Does a Preoperative Bowel Regimen Change Time to Bowel Movement? A Randomized Clinical Trial.

IMPORTANCE: This study is important because it aimed to assess an intervention to decrease patient discomfort after a robotic sacral colpopexy. OBJECTIVE: Our primary outcome was to determine whether preoperative use of polyethylene glycol decreases time to first bowel movement postoperatively. Secondary outcomes include degree of pain with first bowel movement and stool consistency. STUDY DESIGN: This was a randomized controlled trial. The experimental group was assigned polyethylene glycol daily for 7 days before surgery and the control group was not. All patients received polyethylene glycol postoperatively. RESULTS: There was no statistically significant reduction in the time to first postoperative bowel movement when preoperative polyethylene glycol was used (mean [SD] in days for the control and experimental groups of 2.32 [0.99] and 1.96 [1.00], P = 0.21). There was a statistically significant reduction in pain levels with the first postoperative bowel movement in the experimental group (median [IQR] of 4 [2-5] vs 1 [0-2], P = 0.0007). Postoperative day 1 pain levels were also significantly lower in the experimental group (median [IQR] of 4 [3-6] vs 2 [0-4], P = 0.0484). In addition, patients had decreased average postoperative pain levels over 7 days with an estimated difference in the median pain levels of 1.88 units (95% confidence interval, 0.64-3.12; P = 0.0038). CONCLUSIONS: Preoperative administration of polyethylene glycol did not decrease time to first postoperative bowel movement. Patients in the experimental group exhibited less pain with their first postoperative bowel movement and had improved pain levels on postoperative day 1.

Intraoperative Indocyanine Green Dye Use in Ovarian Torsion: A Feasibility Study.

STUDY OBJECTIVE: To determine the feasibility of  intravenous indocyanine green (ICG) dye use in patients with adnexal torsion to intraoperatively evaluate ovarian perfusion after detorsion. DESIGN: A prospective multicenter single-arm feasibility study. SETTING: A teaching hospital. PATIENTS: A total of 12 nonpregnant patients, 18 to 45 years old with surgically confirmed adnexal torsion. INTERVENTIONS: Torsion was surgically confirmed, the involved adnexa were untwisted laparoscopically, and ICG dye was injected intravenously. The absence or presence of ICG perfusion was documented, and the clinical decision for ovarian conservation or removal was determined by the surgeon. MEASUREMENTS AND MAIN RESULTS: The primary outcome was feasibility of using ICG dye including measures such as time to visualized perfusion and operative time. Secondary outcomes included presence or absence of ovarian preservation and postoperative follow-up measures. Intraoperative visualization of ICG perfusion to the detorsed adnexa was achieved in 10 patients (83%) in a median time of 1 minute (0, 2), resulting in entire (n = 9) or partial (n = 1) ovarian conservation. Perfusion was absent in 2 cases, and postoophorectomy histologic necrosis was confirmed in one case. Median operative time was 74 minutes (48, 94). There were no adverse events related to ICG dye use. CONCLUSION: Intraoperative ICG dye use in this study was logistically feasible and conservation of the entire or partial ovary was observed in 83% of patients, including one case where preoperative Doppler flow was absent.

The vertical dimension of obesity: adverse pregnancy outcomes in the short obese versus tall obese parturient.

The objective of this study was to examine the effect of maternal height on adverse perinatal outcomes in obese parturients. This retrospective study was conducted from January 2015 to December 2015. Patients with BMI ≥ 35.0 kg/m2 before delivery were included and divided into 2 groups based on height. Patients ≤63 inches were in the short stature group and those > 63 inches were in the tall stature group. One hundred and twenty-five patients were in the short stature cohort and 124 in the tall stature cohort. Patients in short cohort had a significantly higher risk of preterm delivery <37 weeks (RR = 4.21 [1.24, 12.88]), spontaneous rupture of membranes (RR 1.47 [1.01-2.16]), and second stage caesarean delivery (CD) (RR 2.64 [1.1-6.39]). After multiple regression analysis, Hispanic race and short stature were independent predictors of preterm birth for obese patients.IMPACT STATEMENTWhat is already known on this subject? Compared to normal weight individuals, those who are obese have at a higher risk of adverse obstetric and perinatal outcomes including gestational diabetes, hypertension, pre-eclampsia, thromboembolism, macrosomia, higher incidence of caesarean deliveries and perinatal mortality.What do the results of this study add? Our findings show that short stature is an independent predictor for adverse perinatal outcomes in obese women. Specifically, short obese patients had significantly higher risk of preterm delivery before 37 weeks and second stage CD.What are the implications of the findings for clinical practice and/or further research? Our findings highlight the need for formulating a tailored plan for preconception health including pregnancy weight goals in short obese women. Additionally, maternal fat distribution and its effect on pro-inflammatory cytokine profiles is a potential area for future research, as maternal body composition may be a better predictor of perinatal outcome than BMI.

Rates of Pessary Self-Care and the Characteristics of Patients Who Perform it.

OBJECTIVE: The aims of this study were to determine the percentage of patients who opt to undergo pessary self-care versus those who return to the office for care and to identify any differences in the characteristics between the 2 groups. METHODS: This study is a retrospective chart review conducted at a tertiary care center. Demographic data; details regarding pessary use; body weight; pelvic organ prolapse stage; and medical, surgical, and obstetrical histories were evaluated. Variables were compared between groups of patients using the t test, Wilcoxon rank sum test, χ2 test, and Fisher exact test. RESULTS: The rate of patients choosing to perform pessary self-care was 31%. The patients in the self-care group were significantly younger (65.0 vs 75.0 years, P < 0.001). Those who were performing self-care were more likely to be premenopausal (6.9% vs 1.5%, P = 0.003), have a lower stage of pelvic organ prolapse (61.3% vs 42.1%, P < 0.001), and more likely to be sexually active (40.5% vs 9.6%, P < 0.001). Those not performing self-care had higher rates of vaginal bleeding (26.0% vs 16.4%, P = 0.012) and erosion (23.5% vs 9.9%, P < 0.001). Self-care patients predominantly used the ring with support pessary, whereas those in the non-self-care group were mostly using the Gellhorn. CONCLUSIONS: Only one third of patients who use a pessary chose to perform self-care. Patients who use self-care are younger, premenopausal, sexually active, and have lower degrees of prolapse. These data can help educate patients on the characteristics more often seen in those choosing self-care. This study highlights the importance of further exploring pessary care preferences and using this information for counseling.

Congenital pulmonary airway malformation associated with mosaic Klinefelter syndrome.

A 26-year-old female, G4 P2012 presented for an anatomy scan at 18 weeks. Multiple macrocysts were seen in the left fetal lung, which lead to a diagnosis of congenital pulmonary airway malformation (CPAM) type II. A fetal MRI examination performed at 24 weeks of gestation confirmed the diagnosis of CPAM type II. A genetic amniocentesis was done to rule out a fetal chromosomal abnormality and the fetus was found to have mosaic Klinefelter syndrome. Fetal CPAM is not usually associated with chromosomal abnormalities unless there are other fetal malformations present. This is the first known case where a fetus with CPAM and no other malformation was found to have mosaic Klinefelter syndrome. Therefore, we believe it is prudent to offer prenatal diagnostic testing whenever a fetus with CPAM is identified with ultrasound.