Can obesity impact mesh exposure rate after mid-urethral sling operation? Medium term follow-up.

OBJECTIVE: To study mesh exposure rates among obese (BMI ≥ 30 kg/m2) vs non-obese women after mid-urethral sling (MUS) operation. STUDY DESIGN: This retrospective cohort study included all patients who underwent MUS surgery for stress urinary incontinence April 2014-April 2021 in a tertiary-level university hospital. Data from obese and non-obese patients were compared. RESULTS: A total of 120 (41 %) obese patients and 172 (59 %) non-obese patients who had mid-urethral sling surgery were compared. Of the cohort, 265 (90.7 %) underwent TVT-obturator, 15 (5.1 %) mini-sling TVT, and 12 (4.1 %) retro-pubic TVT. Diabetes mellitus was significantly more prevalent in the obese group (p =.01), without other demographic differences. Mesh post-operative exposure rate was 5.4 % during the study. The obese group had lower incidence of mesh exposure than the non-obese group (1.6 % vs 8.1 % respectively, p =.018). Mean follow-up was 51 months (range 8-87 months) without significant differences between groups (49.9 ± 21.2 vs 51.5 ± 22.3, p =.548). Pelvic organ prolapse, cystocele, and rectocele stages were significantly higher in non-obese patients. Similar numbers of post-menopausal women were in each group. CONCLUSION: This follow-up after MUS surgery showed an association between obesity and lower rate of mesh exposure. Further research is needed to evaluate correlations between estrogen and mesh exposure.

Do maternal albumin levels affect post-operative complications after cesarean delivery?

BACKGROUND: This study explored the correlation between maternal serum albumin levels prior to elective cesarean delivery (CD) and postoperative complications. METHODS: This retrospective cohort study included women admitted for elective CD at term to our tertiary referral center, during the years 2016-2018. Blood samples were collected during the preoperative admission. Information collected included maternal demographics, pregnancy and postoperative complications. Data between patients with preoperative serum albumin levels < 3.3 g/dL or ≥ 3.3 g/dL were compared. RESULTS: Among 796 women admitted for an elective CD, 537 met the inclusion criteria. There were 250 (46.6%) women in the low albumin level group (< 3.3 g/dL) and 287 (53.4%) with serum albumin level ≥ 3.3 g/dL. Patients with serum albumin ≥ 3.3 g/dL had increased rates of surgical site infection (SSI) (5.6% vs. 1.6% respectively; p = 0.02), need for antibiotics during the post-partum period (10.8% vs 3.2%, respectively; p = 0.001), surgical intervention (2.1% vs. 0%, respectively; p = 0.03) and higher rate of rehospitalization (5.2% vs. 0.4%, respectively; p = 0.001). Multivariant analysis showed that albumin level ≥ 3.3 g/dL was independently associated with composite postoperative adverse maternal outcome. CONCLUSIONS: High serum albumin levels among women undergoing CD, might be associated with abnormal postoperative outcomes. Larger prospective studies, with a heterogenous population are needed to validate these observations.

Can the Need for Invasive Intervention in Tubo-ovarian Abscess Be Predicted? The Implication of C-reactive Protein Measurements.

STUDY OBJECTIVE: To evaluate the clinical parameters of hospitalized patients with pelvic inflammatory disease (PID) for the presence of tubo-ovarian abscess (TOA) and predict the need for intervention. DESIGN: A prospective cohort study. SETTING: A tertiary care university medical center. PATIENTS: Ninety-four patients were diagnosed with complicated PID and hospitalized between 2015 and 2017. INTERVENTIONS: Patients with PID were treated with parenteral antibiotics according to Centers for Disease Control guidelines. Demographic, clinical, sonographic, and laboratory data for patients with PID were analyzed. Inflammatory markers including C-reactive protein (CRP), white blood cells (WBCs), erythrocyte sedimentation rate (ESR), and clinical parameters were collected at admission and during hospitalization. MEASUREMENTS AND MAIN RESULTS: Forty-eight of 94 patients (51.1%) hospitalized with complicated PID were diagnosed with TOA sonographically. CRP levels were the strongest predictor of TOA, followed by WBC count, ESR, and fever on admission. The areas under the receiver operating characteristic (ROC) curve for CRP, WBC, ESR, and fever were .92, .75, .73 and .62, respectively. CRP specificity was 93.4% and sensitivity was 85.4% for predicting TOA, with cutoff value of 49.3 mg/L. Twelve patients (25%) failed conservative management and underwent surgical intervention including laparoscopy (n = 7), computed tomography (CT)-guided drainage (n = 4), and laparotomy (n = 1). In this group, CRP levels significantly increased from admission to day 1 and day 2 during hospitalization (128.26, 173.75, and 214.66 mg/L, respectively; p < .05 for both). In the conservative management group, CRP levels showed a plateau from admission to day 1 and then a decrease until day 3 (110, 120.49, 97.52, and 78.45 mg/L, respectively). CONCLUSION: CRP is a sensitive, specific inflammatory marker for predicting TOA in patients with complicated PID, and levels >49.3 mg/L suggest the presence of TOA. In the TOA group, CRP level trends correlated well with success or failure of conservative management. Increasing CRP levels during treatment may be used as an indicator of the need for invasive intervention, and daily CRP measurements can help predict the need for invasive intervention.

Refusal of emergency caesarean delivery in cases of non-reassuring fetal heart rate is an independent risk factor for perinatal mortality.

OBJECTIVE: To assess pregnancy outcome in women who initially refused medically indicated caesarean delivery (CD) in cases of non-reassuring fetal heart rate (FHR) patterns. STUDY DESIGN: A retrospective cohort study, comparing patients who refused and did not refuse caesarean delivery (CD) due to non-reassuring FHR tracings, was conducted. Deliveries occurred between the years 1988 and 2009 in a tertiary medical center. Multivariate analysis was performed to control for confounders. RESULTS: Out of 10,944 women who were advised to undergo CD due to non-reassuring FHR patterns, 203 women initially refused CD. Women refusing medical intervention tended to be older (30.6 ± 6.9 vs. 28.29 ± 6.1, P<0.001) and of higher parity (46.8% vs. 19.9% had more than 5 deliveries; P<0.001) as compared to the comparison group. Refusal of CD was significantly associated with adverse perinatal outcome. Using a multiple logistic regression model controlling for confounders such as maternal age, refusal of treatment was found as an independent risk factor for perinatal mortality (adjusted OR=3.3, C.I. 95% 1.8-5.9, P<0.001). A non-significant trend towards higher rates of adverse perinatal outcome was found when refusal latency time was longer than 20 min (OR=2, 95% CI 0.36-11.95; P=0.29). CONCLUSION: Refusal of CD in cases of non-reassuring FHR tracings is an independent risk factor for perinatal mortality.