Enhancement of Levator Ani Muscle Strength in Postpartum Women: The Impact of Pelvic Floor Muscle Training.

BACKGROUND Levator ani muscle injuries during vaginal childbirth can lead to pelvic organ prolapse (POP). Pelvic floor muscle training (PFMT) is an effective conservative approach to alleviate these symptoms. This study aimed to compare outcomes with and without 3 months of PFMT in 34 women with levator ani muscle injury following vaginal delivery. MATERIAL AND METHODS In a quasi-experimental study, 34 postpartum women were divided into 2 groups: one received PFMT along with home-based materials and regular follow-ups, while the other served as the control. We measured basal tone and maximal levator ani muscle contraction using the Peritron perineometer and assessed changes after 3 months. RESULTS The basal tone and maximal contraction of the levator ani muscle significantly increased following a 3-month intervention period both in PFMT and control group (P=0.0001). The maximal contraction of the levator ani muscle after a 3-month intervention period was significantly higher in PFMT group compared with control group (36.59±1.45 vs 27.76±13.35, P=0.0001), respectively. A significant positive correlation was found between basal tone and maximal contraction (r=0.806, P=0.0001). CONCLUSIONS A 3-month PFMT program effectively increased levator ani muscle strength in postpartum women compared to those who did not undergo PFMT.

Ratio of Serum Calcium to Magnesium Levels on Pregnancy with and without Preeclampsia.

BACKGROUND Preeclampsia increases maternal and perinatal mortality and is affected by calcium and magnesium levels. Reduced extracellular levels of calcium and magnesium constitute the pathogenesis of eclampsia. A reduction in the calcium-magnesium ratio may aid in the detection and prevention of preeclampsia. MATERIAL AND METHODS This was an analytical observational study with a cross-sectional design, including patients with and without preeclampsia (inpatient and outpatient). A total of 246 patients were included in this research; 138 patients had preeclampsia and 108 patients did not. All examinations of magnesium and calcium levels at the Hasan Sadikin Hospital Clinical Pathology laboratory were conducted using an ion selective electrode modified with methylthymol blue complexometric titration. RESULTS Patients with preeclampsia had significantly higher average serum magnesium and calcium levels than did patients without preeclampsia (2.85 vs 2.09, P=0.0001; 4.45 vs 4.85, P=0.025, respectively). Patients with preeclampsia demonstrated significantly lower serum calcium-magnesium ratios than did patients without preeclampsia (1.98 vs 2.60, P=0.0001). Receiver operating characteristic curve analysis on the serum calcium-magnesium ratio showed an area under the curve of 68.0% (P=0.0001), with a cutoff value of 2.36 (sensitivity 64.8%, specificity 62.3%), indicating that patients with serum calcium-magnesium ratios of <2.36 were predicted to have a risk of preeclampsia. CONCLUSIONS Patients with preeclampsia had significantly lower serum calcium-magnesium ratios than did patients without preeclampsia; therefore, a low calcium-magnesium ratio could be a risk factor for preeclampsia.

Diagnostics and Management Challenges of Nonpuerperal Uterine Inversions - Case Series.

Purpose: Non-puerperal uterine inversion (NPUI) is a rare gynaecological entity with unknown actual incidence. It presents diagnostic and surgical challenges, due to its rarity and lack of clinical experience. Methods: Case series of 5 NPUI cases. Case Description: (1) A 44-year-old P3A0 presented with chronic profuse vaginal bleeding and a prolapsed pedunculated fibroid measuring 9x8x7 cm. In theatre, the pedunculated fibroid was extirpated. Haultain procedure was performed to reposition the uterus, followed by suturing the uterus. (2) A 65-year-old P4A0 presented with a solid vaginal mass, with brisk bleeding measuring 10x10x8 protruding from the introitus. In theatre, the mass was excised, followed by Kustner procedure and a subtotal hysterectomy. (3) A 46-year-old P1A1 presented with a large pedunculated fibroid, hypovolemic shock and loss of consciousness. Upon presentation, she was in shock and severely anaemic (Hb 1.4 gr/dL). In theatre, the fibroid was excised followed by uterine repositioning. A large left ovarian cyst (Ø 10 cm) was identified. A subtotal hysterectomy and left salpingo-oophorectomy were performed. (4) A 34-year-old P3A0 presented with an acute vaginal lump measuring 10x6x5 cm. She had delivered her infant 2 months prior. In theatre, a Huntington procedure was performed to reposition the uterus, followed by a total abdominal hysterectomy. (5) A 60-year-old P3A0 presented with vaginal mass measuring 10×10×8 cm and chronic profuse vaginal bleeding. In theatre, uterine inversion was diagnosed. A Haultain procedure was performed, followed by a total abdominal hysterectomy and bilateral salpingo-oophorectomy. All cases had presented with vaginal mass and bleeding to varying degrees. The degree of inversion required various procedures (eg, Kustner, Haultain, Huntington) and different forms of hysterectomy. Conclusion: Non-puerperal uterine inversion is a difficult pathology. Management is always surgical with different types of hysterectomy performed. With conservative surgery, Kustner, Huntington and Haultain procedures are indicated according to the severity and uterine position.

Uterocolon Fistula Formation in 50 Year Old Patient with History of 16 Years Intrauterine Device Use: A Case Report.

Introduction: Uterocolon fistula is one of the complications of intrauterine device (IUD) insertion. Not only may IUD materials cause perforation, but some other risk factors may contribute to its development including uterine abnormalities, thus IUD is contraindicated in patients with anatomical anomaly. Case: P3A1 woman, 50 years old with a history of IUD use for 16 years presented with complaints of fecal discharge from the vagina 8 months ago which worsened after IUD extraction. Physical examination revealed no abdominal tenderness. Speculum examination found feces in the cervical canal. CT scan examination showed multiple uterocolon fistulas and uterine didelphys. Diagnostic laparoscopy and hysteroscopy were carried out and found a recto-uterine fistula, then the patient was scheduled for colostomy and reanastomosis with the stapler method. Conclusion: Diagnosis was very difficult to establish despite proper imaging modalities. The use of direct visual diagnostics (hysteroscopy and laparoscopy) can be a good alternative for the diagnosis of uterocolon fistula. To the best of our knowledge, this is the first case report on recto-uterine fistula in a patient with long-term use of IUD and uterine didelphys.

Correlation between the expression of matrix metalloproteinase 9 and the expression of tissue inhibitor of metalloproteinase-1 of uterosacral ligament in uterine prolapse.

OBJECTIVE: This study aimed to analyze the correlation between the immunoexpression of matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TiMP1) in the uterosacral ligaments in patients with uterine prolapse. METHODS: This analytic-correlative cross-sectional study included 32 patients who were admitted at the Hasan Sadikin General Hospital from July to December 2013. Sixteen of the patients had uterine prolapse, while the rest did not. The patients underwent total hysterectomy, radical hysterectomy, or staging laparotomy. MMP-9 and TiMP1 expression in the uterosacral ligaments was measured via immunohistochemical staining. The median expression per field of view was calculated using a histoscore. RESULTS: MMP-9 expression in patients with uterine prolapse was found to be higher than that in the control group. Meanwhile, TiMP1 expression showed no significant difference between the groups. Spearman's analysis showed a moderate correlation between the expression of MMP-9 and uterine prolapse incidence (P=0.02), with a correlation coefficient of 0.574. CONCLUSION: There is a moderate correlation between MMP-9 expression and the incidence of uterine prolapse. It can be considered one of the primary etiologies of uterine prolapse.