Prevention of preterm delivery after successful tocolysis in preterm labor by 17 alpha-hydroxyprogesterone caproate: a randomized controlled trial.

OBJECTIVE: The objective of the study was to evaluate the use of 17 alpha-hydroxyprogesterone caproate (17P) to reduce preterm delivery. STUDY DESIGN: This open-label, multicenter, randomized controlled trial included women with singleton pregnancies admitted at 24-31 weeks' gestation and cervical length less than 25 mm for preterm labor successfully arrested by tocolytic treatment. Randomization assigned them to receive (or not) 500 mg of intramuscular 17P after tocolysis ended, repeated semiweekly until 36 weeks or preterm delivery. The primary outcome was the time from randomization to delivery. RESULTS: Outcome data were available for 184 of 188 women randomized. The 17P and control groups (similar for most baseline characteristics) did not differ significantly for median [interquartile range] time to delivery (64 [42-79] and 67 [46-83] days, respectively) or rates of delivery before 37, 34, or 32 weeks of gestation or adverse perinatal outcomes. CONCLUSION: Semiweekly injections of 17P did not prolong pregnancy significantly in women with tocolysis-arrested preterm labor.

Tension-free polypropylene mesh for vaginal repair of anterior vaginal wall prolapse.

OBJECTIVE: To study the ongoing results of the repair of anterior vaginal wall prolapse reinforced with tension-free polypropylene mesh (GyneMesh, Gynecare, Ethicon, Issy-Les-Moulineaux, France). STUDY DESIGN: A case series of 87 consecutive women with anterior vaginal wall prolapse who underwent a transvaginal procedure using polypropylene mesh between October 1999 and August 2002. The mean age (+/-SD) was 62.4+/-13.4 years. Before the operation, patients underwent physical examination staging of the prolapse with the International Pelvic Organ Prolapse staging system. Thirteen women had stage 2 anterior vaginal wall prolapse (14.9%), 59 had stage 3 (67.9%), and 15 had stage 4 (17.3%). The polypropylene mesh was placed from the retropubic space to the inferior part of the bladder in a tension-freefashion. Patients were followed for 9-43 months, with a median follow-up (+/-SD) of 24+/-9.6 months. We defined "cure" as satisfactory (stage 1) or optimal (stage 0) outcome for point Ba in the staging system. RESULTS: Eighty-four patients returned for follow-up (96.6%). At follow-up, 77 women were cured (91.6%), 5 women had asymptomatic stage 2 anterior vaginal wall prolapse, and 2 had a recurrent stage 3 (2.4%). There were no postoperative infections. There were a total of 7 vaginal erosions of the mesh (8.3%); 4 necessitated a second procedure for partial excision of the mesh. CONCLUSION: Vaginal repair of anterior vaginal wall prolapse reinforced with tension-free polypropylene mesh is effective and relatively safe. Vaginal erosion occurred in 8.3% of the study population but was easily manageable, with no sequelae.

Total hysterectomy for a nonprolapsed, benign uterus in women without vaginal deliveries.

OBJECTIVE: To compare the different techniques of hysterectomy for a nonprolapsed, benign uterus in women without vaginal deliveries. STUDY DESIGN: A retrospective study in a university hospital analyzed 148 total hysterectomies in women without vaginal deliveries performed from August 1991 to June 2000. Forty-four patients had had cesarean sections (29.7%), and 104 (70.3%) were nulliparous. Twenty-four patients had had abdominal myomectomies (16.2%). The vaginal route (group 1) was used for 77 patients (52%), 56 (37.8%) had laparotomies (group 2), and 15 (10.2%) had laparoscopically assisted vaginal hysterectomies (group 3). RESULTS: The uterine weight was 275 (+/- SD 140) g in group 1, 830 (+/- SD 1620) in group 2 and 331 (+/- SD 160) in group 3. Mean operation time was 87 (+/- SD 76) minutes in group 1, 96 (+/- SD 41) in group 2 and 112 (+/- SD 56) in group 3. There was one serious complication with the vaginal route (sigmoid injury). The hospital stay was 4 (+/- SD 3.1) days in group 1, 7.1 (+/- SD 3.8) in group 2 and 4.3 (+/- SD 1.5) in group 3. CONCLUSION: Vaginal hysterectomy for a nonprolapsed, benign uterus is indicated for women without vaginal deliveries and is feasible in 72% of cases in our recent experience, with a low complication rate. Training in vaginal surgery should allow safe performance of the procedure at most centers.