The use of synthetic mesh for vaginal prolapse in the UK: a review of cases submitted to the British Society of Urogynaecology database.

INTRODUCTION AND HYPOTHESIS: The use of mesh for vaginal prolapse gained popularity during the 1990s. More recently, concerns have been raised regarding the safety of mesh procedures. Mesh can be inserted vaginally, laparoscopically or via an open abdominal route, but there are few data comparing the outcomes. Most previous published data relate to small numbers of procedures. METHODS: This was a review of data submitted to the British Society of Urogynaecology (BSUG) database of all cases reporting the use of mesh placed vaginally or abdominally (open or laparoscopic) between January 2006 and December 2016. The primary outcome was based on the reported patient global impression of improvement (PGI-I). RESULTS: A total of 6,709 cases of mesh prolapse repair were entered during the study period. Women in the laparoscopic group had a lower BMI and were younger. Significantly more patients in the open group (96.4%) described themselves as very much better or much better compared with the laparoscopic group (91%) and the vaginal mesh group (90.7%; p < 0.001). Only 0.5% of patients reported that they were worse or very much worse. CONCLUSIONS: This dataset suggests that the effectiveness of mesh repair might be good regardless of the route of insertion. The improvement in PGI-I seems to be greatest with open sacrocolpopexy.

Fetal monitoring in labor: are accelerations good enough?

OBJECTIVE: To investigate whether accelerations of the fetal heart rate in response to scalp stimulation (the scalp stimulation test) before fetal scalp blood sampling (FBS) are such a good predictor of fetal well-being as to render the FBS unnecessary. METHODS: A retrospective observational study. Cardiotocograms (CTG) from 54 fetuses during labor in whom 70 FBS procedures were performed, were analysed by an investigator blinded to the outcome, to determine whether accelerations were present in response to fetal scalp stimulation during vaginal examination (VE) prior to the FBS. This was compared with the pH obtained at FBS in a 2 x 2 table. The primary outcome measure was the false negative rate of the scalp stimulation test. RESULTS: There were accelerations at 48 VEs before FBS (n = 70). In five cases there was fetal acidosis (pH