Short-term neonatal outcome in diabetic versus non-diabetic pregnancies complicated by non-reassuring foetal heart rate tracings.

OBJECTIVE: Analysis of the impact of non-reassuring foetal heart rate patterns (FHR) and suspected foetal distress during active labour on the neonatal outcome in diabetic compared to non-diabetic mothers. METHODS: Retrospective case-control study comparing the short-term neonatal outcome including Apgar score at 5 min, and arterial/venous umbilical cord blood pH of 57 deliveries of women with different types of diabetes and 114 healthy controls. Patients were selected out of all deliveries with suspected foetal distress during active labour and performed foetal scalp pH samplings (n = 590) at the Medical University of Graz, Austria, during 2008-2009. RESULTS: Arterial pH was significantly lower in the diabetic group (7.215 versus 7.250, p = 0.007). Apgar scores ( > 8) at 5 min were similar in both groups (96.5% versus 95.6%, p = 0.566). The percentage of cases with foetal scalp blood pH <7.25 was higher in the diabetes group, but did not reach statistical significance (14.1% versus 7.1%, p = 0.166). CONCLUSIONS: Newborns of women with gestational and type 1 diabetes and non-reassuring FHR tracing have significantly lower arterial cord blood pH values without consequences on neonatal postpartum adaptation. Special attention to pathological changes in FHR patterns and to the more rapid decline in foetal pH during periods of foetal distress may be warranted in women with gestational and pre-conceptional diabetes during active labour. More frequent foetal scalp pH testing to rule out clinically relevant foetal acidosis needs to be discussed.

Needle suspension of the bladder neck for stress urinary incontinence: objective results at 11 to 16 years.

We analyzed the objective and subjective long-term outcomes of women who underwent needle suspension of the bladder neck 11 to 16 years previously. A total of 132 women underwent a needle suspension procedure at our institution between 1986 and 1991. In a retrospective cohort study, 63 of these women were evaluated by clinical examination, urodynamic testing, cough stress test, and standardized personal interview. Objective continence was defined as no loss of urine either during cystometry or during coughing with the bladder filled to 300 ml. The objective continence rate was 56% (25/45) and the subjective continence rate was 41% (26/63). With regard to patient satisfaction, only 38% (24/63) of the studied patients considered themselves completely cured, and an additional 30% (19/63) improved. The objective and subjective long-term results of needle suspension of the bladder neck are modest. Long-term complications such as urinary retention and overactive bladder syndrome are rare.

[The tension-free vaginal tape operation for the treatment of stress incontinence]. / Die Tension-free-vaginal-tape-Operation zur Behandlung der Stressinkontinenz.

The tension-free vaginal tape (TVT) operation and similar procedures are the newest development in the surgical treatment of female stress incontinence. In contrast to the Burch colposuspension and abdominovaginal sling procedures, the operation aims at supporting the midurethra and not the bladder neck. The only ongoing prospective randomized trial comparing TVT with the Burch colposuspension, conducted by the UK and Ireland TVT Trial Group, shows comparable 2-year results. The TVT operation is a technically simple procedure with a low rate intraoperative and postoperative complications. This and the good cure rates may make this procedure and similar methods the standard operation for the treatment of primary and recurrent stress incontinence.