Effect of vaginal infiltration with ornipressin or saline on intraoperative blood loss during vaginal prolapse surgery: a randomised controlled trial.

INTRODUCTION AND HYPOTHESIS: Hydrodissection incorporating different types of vasoconstrictors is commonly used in vaginal prolapse surgery. There is little evidence as to whether it adds clinical value or whether it exposes the patient to unnecessary risk. The aim of this study was to compare the effect of a vasoconstrictor compared with saline alone on operative blood loss and cardiovascular parameters in a randomised clinical trial setting. METHODS: Patients undergoing vaginal prolapse surgery were randomised to an ornipressin (Por-8, Ferring) solution or saline alone for hydrodissection. The surgeon and patient were blinded to the solution used. Operative blood loss was accurately quantified and blood pressure and pulse readings recorded Pre, intra- and postoperatively. RESULTS: Eighty women were randomised. There was a statistically significant difference in the median blood loss: 35 ml (1-209 ml) in the ornipressin group compared with 81 ml (2-328 ml) in the saline group, p = 0.03. There was no statistically significant difference in the median pre and postoperative blood pressure or pulse rate between groups. CONCLUSIONS: The use of a vasoconstrictor (ornipressin) resulted in a statistically significant decrease in operative blood loss during vaginal prolapse surgery. This occurred without any significant changes in measured cardiovascular parameters.

Pelvic organ prolapse in the neonate: report of two cases and review of the literature.

Pelvic organ prolapse (POP) in the new-born baby is a rare though well-acknowledged clinical condition. We present two cases of complete utero-vaginal prolapse in new-born babies. Both infants were otherwise healthy and neurologically normal in their clinical presentation and evaluation. The prolapse was successfully managed with a non-surgical approach. There appears to be two distinct forms of POP in newborns based on the available literature. There are those that occur in newborns with spina bifida (77 % of cases) and those that occur in neurologically intact newborns (23 %). The management of these two types are distinctly different and are discussed in greater detail in this report.