Surgical repair of pelvic-floor prolapse: lessons learned from longitudinal follow-up of quality-of-life survey.

BACKGROUND: Scant evidence has been reported on the evaluation of quality-of-life (QOL) in patients who had undergone surgical treatment due to pelvic floor prolapse including cystocele. The aim of this study is to evaluate the impact of surgical intervention on patients' QOL before and after surgery. METHODS: Between 1997 and 2007, 135 patients (median age: 66.6 years) with pelvic floor prolapse including cystocele underwent bladder neck suspension with anterior/posterior colporrhaphy. The follow-up period was 39.6 months. Seventy-two patients (53 %) had urinary incontinence. The cystocele was graded as mild (grade 2), moderate (grade 3), and severe (grade 4) in 35, 60, and 40, respectively, according to the Baden-Walker classification. A urodynamic study was performed in 69 patients (51 %) who had obstructive symptoms with 100 ml or more of postvoid residual urine. Postoperative QOL was longitudinally assessed in 114 patients by scoring three disease-specific items (sensation of vaginal bulging, obstructive symptoms, urinary incontinence), and one overall health-related QOL (HR-QOL), and compared with corresponding baseline scores. RESULTS: A longitudinal study demonstrated that a significant improvement in these symptoms was sustained at a median follow-up of 62.2 months. HR-QOL was significantly associated with vitality assessed by SF 36 (p = 0.036). Multivariate analysis revealed that update urinary incontinence, pre-operative HR-QOL was independent prognostic factors for predicting postoperative patient's satisfaction. CONCLUSIONS: Although surgical repair of pelvic floor prolapse can achieve acceptable results with intermediate-term durability as well as improving the QOL, preoperative patients' HR-QOL may be considered in the decision making process for treatment.

Analysis of fetal movements by Doppler actocardiogram and fetal B-mode imaging.

We have presented that fetal surveillance may be enhanced by use of the fetal actocardiogram and by computerized processing of fetal motion as well as fetal B-mode ultrasound imaging. Ultrasonic Doppler fetal actogram is a sensitive and objective method for detecting and recording fetal movements. Computer processing of the actograph output signals enables powerful, detailed, and convenient analysis of fetal physiologic phenomena. The actocardiogram is a useful measurement tool not only in fetal behavioral studies but also in evaluation of fetal well-being. It reduces false-positive, nonreactive NST and false-positive sinusoidal FHR pattern. It is a valuable tool to predict fetal distress. The results of intrapartum fetal monitoring are further improved by the antepartum application of the actocardiogram. Quantified fetal motion analysis is a useful, objective evaluation of the embryo and fetus. This method allows monitoring of changes in fetal movement, as well as frequency, amplitude, and duration. Furthermore, quantification of fetal motion enables evaluation of fetal behavior states and how these states relate to other measurements, such as changes in FHR. Numeric analysis of both fetal actogram and fetal motion from B-mode images is a promising application in the correlation of fetal activity or behavior with other fetal physiologic measurements.

[Studies on features of fetal movement and development of human fetus with use of fetal actogram].

In 167 normal fetuses at 26 to 41 weeks of gestation, features of fetal movement and fetal development were investigated with use of actocardiograph in connection with a microcomputer system. The signals of fetal movement obtained by actocardiograph were stored in a floppy disc every 250 ms for 5 minutes through an AD-converter, and were analyzed every 5 minutes with the computer to reveal 3-dimensional (3-D) histograms. The 3-D histogram of fetal movement was composed of number, amplitude and interval of the signals in 11 voltage steps between 0.05 and 0.55V. The histogram clearly indicated state of fetal behavior, being either resting or active state. Fetal movement such as rolling movement, breathing movement and hiccup could be also identified with the computer analysis. In 68 normal fetuses at 14 to 41 weeks of gestation, the cross-correlation between fetal movement and fetal heart rate (FHR) were examined with the computer analysis. Finally fetal responses to acoustic and light stimulation were evaluated with use of pure-tone generator and flashlight. Acoustic stimulation was carried out in 53 normal fetuses at 28 to 41 weeks and light stimulation was performed in 116 normal fetuses at 18 to 41 weeks of gestation. The fetal responses were evaluated with actocardiogram. As a result, 1) Frequency in active state decreased and resting state increased as gestational weeks advanced, and then the frequencies of both state remained constant after 37 weeks of gestation. Duration of resting state also increased from 26 weeks to 37 weeks. These observations may suggest that fetal behavior can be established by 37 weeks of gestation. 2) Frequency in rolling movement decreased until 37 weeks of gestation, and then the movement increased during 38-41 weeks. Frequency in breathing movement increased to 33 weeks of gestation, then it remained constant. Hiccup occurred most frequently at 30-33 weeks, and it decreased thereafter. The function in fetal respiratory movement may be accomplished by 33 weeks of gestation. 3) Positive cross-correlation between fetal movement and FHR was observed as gestational weeks advanced. The correlation coefficient increased from 14 weeks up to 41 weeks. Acceleration of FHR following fetal movement eventually occurred in fetuses at 16 weeks, but the onset of acceleration delayed than normally occurred in developed fetuses. The delay was shortened in fetuses at 24 weeks and this was comparable to the delay in developed fetuses. These results suggest that the linkage of the acceleration of FHR with fetal movement is established at 24 weeks of gestation.(ABSTRACT TRUNCATED AT 400 WORDS)

Objective and quantitative evaluation of fetal movement with ultrasonic Doppler actocardiogram.

Actocardiogram is the simultaneous recording of fetal movement (FM) and fetal heart rate (FHR) with the use of a single transducer by weak ultrasound. Fetal behavioral states, fetal hiccups, nonpathologic sinusoidal FHR pattern induced by cyclic FM were reported in the use of this technique. Computer processing of FM signals enabled automatic recognition of fetal behavior. Fetal hypoxic state preceding fetal distress was diagnosed by the actocardiogram. Cross-correlation coefficient of FHR and delayed FM was high, showing a new possibility of detailed grading of mild fetal hypoxia.

The ultrasonic Doppler fetal actocardiogram and its computer processing.

Gross fetal movement was detected using a lower frequency ultrasonic Doppler shift than that used in the study of fetal heart action. The movement signal was changed into deflection which was recorded on CTG chart simultaneously with the fetal heart rate (FHR), and was called the fetal actocardiogram. Visual analysis of the actocardiogram showed bursts of active fetal movements in the active fetal state which were concordant with acceleration of FHR. The analysis was useful in the study of fetal behavioural states. Imminent fetal distress produced a loss of FHR acceleration which was accompanied by a burst of fetal movement, i.e. a true non-reactive state of the FHR. The output of the actocardiograph was analysed using a PC98XA computer with a simple statistics of deflection amplitude and interval, displayed as 3-dimensional histograms of the number and frequency, and the formation of the envelope curve of the deflections. The study demonstrated that it is possible to recognize fetal behavioural states automatically. This includes active and resting fetal states as well as fetal breathing movements.

Severe fetal supraventricular bradyarrhythmia without fetal hypoxia.

Cardiac anatomy and rhythm were evaluated in a fetus at 39 weeks' gestation in a pregnant woman referred because of severe fetal bradycardia with a persistent fetal heart rate of 50-60 beats per minute. M-mode echocardiograms revealed supraventricular bradyarrhythmia. Umbilical cord blood analysis did not, however, reveal fetal hypoxia. Diagnostic methods of fetal bradyarrhythmia are discussed, and the importance of differentiating bradyarrhythmia from bradycardia due to fetal hypoxia is emphasized.

Evaluation of fetal development and well-being with ultrasonic Doppler fetal actocardiogram.

A new ultrasonic technique for objective, continuous and simple recordings method of fetal movements on CTG chart has been introduced. Fetal activity and heart-rate will be correlated. This allows a differentiation of fetal active and resting states. The duration of the first one was 24 to 150 minutes, that of the last one 10 to 36 minutes. Fetal actogram is useful in the prediction of imminent fetal distress.

[Evaluation of a non-stress test by automated FHR (fetal heart rate) analysis].

The changes in 5 parameters in 1080 5 minute periods obtained by automated FHR analysis were evaluated in 140 normal and premature labor patients at 26 to 41 weeks of gestation. The FHR-baseline level was between 140.29 +/- 5.04 and 146.90 +/- 6.94 bpm and showed no significant change between 29 and 31 weeks, but then gradually declined to 134.55 +/- 15.74 bpm by the 41st week. FHR-baseline variability (LTV) showed no significant change in the period between 26 and 32 weeks, and increased to 12.82 +/- 3.16 bpm by the 41st week from 9.96 +/- 3.78 bpm in the 33rd week. Variability in a minute was 4.09 +/- 1.03 at 28 weeks, then increased to 5.63 +/- 0.81 by the 41st week. Variability of which the amplitude was 5 bpm or more in 5 minutes showed no change from the 26th to the 41st week. FHR acceleration in 20 minutes was 1.714 +/- 1.204 at 26 weeks, then increased to 4.357 +/- 2.805 by the 40th week, and the mean values were always more than 2 after 30 weeks.

[Urinary total estrogens in normal menstrual cycle and early pregnancy (author's transl)].

A ratio of urinary total estrogens to creatinine (E/C, micrograms/g) was measured in every morning through the cycle in normal menstruating cycling women and during her early pregnancy. The level of follicular phase was 17.7 +/- 5.4 micrograms/g, ovulatory phase 78.8 +/- 8.8 micrograms/g and luteal phase 26.7 +/- 11.2 micrograms/g. In the spontaneous pregnancies E/C levels elevated sharply after 15 weeks of gestation. In the pregnancy after induced ovulation with clomifene citrate and conjugated estrogens, E/C levels were decreased from 7 days prior to the initiation of genital bleeding of spontaneous abortion. The need for multiple determinations over considerable periods of time is solved by our methods of easily repeated sequential measurements of urinary total estrogens estimated by E/C ratio.