Development of symptomatic pelvic organ prolapse over 10 years of mid-life follow-up is affected by occupational lifting and/or pushing for parous women

OBJECTIVE

To document the risk of new-onset symptomatic pelvic organ prolapse (POP) among perimenopausal women and examine whether occupational lifting and/or pushing is a risk factor in the development of POP over a 10-year follow-up window.

STUDY DESIGN

Secondary analysis of prospective, longitudinal data from the Study of Women's Health Across the Nation (SWAN) cohort study.

MAIN OUTCOME MEASURES

We analyzed women with current employment at the start of SWAN who were followed annually during mid-life. At baseline, women self-reported the frequency of occupational lifting and pushing, which was classified as Never, Infrequent (less than half the time), or Frequent (half the time or more) occupational lifting and/or pushing. Women were asked about new-onset symptomatic POP from the second to tenth annual follow-up. Modified Poisson regression was used to quantify crude and adjusted risk ratios (RRs) and 95 % confidence intervals (CIs) for POP according to load-bearing categories. Parous women were modelled separately, as initial analyses suggested effect modification by parity status.

RESULTS

In our sample of 1590 parous women, 8.2 % reported new-onset symptomatic POP over 10 years of follow-up. Multivariable analysis revealed that Infrequent (aRR 1.51, 95 % CI 1.04-2.20) and Frequent (aRR 2.03, 95 % CI 1.29-3.17) occupational lifting and/or pushing were associated with the development of POP.

CONCLUSION

Frequent occupational lifting and/or pushing significantly increased parous women's risk of developing POP symptoms. This strengthens existing evidence that occupational exposures can be risk factors for POP. Gender-based education and prevention strategies in the workplace and in primary health care are necessary to reduce the burden of this condition for mid-life women.

Does size matter? Opioid use after laparoscopy for apical pelvic organ prolapse using an 8mm versus 10-12mm accessory port

STUDY OBJECTIVE

To determine if a change in lateral accessory port (LAP) size from 10-12mm to 8mm among women undergoing laparoscopic native tissue pelvic organ prolapse (POP) surgery was effective at reducing opioid use after surgery.

DESIGN

Prospective cohort of women taking part in a POP surgical registry.

SETTING

Tertiary academic hospital in Calgary, Canada.

PATIENTS

Women undergoing laparoscopic uterosacral ligament apical suspensions for stage ≥2 POP with either uterine preservation or concomitant hysterectomy. 92 women were included during a 15-month study period from June 2020 to September 2021.

INTERVENTIONS

Laparoscopic apical suspension using either a 10-12mm or 8mm LAP, with the change occurring at the mid-point of the study period. Fascial defects from 10-12mm ports were closed with a fascial closure device. Perioperative care and technique were otherwise unchanged.

MEASUREMENTS AND MAIN RESULTS

Post-operative opioid use was measured by mean morphine equivalent daily dose (MEDD), accounting for all oral and intravenous opioids used in the first 24-hours post-surgery. 50 cases (54.3%) used a 10-12mm LAP, 42 cases (45.7%) used an 8mm LAP. Mean MEDD after surgery with a 10-12mm LAP was significantly higher than with an 8mm LAP (35.3 (95% CI 24.9-45.6) vs. 13.6 (95% CI 8.0-19.2), p<0.001). Proportion of women who did not require opioids post-operatively was higher in the 8mm group (45.2%, n=19) than the 10-12mm group (18.0%, n=9) (cOR 3.76, 95% CI 1.47-9.66). Similarly, the proportion of women who did not fill an opioid prescription after discharge was higher in the 8mm group (35.7%, n=15) than the 10-12mm group (16.0%, n=8) (cOR 2.92, 95% CI 1.09-7.81). These results remained statistically significant after adjustment for age, body mass index, race/ethnicity, length of procedure, and concomitant procedures performed.

CONCLUSION

Compared to 10-12mm port, use of an 8mm LAP during laparoscopic native-tissue apical POP surgery is associated with decreased opioid use in the first 24 hours after surgery.

Quality of Antenatal Care for Women Who Experience Imprisonment in Ontario, Canada

IMPORTANCE

Women who experience imprisonment have high morbidity and an increased risk of adverse pregnancy outcomes. Antenatal care could modify pregnancy-related risks, but there is a lack of evidence regarding antenatal care in this population.

OBJECTIVES

To examine antenatal care quality indicators for women who experience imprisonment and to compare these data with data for the general population.

DESIGN, SETTING, AND PARTICIPANTS

This population-based, retrospective cohort study used linked correctional and health administrative data from women released from provincial prison in Ontario, Canada, in 2010 and women in the general population with deliveries at 20 weeks' gestation or greater from January 1, 2005, to December 31, 2015. Data analysis was performed from January 1, 2017, to May 4, 2020.

EXPOSURES

Pregnancies in women with time in prison during pregnancy (prison pregnancies), pregnancies in women with time in prison but not while pregnant (prison control pregnancies), and pregnancies in women in the general population (general population pregnancies).

MAIN OUTCOMES AND MEASURES

Antenatal care quality indicators: first-trimester visit, first-trimester ultrasonography, and 8 or more antenatal care visits.

RESULTS

A total of 626 prison pregnancies in 529 women (mean [SD] age, 26.6 [5.4] years), 2327 prison control pregnancies in 1570 women (mean [SD] age, 26.2 [5.4] years), and 1 308 879 general population pregnancies in 884 063 women (mean [SD] age, 30.3 [5.3] years) were studied. Of 626 prison pregnancies, 193 women (30.8%; 95% CI, 27.1%-34.6%) had a first-trimester visit, 272 (48.4%; 95% CI, 44.4%-52.4%) had at least 8 antenatal care visits, and 209 (34.6%; 95% CI, 31.0%-38.4%) received first-trimester ultrasonography. In 2327 prison control pregnancies, 1106 women (47.5%; 95% CI, 45.3%-49.8%) had a first-trimester visit, 1356 (59.2%; 95% CI, 56.9%-61.4%) had 8 or more antenatal care visits, and 893 (38.5%; 95% CI, 36.4%-40.6%) received first-trimester ultrasonography. Compared with 1 308 879 general population pregnancies, the odds of antenatal care were lower for the first-trimester visit (odds ratios [ORs], 0.11 [95% CI, 0.09-0.13] in prison pregnancies and 0.23 [95% CI, 0.21-0.25] in prison control pregnancies), 8 or more antenatal care visits (ORs, 0.16 [95% CI, 0.14-0.19] in prison pregnancies and 0.25 [95% CI, 0.23-0.28] in prison control pregnancies), and first-trimester ultrasonography (ORs, 0.43 [95% CI, 0.36-0.50] in prison pregnancies and 0.51 [95% CI, 0.46-0.55] in prison control pregnancies).

CONCLUSIONS AND RELEVANCE

This study found that women who experienced imprisonment were substantially less likely to receive adequate antenatal care than were women in the general population whether or not they were in prison during pregnancy. Efforts are needed to improve antenatal care for this population both in prison and in the community.

P1-07-22: A Venezuelan Study of Breast Cancer Estrogen Receptor, Progesterone Receptor and HER2 Receptor Expression by the Standard Method, Immunohistochemistry (IHC), Compared to a New Method, Quantitative Reverse Transcription Polymerase Chain Reaction (RT-PCR)

Background: Assessment of ER, PR and HER2 is of significant importance in breast cancer diagnosis and treatment. We have performed the first large assessment of central IHC for ER, PR and HER2 by a South American (Caracas, Venezuela) Central Lab to Central Lab RT-PCR by Oncotype DX®.

Design: Breast cancer specimens from the Fundación BADAN were evaluated by IHC for ER (clone 1D5), PR (clone 636) using 1% staining for positivity using ASCO/CAP guidelines and HER2 (clone A0485) using ASCO/CAP guidelines of 3+ in ≥30%. Standardized quantitative RT-PCR analysis for ER and PR used Oncotype DX with the pre-defined cutoffs of 6.5 units and 5.5 units for positivity, respectively. For HER2 the standard pre-defined cutoffs were used: positive ≥11.5 units, equivocal &gt;10.7-&lt;11.5 units, and negative ≥10.7 units. For HER2 concordance analysis the equivocal range was excluded from both assays according to ASCO/CAP Guidelines (Wolff et al, 2006). For all quantitative RT-PCR assessments the reference normalized expression measurements ranged from 0 to 15, where each 1-unit increase reflects about a 2-fold increase in RNA.

Result: Evaluable data was obtained in 96 pts for ER, 95 pts for PR (1 patient assessment unavailable) and 89 pts for HER2 (7 patient assessments unavailable). Two-by-two tables (below) compare IHC versus RT-PCR for ER, PR and HER2. The overall concordance for ER between IHC and RT-PCR was 94% (Kappa 0.467; 95% CI 0.107, 0.828); for PR between IHC and RT-PCR was 92% (Kappa 0.668; 95% CI 0.457, 0.878); and for HER2 between IHC and RT-PCR was 97% (Kappa = 0.649; 95% CI 0.280, 1.000). Three IHC 2+ cases and 4 equivocal cases by Oncotype DX were excluded from Concordance and Kappa statistics.

Conclusion: RT-PCR by Oncotype DX for ER, PR and HER2 status is useful for active monitoring of IHC assays as mandated by ASCO/CAP guidelines. There is a high degree of overall concordance between central IHC performed in South America (Caracas, Venezuela) and central RT-PCR for ER, PR and HER2 status.