Outcomes following treatment for pelvic floor mesh complications.

INTRODUCTION AND HYPOTHESIS: Our aim was to determine symptoms and degree of improvement in a cohort of women who presented following treatment for vaginal mesh complications. METHODS: This study was a follow-up to a multicenter, retrospective study of women who presented to four tertiary referral centers for management of vaginal-mesh-related complications. Study participants completed a one-time follow-up survey regarding any additional treatment, current symptoms, and degree of improvement from initial presentation. RESULTS: Two hundred and sixty women received surveys; we had a response rate of 41.1 % (107/260). Complete data were available for 101 respondents. Survey respondents were more likely to be postmenopausal (p = 0.006), but otherwise did not differ from nonrespondents. Fifty-one percent (52/101) of women underwent surgery as the primary intervention for their mesh complication; 8 % (4/52) underwent a second surgery; 34 % (17/52) required a second nonsurgical intervention. Three patients required three or more surgeries. Of the 30 % (30/101) of respondents who reported pelvic pain prior to intervention, 63 % (19/30) reported improvement, 30 % (9/30) were worse, and 7 % (2/30) reported no change. Of the 33 % (33/101) who reported voiding dysfunction prior to intervention, 61 % (20/33) reported being at least somewhat bothered by these symptoms. CONCLUSIONS: About 50 % of women with mesh complications in this study underwent surgical management as treatment, and <10 % required a second surgery. Most patients with pain preintervention reported significant improvement after treatment; however, almost a third reported worsening pain or no change after surgical management. Less than half of patients with voiding dysfunction improved after intervention.

Shoulder dystocia: anticipation and outcome.

Shoulder dystocia is a serious obstetric emergency with several cases of permanent disability and fetal deaths each year. Ninety-eight cases of shoulder dystocia, an incidence of 0.45%, occurred in Farwania Hospital, Kuwait during 1985-1987. Of these 54.1% had one or more birth trauma. The perinatal mortality rate was 71.4 per thousand, with a considerable increase in the rate of maternal complications. Macrosomia, maternal diabetes, augmentation and induction of labor, vacuum extraction, post-term and malposition, were identified risk factors. We found that if all babies weighing greater than or equal to 4.5 kg are delivered by cesarean section, dystocia can be significantly reduced.

Breech vaginal delivery after one cesarean section: a retrospective study.

This retrospective study evaluates the prospects of allowing a vaginal breech to follow a previous lower segment cesarean section by examining data from Farwania Hospital, Kuwait where 33 (38.4%) of 86 patients with a previous cesarean section with fetuses in breech presentation were given a chance for vaginal delivery. The remaining 53 patients were delivered by lower segment cesarean section. Out of 53 patients, 34 patients were sectioned because of the presence of uterine scar. The other 19 patients were sectioned because of the additional presence of other obstetric complications such as diabetes, pre-eclamptic toxemia or large fetus. This group of patients was excluded from comparison.