Weight management during pregnancy: a qualitative thematic analysis on knowledge, perceptions and experiences of overweight and obese women in Singapore.

BACKGROUND: The effect of maternal weight on pregnancy and birth outcomes is of great public health concern. For example, overweight and obesity among pregnant women is associated with adverse reproductive health outcomes including gestational diabetes, birth defects, macrosomia and infant mortality. OBJECTIVES: To understand the knowledge, perceptions and experiences during pregnancy among overweight and obese women in Singapore. METHODS: This is a cross-sectional study which employed qualitative techniques. The inclusion criteria is as follows: (1) Women who were overweight or obese before or during first trimester of pregnancy, (2) are able to report their specific pre-pregnancy or first trimester Body Mass Index (BMI), or weight and height, (3) had singleton pregnancy when overweight, are post-delivery for the pregnancy in which they were overweight, and (4) are 21 to 55 years old. Fifteen interviews were voice-recorded and transcribed verbatim. Then, two researchers independently performed the thematic analysis of the transcripts. RESULTS: The findings revealed that women had gaps in knowledge on the adverse effects of maternal overweight and obesity during pregnancy, and various misconceptions on diet and weight management during pregnancy were prevalent. Conflicting data was obtained for perceptions on the importance, difficulty and levels of motivation for weight management during pregnancy. CONCLUSION: There is a pressing need to address knowledge gaps and misconceptions of pregnant women who are overweight or obese. The importance of weight management during pregnancy should be emphasized, and enabling factors put in place.

Taking a Step Forward in Laparoscopic Donor Nephrectomy: Transvaginal Retrieval of Donor's Kidney.

Laparoscopic donor nephrectomy has been broadly recognized as the gold standard for kidney procurement used in kidney transplantation where it is not uncommon for donors to experience discomfort and aesthetic dissatisfaction over larger incision site. Natural orifice transluminal endoscopic surgery is a surgical approach that allows scarless intraabdominal operations through natural orifices, such as the vagina. In this case report, we describe the first case of transvaginal retrieval of donor's kidney at the National University Hospital, Singapore. A 51-year-old Malay lady with no significant medical history volunteered to a living-related kidney donor. Perioperative antibiotics were administered. A 12 mm Excel port was placed over the left iliac fossa with camera insertion. Two additional ports were inserted over the left rectus sheath edge and left costal margin under direct vision. An additional 5 mm port at the left loin was placed for lateral retraction. A vaginal probe was then inserted to facilitate posterior colpotomy and transection of the left uterosacral ligament. Pneumoperitoneum was subsequently maintained with a LiNA McCartney(®) Tube. A 15 mm Endocatch(®) bag was inserted for retrieval of the kidney. The left kidney was placed in the Endocatch bag after transection of the hilar vessels where the kidney was retrieved vaginally with ease. Colpotomy was closed vaginally using Vicryl-0 continuous suture. Total blood loss was noted as 50 mL with warm ischemia time being 7 minutes and the entire retrieval taking totally 20 minutes. Postoperative recovery was uneventful and the donor was discharged stable 3 days postoperation. The transplanted kidney retained normal graft function. Colpotomy retrieval for donor nephrectomy presents an innovative method for specimen retrieval with minimal disruption of donor anatomy. Doing away with laparotomy for kidney retrieval has indeed shown a reduction in recovery time, reduced postoperative pain, and better cosmetic outcome.

Minilaparoscopic hysterectomy made easy: first report on alternative instrumentation and new integrated energy platform.

Minilaparoscopy is an attractive approach for hysterectomy due to advantages such as reduced morbidities and enhanced cosmesis. However, it has not been popularized due to the lack of suitable instruments and high technical demand. We aim to highlight the first case of minilaparoscopic hysterectomy reported in Asia and the use of a new integrated energy platform, Thunderbeat. We would like to propose an alternative method of instrumentation, so as to improve the feasibility and safety of minilaparoscopic hysterectomy. The first minilaparoscopic hysterectomy in Singapore was successfully completed using the alternative instrumentation and new energy platform. There was no conversion or complication during the surgery. The patient recovered uneventfully. To our knowledge, this is the first report on the use of such alternative instrumentation. This approach in instrumentation and the new energy platform will improve the feasibility and speed of the surgery and ensure safety in our patients.

Get "real" with hysteroscopy using the pig bladder: a "uterine" model for hysteroscopy training.

INTRODUCTION: This study aimed to develop a realistic and lifelike uterine model for the training of hysteroscopy skills. MATERIALS AND METHODS: A lifelike "uterine" model was constructed using female pig bladder. The pig bladder was enclosed within a malleable mould, with both ureters blocked by pins. Both rigid and flexible hysteroscopes were used in this study. RESULTS: Basic diagnostic hysteroscopy can be performed in the usual fashion using this lifelike model. The cost of each learning station is minimal. Pig bladder accurately simulates the human uterus with its realistic tactile feel, and conditions in the surgical environment, including obscuration of vision by debris, uterine "folds", realistic "ostia", incomplete shearing of tissue, "uterine" perforation, etc. CONCLUSION: This low-cost novel model provides realistic tissue resistance and yields an almost anatomically accurate hysteroscopic training tool, thereby allowing trainees to effectively acquire both diagnostic and therapeutic hysteroscopic skills.

Laparoendoscopic Single-Site Surgery (LESS) for a Large Ovarian Tumour: First Clinical Case Report.

Objective. To report the feasibility of removing a 10 cm ovarian fibroma via a laparoendoscopic single-site trocar through trans-umbilical access. Design. Case report. Setting. Teaching and research hospital. Patient. A 64-year-old patient affected by a large 10 cm ovarian tumour. Intervention(s). Bilateral salpingo-oophorectomy a large 10 cm ovarian tumour, using a laparoendoscopic single-site approach with a Covidien SILS multitrocar access device and standard laparoscopic instruments. Main Outcome Measure(s). Conversion to standard laparoscopic technique or laparotomy, estimated blood loss, operative time , extent of scarring, occurrence of intra- and perioperative surgical complications, technical adequacy, and clinical outcome. Result(s). No conversion to standard laparoscopic technique or laparotomy, and no intraoperative or postoperative complications were observed. Total operative time was 99 minutes. The patient was discharged home on postoperative day one. Conclusion(s). Laparoendoscopic single-site bilateral salpingo-oophorectomy of a large ovarian tumour is feasible with standard laparoscopic instruments. It is safe and effective, with good results in terms of excellent cosmesis and minimal postoperative pain.

Effects of Mirena (levonorgestrel-releasing intrauterine system) and Ortho Gynae T380 intrauterine copper device on lipid metabolism--a randomized comparative study.

BACKGROUND: This study aims to assess the effects of levonorgestrel-releasing intrauterine system (LNG-IUS) on lipid metabolism in an Asian population using Ortho Gynae T380 copper containing (nonhormonal) intrauterine device (IUD) as a control. STUDY DESIGN: Ninety-two healthy women requesting IUD for contraception were randomly allocated to the two groups and were followed up at 6-, 12- and 18-month intervals. Serum concentrations of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), apolipoprotein A-I (Apo A-I) and apolipoprotein B were measured pre insertion and at each visit following insertion. RESULTS: There was a marginally significant reduction in TC level in the LNG-IUS group. HDL-C showed a significant reduction in the LNG-IUS group at 6 months but reverted back to its preinsertion value by 1 year. TG, LDL-C and the cholesterol ratios remained stable. Levels of Apo A-I and B also showed no significant reduction in both groups, and their ratios remained stable and insignificant. CONCLUSION: In this randomized comparative study among our local Asian population, it is assuring to note that the LNG-IUS does not have any adverse effects on lipid metabolism.