Laparoscopic prepregnancy transabdominal cerclage: operative and pregnancy outcomes for a novel technique of suture placement using port closure device.

Transabdominal cerclage is an effective surgical intervention for preterm birth prevention. Placement of cervical sutures using a port closure device for prepregnancy laparoscopic abdominal cerclage has been used at our unit in recent years. We report the operative and pregnancy outcomes for prepregnancy laparoscopic abdominal cerclage using the port closure device and compare it with the outcomes of the traditional approach. For prepregnancy laparoscopic transabdominal cerclage (n=52), the port closure device approach was associated with less blood loss during surgery (0.95±4.4 mL vs 5.4±15.7 mL; P=.007) and a shorter hospital length of stay (0.0; 0.0-0.0 days vs 1.0; 0.0-1.0 days; P<.001). There were also trends toward shorter operating times (41.4±15.3 minutes vs 50.1±18.0 minutes; P=.167) and lower perioperative complication rates (0.0%; 0/21 vs 16.1%; 5/31; P=.065) when compared with the traditional technique. There was no significant difference between the port closure device technique and the traditional approach in the rate of preterm birth in a subsequent pregnancy (0.0%; 0/9 vs 22.6%; 7/39; P=.248). Use of the port closure device for suture placement during prepregnancy laparoscopic cerclage for preterm birth prevention was reported. This technique was associated with less blood loss and a shorter hospital length of stay, had trends toward shorter operating times and lower perioperative complication rates, and had similar rates of preterm birth.

MRI remains highly accurate in the diagnosis of appendicitis in pregnancy when read by radiologists of mixed specialty training and experience.

PURPOSE: To audit the accuracy of magnetic resonance imaging (MRI) abdominal studies performed in the diagnosis of appendicitis in pregnant patients when read by radiologists of mixed experience. METHODS: MRI reports from 45 pregnant women presenting to our emergency department for the investigation of appendicitis between 2009 and 2020 were retrospectively reviewed. Where available, these reports were correlated with surgical and pathology reports as well as follow-up clinical information. Following a review of literature, accuracy targets were set. Statistical analyses including sensitivity, specificity, positive, and negative predictive values were calculated. RESULTS: A total of 18 radiology consultants read 45 MRI abdominal studies in the assessment of appendicitis during pregnancy with 62% (n = 28) of these read by specialist radiologists and the remainder by general radiologists. This yielded an accuracy in diagnosis of 99.8%, sensitivity of 80% (95% CI: 49-94.3%), and specificity of 100% (95% CI: 90-100%). The calculated negative predictive value was 94.6% (95% CI: 82.3-98.5%), and positive predictive value was 100% (95% CI: 90-100%). The appendix was not identified in 19 patients (42%). A statistically significant relationship between the presence of right iliac fossa stranding of the fat OR free fluid was associated with appendicitis (p = 0.01). Alternate diagnoses were identified in 8% (n = 4) of cases. CONCLUSION: MRI is a highly accurate imaging modality for the assessment of appendicitis in pregnancy. Even with variable reader MRI experience, MRI demonstrates an accuracy of 99.8% and a positive predictive value for acute appendicitis of 100%. Double reading and the possible inclusion of DWI may help further improve accuracy and minimise false-negative rates.

Web-based education for placental complications of pregnancy.

OBJECTIVE: The objective of this study was to determine whether a web-based education strategy could improve maternal knowledge of placental complications of pregnancy and reduce maternal anxiety in high risk-pregnancies. METHODS: Prospective study in the Placenta Clinic at Mount Sinai Hospital, Toronto, Ontario. Maternal demographics and Internet usage were recorded at the patient's baseline appointment. Placental knowledge was determined using structured verbal and illustrative assessments. The six-item State-Trait Anxiety Inventory (STAI) was administered to assess baseline maternal anxiety. Women were asked to visit the Placenta Clinic website for a minimum of 15 minutes before their follow-up appointment, at which time their placental knowledge and STAI assessments were repeated. RESULTS: Eighteen women were included in the study. Patient knowledge at the baseline appointment was generally poor (median score 10.5 out of a maximum score of 27, range 1 to 22), with major deficits in basic placental knowledge, placenta previa/increta, and preeclampsia. At the follow-up appointment, placental knowledge was significantly improved (median score 23, range 10 to 27; P < 0.001). Educational status (high school or less vs. college or more) had no effect on either baseline knowledge or knowledge improvement. Maternal anxiety at baseline (median score 12 out of a maximum score of 24, range 6 to 23) was significantly reduced at the follow-up appointment (median score 8.5, range 6 to 20; P = 0.005). CONCLUSION: Deficits in maternal knowledge of placental complications of pregnancy in high-risk pregnant women were substantial but easily rectified with a disease-targeted web-based educational resource. This intervention significantly improved patient knowledge and significantly reduced maternal anxiety.

Objectif : Cette étude avait pour objectif de déterminer si une stratégie pédagogique sur le Web pouvait améliorer les connaissances maternelles en matière de complications placentaires de la grossesse et atténuer l'anxiété maternelle dans le cadre des grossesses exposées à des risques élevés. Méthodes : Tenue d'une étude prospective au sein de la Placenta Clinic du Mount Sinai Hospital à Toronto, en Ontario. Les habitudes d'utilisation d'Internet et les caractéristiques démographiques maternelles ont été consignées au cours de la consultation de départ avec la patiente. Les connaissances quant au placenta ont été déterminées au moyen d'évaluations illustrées et verbales structurées. Le six-item State-Trait Anxiety Inventory (STAI) a été administré pour évaluer l'anxiété maternelle de départ. Nous avons demandé aux femmes de consulter le site Web de la Placenta Clinic pendant un minimum de 15 minutes avant leur consultation de suivi; au cours de celle-ci, leurs connaissances quant au placenta ont été évaluées à nouveau et les évaluations STAI ont été menées une fois de plus. Résultats : Dix-huit femmes ont participé à l'étude. Au moment de la consultation de départ, les connaissances des patientes étaient généralement faibles (score médian de 10,5 sur un score maximal de 27, plage de 1 à 22), des déficits majeurs ayant été constatés en matière de connaissances de base quant au placenta, au placenta prævia/increta et à la prééclampsie. Au moment de la consultation de suivi, les connaissances quant au placenta présentaient une amélioration considérablement accrue (score médian de 23, plage de 10 à 27; P < 0,001). Le niveau de scolarité (études secondaires ou moins vs études postsecondaires ou plus) n'a exercé aucun effet sur l'état des connaissances au départ ni sur l'amélioration des connaissances. L'anxiété maternelle au départ (score médian de 12 sur un score maximal de 24, plage de 6 à 23) avait connu une baisse considérable au moment de la consultation de suivi (score médian de 8,5, plage de 6 à 20; P = 0,005). Conclusion : Les déficits en matière de connaissances maternelles quant aux complications placentaires de la grossesse chez les femmes enceintes exposées à des risques élevés étaient substantiels, mais facilement corrigeables au moyen d'une ressource pédagogique sur le Web axée sur la maladie. Cette intervention a mené à une amélioration significative des connaissances des patientes et à une baisse considérable de l'anxiété maternelle.

Trans-vaginal ultrasound simulation: An exploratory qualitative research study focused on the end-users perception of learning.

OBJECTIVE: Simulation has been shown to be beneficial and effective in the intimate educational setting of trans-vaginal ultrasound (TVUS). In addition, quantitative work has shown dyad learning (learning in pairs) to be non-inferior to independent learning simulation in this setting. This study aims to explore trainees' perceptions of learning in TVUS using qualitative research methods. A second aim was to study trainees' perceptions of the method of training, (learning in pairs (dyads) or as individuals). STUDY DESIGN: A three-hour training session using the transvaginal simulator and teaching programme was offered to participants, who either trained individually or as a dyad. Participants were then interviewed using a semi-structured interview technique. Interviews were recorded, transcribed, entered a qualitative research database (NVivo) to allow coding, structured analysis of data and development of themes using Thematic Analysis. RESULTS: Fifteen doctors with no previous experience in TVUS were assigned simulation training either as individuals (n = 7) or dyads (n = 4 pairs, eight people in total). All participants reported the beneficial nature of simulation training and felt they had sufficient time to meet their learning needs. Some frustration was reported with feedback and the repetitive nature of the simulation. For dyad learning, participants perceived the value of the use of a second person to act as a "sound board", to problem solve and to encourage each other. Independent learners reported frustration and difficulty in understanding if and how something went wrong. However, individual learners had the advantage of being able to go at their own pace. CONCLUSION: Previous studies have shown that simulation is effective for training in transvaginal ultrasound. This qualitative research study supports findings of previous quantitative studies by showing that participants appreciated the value of simulation and provided feedback for improvement in educational content. Clinicians and educators providing transvaginal simulation training could consider dyad training as an efficient and educational option, with individual training reserved for those who may need more time.

Sonographic findings and clinical outcomes in women with massive subchorionic hematoma detected in the second trimester.

BACKGROUND: Small hematomas on the placental surface, termed subamniotic hemorrhage, are a common finding either at the routine 18- to 20-week anatomy ultrasound or at subsequent assessments of fetal growth and well-being. Hemorrhage beneath or at the edge of the placenta, or behind an isolated area of the fetal membranes, is of greater concern. THE CASES: We describe the ultrasound findings and clinical outcomes in two women with a diagnosis of massive intrauterine hematoma arising from the fetal membranes. Both required blood transfusion because of the extent of concealed and revealed bleeding. In each case the initial placental appearances and uterine artery Doppler studies were normal. Both hematomas resolved with growth of the fetus and amniotic sac. Each neonate survived the perinatal period favourably. One was born vaginally at 32 weeks' gestation following premature preterm rupture of the membranes, and the second was born by emergency Caesarean section at 37 weeks because of a recurrence of antepartum hemorrhage. CONCLUSION: Large intrauterine hematomas may be acutely detrimental to maternal health in the second trimester. Ultrasound assessment of the placenta is useful to define the perinatal prognosis and may demonstrate gradual resolution. Despite a dramatic initial presentation, this finding may be compatible with a favourable outcome.