Apendicitis aguda en una gestante lúpica / Acute appendicitis in pregnant lupus

El lupus eritematoso sistémico es una enfermedad autoinmune que se caracteriza por un proceso inflamatorio crónico y el aumento de la producción de autoanticuerpos como mecanismos patogénicos. Se presenta con mayor frecuencia en pacientes femeninas y en edad fértil. La gestación en pacientes con esta enfermedad se considera como una condición de extrema precaución, ya que existe influencia de la gestación en la actividad clínica del lupus y del lupus en la evolución de la gestación. Las complicaciones quirúrgicas, como es el caso de una apendicitis aguda, aportan mayor riesgo al binomio madre-feto. El objetivo del presente trabajo es comunicar la experiencia de tratamiento de una paciente de 31 años de edad, con diagnóstico de lupus eritematoso sistémico y a quien a las 35,6 semanas de gestación se le presentó un cuadro de apendicitis aguda que no solo provocó la actividad de la enfermedad, sino que causó la interrupción de la gestación. La paciente y el recién nacido presentaron una evolución favorable sin complicaciones posteriores.

Systemic lupus erythematosus is an autoimmune disease that includes the presence of a chronic inflammatory process and increased production of autoantibodies as etiopathogenic mechanisms. As a disease, it occurs more frequently in female patients and those of childbearing age. Pregnancy in patients with this disease is considered an element of extreme caution since there is an influence of pregnancy on the clinical activity of lupus and lupus on the evolution of pregnancy. The presence of surgical complications, as is the case of acute appendicitis, brings greater risk to the mother-fetus binomial. The objective of this report is to communicate the treatment experience of a 31-year-old patient, diagnosed with systemic lupus erythematosus and who at 35.6 weeks of gestation presented acute appendicitis that not only causes disease activity, but it generates the need to interrupt the pregnancy. The patient and the newborn had a favorable evolution, with no subsequent complications.

Effect of previous wedge resection for interstitial pregnancy on pregnancy and neonatal outcomes following frozen-thawed embryo transfer (FET) cycles of IVF/ICSI: a retrospective study.

OBJECTIVE: The present study aimed to evaluate pregnancy and neonatal outcomes in women, with a previous history of wedge resection for interstitial pregnancy, in frozen-thawed embryo transfer (FET) cycles of IVF/ICSI. METHODS: The present study involved a retrospective case-control assessment of 75 cases and 375 control subjects over 6 years in a single center. To compare pregnancy and neonatal outcomes between cases, treated using wedge resection, and controls without any previous history of ectopic pregnancy, propensity score matching (1:5) was utilized. The study also compared subgroups in the case group. RESULTS: Women with previous wedge resection exhibited higher rates of ectopic pregnancy and uterine rupture rate as compared to control subjects (9.1% vs 1.3%, P = 0.025 and 4.5% vs 0%, P = 0.035, respectively). No statistically significant differences were recorded between the two cohorts with regard to clinical pregnancy rate, live birth rate, and neonatal outcomes. For pregnancy type subgroup analysis, Z-score and rates of large for gestational age were recorded to be significantly lower in twin pregnancy subgroup when compared with singleton pregnancy subgroup (0.10 (- 0.59, 0.25) vs 0.50 (- 0.97, 1.39), P = 0.005; 4.5% vs 26.1%, P = 0.047, respectively). CONCLUSION: The results of the present study indicated that previous wedge resection correlated to a higher risk of ectopic pregnancy and uterine rupture. However, it might not be related to an increased risk of adverse neonatal outcomes. The study recommended cesarean section in these patients. Further studies are required to verify the validity of current recommendations.

Surgical training through simulation dedicated to French Ob-gyn residents. Evaluation and satisfaction.

OBJECTIVE: In order to be able to develop surgical training of residents through simulation, we carried out a descriptive study, evaluating the satisfaction of participating residents and the benefit of the workshops offered during the 4 th Junior Master Class, free annual training organized in 2017 in Lille University Hospital. It is dedicated to ob-gyn residents in France, overseas departments and territories. MATERIAL AND METHODS: During two days, plenary sessions and practical workshops on animal models or simulators were organized in laparoscopy, diagnostic and operative hysteroscopy, vaginal surgery and robotic surgery. A questionnaire was given anonymously to each student, collecting on the one hand their surgical curriculum, on the other hand, the evaluations of the theoretical contribution and the quality of the interventions and materials offered during the plenary sessions. The last part was subdivided into a questionnaire specific to each workshop. RESULTS: The 48 residents who voluntarily followed this training were overwhelmingly satisfied with the quality of the training offered. The practical benefits outweighed the theoretical benefits. These workshops improved their practical skills from 63 % to 84 % depending on the workshops offered. In addition, 100 % of students would recommend this training to other residents and consider it useful for their future practice. CONCLUSION: These very satisfactory results encourage us to organize new surgical training. Simulation is the key point for an appropriate surgical learning.

A multicenter observational survey of management strategies in 442 pregnancies with suspected placenta accreta spectrum.

INTRODUCTION: Management options for women with placenta accreta spectrum (PAS) comprise termination of pregnancy before the viable gestational age, leaving the placenta in situ for subsequent reabsorption of the placenta or delayed hysterectomy, manual removal of placenta after vaginal delivery or during cesarean section, focal resection of the affected uterine wall, and peripartum hysterectomy. The aim of this observational study was to describe actual clinical management and outcomes in PAS in a large international cohort. MATERIAL AND METHODS: Data from women in 15 referral centers of the International Society of PAS (IS-PAS) were analyzed and correlated with the clinical classification of the IS-PAS: From Grade 1 (no PAS) to Grade 6 (invasion into pelvic organs other than the bladder). PAS was usually diagnosed antenatally and the operators performing ultrasound rated the likelihood of PAS on a Likert scale of 1 to 10. RESULTS: In total, 442 women were registered in the database. No maternal deaths occurred. Mean blood loss was 2600 mL (range 150-20 000 mL). Placenta previa was present in 375 (84.8%) women and there was a history of a previous cesarean in 329 (74.4%) women. The PAS likelihood score was strongly correlated with the PAS grade (P < .001). The mode of delivery in the majority of women (n = 252, 57.0%) was cesarean hysterectomy, with a repeat laparotomy in 20 (7.9%) due to complications. In 48 women (10.8%), the placenta was intentionally left in situ, of those, 20 (41.7%) had a delayed hysterectomy. In 26 women (5.9%), focal resection was performed. Termination of pregnancy was performed in 9 (2.0%), of whom 5 had fetal abnormalities. The placenta could be removed in 90 women (20.4%) at cesarean, and in 17 (3.9%) after vaginal delivery indicating mild or no PAS. In 34 women (7.7%) with an antenatal diagnosis of PAS, the placenta spontaneously separated (false positives). We found lower blood loss (P < .002) in 2018-2019 compared with 2009-2017, suggesting a positive learning curve. CONCLUSIONS: In referral centers, the most common management for severe PAS was cesarean hysterectomy, followed by leaving the placenta in situ and focal resection. Prenatal diagnosis correlated with clinical PAS grade. No maternal deaths occurred.

A new non-invasive procedure for refractory PPH after vaginal delivery and caesarean section.

Worldwide, the incidence of postpartum haemorrhage (PPH) is ∼6% and it is the leading cause of maternal mortality. The present study introduces a non-invasive procedure called bilateral cervix apex clamping (BCAC) as a new treatment for refractory PPH. A total of 13 vaginal deliveries and 5 caesarean section patients received the BCAC procedure to stop bleeding. During the procedure, the anterior and posterior walls of the cervical apex were clamped using toothless ovum forceps from the left and right side. The procedure was terminated when the bleeding had nearly stopped without clamping. The success rate of the procedure was 94.4% (17/18) overall, and 92.3% for vaginal delivery and 100% in caesarean section patients. Only one case of vaginal delivery did we resort to exploratory laparotomy and hysterectomy as amniotic fluid embolism occurred. The time spent on the procedure was 2-4 min for vaginal delivery cases and 5-7 min for caesarean section patients. The blood loss reduced significantly after the procedure, before the BCAC and after it was 875(450) ml versus 100(80)ml (p < .0001). There was a reduction in the need for UAE (uterine artery embolisation) from 13 in 22,817 deliveries (2013-2015) to 0 in 18,212 deliveries (2016-2017 (p < .001). But no change in the rate of hysterectomy (5/22817 versus 5/18212) (p = .76). BCAC is a simple, easy, safe, effective and non-invasive procedure that can decrease bleeding in patients with PPH.Impact statementWhat is already known on this subject? The BCAC clamping procedure was first described in Russia 80 years ago as the Genkel-Tikanadze method. But a PUBMED search did not identify and previous studies published on use of the technique.What do the results of this study add? The results of this study show that the BCAC clamping procedure can reduce bleeding significantly in refractory postpartum haemorrhage, when the uterine body is well contracted. The procedure can be performed after both in vaginal delivery and caesarean section. It can also reduce the necessity for UAE and balloon tamponade.What are the implications of these findings for clinical practice and/or further research? BCAC can be used after the failure of regular first line therapy for postpartum haemorrhage.

Pelvic organ prolapse and uterine preservation: a survey of female gynecologists (POP-UP survey).

BACKGROUND: The aim of this study was to explore the personal views of female gynecologists regarding the management of POP with a particular focus on the issue of uterine sparing surgery. METHODS: A questionnaire based survey of practicing female gynecologists in the Czech Republic, Slovenia and Slovakia. RESULTS: A total of 140 female gynecologists from 81 units responded to our questionnaire. The majority of respondents stated they would rely on a urogynecologist to aid them with their choice of POP management options. The most preferred options for POP management were sacrocolpopexy and physiotherapy. Almost 2/3 of respondents opted for a hysterectomy together with POP surgery, if they were menopausal, even if the anatomical outcome was similar to uterine sparing POP surgery. Moreover, 81.4% of respondents, who initially opted for a uterine sparing procedure, changed their mind if the anatomical success of POP surgery with concomitant hysterectomy was superior. Discussing uterine cancer risk in relation to other organs had a less significant impact on their choices. CONCLUSIONS: The majority of female gynecologists in our study opted for hysterectomy if they were postmenopausal at the time of POP surgery. However, variation in information provision had an impact on their choice.

Developing a 3D animation tool to improve veterinary undergraduate understanding of obstetrical problems in horses.

BACKGROUND: Many challenges are encountered in both teaching and learning veterinary obstetrics. This may be due to outdated teaching materials, as the main model of content transmission remains centred around text and images. METHODS: Visualisation methods such as three-dimensional (3D) and Graphics Interchange Format (GIF) tools were applied in an attempt to improve obstetrics education outcomes in the third-year class. Traditional teaching methods were utilised in the fourth-year and fifth-year students. RESULTS: These supplementary tools significantly increased the third-year students' final examination results compared with the results of fourth-year and fifth-year students (P<0.05). These examinations were designed to evaluate comprehension of the subject matter. Self-assessment questionnaire results further indicated that 3D animation and GIF promoted learning efficiency. CONCLUSION: Incorporation of 3D animation learning tools into the veterinary curriculum is predicted to better prepare students for the management of obstetrical cases after graduation.

[Epidemiological, clinical and therapeutic features of acute pelvic pain in female patients hospitalized in the Yaoundé Gynaecology-Obstetrics and Pediatrics Hospital]. / Aspects épidémiologiques, cliniques et thérapeutiques des algies pelviennes aiguës de la femme à l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé (HGOPY).

INTRODUCTION: Acute pelvic pain is an important cause of morbi-mortality. The purpose of this study was to describe the epidemiological, clinical and therapeutic features of acute pelvic pain in Yaoundé. METHODS: We conducted a cross-sectional, descriptive study with collection of prospective data in the Department of Gynecology and Obstetrics at the Yaoundé Gynaecology-Obstetrics and Pediatrics Hospital over the period 1st April-31st July 2015. We included all female subjects admitted for pelvic pain whose course was less than one month and who agreed to participate in the study. All women who were in the third trimester of pregnancy or in the post-partum period were excluded. Epi info software, version 3.5.4 was used to analyze data. Data were shown as frequency and percentage. RESULTS: During the study period, a total of 5915 women presented to the Yaoundé Gynaecology-Obstetrics and Pediatrics Hospital, of whom 125 (2.11%) had acute pelvic pain. The average age of patients was 29.5 ± 6.9 years. Pain was caused by upper genital tract infections (36.8%) and ectopic pregnancy (18.4%). Most patients received medical treatment (92.8%), associated with antibiotics in 65.5% of cases, anti-inflammatory drugs in 56.9% of cases and analgesics in 39.7% of cases. Surgery was performed in 25 (20%) patients via laparotomy (80%) and coelioscopy (20%). Surgery was indicated in patients with ectopic pregnancy (76% of cases). Regression of pain was obtained in 99% of cases. CONCLUSION: Acute pelvic pain mainly affected young women with upper genital tract infections and ectopic pregnancy. In the case of ectopic pregnancy surgical treatment via laparotomy was the gold standard treatment.

Society for Maternal-Fetal Medicine (SMFM) Consult Series #49: Cesarean scar pregnancy.

Cesarean scar pregnancy is a complication in which an early pregnancy implants in the scar from a prior cesarean delivery. This condition presents a substantial risk for severe maternal morbidity because of challenges in securing a prompt diagnosis, as well as uncertainty regarding optimal treatment once identified. Ultrasound is the primary imaging modality for cesarean scar pregnancy diagnosis, although a correct and timely determination can be difficult. Surgical, medical, and minimally invasive therapies have been described for cesarean scar pregnancy management, but the optimal treatment is not known. Women who decline treatment of a cesarean scar pregnancy should be counseled regarding the risk for severe morbidity. The following are Society for Maternal-Fetal Medicine recommendations: We recommend against expectant management of cesarean scar pregnancy (GRADE 1B); we suggest operative resection (with transvaginal or laparoscopic approaches when possible) or ultrasound-guided vacuum aspiration be considered for surgical management of cesarean scar pregnancy and that sharp curettage alone be avoided (GRADE 2C); we suggest intragestational methotrexate for medical treatment of cesarean scar pregnancy, with or without other treatment modalities (GRADE 2C); we recommend that systemic methotrexate alone not be used to treat cesarean scar pregnancy (GRADE 1C); in women who choose expectant management and continuation of a cesarean scar pregnancy, we recommend repeat cesarean delivery between 34 0/7 and 35 6/7 weeks of gestation (GRADE 1C); we recommend that women with a cesarean scar pregnancy be advised of the risks of another pregnancy and counseled regarding effective contraceptive methods, including long-acting reversible contraception and permanent contraception (GRADE 1C).

Risk factors for spontaneous miscarriage above 12 weeks or premature delivery in patients undergoing cervical polypectomy during pregnancy.

BACKGROUND: It currently remains unknown whether the resection of cervical polyps during pregnancy leads to miscarriage and/or preterm birth. This study evaluated the risk of spontaneous PTB below 34 or 37 weeks and miscarriage above 12 weeks in patients undergoing cervical polypectomy during pregnancy. METHODS: This was a retrospective monocentric cohort study of patients undergoing cervical polypectomy for clinical indication. Seventy-three pregnant women who underwent polypectomy were selected, and risk factors associated with miscarriage above 12 weeks or premature delivery below 34 or 37 weeks were investigated. A multivariable regression looking for predictors of spontaneous miscarriage > 12 weeks and PTB < 34 or 37 weeks were performed. RESULTS: Sixteen patients (21.9%, 16/73) had spontaneous delivery at < 34 weeks or miscarriage above 12 weeks. A univariate analysis showed that bleeding before polypectomy [odds ratio (OR) 7.7, 95% confidence interval (CI) 1.6-37.3, p = 0.004], polyp width ≥ 12 mm (OR 4.0, 95% CI 1.2-13.1, p = 0.005), the proportion of decidual polyps (OR 8.1, 95% CI 1.00-65.9, p = 0.024), and polypectomy at ≤10 weeks (OR 5.2, 95% CI 1.3-20.3, p = 0.01) were significantly higher in delivery at < 34 weeks than at ≥34 weeks. A logistic regression analysis identified polyp width ≥ 12 mm (OR 11.8, 95% CI 2.8-77.5, p = 0.001), genital bleeding before polypectomy (OR 6.5, 95% CI 1.2-55.7, p = 0.025), and polypectomy at ≤10 weeks (OR 5.9, 95% CI 1.2-45.0, p = 0.028) as independent risk factors for predicting delivery at < 34 weeks. Polyp width ≥ 12 mm and bleeding before polypectomy are risk factors for PTB < 37 wks. CONCLUSIONS: Our cohort of patients undergoing polypectomy in pregnancy have high risks of miscarriage or spontaneous premature delivery. It is unclear whether these risks are given by the underlying disease, by surgical treatment or both. This study establishes clinically relevant predictors of PTB are polyp size> 12 mm, bleeding and first trimester polypectomy. PTB risks should be exposed to patients and extensively discussed with balancing against the benefits of intervention in pregnancy.

Core outcome set for studies investigating management of selective fetal growth restriction in twins.

OBJECTIVE: Selective fetal growth restriction (sFGR) occurs in monochorionic twin pregnancies when unequal placental sharing leads to restriction in the growth of just one twin. Management options include laser separation of the fetal circulations, selective reduction or expectant management, but what constitutes the best treatment is not yet known. New trials in this area are urgently needed but, in this rare and complex group, maximizing the relevance and utility of clinical research design and outputs is paramount. A core outcome set ensures standardized outcome collection and reporting in future research. The objective of this study was to develop a core outcome set for studies evaluating treatments for sFGR in monochorionic twins. METHODS: An international steering group of clinicians, researchers and patients with experience of sFGR was established to oversee the process of development of a core outcome set for studies investigating the management of sFGR. Outcomes reported in the literature were identified through a systematic review and informed the design of a three-round Delphi survey. Clinicians, researchers, and patients and family representatives participated in the survey. Outcomes were scored on a Likert scale from 1 (limited importance for making a decision) to 9 (critical for making a decision). Consensus was defined a priori as a Likert score of ≥ 8 in the third round of the Delphi survey. Participants were then invited to take part in an international meeting of stakeholders in which the modified nominal group technique was used to consider the consensus outcomes and agree on a final core outcome set. RESULTS: Ninety-six outcomes were identified from 39 studies in the systematic review. One hundred and three participants from 23 countries completed the first round of the Delphi survey, of whom 88 completed all three rounds. Twenty-nine outcomes met the a priori criteria for consensus and, along with six additional outcomes, were prioritized in a consensus development meeting, using the modified nominal group technique. Twenty-five stakeholders participated in this meeting, including researchers (n = 3), fetal medicine specialists (n = 3), obstetricians (n = 2), neonatologists (n = 3), midwives (n = 4), parents and family members (n = 6), patient group representatives (n = 3), and a sonographer. Eleven core outcomes were agreed upon. These were live birth, gestational age at birth, birth weight, intertwin birth-weight discordance, death of surviving twin after death of cotwin, loss during pregnancy or before final hospital discharge, parental stress, procedure-related adverse maternal outcome, length of neonatal stay in hospital, neurological abnormality on postnatal imaging and childhood disability. CONCLUSIONS: This core outcome set for studies investigating the management of sFGR represents the consensus of a large and diverse group of international collaborators. Use of these outcomes in future trials should help to increase the clinical relevance of research on this condition. Consensus agreement on core outcome definitions and measures is now required. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Is Communication Improved With the Implementation of an Obstetrical Version of the World Health Organization Safe Surgery Checklist?

OBJECTIVE: Communication failures are consistently seen as a root cause of preventable adverse outcomes in obstetrics. We assessed whether use of an Obstetric Safe Surgery Checklist for cesarean deliveries (CDs), based on the WHO Safe Surgery Checklist, can improve communication; reduce team member confusion about urgency of the case; and decrease documentation discrepancies among nursing, obstetric, anesthesia, and pediatric staff. METHODS: Retrospective review of 600 CDs on our 2 labor and delivery suites before and after the introduction of 2 consecutive versions of our obstetric safe surgery checklist (100 cases in each cohort) was undertaken. The first version was released in 2010, and after modifications based on initial findings, our current version was released in 2014. One hundred consecutive CDs were identified from each of the 3 periods at each hospital, and charts for those patients and newborns were abstracted. Notes by obstetricians, nurses, anesthesiologists, and pediatricians were reviewed. We compared the rates of agreement in the documentation of the indication for the CD between the different members of the team. Chi-square analyses were performed. RESULTS: Complete agreement among the 4 specialties in the documented indication for CD before introduction of our initial safe surgery checklist was noted in 59% (n = 118) of cases. After initial checklist introduction, agreement decreased to 43% (n = 86; P = 0.002). We then modified our checklist to include indication for CD and level of urgency and changed our policy to include pediatric staff participation in the timeout. Agreement in a subsequent chart review increased to 80% (n = 160), significantly better than in our initial analysis (P < 0.001) and our interim review (P < 0.001). The greatest improvement in agreement was observed between obstetricians and pediatricians. CONCLUSIONS: Implementation of a safe surgery checklist can improve communication at CDs, but care should be taken when implementing checklists because they can have unanticipated consequences. Ongoing review and modification are critical to ensure safer medical care.

Hypnosis, anesthesia, pain management, and preparation for medical procedures.

Hypnosis has a long history of use for anesthesia and pain management, as well as in assisting patient to prepare for medical procedures. This article reviews the history of hypnosis applications in clinical medicine and dentistry. Research on hypnotic susceptibility or hypnotic ability shows that the ability to respond effectively to hypnosis is a relatively stable trait, partially heritable, and measurable by means of several standard procedures. Persons low in hypnotic ability may benefit from alternative therapeutic interventions; however, the majority of medical patients will benefit from the integration of adjunctive hypnotic therapies into their medical and dental care. The article closes with a discussion of the stronger evidence-based applications of hypnosis in healthcare, and the need for well-trained certified hypnosis practitioners.

Bilateral cervix apex clamping procedure can be used as a new noninvasive second line therapy for postpartum hemorrhage.

In this study, we present a noninvasive procedure of bilateral cervix apex clamping (BCAC) procedure to control refractory postpartum hemorrhage (PPH) in vaginal delivery as a new second line therapy for refractory PPH. The procedure clamps the anterior and posterior walls of the cervical apex using toothless ovum forceps to arrest bleedingafter the failure of the first line therapy for PPH. 44 women were performed BCAC to control persistent bleeding in 13,359 vaginal deliveries from 1 January 2016 to 31 May 2018. In all of the BCAC, it can reduce bleeding significantly. The bleeding speed after BCAC was far less than that before it (2.64 ± 4.99 ml/min vs 20.23 ± 9.40 ml/min P < 0.001). The blood loss after BCAC was less than that before it (146.57 ± 170.83 vs 797.84 ± 200.73 ml P < 0.001). 41 (93.2%) BCACsucceeded and 3(6.8%) failed turned to intrauterine balloon tamponade, 2 succeeded and 1 failed turned to hysterectomy. In the successful group the bleeding speed after the BCAC was 1.38 ± 0.99 ml/min less than that 19.84 ± 6.27 ml/min in the failure group. (p < 0.001). The blood loss in the success group is also less than that in the failure ones after BCAC (107.29 ± 78.36mL vs 683.33 ± 202.07 ml P < 0.001) Even in the failure group, the bleeding speed also reduced after BCAC compared with that before BCAC (19.84 ± 6.27 vs 29.17 ± 7.12 ml/min p = 0.02). But the blood loss had no statistical difference (683.33 ± 202.07 vs 950 ± 132.29 ml p = 0.27) In all of the 13,359 vaginal deliveries, the incidence of PPH was 1.21% while the severe PPH was only 0.27%. The BCAC may reduce the incidence of severe PPH (0.27%) and also can reduce the necessity of IUBT (3/13,359 0.22‰), uterine artery embolization (UAE) (0/13,359) and even the exploratory laparotomy hysterectomy (1/13,359). Because it is effective, convenient, cheap and noninvasive, so we think it can be used as a new second line noninvasive treatment for PPH.

Surgical repair of traumatic cloaca: a modified technique.

AIM: A modified repair technique for traumatic cloaca caused by obstetric anal sphincter injury was evaluated, and its feasibility and functional outcome were investigated. METHODS: A retrospective review of 23 consecutively enrolled patients diagnosed with traumatic cloaca who underwent the modified repair technique between September 2010 and August 2018 was performed. Demographic, clinical feature, operative and follow-up data were recorded. RESULTS: The patients diagnosed with traumatic cloaca who underwent surgical repair after obstetric anal sphincter injury had a median time from obstetric injury of 24 (12-35) years. The median preoperative Wexner faecal incontinence score was 16 (14-17). The postoperative hospital stay was 6 (6-7) days. The median postoperative Wexner faecal incontinence score decreased to 2 (2-3). The anal resting pressure increased from 9.00 (5.25-11.50) mmHg to 56.00 (55.00-65.75) mmHg (P < 0.01) and the anal squeeze pressure increased from 29.00 (22.50-33.20) mmHg to 110.00 (96.20-121.50) mmHg (P < 0.01) at 2 months after the repair. Sixteen patients completed the Faecal Incontinence Quality of Life Scale questionnaire, and there were significant improvements 1 year after surgical repair in lifestyle (3.10 [2.60-3.70] vs 2.60 [1.90-3.00], P < 0.01), coping/behaviour (3.38 [2.57-3.44] vs 2.33 [1.89-3.00], P < 0.01), depression/self-perception (3.11 [2.27-3.44] vs 2.33 [1.89-3.00], P < 0.01) and embarrassment (3.33 [2.75-3.67] vs 2.33 [2.33-3.00], P < 0.01). No patient presented rectovaginal fistula postoperatively within the median follow-up period of 24 (12-48) months. CONCLUSIONS: The modified repair technique for traumatic cloaca is feasible and achieves good functional outcomes and improved life quality.