Quality of Life after Treatment for Pelvic Organ Prolapse in Real-World Study: Recommendations, Vaginal Pessary, and Surgery.

Background and Objectives: Pelvic organ prolapse (POP) is a common condition in women, with its prevalence increasing with age, and can significantly impact the quality of life (QOL) of many individuals. The objective of this study was to assess the overall improvement, quality of life, and continuation of primary treatment for POP over a 24-month period in a real-world setting. Materials and Methods: This is a prospective, observational, follow-up study of women with symptomatic POP who, as a primary treatment, opted for recommendations (lifestyle changes and pelvic floor muscle training), pessary therapy, or surgery. The primary outcome measure was a subjective improvement at the 24-month follow-up, measured with the Patient Global Impression of Improvement (PGI-I) scale. Secondary outcome measures were the continuation rate of the primary treatment method, reason for discontinuation, and the quality of life evaluated with the P-QoL questionnaire. Results: We included 137 women, with 45 women (32.8%) in the recommendations group, 39 (28.5%) in the pessary group, and 53 women (38.7%) in the surgery group. After 24 months, surgery, in comparison with pessary treatment and recommendations, resulted in significantly more women reporting a subjective improvement: 89.6%, 66.7%, and 22.9% (p < 0.001), respectively. Overall, 52% of women from the recommendations group and 36.4% from the pessary group switched to another treatment or discontinued the primary treatment within 24 months. However, women who continued the primary treatment, pessary use, and surgery showed similar subjective improvements (90.5% and 89.6%, respectively) and quality-of-life improvement. Conclusions: The chance of significant improvement was higher following surgery. However, after 24 months, both vaginal pessaries and surgery showed an important quality-of life improvement and can be proposed as primary treatment methods for pelvic organ prolapse.

Lithuania's experience in reducing caesarean sections among nulliparas: the impact of the quality improvement course.

BACKGROUND: To evaluate the role of the quality improvement course (QIC) to reduce the caesarean section (CS) rate among nulliparas (Robson groups 1 and 2) and to find out which group of women have reduced the CS rate following attendance at the course. METHODS: The QIC was organized in 2015. For the evaluation of the CS rate after the OIC, deliveries from the selected hospitals in 2014 and 2016 were compared using MS EXCEL and SPSS 23.0. RESULTS: Nulliparas accounted for 44.6% (3585/8046) and 42.9% (3628/8460) of all the deliveries in 2014 and 2016 years, respectively. The CS rate among nulliparas decreased from 19.0% (665/3502) in 2014 to 16.8% (593/3526) in 2016 (p = 0.018). The greatest decrease in absolute contribution to the overall CS rate was recorded in group 1 (p = 0.08). Perinatal mortality was 3.1 in 2014 and 3.9 in 2016 per 1000 deliveries (p = 0.569). CONCLUSION: The QIC has helped to reduce the CS rate among nulliparas without a negative influence on perinatal mortality. The greatest decrease in the overall CS rate was recorded among nulliparous women who were treated with oxytocin and managed to reach a full cervical dilatation.

Is it necessary to postpone pregnancy after bariatric surgery: a national cohort study.

The optimal interval between bariatric surgery (BS) and pregnancy remains clearly undefined. The aim of this study was to assess pregnancy outcomes according to the interval from BS to conception. The nationwide study cohort consisted of 130 women with previous BS and postoperative singleton delivery during 2005-2015 in Lithuania. Women who conceived within the first 12 months after BS were included in the early conception (EC) group (n = 30); who became pregnant after 1 year were included in the late conception (LC) group (n = 100). Mean surgery-to-conception time in the EC group was 6.9 ± 3.5 months; in the LC group was 41.4 ± 21.6 months. Anaemia was diagnosed significantly more frequently in women who conceived after 12 months compared with the EC group (56.0% versus 33.3%, p = .04). No significant differences were found between the EC and the LC group regarding gestational diabetes, preeclampsia, caesarean section rate, and adverse neonatal outcomes.Impact statementWhat is already known on the subject? Bariatric surgery is recognized as a safe and highly effective approach to obesity treatment. Optimal interval between bariatric surgery and conception remains undefined, however most bariatric surgeons advise patients to delay pregnancy for 12-18 months.What do the results of this study add? The results of our study did not show significant differences in pregnancy complications and neonatal outcomes in women who conceived within the first 12 postoperative months and in women who conceived later. Women who become pregnant within the first year after surgery, should be reassured that obstetric complication rates generally are low.What are the implications of these findings for clinical practice and/or further research? Patients with prior BS should be provided with multidisciplinary prenatal care and screening for nutritional deficiencies during pregnancy. Further studies are needed to determine the optimal interval after BS and to assess the influence this interval has on perinatal outcomes.

Comparison of midwife-led and obstetrician-led care in Lithuania: A retrospective cohort study.

OBJECTIVE: To compare midwife-led and obstetrician-led care and their relation to caesarean section rates and obstetric and neonatal outcomes in low-risk births. DESIGN: Hospital registry based retrospective cohort study. SETTING: Tertiary-care women's hospital in Kaunas, Lithuania. PARTICIPANTS: A total of 1384 and 1283 low-risk delivering women in 2012 and 2014, respectively. METHODS: The women choose either a midwife as their lead carer (midwife-led group), or an obstetrician-gynaecologist (obstetrician-led group). MAIN OUTCOME MEASURES: The primary outcome was caesarean birth. Secondary outcomes included instrumental vaginal births, amniotomy, augmentation of labour, epidural analgesia, episiotomy, perineal trauma, labour duration, birthweight and Apgar score < 7 at 5 min. RESULTS: The proportion of caesarean births was 4.4% in the midwife-led and 10.7% in the obstetrician-led group (p < 0.001) in 2012, and 5.2% and 11.8% (p < 0.001) in 2014, respectively. Younger maternal age (≤34 years) and midwife-led care was associated with a significantly decreased odds for caesarean section and nulliparity with a significantly increased odds for caesarean birth. Women in the midwife-led group had fewer amniotomies and labour augmentations compared with the obstetrician-led group. Episiotomy, perineal trauma, duration of labour and neonatal outcomes did not differ between the groups. CONCLUSION: Midwife-led care for women with low-risk birth reduced the caesarean section and several medical interventions with no apparent increase in immediate adverse neonatal outcomes compared with obstetrician-led care. IMPLICATIONS FOR PRACTICE: Midwife-led care for low-risk women should be encouraged in countries with health care system where obstetrician-led care births dominates.

Maternal obesity and obstetric outcomes in a tertiary referral center.

BACKGROUND AND AIM: Obese women are at an increased risk of various adverse pregnancy outcomes. The aim of our study was to evaluate the impact of obesity on maternal and neonatal outcomes in a tertiary referral center and to compare obstetric outcomes by the level of maternal obesity. MATERIALS AND METHODS: A cohort study included 3247 women with singleton gestations who gave birth at the Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences, in 2010. Pregnancy complications and neonatal outcomes were identified using the hospital Birth Registry database in normal weight (body mass index [BMI] 18.5-24.9kg/m2, n=3107) and prepregnancy obese (BMI ≥30kg/m2, n=140) women. Pregnancy outcomes were compared according to the level of obesity (BMI 30-34.9kg/m2, n=94 and BMI ≥35kg/m2, n=46). RESULTS: Obese women were significantly more likely to have gestational hypertension (OR=8.59; 95% CI, 5.23-14.14; P<0.0001), preeclampsia (OR=2.06; 95% CI, 1.14-3.73; P<0.0001), gestational diabetes (OR=5.56; 95% CI, 3.66-8.49; P<0.0001), dystocia (OR=2.14; 95% CI, 1.36-3.38; P<0.0001), induced labor (OR=2.64; 95% CI, 1.83-3.80; P<0.0001), failed induction of labor (OR=18.06; 95% CI, 8.85-36.84; P<0.0001), cesarean delivery (OR=1.76; 95% CI, 1.25-2.49; P=0.001), large-for-gestational-age newborns (OR=3.68; 95% CI, 2.51-5.39; P<0.0001). Significantly increased risk of gestational diabetes, preeclampsia, dystocia and newborns with Apgar score ≤7 after 5min was only observed in women with BMI ≥35kg/m2. CONCLUSIONS: Maternal obesity is significantly associated with an increased risk of gestational hypertension, preeclampsia, gestational diabetes, dystocia, labor induction, failed induction of labor, large-for-gestational-age newborns and cesarean delivery.

Cesarean section rates in Lithuania using Robson Ten Group Classification System.

BACKGROUND AND OBJECTIVE: The aim of this study was to analyze cesarean section (CS) rates using Robson Ten Group Classification System (TGCS) and to identify the main contributors to the overall CS rate in Lithuania. MATERIALS AND METHODS: A prospective cross-sectional study was carried out. All women who delivered between January 1 and December 31, 2012, in Lithuania were classified using the TGCS. The CS rates overall and in each Robson group were calculated, as was the contribution of each group to the overall CS rate. RESULTS: The CS rate was 26.4% (6697 among 25,373 deliveries) in 2012. Nulliparous women with single cephalic full-term pregnancy in spontaneous labor (Group 1) or who underwent induction of labor or prelabor CS (Group 2) and multiparous women with a previous CS (Group 5) were the greatest contributors (67.7%) to the overall CS rate. In addition, significant variation of CS rates between different institutions was observed, especially in women with single cephalic full-term pregnancy without previous CS (Groups 1-4), showing big differences in obstetric care across country. CONCLUSIONS: Women in Groups 1, 2 and 5 were the largest contributions to the overall CS rate in Lithuania. It seems that efforts to reduce the overall CS rate should be directed on increasing vaginal birth after CS and reducing CS rates in nulliparous women with single cephalic full-term pregnancy (Groups 1 and 2).

La laparoscopia mejora la precisión diagnóstica de la enfermedad pelviana inflamatoria / Laparoscopy improves the diagnostic accuracy in pelvic inflammatory disease

El objetivo de este estudio fue evaluar los criterios de diagnóstico clínico y los hallazgos laparoscópicos en mujeres con enfermedad pelviana inflamatoria (EPI). Métodos: Se inscribieron en el estudio setenta y tres mujeres de 18 a 35 años que acudieron al servicio de Ginecología del Hospital de la Universidad Lituana de Ciencias de la Salud con síntomas clínicos de enfermedad pelviana inflamatoria. Todas las pacientes fueron sometidas a un examen clínico y pruebas de laboratorio bajo el mismo protocolo. La laparoscopia diagnóstica se realizó dentro de las 12 horas posteriores al ingreso. Resultados: Se confirmó la presencia de EPI por laparoscopia en el 71.2% de los casos. La EPI verificada por laparoscopia tuvo una correlación significativa con los siguientes síntomas: dolor abdominal bajo, dolor a la movilización cervical y dolor anexial. Se detectó la presencia de Chlamydia trachomatis y de Neisseria gonorrhoeae en muestras endocervicales en el 46.1% y el 26.9% de las mujeres con EPI confirmada. Conclusiones: El diagnóstico preliminar de EPI debe basarse en criterios de diagnóstico clínico. La laparoscopia diagnóstica temprana mejora la precisión diagnóstica y determina con mayor exactitud la gravedad de la enfermedad.

La laparoscopia mejora la precisión diagnóstica de la enfermedad pelviana inflamatoria / Laparoscopy improves the diagnostic accuracy in pelvic inflammatory disease

El objetivo de este estudio fue evaluar los criterios de diagnóstico clínico y los hallazgos laparoscópicos en mujeres con enfermedad pelviana inflamatoria (EPI). Métodos: Se inscribieron en el estudio setenta y tres mujeres de 18 a 35 años que acudieron al servicio de Ginecología del Hospital de la Universidad Lituana de Ciencias de la Salud con síntomas clínicos de enfermedad pelviana inflamatoria. Todas las pacientes fueron sometidas a un examen clínico y pruebas de laboratorio bajo el mismo protocolo. La laparoscopia diagnóstica se realizó dentro de las 12 horas posteriores al ingreso. Resultados: Se confirmó la presencia de EPI por laparoscopia en el 71.2% de los casos. La EPI verificada por laparoscopia tuvo una correlación significativa con los siguientes síntomas: dolor abdominal bajo, dolor a la movilización cervical y dolor anexial. Se detectó la presencia de Chlamydia trachomatis y de Neisseria gonorrhoeae en muestras endocervicales en el 46.1% y el 26.9% de las mujeres con EPI confirmada. Conclusiones: El diagnóstico preliminar de EPI debe basarse en criterios de diagnóstico clínico. La laparoscopia diagnóstica temprana mejora la precisión diagnóstica y determina con mayor exactitud la gravedad de la enfermedad. (AU)

Group B streptococcus and Escherichia coli colonization in pregnant women and neonates in Lithuania.

OBJECTIVE: To evaluate the prevalence of maternal and neonatal colonization with group B streptococcus (GBS) and Escherichia coli, and examine GBS serotypes and susceptibility to antibiotics. METHODS: A prospective cross-sectional study was carried out in Lithuania between October 2006 and June 2007. Lower vaginal/rectal swabs were obtained from pregnant women (n=998) and ear canal/throat swabs were obtained from their newborns (n=827) for culture. RESULTS: Overall, maternal and neonatal GBS colonization rates were 15.3% and 6.4%, respectively. Serotypes III (34.5%) and Ia (29.7%) were most common. All GBS isolates were susceptible to penicillin and 4.1% were resistant to erythromycin. Overall, maternal and neonatal E. coli colonization rates were 19.9% and 14.4%, respectively. In total, 71.4% of newborns with E. coli colonization were born to E. coli-negative mothers. E. coli was resistant to ampicillin and piperacillin in 25.9% and 16.6% of cases, respectively. The majority of E. coli-colonized newborns were contaminated with maternal fecal, but not vaginal, E. coli strains. CONCLUSION: Maternal and neonatal GBS colonization rates, serotypes, and susceptibility to antibiotics were comparable to those reported in previous studies. Population-based data regarding early-onset neonatal infection rates will enable the formulation of a prevention program for early-onset GBS disease in Lithuania.

Prevalence of maternal group B streptococcal colonisation in European countries.

BACKGROUND: Group B streptococcus (GBS) is a leading cause of neonatal sepsis in many industrialised countries. However, the burden of perinatal GBS disease varies between these countries. We undertook a systematic review to determine the prevalence of maternal group B streptococcal colonisation, one of the most important risk factor for early onset neonatal infection, and to examine the serotype distribution of the GBS strains isolated and their susceptibility to antibiotics in European countries. METHODS: We followed the standard methodology for systematic reviews. We prepared a protocol and a form for data extraction that identifies key characteristics on study and reporting quality. The search was conducted for the years 1996-2006 including electronic, hand searching and screening of reference lists. RESULTS: Twenty-one studies presented data on 24,093 women from 13 countries. Among all studies, GBS vaginal colonisation rates ranged from 6.5 to 36%, with one-third of studies reporting rates of 20% or greater. The regional carriage rates were as follows: Eastern Europe 19.7-29.3%, Western Europe 11-21%, Scandinavia 24.3-36%, and Southern Europe 6.5-32%. GBS serotypes III, II and Ia were the most frequently identified serotypes. None of the GBS isolates were resistant to penicillin or ampicillin, whereas 3.8-21.2% showed resistance to erythromycin and 2.7-20% showed resistance to clindamycin. CONCLUSION: Although there is variation in the proportion of women colonised with GBS, the range of colonisation, the serotype distribution and antimicrobial susceptibility reported from European countries appears to be similar to that identified in overseas countries.