RESUMO
INTRODUCTION AND HYPOTHESIS: Entry into the peritoneal cavity can be challenging in patients with posthysterectomy prolapse; however, it is important for vaginal surgeons to be able to enter the peritoneal cavity using various techniques to perform an intraperitoneal vaginal vault suspension. METHODS: We present surgical footage of various methods of accessing the peritoneal cavity in posthysterectomy prolapse using posterior, anterior and apical approaches. RESULTS: This video highlights surgical techniques that can be used to enter the peritoneal cavity in posthysterectomy prolapse in a safe and reliable manner. CONCLUSIONS: Vaginal surgeons should be able to safely and confidently identify and enter the peritoneal cavity using various approaches to perform an intraperitoneal vaginal vault suspension.
Assuntos
Histerectomia/efeitos adversos , Prolapso de Órgão Pélvico/cirurgia , Cavidade Peritoneal/cirurgia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Urogenitais/métodos , Feminino , Humanos , Prolapso de Órgão Pélvico/etiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Urogenitais/educação , Vagina/cirurgiaRESUMO
PURPOSE: To develop uniform and reliable reference ranges for amniotic fluid volume (AFV) across gestation in normal singleton pregnancies using quantile regression (QR). METHODS: An analysis of true AFVs determined by dye-dilution techniques or by direct measurement at cesarean delivery in normal singleton pregnancies. AFV centiles were established by QR, a flexible semi-parametric approach of estimating rates of change across the entire distribution of AFV rather than just in the mean as is observed with standard linear regression. RESULTS: The study evaluated 379 women with normal singleton pregnancies between 16 and 41 weeks gestation. QR was used to determine the association between AFV and gestational age (GA). A second-order quantile regression model indicated a nonlinear relationship between AFV and gestational age at the upper centile range (≥80th percentile). CONCLUSION: This study defines normative centile charts for true AFVs between 16 and 41 weeks gestation in normal singleton pregnancies using QR. This statistical approach more appropriately reflects true AFV across gestation at each centile of interest (e.g. 5th, 50th, 95th, etc.) as compared to standard linear regression.