Apgar score and postpartum endometritis.Impact statementWhat is already known on this subject? Postpartum endometritis is a leading cause of postpartum febrile morbidity. Caesarean sections, in particular non-elective cesareans, are an important risk factor for the development of postpartum endometritis. Controversy exists concerning the sterility of the placenta and uterus. The diagnosis of endometritis is based mainly on clinical findings and does not necessitate bacterial isolation from the uterine cavity. Positive culture at caesarean section has been associated with positive postoperative culture and yet, currently, professional organisations do not recommend the routine sampling of intrauterine cultures during caesarean section.What do the results of this study add? Since positive uterine culture rate was higher in non-elective CSs and associated with lower birth weight and 1-minute Apgar score and postoperative endometritis, obtaining uterine culture in those cases might be of clinical value.What are the implications of these findings for clinical practice and/or further research? Obtaining routine intrauterine cultures during non-elective caesarean sections might be useful for detecting significant pathogens and tailoring antibiotic treatment in postpartum endometritis. Further studies are necessary in order to determine the impact of obtaining intrauterine cultures during caesarean sections, particularly non-elective cesareans.

Dehiscence of cesarean section scar during pregnancy and delivery - risk factors

OBJECTIVE

We wanted to identify risk factors for dehiscence of cesarean section (CS) scars in patients undergoing repeated cesarean section.

MATERIAL AND METHODS

This was a retrospective case-control study over a 3-year period in our medical center (2011-2014), comparing women who had repeated CS without complications and women diagnosed with dehiscence. Data were collected from medical records and the groups were compared for demographic and obstetrical data.

RESULTS

Dehiscence was identified in 27 women, while 54 women without dehiscence were the control group. Statistically significant differences were found in the need for augmentation, the number of previous cesarean sections, cesarean section in the active phase of labor and length of hospitalization.

DISCUSSION

The need for augmentation of labor, CS in the nonactive stage and more than one cesarean section, all increased the risk of dehiscence. There was no association between dehiscence and scar pain, time elapsed since the previous cesarean section, the method of wound closure or fever.

Cervical traction suture technique during large loop excision of the transformation zone increases complete lesion excision

PURPOSE

A surgical technique was developed in the past by our group to reduce the rate of inadvertent complications. It was then seemed that it also increased the rate of complete lesion excision. The objective of the study was to evaluate the effectiveness of a cervical traction suture technique in increasing the prevalence of complete lesion excisions and reducing the incidence of unintended injuries to adjacent tissues during large loop excision of the transformation zone (LLETZ).

BASIC PROCEDURES

A retrospective cohort study, including all consecutive patients who underwent LLETZ between January 2016 and June 2018, at the outpatient Colposcopy clinic of a general hospital in Galilee Medical Center. We divided patients into two groups based on whether their LLETZ utilized the cervical traction suture technique. We compared these two groups using an independent-samples t test, and we compared the study-specific proportions to those reported in the literature using the proportion test.

MAIN FINDINGS

A total of 66 patients were included in the analysis; 33 had undergone LLETZ with a traction suture, and 33 had undergone LLETZ without a traction suture. The prevalence of complete lesion excision was 93.3 % among patients undergoing LLETZ with a traction suture and 72.7 % among those without a traction suture (p = 0.04). The incidence of unintentional injuries to adjacent organs was 12.1 % in women with a traction suture and 18.2 % in women without a traction suture (p = 0.73).

PRINCIPAL CONCLUSIONS

Using a cervical traction suture along with LLETZ can increase the rate of complete lesion excision and may reduce the prevalence of unintended injuries.

Early prediction of methotrexate treatment outcome in tubal ectopic pregnancy based on days 0 and 4 human chorionic gonadotropin levels

AIM

Methotrexate (MTX) is an efficient treatment for ectopic pregnancy, used according to 'single-dose' protocol. Treatment success is evaluated on days 4 and 7 after dose administration, and defined as a decline of ≥15% in beta-human chorionic gonadotropin (β-hCG) levels, with a positive predictive value of 93%. A decrease on day 4 β-hCG levels was determined to be a good predictor for treatment success. We retrospectively examined changes in β-hCG levels between days 0 and 4 after MTX treatment as an early predictor for treatment outcome.

METHODS

The 'success group' consisted of patients with resolved ectopic pregnancy after a single MTX dose and 'failure group' included patients who required additional MTX doses or underwent surgery after the first dose. For each group, demographic and pregnancy data were analyzed as well as initial (admission day), days 0, 4 and 7 β-hCG levels.

RESULTS

Of 159 women included in the study, MTX treatment was successful in 117 patients (73.6%) while 42 patients (26.4%) were defined as treatment failure. In the success group, most patients (58.9%) demonstrated a decrease in β-hCG values between days 0 and 4 as opposed to the failure group in which an increase in β-hCG values was observed (76.2%). Decrease of >18% in β-hCG levels was predictive of treatment success (positive predictive value 92%). Increase in β-hCG values is less predictive of treatment failure with positive predictive value of 54%.

CONCLUSION

Differences in β-hCG levels between days 0 and 4 may serve as an early predictor for treatment outcome.

A novel extended prophylactic antibiotic regimen in preterm pre-labor rupture of membranes: A randomized trial

OBJECTIVES

Prophylactic antibiotic use in preterm pre-labor rupture of membranes (PPROM) is associated with a significant reduction in intra-amniotic infection and improved neonatal outcome. However, data is insufficient to determine the optimal antibiotic regimen. Considering the rise in Escherichia coli and Klebsiella pneumonia early-onset sepsis rate and the emergence of ampicillin resistance, our aim is to compare the efficiency of two antibiotic regimens in prolonging pregnancy and reducing infectious morbidity.

DESIGN

This multicenter randomized unblinded controlled prospective trial compared two antibiotic prophylactic protocols in PPROM: ampicillin + roxithromycin vs. cefuroxime + roxithromycin in 84 women with PPROM, from 12/2015-12/2019.

RESULTS

The median latency period was significantly longer (p = 0.039) in the cefuroxime + roxithromycin group (4.63 [0.59-50.18] days) than in the ampicillin + roxithromycin group (2.3 [0.15-58.3] days). Neonatal admission to neonatal intensive care unit rate, hospitalization length, neonatal respiratory distress syndrome, neonatal fever, and need for respiratory support or mechanical ventilation, were similar between the groups. K. pneumonia cultures were significantly more frequent in the ampicillin + roxithromycin group. None of the cultures were group B Streptococcus positive.

CONCLUSIONS

To prolong latency period and reduce gram-negative early-onset sepsis, cefuroxime + roxithromycin is recommended as the first-line protocol in PPROM.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02819570.

Routine uterine culture swab during cesarean section and its clinical correlations: A retrospective comparative study

OBJECTIVES

Cesarean sections, particularly non-elective cesareans, are an important risk factor for the development of postpartum endometritis, a leading cause of postpartum febrile morbidity. We evaluated the yield of obtaining routine intrauterine culture during elective and non-elective cesarean sections, in the prevention and management of postpartum endometritis.

STUDY DESIGN

A retrospective comparative study investigating the distribution of uterine cultures obtained immediately after fetus and placenta delivery during cesarean sections performed in a single tertiary hospital during 2017. True pathogenic bacteria were included in the study analysis and considered as positive results, while other contaminant bacteria were excluded.

RESULTS

Positive uterine cultures were identified in 10.7 % (88/821) of cesarean sections, with no significant difference in prevalence between elective and non-elective cesareans. Escherichia coli (E.coli), isolated in 40.9 % of the positive cultures of all women, was the most common organism in non-elective cesareans vs. Group B Streptococcus (GBS) in elective cesareans. Higher rate of positive cultures was found in term vs. preterm cesareans (17.5 % vs 10.5 %, respectively, p-value = 0.04). E.coli was the most frequent pathogen reported in both women with intact membranes or premature rupture of membranes (46.3 % and 47.3 % respectively). Eight women (9.1 %) with positive cultures presented with postpartum fever; all had undergone non-elective cesarean section. In one-third of these cases the empirical antibiotic treatment was adjusted according to the uterine culture results and susceptibility testing results.

CONCLUSIONS

Obtaining routine intrauterine cultures during non-elective cesarean sections might be useful for detecting significant pathogens and tailoring the antibiotic treatment in postpartum endometritis.

Long-term outcome (5-10 years) after non absorbable mesh insertion compared to partially absorbable mesh insertion for anterior vaginal wall prolapse repair

Objective:

To evaluate long-term (5-10 years) outcomes of Minimally Invasive Surgical (MIS) kit insertion with Prolift^® (non-absorbable) mesh compared to the use of Prolift M^® (partially absorbable), for anterior vaginal wall prolapse repair.

Study design:

In this retrospective study we compared women undergoing MIS kit Prolift^® insertion (n=90) vs. Prolift M^® insertion (n=79) for anterior vaginal wall prolapse repair between 2006 and 2012 at our Institution. A number of 169 women fulfilled the inclusion criteria and were included in the study.

Results:

During the study period 128 women (76%) completed full follow-up; of them 58 (73%) following MIS kit Prolift^® insertion, and 70 (88%) following MIS kit ProliftM^® insertion. There was no significant difference between the Prolift® and Prolift M^® regarding parity (3.04 vs. 2.88, p=0.506), presence of hypertension (24.1% vs. 39.1%, p=0.088), diabetes mellitus (3.4% vs. 11.6%, p=0.109), or urinary stress incontinence (39.7% vs. 47.1%, p=0.475). All participants had been diagnosed with POP grade 3 or 4 before the procedure. No significant complications during the procedure or postoperative period were identified in the study groups. The follow-up period was at least five years in duration for both groups. Both groups were comparable according to questionnaires focused on function and satisfaction.

Conclusion:

Patients undergoing MIS kit Prolift^® and Prolift M^® insertion for anterior vaginal wall prolapse repair had comparable early and late postoperative outcomes. No differences in patient's function and satisfaction between the two groups were identified. According to our findings, there is no superiority to either of the two studied mesh devices.