ABSTRACT
Background: The introduction of vaginal natural orifice transluminal endoscopic surgery (vNOTES) to the toolbox of gynecologic surgeons has the potential to reverse the trend of vaginal hysterectomy declines. Methods: This review discusses nuances of the vNOTES technique applied to hysterectomy; describes vNOTES hysterectomy, step-by-step (including tips and tricks for low- and high-complexity cases for surgeons who may want to incorporate vNOTES hysterectomy into their surgical repertoires); and examines evidence and research trends in this field. Results: The descriptions in the text, figures, tables, and videos all contribute to giving readers a clear understanding of vNOTES, its advantages, limitations, and research potentials. Conclusions: vNOTES hysterectomy is a unique blend of vaginal, laparoscopic, and laparoendoscopic single-site surgery (LESS) techniques and is not a new procedure, but rather another tool to use in minimally invasive gynecologic surgery. (J GYNECOL SURG 40:78).
ABSTRACT
OBJECTIVE: To investigate associations between neonatal delivery weight and future risk of maternal type 1 or type 2 diabetes. METHODS: Data included in the Swedish Medical Birth Registry and Swedish National Diabetes Registry were merged to include all women born during 1930-1989; patients with pre-existing diabetes or gestational diabetes were excluded. Cox regression analyses were performed to identify associations between the neonatal delivery weight from the most recent pregnancy and later occurrence of diabetes. RESULTS: There were 1 873 440 patients included in the analyses. An increased risk of type 1 (hazard ratio 3.60, 95% confidence interval [CI] 3.23-4.01) or type 2 diabetes (hazard ratio 2.77, 95% CI 2.68-2.87) was observed among patients who had a large for gestational age neonate compared with patients who had neonates within one standard definition of the mean weight for gestational age; the odds of developing type 1 (odds ratio 10.27, 95% CI 7.37-14.31) or type 2 diabetes (odds ratio 8.50, 95% CI 6.01-12.02) within 1 year of delivery was also increased compared with patients who had a neonate within one standard deviation of the mean weight for gestational age. CONCLUSIONS: Delivering a large for gestational age neonate was a potent risk factor for the later development of maternal type 1 or type 2 diabetes.
Subject(s)
Birth Weight , Diabetes Mellitus, Type 1/etiology , Diabetes Mellitus, Type 2/etiology , Adult , Female , Humans , Infant, Newborn , Odds Ratio , Parturition , Postpartum Period , Pregnancy , Proportional Hazards Models , Registries , Regression Analysis , Risk Factors , SwedenABSTRACT
OBJECTIVE: Due to the high incidence of neonatal complications in diabetic pregnancies, the aim of our study was to investigate whether elective cesarean section could prevent adverse neonatal outcome. DESIGN: Population-based study. SETTING: Data were extracted from the Swedish Medical Birth Registry. POPULATION: All women (n=13 491) with diabetic pregnancies during the period 1990-2007. METHODS: Neonatal outcome in diabetic pregnancies was compared after elective cesarean section at 38 completed gestational weeks with planned vaginal delivery at 39 completed weeks of gestation or later. Odds ratios with 95% confidence intervals for Apgar scores <7 at 5 min after birth were calculated using multiple logistic regression. MAIN OUTCOME MEASURES: Apgar score <7 at 5 min after birth. RESULTS: A significantly decreased risk of Apgar score <7 at 5 min after birth in the group who underwent an elective cesarean section at 38 completed gestational weeks was found compared with those who continued pregnancy to 39 completed weeks of gestation or more, irrespective of final mode of delivery. CONCLUSIONS: Our results indicate a protective effect of planned cesarean section on the risk of low Apgar scores in diabetic pregnancies.
