Satisfactory medium-long term patient reported outcomes after laparoscopic single-mesh sacrohysteropexy.

Background: There is scarce information on the effectiveness of the laparoscopic single mesh sacrohysteropexy (smSHP). Attachment of a single sheet of flat mesh posteriorly to the cervix provides less mesh use and a less invasive distal mesh fixation. Objectives: To assess medium to long-term follow-up results of patients who underwent laparoscopic smSHP utilising a less invasive technique with single sheet flat mesh. Materials and Methods: In the present retrospective cohort study, the data of 71 women who underwent laparoscopic smSHP for apical uterine prolapse with or without colporrhaphy (anterior and/or posterior) at the urogynaecology unit of a university hospital between January 2008 and January 2020 was reviewed. Data was collected on demographics, presenting symptoms, preoperative findings, surgery, and postoperative outcomes. Main Outcome Measures: Medium to long-term patient-reported outcomes. Results: The median age of the study population was 44 years. Median follow-up duration was 5 years (1-12). Symptomatic recurrence over time and repeat surgery rates were 13.1% and 3.1% respectively. Comparison of the pre-operative and medium to long-term evaluation scores of the pelvic floor distress inventory-20 (PFDI-20) and assessment of the patient global impression of improvement (PGI-I) revealed long-standing improvement in pelvic floor dysfunction. Conclusions: Laparoscopic smSHP appears to be successful and safe with low recurrence and complication rates and provides satisfactory patient reported outcomes. What's new?: Medium to long-term patient-reported outcomes based on PFDI-20 and PGI-I surveys are satisfactory following smSHP.

Depot-medroxyprogesterone acetate in anticoagulated patients with previous hemorrhagic corpus luteum.

OBJECTIVE: To investigate the safety of depot-medroxyprogesterone acetate (DMPA) in women of reproductive age with prosthetic heart valves, as well as the impact of DMPA on the prevention of hemorrhagic corpus luteum in these patients with previous bleeding events. METHODS: In this prospective study we enrolled 13 patients who were receiving chronic anticoagulation for prosthetic heart valves, and who suffered from ovarian bleeding. After the initial bleeding episode(s), DMPA was initiated with the intent of preventing recurrent bleeding events by means of ovulation suppression. Follow-up included close monitoring of anticoagulation intensity, lipid profile, measurement of systolic and diastolic blood pressures and weight, and a general physical and gynecological examination. RESULTS: Of the participating 13 patients, one stopped DMPA after the third injection because she wanted to have a child. Among the remaining 12 women, over a mean follow-up of 39.9 months all patients were well and no hemorrhagic corpus luteum was observed. During the follow-up, anticoagulation intensity, assessed by the international normalized ratio (INR), was in the optimum therapeutic ranges at all times (range 2.5-3.5), except for values of 4.6, 5.8 and 5.9 in three patients at 9, 12 and 24 months, respectively. With regard to lipid profile, we observed a significant decrease in high-density lipoprotein cholesterol levels at 12 months, and significant increases in total cholesterol and triglyceride levels after 30 months compared to baseline serum levels. No significant changes were observed in serum low-density lipoprotein cholesterol levels. Mean body weight was higher at months 12 and 30, compared with baseline values (p > 0.05). CONCLUSION: DMPA, which is an effective contraceptive agent, can be used to prevent bleeding from the corpus luteum by means of ovulation suppression in anticoagulated patients with prosthetic heart valves. However, meticulous surveillance should be provided during the follow-up, including close monitoring of anticoagulation intensity and lipid profile.

Serum concentrations of lipids and apolipoproteins in normal and hyperemetic pregnancies.

OBJECTIVE: Hyperemesis gravidarum (HEG) is intractable nausea and vomiting. The purpose of this study was to test the hypothesis that women with HEG have lower cholesterol and triglyceride levels, to find any role in the etiology of reduced risk of spontaneous abortion in hyperemetic patients. STUDY DESIGN: The study group consisted of 39 women with normal ongoing pregnancy and 35 women with HEG. The concentrations of triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, total cholesterol and apolipoprotein (apo)-A and -B were analyzed. The independent-samples t test, Mann-Whitney U test, chi2 test, Kruskal-Wallis variance analysis and Spearman's correlation were used to examine differences between groups. RESULTS: Serum HDL cholesterol, LDL cholesterol and total cholesterol, apo-A and apo-B were higher in normal pregnancies compared with hyperemetic pregnancies. There were no significant differences in apo-B/apo-A, HDL cholesterol/apo-A and total cholesterol/HDL cholesterol ratios between the hyperemetic patients and controls. A negative correlation was found between total cholesterol and serum thyroxine level. CONCLUSION: We found decreased levels of total cholesterol, LDL cholesterol, apo-A and apo-B in hyperemetic patients and the same spontaneous abortion rate in the two groups in our study.

Tubal pregnancy after pomeroy sterilization.

Tubal sterilization is one of the options chosen by the women who have completed their fertility. Although ectopic pregnancy after tubal sterilization is rare, all women undergoing this procedure should be informed about the risk of it. An ectopic pregnancy in a 36-year-old woman who had undergone tubal sterilization is described.

Copper, zinc and magnesium status in hyperemesis gravidarum.

Plasma copper (Cu), zinc (Zn) and magnesium (Mg) levels were measured in three groups of women; (1) pregnant women suffering from hyperemesis gravidarum (HG)(n=43); (2) pregnant women with uncomplicated pregnancies (n=11) and (3) non-pregnant women (n=11). Plasma Cu, Zn and Mg levels were measured by atomic absorbtion spectrophotometer. We determined that plasma Zn and Mg levels were lower in patients with HG and significant differences were noted between the control groups and HG patients (P < 0.05, P < 0.01). We still need further large cohort studies in order to understand if this is the cause or consequence of hyperemesis gravidarum.