Martius fat pad flap procedure for management of obstetric rectovaginal fistula: A case report.

Obstetric trauma is a risk factor for rectovaginal fistula, and it is a challenge for both patients and surgeons. In this case report, we describe the surgical technique of the Martius fat pad flap for repair of a rectovaginal fistula. The patient was a 30-year-old woman, para 1, with a previous spontaneous vertex vaginal delivery of a 2500-g male baby at 37 weeks of gestation. There was a history of arrest of descent, and the patient had a third-degree perineal laceration that was repaired in the operating room. Twelve days after delivery, the patient complained about fecal vaginal discharge and was diagnosed with a rectovaginal fistula. Physical examination revealed a rectovaginal fistula with a 2 cm diameter and located 1 cm from the hymen. The tone of the external anal sphincter was within normal limits, which was confirmed with transperineal ultrasound scan. The repair was done 3 months after the previous repair in order to allow for the restoration of tissue integrity and the complete healing of the previous wound. The rectovaginal fistula was repaired with a Martius fat pad flap in a transperineal approach. After 60 days of follow-up, the wound involving the labia majora and the fistula were healed completely.

Differences Between 25-hydroxyvitamin D Levels in Patients with Pelvic Organ Prolapse and Non-Pelvic Organ Prolapse: A Systematic Review.

OBJECTIVES: Treatment options for cases of pelvic organ prolapse still lead to the use of a pessary rather than a surgical method. Additional therapy is needed to help treat or prevent pelvic organ prolapse. Vitamin D deficiency has consistently been associated with decreased muscle function, so it is assumed that it will affect the pelvic floor muscles. This paper systematically explores the differences between 25-hydroxyvitamin D levels in patients with pelvic organ prolapse and non-pelvic organ prolapse. STUDY DESIGN: A systematic review was conducted through the PubMed, Google Scholar, Cochrane Library, and ScienceDirect databases using relevant keywords. Articles published in the last 10 years-from 2012 to 2022-that were written in English, that discuss the status or effect of vitamin D on pelvic organ prolapse, and that focus on 25 OH-vitamin D were included in the review. RESULTS: In total, 717 articles were filtered but 8 articles met the criteria. A total of 1339 women with prolapse and without prolapse with ages ranging from 20 years to 78 years were included in the study. The studies found did not use the same standard threshold in determining deficiency status. Most studies have found that there are lower levels of vitamin D in women who have had pelvic organ prolapse. A total of 7 of 8 studies confirmed the comparison of vitamin D-25OH levels in women with pelvic organ prolapse and without pelvic organ prolapse at P < 0.05. CONCLUSIONS: There are differences between 25-hydroxyvitamin D levels in patients with pelvic organ prolapse and non-pelvic organ prolapse.

Knowledge and confidence levels improvement among obstetrics residents regarding caesarean section training using video-mannequins combination.

Background: Cesarean section rates are increasing worldwide. Obstetrics and gynecology residents are required to be experts in this surgery to provide safe procedures. Because of the COVID-19 pandemic situation, an alternative teaching strategy is needed to achieve adequate cesarean section skills. The purpose of this study was to identify the effect of video, mannequins, and the combination of video mannequins on residents' knowledge and confidence regarding cesarean section. Method: A quasi-experimental study with pre-test and post-test designs was done. Based on stratified random sampling, 33 obstetrics and gynecology residents involved as study participant. Three groups were formed and received different interventions, learning using videos, mannequins, and a combination of video-mannequins. Two kinds of questionnaires were used to examine residents' knowledge and their confidence levels. The collected data were analyzed statistically. Results: Video (0.42(CI95%-0.11-0.9)), mannequin simulation (0.60(CI95%-0.04-1.25)), and the combination of video-mannequin (1.3(CI95%0.73-1.93)) significantly increased resident's knowledge regarding caesarean section skill. Study participant showed increased scores regarding confidence in their caesarean section skills according to all learning subjects (p < 0.05) but a difference in confidence level occurred in level C- 7th semester residents (p < 0.05). Conclusion: The combination of videos and mannequin simulations is the best method for increasing knowledge of cesarean sections, compared to single video and mannequin simulations. The confidence level has been shown to increase in all subject studies but the effectiveness at each level of resident needs to be investigated further.

A 63-Year-Old Postmenopausal Woman with Uterine Inversion Associated with a Submucosal Geburt Fibroid Successfully Treated by Surgical Reversal Using the Spinelli Procedure.

BACKGROUND Reproductive health affects long-term quality of life, including in the elderly. Uterine inversion is common in postpartum women in developing countries and menopausal women are also at risk. CASE REPORT A 65-year-old menopausal woman had 3 children and a history of uterine tumors and curettage. She had received a different diagnosis - a cervical tumor - exactly 3 years ago. She was admitted to a referral hospital for lower abdominal pain, difficulty in defecating, and a mass in the genitals when straining, accompanied by blood clots. There was a 20×20 cm mass protruding from the vagina, and the uterine fundus of the uterus was not palpable. The patient was diagnosed with chronic uterine inversion due to submucous leiomyoma. Management requires the collaboration of multidisciplinary professionals in hospitals. These patients receive therapy to improve their general condition, transfusions, antibiotics, and a hysterectomy plan. The results of the Urogynecology Division showed that a 20×15 cm mass came out of the vagina, with a large necrotic area. The patient was first managed by Spinelli procedure to correct the uterine inversion, followed by an abdominal hysterectomy. Histopathology revealed the final diagnosis as a benign mesenchymal lesion, leiomyoma with myxoid degeneration. CONCLUSIONS Timely diagnosis and management by a multidisciplinary team can help reduce morbidity and mortality in patients with submucosal uterine leiomyoma leading to chronic uterine inversion.

Role of platelet-rich plasma in pelvic floor disorders: A systematic review.

Background: Management for pelvic floor disorders needs to be improved. Platelet-rich plasma (PRP) offers an innovative treatment in general medical care to promote cell regeneration. Objective: This review aims to investigate the role of PRP in pelvic floor disorders. Materials and Methods: 6 international databases were accessed using several keywords namely PubMed, Science Direct, Cochrane Library, ProQuest, Google Scholar, and Scopus. The inclusion criteria were articles written in English, published in 10-yr period from 2012 until 2022, and investigated the relevant topic. This systematic review followed PRISMA guideline. Results: 644 articles were found in several databases and 15 articles met the criteria. Management for pelvic floor disorders needs to be improved, but there are still many challenges, such as less effective treatments, risk of recurrence, and postoperative wound healing. PRP offers an innovative treatment in general medical care to promote cell regeneration. A total of 644 articles from the database were found, but 15 studies met the criteria. A total of 600 women with various pelvic floor disorders treated with PRP were analyzed. PRP positively impacts female sexual dysfunction, perineal trauma, vulvovaginal atrophy, stress urinary incontinence, vesicovaginal fistula, perineal rupture, and pelvic organ prolapse. Dosages, preparation techniques, injection techniques, and additive materials are varied. Most studies do not report side effects from the therapy, but the urinary disorder complaints must be paid attention to. Conclusion: PRP can be used to manage pelvic floor disorders. Future studies should clarify and standardize the dose in each case and how to make PRP produce the best results.

Does freeze dried amnion useful as scaffold for mesenchymal stem cell for repair of vesicovaginal fistula? An overview of proliferative and remodeling phase in the wound healing process.

BACKGROUND: Surgery is still the main solution for vesicovaginal fistula, but postoperative wound healing represents a challenge, and the recurrence rate remains high. There is a need to develop therapeutic methods to increase the success of therapy and women's quality of life. OBJECTIVE: To explore whether human freeze-dried amnion is useful as a mesenchymal stem cell scaffold for repair of vesicovaginal fistula through assessment of the proliferative and remodelling phases. METHODS: This experiment was undertaken using a New Zealand rabbit model. The research was divided into two stages: (1) an experiment to create a model of a vesicovaginal fistula; and (2) a laboratory experiment to close a vesicovaginal fistula as a result of the first stage. The second stage used a post-test-only control group design. The wound-healing process was assessed based on the expression of platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), occludin and claudin-4. Data were analysed descriptively and statistically. RESULTS: Expression of PDGF, VEGF, FGF, occludin and claudin-4 in vesicovaginal fistula models sutured with human freeze-dried amnion was higher compared with models without human freeze-dried amnion. Significant differences were found in average expression of PDGF, VEGF, FGF, occludin and claudin-4. CONCLUSION: Human freeze-dried amnion plays a role in the wound-healing process in vesicovaginal fistula repair models. It is hoped that this research will improve urogynaecological services.

Simulation-based training using a novel Surabaya hysterectomy mannequin following video demonstration to improve abdominal hysterectomy skills of obstetrics and gynecology residents during the COVID-19 pandemic in Indonesia: a pre- and post-intervention study.

PURPOSE: During the coronavirus disease 2019 (COVID-19) pandemic, the number of abdominal hysterectomy procedures decreased in Indonesia. The existing commercial abdominal hysterectomy simulation model is expensive and difficult to reuse. This study compared residents' abdominal hysterectomy skills after simulation-based training using the Surabaya hysterectomy mannequin following a video demonstration. METHODS: We randomized 3rd- and 4th-year obstetrics and gynecology residents to a video-based group (group 1), a simulation-based group (group 2), and a combination group (group 3). Abdominal hysterectomy skills were compared between before and after the educational intervention. The pre- and post-tests were scored by blinded experts using the validated Objective Structured Assessment of Technical Skills (OSATS) and Global Rating Scale (GRS). RESULTS: A total of 33 residents were included in the pre- and post-tests. The OSATS and GRS mean differences after the intervention were higher in group 3 than in groups 1 and 2 (OSATS: 4.64 [95% CI, 2.90-6.37] vs. 2.55 [95% CI, 2.19-2.90] vs. 3.82 [95% CI, 2.41-5.22], P=0.047; GRS: 10.00 [95% CI, 7.01-12.99] vs. 5.18 [95% CI, 3.99-6.38] vs. 7.18 [95% CI, 6.11-8.26], P=0.006). The 3rd-year residents in group 3 had greater mean differences in OSATS and GRS scores than the 4th-year residents (OSATS: 5.67 [95% CI, 2.88-8.46]; GRS: 12.83 [95% CI, 8.61-17.05] vs. OSATS: 3.40 [95% CI, 0.83-5.97]; GRS: 5.67 [95% CI, 2.80-8.54]). CONCLUSION: Simulation-based training using the Surabaya hysterectomy mannequin following video demonstration can be a bridge to learning about abdominal hysterectomy for residents who had less surgical experience during the COVID-19 pandemic.

Successful use of condom catheters for management of uterine inversion: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Uterine inversion is a rare case but can lead to maternal death. Treatment options start from repositioning the uterus to surgery. Surgery should be prevented because this procedure is associated with complications and long-term effects on women. A case report describes the use of condom chateters in the management of bleeding due to uterine inversion. CASE PRESENTATION: Mrs. SIM, a 35-year-old secondary primigravida woman, was referred from the midwife's independent practice 3 h after her third delivery with a diagnosis of uterine prolapse and hypovolemic shock. The patient successfully underwent a manual placenta but part of her uterus turned inside out accompanied by bleeding. At the referral hospital, the patient was diagnosed with uterine inversion. The main action is to reposition the uterus, then maintain it with internal bimanual compression. After the patient's perineum was sutured, the patient was observed for uterine contractions and given antibiotics. The patient had intermittent uterine contractions and bleeding therefore she was initiated to insert a condom catheter. The patient showed signs of improvement in her general condition and no active bleeding was found. CLINICAL DISCUSSION: An accurate diagnosis needs to be made early so that there is no misdiagnosis between uterine prolapse and uterine inversion. Good teamwork is needed in case management. It is necessary to approach both primary and tertiary health facilities for case screening and initial management. CONCLUSION: Condom catheters can be helpful in the management of uterine inversion, particularly in stopping bleeding.

Obstetrics and gynecology residents' satisfaction and self-confidence after anal sphincter injury simulation-based workshop in Indonesia: a pre- and post-intervention comparison study.

PURPOSE: Obstetric anal sphincter injury (OASI) is one of the most common complication during delivery. Simulation models using manikin can be used as an effective medical learning method to improve students' abilities before meeting patients. It aimed to describe the development of anal sphincter injury model and assess the resident satisfaction and self-confidence after perineal repair workshop with anal sphincter injury simulator in Indonesia. METHODS: This was cross-sectional study with evaluation of outcome before and after workshop. We created silicone-latex simulation anal sphincter injury model. Then, we validated this simulation and made it as simulation model for workshop. We asked residents' satisfaction repairing anal sphincter injury using simulation model and residents' self-confidence when practicing the anal sphincter injury repair. RESULTS: All residents felt the simulation-based workshop was valuable (100%). Most of score for similarity simulation model were good (about 8). The self-assessment of confidence was measured prior to the workshop and after the workshop. The overall self-confidence was increased significantly after workshop in procedure identification external sphincter ani (EAS) (P=0.031), suturing anal mucosa (P=0.001), suturing internal sphincter ani (P=0.001), suturing external sphincter ani (EAS) (P <0.001), evaluation of sphincter ani tone (P=0.016). CONCLUSION: Anal sphincter injury simulator improves the self-confidence of residents in procedure identification external sphincter ani (EAS), suturing anal mucosa, suturing internal sphincter ani, suturing external sphincter ani (EAS) and evaluation of sphincter ani tone.

Giant Fibroepithelial Polyps of the Vulva in a Woman with Uterine Myoma and Primary Infertility: A Case Report and Literature Review.

BACKGROUND Reproductive health is closely related to long-term quality of life and maternal well-being in obstetrics. The overall incidence of fibro-epithelial polyps in the general population is about 46%, but a location on the vulva is quite rare, and is very rare when the size is more than 5 cm. CASE REPORT A 23-year-old woman reported irregular bleeding and a mass on the vulva. After anamnesis, physical examination, biopsy, and radiology imaging, the patient was diagnosed with uterine myoma, primary infertility, and a large solid and benign mass on the vulva. The mass found on the vulva was apparently unrelated to intra-abdominal organs and urogynecology. After performing an excision accompanied by a laparoscopic myomectomy, the histopathological results showed that the mass on the vulva was a 16×11×6 cm fibroepithelial polyp weighing 700 g. After 7 months of therapy, the submucosal uterine myoma recurred. Submucosal uterine myomas were found rooted into the vaginal canal, so the surgeon performed an extirpation operation. Eight months later, the patient succeeded in having a pregnancy that ended in delivery by cesarean section. CONCLUSIONS Giant fibroepithelial polyps are very rare. Management is by excision accompanied by a laparoscopic myomectomy. They affect reproductive health and require appropriate management and diagnosis.