[Training simulation during the announcement of fetal malformation discovered on screening ultrasound: Results of a pilot study]. / Formation par simulation à l'annonce d'une malformation fœtale découverte en échographie de dépistage : résultats d'une étude pilote.

OBJECTIVES: Breaking bad news (BBN) to a pregnant woman with fetal abnormalities (FA) on ultrasound (US) examination is a challenge. Announcement technique influences patient reaction. Physicians receive little training in BBN. The simulation and using a BBN protocol as the English SPIKES protocol which guides the announcement consultation according to 6 steps (Setting Up, Perception, Invitation, Knowledge, Emotions and Empathy, Strategy and Summary) can be used for this teaching. The objective was to assess feasibility simulation scenarii of BBN for FA discovered during US and to evaluate the usefulness of SPIKES protocol in this situation. METHODS: Two scenarios have been created combining US simulator (US Mentor, Symbionix®) with simulated patient (SP). Scenarii objectives were to diagnose FA and break it to SP. Checklist derived from SPIKES was fulfilled by two investigators thanks to video recording, the SP and every participant (residents, physicians, fetal medicine specialists [FMS]). Participants filled out survey about the usefulness of this exercise too. RESULTS: Nine physicians (3 residents, 4 physicians, 2 FMS) produced 18 scenarii. Seventy-eight percent of physicians thought simulation was like real situation of BBN during US examination. Majority of participant (88%) found that this simulation training could help them to increase their ability to BBN and that it can be used to teach residents (89%) or physicians (100%). FMS had better SPIKES checklist than physicians (P<0,05). CONCLUSION: Simulation scenario of BBN for FA discovered during US is feasible by combining US simulator and SP. SPIKES protocol can be useful but a validated checklist should be created.

COVID-19 infection in first trimester of pregnancy marked by a liver cytolysis in a woman previously treated by hydroxychloroquine for repeated implantation failure: a case report.

BACKGROUND: In December 2019, a new disease (COVID-19) caused by a novel coronavirus called SARS-CoV-2 emerged in China and spread to many other countries. There is only limited data about the clinical features of COVID-19 during pregnancy, especially in first trimester. CASE PRESENTATION: We report a COVID-19 infection in a 35 years-old patient in first trimester of pregnancy and its consequent medical care. At 7 weeks of pregnancy, the patient, who did not have any pregestational comorbidities, complained of intense nausea and asthenia. An important liver cytolysis was discovered with biological perturbations of transaminases levels. No respiratory symptoms were recorded. Classical viral aetiologies and drug-related toxicity were discarded. Because of the aggravation of the symptoms and the occurrence of the breathlessness, the patient was tested for the COVID-19 in a nasopharyngeal swab. The RTq-PCR assay indicated the presence of SARS-CoV-2 RNA. In the absence of severe symptoms, the patient was monitored at home according to the French government guidelines. After a few days, the symptoms resolved without any complications. The pregnancy is still ongoing without any visible sequelae on the foetus so far. CONCLUSIONS: This first case illustrated the difficulty of COVID-19 diagnosis in patients with isolated digestive symptoms in first trimester of pregnancy that could be confused with gravida hyperemesis. Monitoring of pregnancy after an episode of COVID-19 should be strengthened with bimonthly foetal growth ultrasounds and doppler assessments because of the risks for intrauterine growth restriction. Comprehensive data on larger numbers of first trimester gravid women with COVID-19 are required to better understanding the overall impact of SARS-CoV-2 on maternal and birth outcomes.

[Optimizing training in limited obstetric ultrasound for midwives through a combination of e-learning and simulation]. / E-learning et simulation en échographie focalisée pour la formation continue des sages-femmes en salle de naissance.

OBJECTIVE: To evaluate a training program in limited obstetric ultrasound, combining e-learning and simulation. METHODS: This a descriptive cohort study in Single-center study conducted in a French university hospital. Thirty-three practicing midwives who had not received basic training in ultrasonography had unlimited access to an e-learning platform offering interactive theoretical instruction modules. Then, they attended a one-day simulator-based obstetric ultrasound workshop. A theoretical competency test was taken before the e-learning component (T1), then before (T2) and after (T3) the simulation workshop. Their competency in specific practical tasks was assessed before and after the workshop. A learner satisfaction questionnaire was completed after the program. RESULTS: The mean score obtained in the theoretical competency test was 46.6% (range 8.3-83.3%) at T1, 87.2% (66.6-100%) at time T2, and 91.6% (66.6-100%) at T3. Significant improvements were observed between times T1 and T2 (P<0.001) or T3 (P<0.001), as well as in the performance of certain practical tasks, such as placental location (P=0.02) and visualization of the cervix (P=0.03). The mean number of logins to the e-learning platform during the program was 11.2 per participant (6-24). Most participants were satisfied with the training and reported an improvement in their daily practice. CONCLUSION: Training in limited obstetric ultrasound, combining e-learning to acquire theoretical knowledge and a hands-on simulation workshop, appears to meet the needs of practicing midwives. Most participants were satisfied with the proposed teaching and the rapid acquisition of ultrasound skills applicable to their clinical practice.

[Contribution of chromosomal microarray analysis by a multidisciplinary prenatal diagnosis center]. / Apport de l'analyse chromosomique par puce à ADN dans un centre de diagnostic prénatal pluridisciplinaire.

OBJECTIVE: Chromosomal analysis by array CGH is a cytogenetic technique that has opened its application to prenatal diagnosis in recent years. The main objective of the study was to analyze the contribution for couples using chromosomal analysis by array CGH in a CPDPN. METHODS: A retrospective cohort study was conducted in 2015 in a CPDPN. All the patients with array CGH analysis were included in the study. The analysis indications were CN≥3.5mm, ultrasound signs, intra-uterine growth retardation and fetal deaths. Data were collected in the prenatal diagnosis and genetic records. RESULTS: In total, 155 patients underwent analysis by array CGH, which corresponds to 36% of patients with invasive sampling indication. Fifteen CGH analysis were positive which represents 9.6% of indications. None of those diagnoses was possible with standard karyotype. These positive results have changed the outcome of pregnancy and what to do for a future pregnancy in 54% of cases. CONCLUSION: Array CGH enables a diagnostic gain despite a delicate interpretation and changes taking care of patients in future pregnancies. These results should be confirmed in a prospective multicenter study.

[What measures of perineal protection at birth are consensual in France? Results of a Delphi survey]. / Quelles mesures de protection périnéale à l'accouchement sont consensuelles en France ? Résultats d'une enquête Delphi.

OBJECTIVE: To evaluate expert's opinion in order to obtain a consensus on the different measures of perineal protection at the time of vaginal delivery. METHODS: A survey using the Delphi method was carried out with a panel of French obstetricians, urogynecologists and midwives. The questionnaire included 22 questions grouped into four groups: expulsive efforts, indications of episiotomy, episiotomy repair and other forms of perineal protection. The experts had to answer on a 9-point scale, both on the validity and the clarity of each proposal. After analysis of the replies of the first round, a second round was sent to the same experts for certain proposals. Each turn was the subject of two raises. To be validated, each proposal had to obtain a median equal to or greater than 7/9 and an agreement between the experts greater than 65% in the first round, and more than 75% in the second round. RESULTS: The study was conducted between March and October 2016. Of the 300 experts initially selected, 93 (31%) responded to the first round, including 63 obstetricians (67.7%), 12 urogynecologists (12.9%) and 18 midwives (19.4%). In the second round, 72 experts replied, representing 77.4% of the experts who also answered the first round. At the end of the two rounds, 11 proposals were validated, and 11 rejected. The following recommendations have been validated. Uterine expression should be proscribed. The two modes of pushing (blocked in Valsalva and by blowing) can be indifferently proposed, in case of fetal progression and in the absence of fetal distress. The midline episiotomy should be proscribed. The medio-lateral (or lateral) episiotomy should be left to the discretion of the accoucheur. The maintenance of the fetal head with one hand must be systematic to the expulsion to protect the perineum. Repair of the episiotomy should be made (except in some cases) with a rapid absorbable suture. The prescription of NSAIDs and/or painkillers of level 2 should be preferred to reduce the pain of post-natal perineal scars. CONCLUSION: Several measures of perineal protection at the time of vaginal delivery are consensual in France. Other measures should be studied further. LEVEL OF EVIDENCE: 4.

Cranberry capsules to prevent nosocomial urinary tract bacteriuria after pelvic surgery: a randomised controlled trial.

OBJECTIVE: To evaluate whether cranberries are able to prevent postoperative urinary bacteriuria in patients undergoing pelvic surgery and receiving transurethral catheterisation. DESIGN: Randomised, double-blind, placebo-controlled trial. SETTINGS: French tertiary Care centre, University Hospital. POPULATION: A total of 272 women undergoing pelvic surgery aged 18 or older. METHODS: Participants undergoing pelvic surgery were randomised to 36 mg cranberry (proanthocyanidins, PAC) or placebo once daily for 10 days. Statistical analysis was performed by a chi-square test. MAIN OUTCOME MEASURES: The primary and secondary outcomes were postoperative bacteriuria, defined by a positive urine culture, within the first 15 and 40 days, respectively. RESULTS: Two hundred and fifty-five participants received the intended treatment: 132 (51.8%) received PAC and 123 (48.2%) received placebo. There were no significant differences in baseline demographics, intra-operative characteristics or duration and type of catheterisation between the two groups. PAC prophylaxis did not reduce the risk of bacteriuria treatment within 15 days of surgery [27% bacteriuria with PAC compared with 25% bacteriuria with placebo: relative risk 1.05, 95% CI 0.78-1.4, P = 0.763). The same result was observed on day 40. Bacteriuria occurred more often in older women with increased length of catheterisation. CONCLUSION: Immediate postoperative prophylaxis with PAC does not reduce the risk of postoperative bacteriuria in patients receiving short-term transurethral catheterisation after pelvic surgery. TWEETABLE ABSTRACT: PAC prophylaxis does not reduce the risk of postoperative bacteriuria in patients undergoing pelvic surgery.

[French translation of "An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction" published in Int Urogynecol J 2010;21(1):5-26]. / Traduction française de la terminologie commune International Urogynecological Association (IUGA)/International Continence Society (ICS) sur les troubles de la statique pelvienne chez la femme initialement publiée dans Int Urogynecol J 2010;21(1):5-26.

INTRODUCTION AND HYPOTHESIS: Given its increasing complexity, the terminology for female pelvic floor disorders needs to be updated in addition to existing terminology of the lower urinary tract. To do this, it seems preferable to adopt a female-specific approach and build on a consensus based on clinical practice. METHODOLOGY: This paper summarizes the work of the standardization and terminology committees of two international scientific societies, namely the International Urogynecological Association (IUGA) and the International Continence Society (ICS). These committees were assisted by many external expert referees. A ranking into relevant major clinical categories and sub-categories was developed in order to allocate an alphanumeric code to each definition. An extensive process of 15 internal and external reviews was set up to study each definition in detail, with decisions taken collectively (consensus). RESULTS: Terminology was developed for female pelvic floor disorders, bringing together more than 250 definitions. It is clinically based and the six most common diagnoses are defined. The emphasis was placed on clarity and user-friendliness to make this terminology accessible to practitioners and trainees in all the specialties involved in female pelvic floor disorders. Imaging investigations (ultrasound, radiology, MRI) exclusively for women have been added to the text, relevant figures have also been included to complete the text and help clarify the meaning. Regular reviews are planned and are also required to keep the document up-to-date and as widely acceptable as possible. CONCLUSIONS: The work conducted led to the development of a consensual terminology of female pelvic floor disorders. This document has been designed to provide substantial assistance in clinical practice and research. LEVEL OF EVIDENCE: 4.

[Absent or hypoplastic thymus: A marker for 22q11.2 microdeletion syndrome in case of polyhydramnios]. / La dysgénésie thymique : marqueur de microdélétion 22q11.2 dans le bilan d'un hydramnios.

OBJECTIVES: In prenatal diagnosis of 22q11.2 microdeletion syndrome, without cardiac malformation or multiple associated congenital anomalies, we study the presence of polyhydramnios and its association with thymic dysgenesis. MATERIALS AND METHODS: This was a multicenter retrospective observational study. It was performed in two multidisciplinary centers for prenatal diagnosis in the south of France between January 1, 2010 and June 30, 2013. Inclusion criteria were prenatal diagnosis of 22q11.2 deletion syndrome. We excluded from the study any fetus with cardiac malformation or multiple associated congenital anomalies. RESULTS: During the inclusion period, eleven antenatal diagnoses of 22q11.2 microdeletion syndrome have been made. Six cases were excluded: 5 fetuses with cardiac malformation and one with multiple associated congenital anomalies. Therefore, five cases of isolated polyhydramnios were included. All 5 fetuses had a thymic dysgenesis: 3 had a thymic agenesis and 1 thymic hypoplasia diagnosed by sonography and 1 had a thymic agenesis diagnosed by retrospective reading of fetal MRI. CONCLUSION: When faced with a polyhydramnios, the presence of a thymic dysgenesis should be search for by ultrasound screening and would alert to the possibility of a 22q11.2 microdeletion syndrome. The confirmation of this is diagnosis by amniocentesis would enable improved antenatal support for parents and would enable early implementation of the multidisciplinary neonatal care that is required to avoid serious complications of this syndrome.

[Methods of pushing at vaginal delivery and pelvi-perineal consequences. Review]. / Mode de poussée à l'accouchement et conséquences pelvi-périnéales. Revue de la littérature.

INTRODUCTION: The main objective of that review was to evaluate the pelvi-perineal consequences of the different methods of pushing at vaginal delivery. METHODS: A review on PubMed, the Cochrane Library and EM-Premium was performed from 1984 to 2014. Among 29 manuscripts analysed, only nine randomised controlled trials (including one meta-analysis of three trials) comparing Valsalva and spontaneous pushing were selected. A 10 th study, secondary analysis of a randomized controlled trial comparing different methods of perineal protection (warm compresses, massage and manual protection), was also selected. RESULTS: Two trials have shown that spontaneous pushing reduces the risk of perineal tears, but studies were heterogeneous and discordant results do not allowed definitive conclusions. Results on the duration of the second stage of labour are conflicting. The method of pushing does not seem to affect the rate of episiotomy, instrumental delivery and cesarean section. Maternal satisfaction seems to be better after spontaneous pushing. It seems that there is no negative effect of spontaneous pushing on neonate well-being, and one study has shown a significant improvement of prenatal fetal parameters during the expulsive phase. CONCLUSION: According to current knowledge, both techniques of pushing during the expulsive phase at delivery seem comparable in terms of duration, risk of perineal tears and neonatal outcome.

[Assessment of gynecology obstetric interns training on birth simulator]. / Évaluation de la formation des internes de gynécologie obstétrique sur simulateur d'accouchement.

OBJECTIVE: The aim of this study was to assess the gynecology obstetric residents training on a birth simulator. MATERIALS AND METHODS: This is a prospective monocentric study, which had included residents at the beginning of their formation and performed on SIMone™, 3B SCIENTIFIC(®) birth simulator. It had included four sessions (supervised by two seniors registrar): two on instrumental extraction (vacuum and forceps) and two on labor monitoring. The two sessions were performed at one month. A theoretical formation was accomplished after the first assessment. Three assessments were performed based on two score scales (extraction and labor monitoring). A free training was allowed at each extraction session. RESULTS: Twelve interns were included in this study. There was a significant scores improvement between first and third session for instrumental extraction (2.4 points on 11 [±1.8] vs. 8 [±0.9]; [P<0.05]) and for labor monitoring (5.2 [±1.4] points on 9 vs. 6.6 [±1.3]; [P<0.05]). Interns considered this training improved their theoretical and practical knowledge for respectively 11 and 12 interns on 12. For 9 interns, a most important debriefing with teachers was desirable. CONCLUSION: Training on birth simulator allows an improvement of knowledge and skill of gynecology obstetric interns. A structured debriefing should be instituted after the sessions.

[Evaluation of urine postvoid residuals in post-partum period: a prospective and descriptive clinical study]. / Évaluation des résidus postmictionnels du postpartum: étude prospective descriptive.

INTRODUCTION: Few studies have evaluated urine postvoid residuals (PVRs) and their risk factors during the post-partum (PP) period. The aim of this prospective study was to screen postvoid residuals in a cohort of patients in PP, and to identify the risk factors. MATERIALS AND METHODS: For three months, patients in PP were given an evaluation of their PVR (ultrasounds method) after a spontaneous urination. Clinical data as regards delivery were collected. RESULTS: One hundred and sixty-eight patients were included. Among them, 61% had a urine volume at the first urination over 500 mL, and 52% presented with a pathological PVR (PVR over 150 mL for a urine volume over 150 mL). The median PVR was 153.50 mL. The median volume of the first spontaneous urination was 400 mL. Among patients with a pathological PVR, the total duration of the labor and the duration of its second phase were significantly longer (P=0.003 and P<0.05, respectively), and the volume of the first urination was higher. Indwelling catheterization during the delivery decreased the volume of the first spontaneous urination (volume over 500 mL in 28% vs 72% of patients, P=0.017) but was not associated with a decreased PVR in non-pathological deliveries. Instrumental deliveries were associated with higher PVRs than caesarean or physiological deliveries (244 mL, 180 mL et 156 mL; P=0.033). A bacteriuria was not significantly associated with PVR (54% vs 49%, P>0.05). CONCLUSION: We were able to identify risk factors for PVR in the PP, such as the duration of labor, instrumental delivery and elevated volume of the first urination after delivery.

[Prevention and treatment of intra-uterine synechiae: Review of the literature]. / Prévention et traitement des synéchies endo-utérines : revue de la littérature.

Intra-uterine adhesions are a major cause of secondary infertility. The prevalence of adhesions is probably underestimated due to the heterogeneity of the symptoms. An exhaustive literature search using search engines MEDLINE, Pubmed, Cochrane library and Web of Science was performed to make a focus on the origins, consequences and methods of prevention of intra-uterine adhesions. Intra-uterine adhesions are likely to occur after any endo-uterine surgery via dysregulated activation of coagulation chain linked to the inflammatory process. Early and late obstetric complications are also recognized as caused by adhesions. The diagnosis is currently performed by hysteroscopy but it remains an invasive procedure even if it can be done with an ambulatory management. Several research approaches inspired by intra-abdominal surgery for the prevention of pelvic adhesions have been developed. However, no current method of prevention has proven its effectiveness in terms of improving spontaneous fertility. The improvement in surgical practices, the design of new intra-uterine medical devices and new research especially in the field of endometrial stem cells can maybe reduce the rate of adhesions end their complications after intra-uterine surgery.

Evaluation of a laparoscopic training program with or without robotic assistance.

The aim of the present study was to evaluate the value of a box trainer simulator in laparoscopy training. A further aim was to determine if robotic-assisted approaches further improved the young residents' skills in laparoscopic surgery. The study was a prospective randomized study. Twelve residents in obstetrics & gynecology completed four laparoscopy-related procedures of varying complexity using a box trainer simulator. Participants were randomized into two groups; robotic-assisted laparoscopy (LRA) and traditional laparoscopy (TL). All subjects were assessed with a time and technical score, which are quantitative and qualitative approaches (respectively). All residents completed the training and a satisfaction questionnaire, which confirmed that the training was well regarded. Regardless of the workshop type, there was a clear time and technical improvement for the difficult tasks. The improvement of time score was most apparent for simple tasks in LRA and for more complex tasks in TL. After training, we did not find a significant difference for the technical score between Novices and Experts in TL and LRA. These findings suggest that training in laparoscopy surgery is useful, reproducible and well accepted by both novice and more advanced trainees. Furthermore, gynecological endoscopy center consider including robotic-assisted approaches in their surgical training program.

[Functional symptoms and associations of women with genital prolapse]. / Prévalence des troubles fonctionnels et associations anatomo-fonctionnelles chez les femmes présentant un prolapsus génital.

OBJECTIVE: To assess functional symptoms related to genital prolapse and to test anatomo-functional associations. PATIENTS AND METHODS: Observational study, performed between January 2005 and June 2012, on all patients operated for prolapse in a French tertiary referral centre. Data were collected from standardized patients' notes, including baseline characteristics, complete interview on urinary and colo-rectal functional symptoms, MHU score, and POP-Q (Pelvic Organ Prolapse Quantification) clinical evaluation. RESULTS: Three hundred and seventy-four patients, with a mean age of 65.1 years old, mean parity of 2.5, and mean BMI of 25.4, were included. These patients were post-menopausal in 92.5% of cases. Urinary symptoms were: SUI in 30.5%, urgencies in 44.4%, and voiding difficulties in 38.8%. Colo-rectal symptoms, such as defecatory dysfunction and anal incontinence, occurred in 25.1% and 18.5%, respectively. On clinical examination, anterior vaginal wall prolapses were the most common (74.1%). Patients with stage 3-4 cystocele suffered significantly more frequently of nocturia (P=0.04), voiding difficulties (P=0.04), and occult stress urinary incontinence (P<0.001). Patients with stage 3-4 rectocele suffered significantly more frequently of defecatory dysfunction (P=0.005) and performed more often maneuver for defecation (P<0.001). CONCLUSION: Urinary and colo-rectal symptoms are commonly associated with genital prolapse. Anatomo-functional associations were shown regarding different prolapse types and stages. LEVEL OF PROOF: 4.

[Should we perform intra-operative endometrial biopsy during pelvic reconstructive surgery with uterine preservation?]. / Doit-on faire une biopsie d'endomètre peropératoire dans les cures de prolapsus avec conservation utérine?

OBJECTIVE: To evaluate the interest of systematic endometrial biopsy at the time of vaginal reconstructive surgery with uterine preservation. METHODS: We performed a retrospective monocentric study on all women who had vaginal reconstructive surgery with uterine preservation from 2005 to 2012. All following parameters have been studied: baseline characteristics (age, parity, BMI, hormonal status, medical history), prolapse stage using the POP-Q, preoperative pelvic ultrasound (endometrial thickness), and type of surgery. Women with previous hysterectomy were excluded. RESULTS: Four hundred and fourteen patients were operated during this period, and 268 have uterine preservation (64.7%). Baseline characteristics were mean age 64.7±10.7 (39 to 92), mean parity 2.6±1.5, mean BMI 25.5±4.2, menopause 238 (88.8%), HRT 32 (12%), previous breast cancer 16 (6%), diabetes mellitus 31 (11.6%), and hypertension 87 (32.5%). Prolapse were at stage II in 127 (47.3%), stage III in 99 (36.9%) and stage IV in 17 (6.3%). Preoperative pelvic ultrasound has been done in 255 patients (95.2%), and mean endometrial thickness was 5.1mm (range 1.6-16). Overall, 152 intra-operative endometrial biopsies were assessable (56.7%). In 24 cases (15.8%), samples were too small to be interpretable. Finally, the 128 interpretable biopsies (82.2%) have shown one carcinoma (0.8%), four hyperplasia (3.2%), two endometrial polyps (1.6%), and 121 normal endometria (94.5%). The only cancer was discovered on a 77 year old patient, with a history of previous breast cancer, and with a preoperative endometrial thickness of 7 mm. No patient with normal preoperative ultrasound endometrial screening had abnormal endometrial biopsy. CONCLUSION: Vaginal reconstructive surgery with uterine preservation implicates a preoperative endometrial evaluation by ultrasound. Intra-operative endometrial biopsy does not seem to be justified.

[Indications of mesh in surgical treatment of pelvic organ prolapse by vaginal route: expert consensus from the French College of Gynecologists and Obstetricians (CNGOF)]. / Indications de la cure du prolapsus génital par voie vaginale avec prothèse : consensus d'experts du Collège national des gynécologues et obstétriciens français (CNGOF).

OBJECTIVE: To determine the indications and contraindications concerning prosthetic surgery by vaginal route for pelvic organ prolapse. METHODS: Literature review and rating of proposals using a formal consensus method. RESULTS: Before surgery for genital prolapse, the patient should be counselled about the different existing techniques (abdominal and vaginal surgery with and without mesh), the reasons why the surgeon offered her the placement of a synthetic mesh and also other nonsurgical treatments (pelvic floor rehabilitation and pessary). The intervention must be preceded by an assessment of bothersome pelvic, urinary, digestive and sexual symptoms. For the surgical treatment of cystocele, the use of a synthetic mesh placed by vaginal route is not recommended routinely. It should be discussed on a case by case considering the risk/benefit ratio. In patients presenting with cystocele recurrence, the placement of a synthetic mesh is a reasonable option, in order to reduce the risk of cystocele recurrence. With the exception of a few situations (rectocele recurrence), the placement of a synthetic mesh is not recommended as first-line therapy for the surgical treatment of rectocele by vaginal route. In case of uterine or vaginal vault prolapse, repositioning the vaginal vault or uterus using synthetic mesh arms is not recommended as first-line surgical therapy. CONCLUSION: Surgeons should implement established preventive recommendations that may reduce the risk of complications.

Can the PFDI (Pelvic Floor Distress Inventory) or PFIQ (Pelvic Floor Impact Questionnaires) be used to predict outcome in pelvic reconstructive surgery?

OBJECTIVE: To determine a syndrome score threshold on PFDI or PFIQ predictive of a significant improvement in post-operative functional results. DESIGN: A retrospective case review (Canadian Task Force Classification II-2). SETTING: University and research hospital. POPULATION: Women diagnosed with pelvic organ prolapse and repaired with synthetic vaginal mesh. METHODS: Quality of life was arbitrarily considered to have improved significantly if the score decreases by more than 50% between pre-operatively and 36 months post-operatively. We investigated the pre-operative cut-off score predictive of no quality of life improvement at M36 from a prospective trial for surgical pelvic organ prolapse treatment. RESULTS: The most accurate pre-operative cut-off score predicting a failure to improve quality of life at 36 months post-operatively was 62/300 (PFDI Score). This cut-off value had a positive predictive value of 83.6% and specificity of 62.1%. No significant threshold was obtained from the PFIQ score. CONCLUSION: The intensity of symptoms before surgery may interfere as a predictive factor for outcome.

Prospective ultrasonographic follow-up of synthetic mesh in cohort of patients after vaginal repair of cystocele.

OBJECTIVE: We sought to validate a sequence of ultrasonographic mesh measurements to determine the relevant time points in the postoperative monitoring of mesh size. METHODS: Mesh was measured preoperatively ex vivo, prior to insertion, in 25 patients scheduled to undergo vaginal repair of cystocele involving insertion of a Ugytex™ transobturating polypropylene mesh. A 2D/3D perineal ultrasound scan was performed at the end of the surgical procedure (D0), then on third day after surgery (D3) and 6 weeks (W6) after the operation. Medio-sagittal view was used to measure mesh total length and the sagittal arc (length between the most distant points of the mesh). RESULTS: Time-course changes in sagittal arc were marked by a 8% increase on D3 (with respect to D0) and a 20% decrease at W6 (with respect to D3). Mesh total length at W6 on average corresponded to 74% (±20) of mesh total length measured on D3. CONCLUSION: This study showed the changes in the mesh ultrasonographic measurements following vaginal placement by vaginal route. The D3 ultrasound scan should appear to be suitable as a reference for subsequent ultrasonographic monitoring.